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  2. 2017
  3. April
  4. P
  5. Pre-Intervention Survey
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Exit Survey
 
 
Have you assisted a parent to KC with their infant in the past 12 months? 
 
Yes
 
No
 
 
 
How many times in the last month have you assisted a parent to KC with their infant?
   
 
 
 
In the past, what barriers have prevented you from assisting parents to KC (check all that apply)?
 
Clinical concerns about temperature, airway, infant stress, etc
 
My patient is too small (How small is too small? _____ grams)
 
No time during my busy day
 
I do not have the necessary equipment
 
I do not know what KC is
 
I need more training
 
I don’t think KC is a benefit to parent/infant
 
Parents are not aware of KC benefits and/or do not want to KC
 
Peer pressure
 
Other (please explain):

 
 
 
Under what circumstances are you comfortable assisting parents to KC with their infant (check all that apply)?
 
My patient is stable on room air
 
My patient is stable on nasal CPAP
 
My patient is stable on a ventilator
 
My patient is big enough (What is big enough? _____ grams)
 
Proper equipment is available
 
Unit guidelines are available
 
Parent handout is available
 
I am adequately trained to promote KC with parents
 
I need to see other staff support KC
 
Other (please explain):

 
 
 
What is your age?
   
 
 
 
What is your sex?
   
 
 
 
What is your race?
   
 
 
 
How many years have you been a nurse?
   
 
 
 
How many years have you been an NICU nurse?
   
 
 
 
What is your full time equivalent (FTE)?
   
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