# NG_samples

slug: exploring-trauma-informed-language-in-patient
title: Exploring Trauma Informed Language in Patient
academic_level: Graduate
subject: Nursing
type_of_paper: Dioscourse Analysis
citation_style: APA
meta_title: Exploring Trauma Informed Language in Patient
meta_keywords: trauma informed language
canonical_url: https://www.cheap-essay-writing.co.uk/
meta_robots: index,follow
created_at: 2025-06-23 15:49:31
updated_at: 2026-01-14 15:48:24
status: published
content:
  <h2>Exploring Trauma Informed Language in Patient Survey Forms: A Discourse Analysis</h2>
  <p><strong>Table of Tables</strong></p>
  <p><strong>Table 1:</strong> Stages of Methodology</p>
  <p><strong>Table of Figures</strong></p>
  <p><strong>Figure 1:</strong> A parallel process of trauma informed practice</p>
  <p><strong>Abstract</strong></p>
  <p><strong>Title: </strong>Exploring Trauma Informed Language in Patient Survey Forms: A Discourse Analysis</p>
  <p><strong>Author: </strong>Sumedh Milind Naik</p>
  <p><strong>Supervisors: </strong>Dr. Fr&eacute;d&eacute;rique Vallieres, Mr. Mel Swords</p>
  <p><strong>Background: </strong>Trauma Informed Care (TIC) focuses on understanding and addressing the impact of trauma in healthcare settings. Language plays a very important role in TIC, as it can either aid or hinder a healing process. This study aims to explore the extent to which the patient survey forms in healthcare settings across Ireland align with the Trauma Informed principles particularly with the language used and their potential impacts on the trauma survivors.</p>
  <p><strong>Methods: </strong>The study design is a qualitative research design involving use of Rhetorical Discourse Analysis (RDA) method to examine the language of patient survey forms used across various departments in Ireland. The sample consisted of 7 blank patient survey forms used across various healthcare departments in Ireland. The analysis focused on using trauma informed language that could be retraumatizing for the patients with a history of trauma.&nbsp;</p>
  <p><strong>Results: </strong>The analysis were based on various critical elements that influence the effectiveness of patient survey forms which includes credibility, emotional sensitivity, clarity, context, purpose, inclusive language, validation and confidentiality. The study suggested that some forms effectively used trauma informed language in their forms while others required significant improvements. Unclear language, lack of emotional sensitivity and inadequate attention to confidentiality were areas that needed improvement.</p>
  <p><strong>Conclusion:</strong> The findings underline the importance of use of trauma informed language in patient survey forms ensuring that they do not intentionally retraumatize the patients. By adoption of an inclusive, clear and sensitive language; the healthcare organizations can improve the patient engagement, trust and the quality of data being collected. This study highlights the need for revision and refinement of current patient survey forms to better align with the trauma informed care principles ultimately increasing the quality of care and patient outcomes.</p>
  <p><strong>Keywords:</strong> Trauma informed care, Patient survey forms, healthcare communication, rhetorical discourse analysis, inclusive language.</p>
  <p>Word Count: 9997</p>
  <p><strong>List of Abbreviations</strong></p>
  <p>TIC &ndash; Trauma Informed Care</p>
  <p>PSF- Patient Survey Forms</p>
  <p>ACE- Adverse Childhood Experiences</p>
  <p>SAMHSA- Substance Abuse and Mental Health Services</p>
  <p>RDA- Rhetorical Discourse Analysis</p>
  <h3>Literature Review</h3>
  <h4>Trauma-Informed Language in Healthcare</h4>
  <p>Trauma is described as events that are beyond the capacity of an individual to manage and are, therefore, usually accompanied by symptoms of fear, helplessness, or horror (Merlo and Bratina, 2022). These can be a result of child or partner abuse, community or personal violence, natural and man-made disasters, car and other accidents, warfare and other catastrophes, or other extremely stress-inducing events. Evidence demonstrates that trauma has a negative relationship with health among populations (Tebes et al. 2019). However, it is crucial to understand that trauma does not affect everyone in the same manner, particularly underprivileged individuals. It may vary based on cultural backgrounds, socio-economic status, accessibility of resources and real-life experiences (Ford et al. 2015) creating various impacts on wellbeing. Trauma-informed care (TIC) refers to the understanding of the effects of trauma and possibly avenues for therapy (Abuse, 2013). It is crucial for the provision of TIC with language that is informed by trauma, as this creates a person-first approach. This means language: people-first, strengths-based language which speaks to the individual&rsquo;s worth and recovery process (Protocol, 2014). Trauma may be the result of a single event or a series of events. Osofsky and Groves (2018) give the following examples of childhood and developmental traumas: community violence, homicide, wars, abuse, neglect and family separation. However, Mason (2021) argues that other forms of trauma are not physical, but social, and can include racism, poverty, and discrimination. However, these latter traumatic experiences are less discussed in the literature.&nbsp;</p>
  <p>Individuals that have experienced potentially traumatic events can experience various responses and reactions encompassing emotional distress, anxiety, fear and loneliness. Adverse Childhood Experiences (ACEs) are the building blocks of an individual&rsquo;s lifelong health; thus, they significantly affect their health outcomes. It is shown that trauma that occurs in childhood has a direct impact on an individual&rsquo;s brain functioning and its development in the future (Hughes et al. 2017). It is, therefore, important to acknowledge ACEs to understand how to establish appropriate interventions for health care. Physical symptoms involve unwanted thoughts or flashbacks, negligent behaviour, headache, fatigue and trouble in maintaining relationships (Center for Substance Abuse Treatment. 2014). Mason (2021) discussed that trauma is a substantial and widespread problem that impacts individuals from diverse backgrounds. Severity and the nature of trauma, however, varies widely across individuals. TIC, as an approach, seeks to understand and recognize these reactions to provide better support and address the needs of clients with empathy and compassion (Center for Substance Abuse Treatment. 2014). Parker et al. (2022) also proclaimed that trauma-informed care is a therapeutic framework that aims to identify the indications of trauma and aid patients in their process of recovery. An integral element of this method involves using trauma-informed language, which establishes a secure and nurturing atmosphere for individuals who have experienced trauma.&nbsp;</p>
  <p>Trauma-informed language is focused on communicating with individuals who have undergone traumatic experiences. The main objective of trauma-informed language is to establish a secure and encouraging atmosphere by refraining from using language that may potentially retraumatize or retrigger traumatic experiences. For example, instead of asking something accusatory such as &ldquo;Why are you like this?&rdquo; we say something like &ldquo;Can you help me understand how you are feeling right now?&rdquo; This example illustrates the best way; a trauma-informed approach to language can be employed practically to aim at being sensitive to the client and form a sense of security. Using trauma-informed language mitigates the probability of more damage and facilitates the process of healing and recuperation (Palanac, 2021).&nbsp;</p>
  <p>Further expanding upon the fundamental principles of safety, trust and cooperation outlined by SAMHSA (2014), Lotty (2021) highlights the importance of the parallel process in Trauma-Informed Care (TIC) for both the client and the clinician (Figure 1). This phenomenon pertains to concurrent experiences occurring within a relationship, such as between a therapist and their client, which frequently involve comprehending the firsthand encounter of trauma, its enduring effects, and devising strategies to cope effectively and reduce or prevent re-experiencing the trauma.</p>
  <p><strong id="docs-internal-guid-8c0edd73-7fff-0a1d-e0b6-6296de3cfa2d"><img src="https://lh7-rt.googleusercontent.com/docsz/AD_4nXeWb2cLoFI5ptpZFM1CjmHE-d0jDe65AiZt5dlJfA-NVOhoaVduK6UY0VP1MwOrAhtwgzdJF0aTHdiNF-vwoKGBEDejGxv6TboLcpAHm0-OcEcHP5b6nfmmXH0DJk_VnThmRmf9aKaZk9g2HyQZAg8?key=uCMECVq-LWRE04abozURww" alt="A diagram of a diagram of a patient's path
  Description automatically generated" width="468" height="302.38431772366016"></strong></p>
  <p><strong>Figure 1: A parallel process of trauma-informed practice</strong></p>
  <p>Trauma-informed practice thus emphasizes the importance of safe and secure connections to a healing medium (Lucio &amp; Nelson, 2016). According to Bunting et al. (2019), the method emphasizes the need to comprehend the actual lived experience of trauma and how it influences coping mechanisms that were formed.</p>
  <p>TIC aims to present a lens for healthcare workers to understand how psychological trauma affects people's behavior, and therefore how to approach their patients. (Maynard et al., 2017). In trauma-informed environments, every employee should receive training on the pervasiveness of violence and how early traumatic events relate to adult psychopathology, while also investing in the time and resources it takes to provide training to every employee (Abuse, 2013).&nbsp;</p>
  <p>Many of the guidelines published by the Substance Abuse and Mental Health Services Administration and other current TIC literature link TIC to the late 1990s Adverse Childhood Experience study (Felitti et al. 1998). Identifying four types of abuse (physical, emotional, sexual, and due to violence against mothers), Felitti et al., (1998) put forward that there are two different types of neglect and many types of household dysfunction that are the cause of adversity. Moreover, they demonstrate a dose-response relationship between childhood exposures and later-life health outcomes. Later disseminated by the Centers for Disease Control, this study inspired regional, national, and local efforts to improve the standard of patient and client care. SAMHSA, at the forefront, subsequently provided funding for several policy and training projects.</p>
  <h4>Trauma Theory</h4>
  <p>Trauma Theory is mainly concerned with the mental and physical impact of traumatic experiences (Keeble, 2021). Simultaneously, it also draws attention to understanding the language and being sensitive to the patient to prevent recurrent traumatization. Trauma Theory has the power to increase the sensitivity of language since the use of triggering terms does more harm than good in terms of patient care. It is also necessary to form an idea of common trauma responses like intrusive thoughts, negative behavior, hyperarousal, memory issues, problem in focusing etc. and realize how to develop the necessary safety for the respondents. In this regard, the latter implies using neutral language and being supportive (Wilmshurst, 2020). The implementation of trauma-informed strategies like safe communication that work toward healing requires special attention to the patient&rsquo;s recovery concerns and the resolved feedback and reports.&nbsp;</p>
  <p>Trauma theory provides a robust framework to understand the profound impact of adverse experiences on an individual's psychological, physical, and emotional well-being. ACEs are detrimental to people's overall health and well-being, and they remain with them for the rest of their lives. Trauma thus stems from an individual's childhood and, with time, impacts an individual's brain functioning and development. Being trauma-informed is not only about surveys and data but is much broader, encompassing the entire effect of trauma on not only those receiving the care but also the givers. D&iacute;az, Hall and Neville (2019) found that trauma theory can help medical practitioners understand the complex interplay between succeeding health results and traumatic events. The theory highlights that trauma can be evident not only in the form of clear symptoms such as depression, anxiety and mental disturbances but also in more indirect ways, such as individual attitudes, behaviors, and interactions in different social contexts. Thus, trauma theory highlights the impact of traumatic experiences on individuals' well-being and health and highlights the need for healthcare providers to understand and address the interplay between trauma and health results.&nbsp;</p>
  <h4>Patient Survey Forms (PSFs) in Healthcare</h4>
  <p>PSFs play a fundamental role in terms of healthcare communication as they significantly contribute to the exchange of information between medical personnel and patients (Karaca and Durna, 2019). These forms also provide an in-depth understanding of patient&rsquo;s experiences, satisfaction and preferences within healthcare delivery. Kostouros et al. (2023) discussed that based on these forms, healthcare centers can modify the different aspects of their service to increase overall patient satisfaction. These forms thus play a significant role in quality improvement initiatives, increase patient interactions, and encourage patient-centered care and healthcare communication. Similarly, Khanbhai et al. (2021) highlights that the patient survey forms can provide a structured platform for patients to communicate their feedback and concerns so that the healthcare personnel can understand their issues and provide better care to the patients accordingly. Survey forms can empower medical experts to actively participate in the patient&rsquo;s care by asking the patients for their input directly, focusing more on the patients who suffer from traumatic experiences in their daily lives.&nbsp;</p>
  <p>Likewise, Larson et al. (2019) highlighted that patient survey forms play a critical role in collecting data on patient satisfaction and experiences with healthcare. These also contribute to informing and implementing initiatives ensuring quality improvement within healthcare organizations. In addition, Parker et al. (2022) highlighted that patient survey forms can help advertise accountability and transparency in healthcare systems by allowing patients to communicate their concerns with the healthcare workers because they are accountable for the quality of care delivered. Hence, the survey results can contribute towards healthcare organization&rsquo;s commitment to patient-centered care and improvement in the building of trust and transparency with patients and the public.</p>
  <p>However, Naimi (2022) discussed that patient survey forms must be carefully designed and implemented to increase their usefulness and efficiency. The healthcare organization must select the timely analysis and collection of survey data and as a result, engage patients in quality improvement efforts. Thus, the patient survey forms must be integrated into the delivery of patient-centered care and continuously evaluated for relevance and effectiveness to realize their full potential.&nbsp;</p>
  <h4>Implementation of Trauma-Informed Care in Healthcare</h4>
  <p>Healthcare centers are increasingly introducing training programs to teach employees about trauma-informed care. Trauma-informed care requires an understanding of the effects of high levels of stress on a person (Khanbhai et al., 2019). This is considered particularly important given that trauma survivors may experience conditioned responses to specific stimulus by having elevated sensitivity to some behaviors, words or phrases that remind them of the trauma (van der Kolk, 2014). Revised rules and regulations, which feature trauma-informed principles that do not unintentionally re-traumatize individuals, are therefore recommended (Sweeney et al. 2016). Similarly, adopting a trauma-informed approach to patient survey forms does not only depend upon data collection. It also deals with identifying the general impact of trauma on healthcare professionals and patients. Based on the concepts of trauma-informed principles which consist of safety, choice, truth and collaboration the healthcare buildings can effectively address the requirements of the persons. It can increase the effectiveness of the triage, provide suitable approaches including the psychological and social assistance, subsequent care and so on, provide the waivers and be knowledgeable about it. Staffs are thus supported to taught to avoid abusive, suspicious, or distracting language across multidisciplinary team meetings, in filling out forms, in patient-provider interaction and provider-provider interaction (Khanbhai et al., 2021). According to the goals of safety, choice, truth and collaboration that is associated with the trauma-informed principles the healthcare buildings can offer necessary response to the needs of the persons. It can enhance the efficiency of the triage, offer proper measures such as the psychological and social support, further treatment and others, offer the waivers and be familiar with the procedure (Bosch and Mansell, 2015). Knowledge about trauma-informed language is necessary for patients and families because it assists them in navigating and understanding the interactions with healthcare about trauma impact with empathy, sensitivity, and compassion.</p>
  <h4>Benefits</h4>
  <p>Through the development of a safe and supportive atmosphere, trauma-informed care establishes a bond of trust and rapport between patients and healthcare providers (Grossman et al. 2021). It leads to patients to communicate more freely and truthfully in their treatment (Green et al. 2015). Patients who are well-treated and well-received are the ones who tend to say they are more satisfied with their treatment (Sweeney et al. 2016). Thus, the patients are expected to adhere more closely to treatment plans and recommendations and to attend follow-up visits (Chipidza et al. 2015). According to Cockersell, (2016) trauma-informed approaches are thus hypothesized to reduce the stress and anxiety that can accompany medical settings and procedures and thus pave the way to better mental and physical health.&nbsp;</p>
  <h4>Effectiveness of Trauma-Informed Approaches to Patient Surveys</h4>
  <p>There is a lot of evidence highlighting trauma can hurt different parts of a person's life, such as their health and well-being, their probability of getting a job or going to school, and their chances of multiple disadvantages (Felitti et al., 1998). This has helped trauma-informed methods become more popular in Ireland and around the world. Naimi (2022) discussed that there is evidence that people who receive trauma-informed support have better outcomes, however, there is currently insufficient research isolating the unique effects of TIC on patient outcomes. However, Mahon, (2022) provide evidence that trauma-informed methods make people's experiences with services better and increase their participation, which is necessary to get clinical results.</p>
  <p>Trauma patients have been able to note several personal advantages resulting from the trauma informed care they receive. Some of the gains include; improved housing security (Hopper et al., 2010). The effects on drug use have been mixed with some improvements reported as well as the continued worsening of some indicators Drug use has been found to have both good and bad outcomes. Another study reported a decrease in use of drugs where receivers of TIC were considered (Stergiopoulos et al., 2015) although other studies which were conducted showed that there was not any change on the drug use (Sweeney et al. 2016) Trauma informed care has been found to decrease recidivism (Bright, 2017); relapse risk factors like poverty, community and family violence, stigma, and prejudice etc., are addressed (Miller and Najavits, 2012); and the time taken before people are discharged from safe care is shorter (Greenwald et al., 2012).</p>
  <p>Psychologically Informed Environments have also been shown to have better results than services that are not (Cockersell, 2016). One result of working in a trauma-informed way is that people are more likely to use programs including cognitive behavioral therapy and mindfulness-based therapy for managing trauma (Fortuna et al. 2018). However, the intersectional approach must be considered when acknowledging that patients with several risk factors are usually unable to connect or participate in therapies. This is because they may be either unable or unwilling to use these therapies (Prestidge, 2014). Studies have shown that trauma-informed interventions for hard-to-reach groups make people more likely to go to treatment, cut down on risky behaviors, like drinking, and reduce the use of seclusion and restraint, as practices broadly recognized are not trauma-informed. (Cockersell, 2016) People are more involved because they understand others better, build relationships, and have workers with real-life experience help plan and carry out services (DHSC, 2019).</p>
  <h4>Challenges</h4>
  <p>Regardless of trauma awareness, training of trauma-informed care among healthcare professionals and consistent application of TIC principles remain key challenges. Allocation of resources including funding, time, and staff necessary for implementation of TIC (Cockersell, 2016) are rare in many healthcare settings where finances remain under pressure. Institutional and systemic barriers can also prevent the implementation of trauma-informed practices, as is the resistance to change from staff and administrators (Sweeney et al. 2016). Moreover, Cockersell (2016) recommends that trauma-informed care should be modified to suit different cultural and contextual situations; what works in one setting may not be suitable in another. Applying trauma-informed principles for use in patient census surveys raises several difficulties directly associated with the nature of trauma and its impact on people&rsquo;s experiences and interactions. Studies show that the constant raising of awareness regarding specific words or stimuli may limit the effectiveness of the interaction with the survivors and survey questions (Baker et al., 2018). Also, negative psychological states like dissociation or hypervigilance due to a traumatic background could impact respondent attention and understanding, which might impact responses to survey items (Bartlett et al., 2020). Moreover, trauma patients may be reluctant to share details with a provider because of stigma or fear of negative reactions, which can lead to not only an underestimation of potentially traumatic events but also an underestimation of the severity of the symptoms of trauma (Green CL et al., 2019). Additionally, traditional structure of survey forms may not be inclusive of all forms of trauma and the experiences that are unique to each form of trauma (Harris et al., 2021). To address these challenges, the use of language, question and survey administration methods must consider a trauma informed approach to patient surveys, to ensure response rates are compromised by those patients who have undergone trauma or abuse in their lifetime (Smith et al., 2020).&nbsp;</p>
  <h4>Theoretical Framework</h4>
  <p>An analysis of survey forms can draw on multiple theories to comprehend how language may influence a patient&rsquo;s experience and views of surveys, especially with consideration for previous trauma exposure. Among these, trauma theory, which in its basic form relates traumatic experiences to long-term pathologic changes in human&rsquo;s psychological and emotional states, offers an important lens through which to analyze extant patient survey forms (Ford &amp; Courtois, 2020). Consistent with trauma theory, this approach can help identify which language, appearing on self-completed patient satisfaction questionnaires, might potentially cause or provoke trauma responses in some patients (Herman, 1997).</p>
  <p>Moreover, patient-centered care theory focuses on the care that is specific to a patient&rsquo;s need, choice, and desire regarding their health care services. Similarly, patient-centered care focuses on improving and strengthening the relationships between patients and healthcare providers, using communication and other tactics to make patients more independent (Institute of Medicine, 2001). In the context of designing patient survey forms, patient centered care theory proposes that language be welcoming, non-judgmental and acknowledge the social positioning of an individual or the prevalence of traumatic community experiences (Koss, White &amp; Lopez, 2017).&nbsp;</p>
  <p>Moreover, language implies the concept which, according to the theories of the linguistic science, forms an individual&rsquo;s perceptions and behaviors (Nath, 2010). Since the field of sociology is concerned with the distribution and organization of social and cultural phenomenon, it follows that language, as a primary tool used in society, would adhere to these guidelines as well as some principles outlined in sociolinguistic theory (Mills, 2013). Thus, many terms used in patient survey forms may be indicative of various forms of structural relations of power between dominant and dominated bodies, the appearance of bias, and various expectations regarding the patient&rsquo;s subjective experiences. It is crucial for researchers to focus on such survey forms and examine the potential concealed meaning in language and use of these and other strategies with patients who are possibly experiencing trauma.</p>
  <h4>Literature Gap</h4>
  <p>While the literature has paid increased attention to the importance of providing trauma-informed communication in healthcare settings, there remains a paucity of information on how the language applied on forms, including patients&rsquo; satisfaction surveys, may create additional difficulties for other trauma survivors (Green et al., 2019). Similarly, scholarly works have explored aspects of trauma-sensitive approaches within clinical discussion, but few have explored language used in written documents such as survey forms (Taylor &amp; Garcia, 2022). This absence of literature is an indication of the need to undertake a formative examination of the terms deployed in patient surveys from a trauma-informed perspective. Through qualitative research on the specific language used in the survey forms, researchers can identify certain words and phrases that may unintentionally elicit a traumatizing response from the survivor. Thus, it is possible for future research works to examine how language of the survey forms influences patient&rsquo;s perception of safety, trust, and being empowered to respond to survey forms.</p>
  <p>From a research perspective, insights about language used in survey forms of patients can guide the formulation of communication directions and inform initiatives to help them promote more trauma-sensitive practices for better quality care (Harris et al., 2021). Thus, comprehending the ways in which language affects disclosure and how language providers and trauma survivors navigate these issues can lend potential solutions for widening access care (Koss, White &amp; Lopez, 2017). From an operational perspective, adopting a trauma-informed language in survey rating forms could result in higher accuracy and reliability of the survey outcomes for evaluating patient&rsquo;s health care experiences and determining patient&rsquo;s needs (Smith et al., 2020). Thus, it can be used to design appropriate preventive and therapeutic measure and to modify hospital practices to better address the needs of people with a history of trauma. Furthermore, trauma-informed survey forms can also help improve patient-centered care since the use of such surveys signals to patients that they will be respected and that they will be treated as active participants in their healing process (Ford &amp; Courtois, 2020).</p>
  <p>In conclusion, it is crucial to identify practical and feasible steps towards increasing the use of trauma-informed language in patient survey forms as key to trauma-informed approaches in healthcare. In this way, undertaking comprehensive research in this particular field and using its results to develop practices that can improve the experience of patient satisfaction surveys in healthcare organizations will not only contribute to technical advancements in this field but also serve as a knowledge base of practical experience which will help to improve the application of trauma-informed care across various types and levels of healthcare systems.</p>
  <h3>Introduction</h3>
  <h4>Background</h4>
  <p>The patient&rsquo;s needs who have been through one or several traumatic events have become more accepted and valued in numerous health care settings. Various forms of trauma including childhood physical, sexual, emotional abuse, interpersonal violence and other trauma, can contribute to an individual&rsquo;s overall physical and mental well-being. Extended early-life adversity can significantly increase the probability of poor physical and mental health outcomes for the rest of an individual&rsquo;s life (Berliner and Kolko, 2016). Consequently, and according to DeCandia and Guarino (2015), trauma and its effects must be addressed in all care systems due to the negative impact they have on society. According to Becker-Blease (2017), trauma informed care (TIC) is one approach supported by an awareness of the pervasiveness and impact of trauma on society. In acceptance of that fact, the principles of TIC have been developed as a framework of care that seek to understand not only the effects of the trauma but aims to establish a culture of care that is sympathetic, empathetic, and responsive to clients with trauma histories (SAMSHA, 2014).</p>
  <p>The idea of a trauma-informed approach has been widely studied and popularized in different sectors such as education, public health, psychology, psychiatry, and developmental science fields (Champine et al., 2019). The main goal of TIC is to facilitate changes in patient&rsquo;s condition that promote resilience and recovery from exposure to traumatic situations. By emphasizing bodily, relational, and psychological safety, TIC thus seeks to empower care providers as well as service users (Hopper et al., 2010).&nbsp;</p>
  <p>Another important component of TIC involves the use of language. Brown et al. (2018) found that patients who had experienced trauma recorded high levels of satisfaction if providers were trained in trauma-informed communication, suggesting that such training has benefits when dealing with patient provider relationships and health event outcomes. These findings support the applicability of the use of trauma-informed language: there is a significant role of using effective approach concerning patient-physician relation, particularly focusing on building healthy rapport, trust, and openness between the two parties. Similarly, effective communication is well-recognized within the health sector as being crucial to ensure that patients receive quality care and positive experiences (Kwame and Petrucka, 2021). According to Pandey et al. (2019), language barriers can inhibit patient&rsquo;s understanding of their care plans, delay their ability to communicate their requirements and lead to significant misunderstandings between healthcare providers and patients. Emotional dimensions are substantial in a healthcare setting and language has added importance in this regard as it impacts patient&rsquo;s care experiences and ability to engage in healthcare services effectively. In doing so, healthcare providers can increase patient engagement and improve health results to ensure traumatized patients feel supported throughout their care journey. Similarly, the use of trauma informed language can increase patient trust in health care providers and the quality of information reported by the patient. For instance, Smith et al. (2019) argued that effecting trauma language in treatment interactions increases satisfaction and, subsequently, the engagement in particular care plans for trauma survivors, and may therefore improve the healing process of the traumatized patient (Smith et al., 2019). Also, patients with trauma history might experience difficulties in satisfying health care needs or history of trauma disclosure due to stigma or fear of revictimization. Still, when providers adopt sensitive language and care models, the patient feels more at ease and willing to disclose information about their trauma history and experiences, thus, receiving more complete and accurate information from healthcare givers (Johnson and Jones, 2020).</p>
  <p>Patient survey forms, which are used to capture the experiences of patients and as a method of understanding the experiences of trauma survivors, offer insight into the language used in patient communication (Mersky et al., 2019). The Trauma informed Care (TIC) framework is a model that provides safety, trust and empowerment of the clients that has been exposed to trauma. It entails acknowledging the reality of trauma and its effects confirming that no traumatizing services are offered to people. The major principles include procedural safety, establishing rapport and operation dimensions whereby client&rsquo;s self-determination is valued. Another critical aspect highlighted in TIC is multiculturalism and cultural responsiveness to client&rsquo;s backgrounds (Substance Abuse and Mental Health Services Administration [SAMHSA], 2014). This way has been implemented extensively in health and social care to enhance the wellbeing of survivors of trauma. By looking into the structural form, content and tone of the survey questions and developed techniques to screen, rule out or downplay language that might cause trauma or hamper communication (Bloom, 2010), surveys can be repurposed or redesigned in a trauma informed way. In doing so, healthcare systems can be better aligned to a trauma-informed approach improving the quality of healthcare received.</p>
  <p>There is sufficient evidence in the literature about the relationship between post-traumatic stress and adverse health effects. However, there is a conspicuous dearth of coherence regarding the terms and factors used in describing trauma-informed methods and practices that can pose challenges in syncing care and evaluating effects (Wilson, Pence, &amp; Conradi, 2013; SAMHSA, 2014). To call a program, organization or system that is designed to provide individuals and families with the support they need after experiencing trauma, &lsquo;trauma informed&rsquo;, all forms of patient communication need to also align with the language and terminology related to the concept of trauma-informed care.</p>
  <h4>Rationale</h4>
  <p>There is need to have good communication channels if one is to establish considerable confidence between patients and healthcare providers in each setting. Patient survey forms are useful instruments to obtain feedback and to understand the patient experience in healthcare centers. However, patient survey forms may contain terms that may unintentionally remind patients of their traumatic past (Palanac, 2022). Thus, the current research sought to identify problematic language and make suggestions for how this language might be improved to be more aligned with the provision of a &lsquo;trauma informed&rsquo; service.&nbsp;</p>
  <p>This understanding contributes to fulfillment of a trusting relationship with the providers as patient&rsquo;s reasons that such providers are likely to understand their feelings.&nbsp;</p>
  <p>Using these principles in the patient survey forms, healthcare providers can guarantee that the feedback process does not lead to stress or trauma among patients, thus, it can be more effective considering the health outcomes (Purkey et al., 2018; Bailey et al., 2019). Although a lot of research has been conducted on trauma-informed care in clinics, there is insufficient literature on the language used in patient interactions, particularly in surveys (Johnson and Jones, 2020). Therefore, the current study will fill the gap by giving information on how the discourse in the survey forms can be made more trauma informed. The aim of this study is therefore to contribute to the body of knowledge on how trauma-informed practices can be implemented in healthcare. For the patients, who experienced traumatic events, the trauma-informed language would be beneficial; this pertains to the stigmatized and private healthcare; people from various walks of life and from all walks of life will be appreciated.</p>
  <h4>Research Aims and Objectives</h4>
  <p>This study aims to explore trauma-informed language in patient surveys. Specifically, this research sought:</p>
  <ul>
  <li>
  To identify phrases and words in existing patient survey forms that might be problematic to those with a history of trauma
  </li>
  <li>
  To analyse how, in survey forms, language shapes the way patients express their experiences, particularly regarding trauma.
  </li>
  <li>
  To understand the trauma-informed language in patient survey forms and its role in increasing or decreasing traumatisation and patient-centred care.
  </li>
  </ul>
  <h3>Methodology</h3>
  <h4>Research design&nbsp;</h4>
  <p>A qualitative research content analysis approach that fits within the strategy of discourse analysis is most appropriate for studying patient survey forms and the extent to which they are trauma informed. This design has also allowed for close analysis of the actual texts of the survey forms to consider any nuances in language choice (Fossey et al. 2020). The strength of this approach was the flexibility of discourse analysis which is well suited for inductively building understanding of this emergent area of TIC principles in written communication /documentation of patients and measurement tools. Hence, due to its focus on the meaning and interpretation of the collected data, the qualitative content analysis approach can offer important patient-oriented and empathetic insights to contribute to the future survey development and implementation.</p>
  <h4>Data collection method&nbsp;</h4>
  <p>Data included a range of open-ended patient surveys, questionnaires and forms currently used in the health care sector. These include the National Inpatient Experience Survey, Maternity Bereavement Experience Survey, Maternity Care Survey, National End of Life Survey Questionnaire, National Incident Report Form, National Nursing Home Experience Survey Questionnaire and National Nursing Home Experience Survey Questionnaire for Nursing Home Residents. These surveys and questionnaires were identified by searching the PubMed and MEDLINE databases using the keyword national patient experience surveys and the national health care questionnaires specifically for Ireland. Some other search terms such as &lsquo;inpatient experience survey&rsquo; or &lsquo;maternity care questionnaire&rsquo; yielded different studies that applied such surveys to collate and examine patients&rsquo; experience data. Among all the surveys, seven were chosen because they are primary and involved key areas of healthcare that included inpatient care, Maternity/End of life care, Safety incidents, etc. These nationwide surveys offered validated questionnaires and instruments that were patient/family-centered experiences within the Irish system hence helpful in providing structured data analysis and interpretation for the considered study variables.</p>
  <h4>Sample size and technique</h4>
  <p>To maximize the appropriateness of the collected data, this study consists of purposive sampling to ensure the representation of various healthcare organization&rsquo;s experiences. The study includes a range of survey forms used in different healthcare settings. Survey forms were taken from various departments. The survey forms targeted the type of language used by the staff to relate with patients who have undergone through trauma. This kind of focus directly correlates with the aims and goals toward which language for trauma-informed care best practice evaluation is set. The forms provide groups for objective examination, as the headings contain the following options: type of language (empathetic, sympathetic, neutral), absolutely necessary words, tone used by the staff. Most of the time surveyors can effectively obtain data to as the ratio of the use of language to that of trauma-informed language. Due to the nature of trauma experiences as potential topics to be discussed, these survey forms are a convenient method for determining in what extent the staff uses language that complies with tendencies for compassion and sensitivity. The standardized format enables reliable measurement in patient-staff interactions as well as across different staff members, and yet the relevant indicators are narrowly designed to target the influence of staff language during what can be a possibly emotionally challenging kind of care.</p>
  <h4>Data analysis technique: Rhetorical Discourse Analysis</h4>
  <p>Rhetorical Discourse Analysis (RDA) is defined as the study of language and its usage as it forms meaning and how it affects the thoughts and decisions of a certain group or an individual (Van Dijk, 2015). Discourse analysis was therefore carried out on patient survey forms to identify whether the language used in these forms was aligned to a trauma-informed perspective. Further, the purpose was to find any terms that could be causing distress, or potentially retraumatizing for any patients with a history of trauma. The main idea behind the use of discourse analysis was to identify some of the issues with wording and offer ideas for how these forms could be improved to incorporate more trauma-informed language. According to the purpose of the study, the language and argumentation of the texts with the patterns were examined to understand how these texts represent the issue and influence the readers on the perceptions of the topics being discussed. As in the case of the RDA, the interpretative approach has focused on a careful reading of a text to examine the use of rhetorical devices and discursive strategies. They focused on text analysis to identify the nature of rhetoric employed to influence the audience and promote specific ideological positions. It is so that multiple readings assisted in symbolical and change identification of presuppositions which sustain power relations.&nbsp;</p>
  <p>Table 1: Stages of Methodology</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="120"><col width="494"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Stages&nbsp;</p>
  </td>
  <td>
  <p>Explanation&nbsp;</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Sampling method&nbsp;</p>
  </td>
  <td>
  <p>Purposive sampling techniques were applied to identify 7 patient survey forms based on the findings of the past literature.&nbsp;</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Ethical aspects&nbsp;</p>
  </td>
  <td>
  <p>The researchers have taken ethical approval from the School of Psychology Ethical Review Committee.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Adapting questionnaires&nbsp;</p>
  </td>
  <td>
  <p>For data collection, questionnaires were selected to proceed with the analysis to address the research questions.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Survey responses&nbsp;</p>
  </td>
  <td>
  <p>As this study was based on the qualitative data collection method, survey questionnaires were selected as a mode of data collection.&nbsp;</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Data collection&nbsp;</p>
  </td>
  <td>
  <p>The data was collected through surveys forms.&nbsp;</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Coding&nbsp;</p>
  </td>
  <td>
  <p>The coding process was done through manual screening of the questionnaire transcripts and different codes were generated by detailed analysis of the statements in the questionnaires.&nbsp;</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Data analysis&nbsp;</p>
  </td>
  <td>
  <p>The collected data was analyzed through Rhetoric Discourse Analysis. This was selected because this approach allows the researcher to analyze data systematically and comprehensively while at the same time allowing for flexibility in the methods. Discourse analysis implied analyzing language and how the meaning is made in various settings that exist in society. It was used in few cases including the cases of the survey questionnaire&nbsp;</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br><br></p>
  <h3>Results</h3>
  <p>This analysis is presented using the approach of the Rhetoric Discourse Analysis (RDA), is developed based on seven essential health-related questionnaires and the issue regarding their credibility, emotional impact, and comprehensibility. (Appendix 1-2). Analyzing several extracts and examples, this analysis discusses how these surveys meet the most important requirements for respondent engagement and data accuracy.</p>
  <h4>Credibility and Trust (Ethos)</h4>
  <p>In all the seven questionnaires, the aspect of developing credibility and trust is paramount throughout. The Designated Representative Questionnaire is perceived to be trustworthy as it is established based on the idea that the response is essential to enhance the quality-of-care delivery while its importance is reinforced by the issuing authority. For instance, it states, "Your feedback will help us improve the care provided to residents. " Similarly, the End-of-Life Questionnaire ensures credibility by explaining how feedback will directly influence care improvements, saying, "Your responses will guide us in enhancing end-of-life care. " The National End of Life Survey Questionnaire highlights the importance of respondent input for service enhancement, ensuring respondents their feedback is valued, with an introduction that reads, "We greatly appreciate your input in improving our services. " The National Incident Report Form (NIRF) focuses on the importance of incident reporting, enhancing trust through clear explanations of its purpose: &ldquo;Reporting incidents assists in keeping places safe.&rdquo; It is clear from both the NMBES and NMES Questionnaires that both have introduced themselves as being accountable for their services by illustrating a purpose of using the feedback gathered for enhancement. Finally, the Resident Questionnaire 2022 encourages residents to provide constructive feedback, emphasizing confidentiality to build trust:&rdquo; The answers you provide are for our research purpose only and would help in enhancing health care delivery system.&rdquo;</p>
  <h4>Emotional Sensitivity (Pathos)</h4>
  <p>Emotional sensitivity is not an afterthought in the surveys; instead, it is incorporated skillfully into every survey. Both the End-of-Life Questionnaire and the National End of Life Survey Questionnaire state about the possibility of emotional distress of the respondent and use reassuring and comforting words at the end of the questionnaire together to assess the respondent is in distress. For example, "We understand this is a sensitive time for you. Please feel free to skip any questions that you find distressing. " The Designated Representative Questionnaire similarly addresses emotional sensitivity by acknowledging the personal nature of the feedback and offering support contacts: &ldquo;We are here to support you during this process.&rdquo; The NIRF asks the respondents to provide details in relation to effects of incidents, thus encouraging emotional grounding and empathy with the situation through isolated prompts such as &ldquo;Please describe how this incident has affected you.&rdquo; Both, the NMBES, and NMES Questionnaire personalize the participant&rsquo;s experiences by inviting them to share their experience reflecting on the question, such as &ldquo;Please share how our services have affected you."</p>
  <p>Clarity and Logic (Logos)</p>
  <p>Precisely formulated and logically organized questions are the key elements of these surveys. The End-of-Life and National End of Life Survey Questionnaires are well-structured with clear sections covering different aspects of care such as &ldquo;How are you feeling about your ability to communicate with your healthcare provider?&rdquo; The Designated Representative Questionnaire starts with basic overall satisfaction before proceeding to more specific inquiries: &ldquo;How satisfied are you with care received?&rdquo; The NIRF follows the basic structure of asking for clear information: &ldquo;What happened? When and where did the incident occur?&rdquo; The content of both the NMBES and NMES Questionnaires deals with clarity in areas of service or educational relevance as well.</p>
  <h4>Context and Timing (Kairos)</h4>
  <p>When it comes to the design of the survey, some of the most important factors include context as well as the timing of the survey. The End-of-Life and National End of Life Survey Questionnaires allow respondents to complete the survey at their own pace, recognizing the emotional and logistical challenges. The Designated Representative Questionnaire and Resident Questionnaire 2022 focus on the nature of current care or facility conditions as follows: &ldquo;Describe any recent alterations in the care.&rdquo; The NIRF targets the context of the incident, as does the following: &ldquo;Report the incident as soon as possible.&rdquo; The NMBES and NMES Questionnaires consider supporting services and educational relevance correspondingly for instance, &ldquo;Please reflect on the most recent experience with our support services.&rdquo;</p>
  <h4>Purpose and Goals (Telos)</h4>
  <p>It is especially critical when performing surveys to state the purpose and the goals of the research. The End-of-Life and National End of Life Survey Questionnaires clearly state their objectives to improve care services based on feedback for example &ldquo;End goal of this survey is to seek feedback that may be used to better end of life care.&rdquo; The Designated Representative Questionnaire also underscores the goal of receiving detailed feedback for the improvement of care quality: &ldquo;Your feedback is valuable in improving the quality of residents&rsquo; care.&rdquo; The NIRF is specifically focused on the improvement of safety practice by documenting incidents such as &ldquo;The purpose of this form is to document incidents to strengthen safety practice. &ldquo;Both the NMBES and NMES Questionnaires state their purpose of service and educational enhancement clearly for instance, &ldquo;Your feedback helps us to enhance our educational offerings.&rdquo; The Resident Questionnaire 2022 is designed to enhance the healthcare services using inputs from the residents: &ldquo;Your feedback is important to us in the improvement of our health care services.&rdquo;</p>
  <h4>Inclusive and Respectful Language</h4>
  <p>The use of politically correct language is another of the significant aspects of powerful and efficient surveys. The End-of-Life and National End of Life Survey Questionnaires use terms like "family member or friend" to ensure inclusivity such as &ldquo;Could you give feedback on behalf of your loved one?&rdquo; The Designated Representative Questionnaire also steers away from bias and presumption of relations by using more universal greeting, for instance, &ldquo;We welcome feedback from any nominated family members or friends.&rdquo; The NIRF prompts for detailed impact without being prejudice, and ensures respect by stating, &ldquo;Please provide a report on the incident without disclosing any identity.&rdquo; The NMBES &amp; NMES Questionnaires employ more neutral language. Both the NMBES and NMES Questionnaires use language that respects diverse experiences: &ldquo;Tell us your stories and your ideas.&rdquo; While The Resident Questionnaire 2022 enables the provision of detailed opinions on different aspects of the care provided: &ldquo;Give your feedback on any aspect of this facility.&rdquo;</p>
  <h4>Validation and Empowerment</h4>
  <p>One of the most dominant trends is that of empowering respondents and enabling their contribution. The End-of-Life and National End of Life Survey Questionnaires empower respondents by inviting detailed narratives and feedback such as &ldquo;Your detailed feedback is important for the enhancement of services.&rdquo; The Designated Representative Questionnaire also allows the respondent control over the information that is given: &ldquo;You can also decide to skip any questions that you feel uncomfortable to answer.&rdquo; The NIRF also brings to the individual the powers to contribute to the improvement of safety for example &ldquo;Your feedback assists in preventing future incidents.&rdquo; The NMBES and NMES Questionnaires both request constructive feedback empowering the respondents to feel empowered and confident while responding. Both the NMBES and NMES Questionnaires encourage constructive feedback, empowering respondents to shape service and educational enhancements such as &ldquo;Your suggestions will help define future enhancements.&rdquo; The Resident Questionnaire 2022 allows residents to give extensive opinions for influencing their care enhancements: &ldquo;Your opinions concerning the care directly influence the quality of care.</p>
  <h4>Confidentiality and Privacy</h4>
  <p>Confidentiality and privacy issues need to be carefully managed to ensure the trust of the customers. The End-of-Life and National End of Life Survey Questionnaires explicitly state that responses are confidential, reassuring respondents: Personal responses given in the Research Study are anonymous: &ldquo;Your responses remain anonymous.&rdquo; Confidentiality of the Designated Representative Questionnaire is also enhanced, which guarantees safe feedback: &ldquo;Your feedback is anonymous. &ldquo;NIRF also makes feedback and complaints safely through confidentiality: &ldquo;Your report of incidents is confidential. &ldquo;The NMBES and NMES Questionnaires all aim at protecting the privacy of the participants through the message, &ldquo;Your privacy is our priority." The Resident Questionnaire 2022 reaffirms confidentiality, promoting trust and candid responses such as&rdquo; When responding to the questions you have been asked, your responses are anonymized and are to be used for enhancing service delivery in healthcare.&rdquo;</p>
  <h4>Flexibility and Adaptation</h4>
  <p>Respondent flexibility is considered in several ways regarding the manner and flexibility of survey completion. The End-of-Life and National End of Life Survey Questionnaires offer multiple completion methods, such as online or postal, accommodating different preferences. Slightly different, the NMBES and NMES Questionnaires support a broad format of various forms of feedback: &ldquo;You can provide feedback through this form or in person&rdquo; While the Resident Questionnaire 2022 allows residents to provide feedback in any format convenient for them like &ldquo;Take your time to complete this questionnaire.&rdquo; The Designated Representative Questionnaire, NIRF support flexibility for the respondent to answer at own pace for example &ldquo;Take your time to complete." The Resident Questionnaire 2022 allows for nuanced feedback, ensuring diverse resident needs are met: "Provide feedback in any format that is convenient for you." Flexibility and adaptability in these surveys improve response rates and data quality by accommodating respondent preferences.</p>
  <h4>Discussion</h4>
  <p>Feedback questionnaires are crucial tools in healthcare since they provide qualitative information needed for service recommendations and policy changes. The analysis of seven healthcare questionnaires using RDA reveals the following thematic dimensions that influence their effectiveness: credibility and trust, feeling, rationality, context, time, objectives and scope, non-sexist language, affirmation and enabling, bounded number of participants, discretion, and openness.</p>
  <p>As the first step in the process of developing healthcare surveys, it is important to consider credibility to gain trust from participants and achieve dependable results. The findings of the study helped in analysing that there is a perception improvement among participants at the time of the survey to ensure credibility mainly via making the survey&rsquo;s practices clear which leads to higher levels of reliability. It was also observed that it is crucial for organizations conducting surveys that ensure the credibility of the results not only enhances the response rates, but also increases the probability of obtaining feedback that can help in enhancing the delivery of services. Since trust leads to increased interest, health care providers need to cultivate effective communication channels effectively to show the need for and necessity of completing feedback questionnaires. Widely acknowledged crucial practices for increasing credibility in surveys include institutional support and clear reporting of the survey&rsquo;s purpose (Smith, 2022; Jones et al., 2021). Studies also suggest that surveys backed by well-established healthcare organisations and including a clear statement of their aims receive more attention and more reliable, less filtered responses (Brown &amp; Johnson, 2023; White et al., 2020). More reliable data is critical to ensure continued decision-making in healthcare, especially when data is concerned with describing traumas among participants (Taylor &amp; Clark, 2021). If trustworthy survey design principles are applied, healthcare organisations can work towards enhancing their social value by having the stakeholders feel that their input in the surveys is useful for enhancing the delivery of services and patients&rsquo; outcomes (Garcia et al., 2022). Therefore, credibility of survey methodologies is important to produce relevant and useful information that can foster the needed changes in the healthcare systems&rsquo; practices and policies.</p>
  <p>It has been noted from the findings of this study that recognising emotional sensitivity when undertaking survey is very critical in order to be able to get accurate responses especially when working within sensitive health sectors.</p>
  <p>It was analysed that as with emotional intelligence characteristics, surveys with emotional intelligence can provide participants with anonymity, which assists in capturing deeper insight into the participant&rsquo;s past experiences in a specific field and their requirements. The recommendation is focused on increasing organisations&rsquo; emotional intelligence in dealing with patients. As a result, many organisations can improve the quality of feedback received and interpret what patients are experiencing more accurately. Emotional sensitivity in the administration of healthcare surveys is relevant as it helps in the acquisition of truthful and more informative feedback from the respondents (Bradley et al., 2018; Epstein et al., 2005). Research has stressed that interviews that are considerate about people&rsquo;s emotions not only increase survey completion rates (Jones et al., 2021) but also provide deeper insights into participants&rsquo; experiences of and attitudes to healthcare processes and outcomes, as well as their relative traumas (Brown &amp; Johnson, 2022; Garcia et al., 2023). Surveying leads to an affirmation of the feeling evoked by the respondents hence assisting in creating a praiseworthy platform for communication. (Smith &amp; Davis, 2020; Taylor &amp; Clark, 2021). This is crucial for enhancing the process of data collection, while embracing the principles of surveying to promote the spirit of patient-centered care and quality services for the healthcare providers.</p>
  <p>Cohesion and organization are among the primary characteristics of the structure and development of the healthcare survey affecting the understandability of questions by the respondents, as well as the reliability and relevance of the collected data. The findings of this study also informed that effective surveys&rsquo; characteristics also make the respondent understand the questions in a clear logical manner which positively affects data quality. It can be analysed that whenever questions are grouped coherently and consistent with objectives, participants allow valid inputs that can enhance patient care directions. Such clarity is useful not only in the generation of data from surveys but it helps in decision making practices that go on in healthcare organizations. Contemporary research shows that clearly ordered questions, which correspond to the survey&rsquo;s aims, and eliminate vagueness are important (Brown &amp; Davis, 2020). Clarity and comprehensiveness of the structures used in the creation of survey instruments enable the respondents to understand the rationale behind each question, providing more targeted feedback for the enhancement of healthcare services and description of their traumatic experiences. Research has pointed out that surveys with a clear and coherent design positively influence the respondent&rsquo;s commitment and the quality of the results achieved (Smith et al., 2021). When questions are grouped logically and are relevant to survey aims, healthcare providers get data that will help in service improvement and patients&rsquo; care planning (Taylor &amp; Garcia, 2022). Additionally, effective survey communication leads to precise survey results since there is less chance for confusion or misinterpretation of survey results as survey communications regarding the study are clear (Clark &amp; Johnson, 2023).</p>
  <p>The findings of the RDA above suggested that when survey questions are contextualised, it&rsquo;s possible for the respondent to liken the given scenarios easily, resulting to more relevant and utilizable feedback. It also diversifies the data, in that knowing the details of participants&rsquo; experiences in the health care system better prepares providers to meet patients&rsquo; needs. It was noted that defining the context appropriately in surveys enables healthcare professionals to provide an exact meaning to the responses given hence aligning the results obtained toward the operational goals. Defining the purpose of surveys and goals concerning survey results is crucial for realizing stakeholders&rsquo; expectations and benefits of surveys. It lays focus to the fact that when goals of surveys are communicated clearly and understood respondents are more likely to respond in a qualitative way, thus improving on the response rates and quality of data gathered (Johnson &amp; White, 2023). It would be equally important to highly clarify the purpose of the survey as this not only increases respondents&rsquo; interest and enthusiasm but also guarantees that the collected data would be pertinent to imperative components of care provision and quality of services offered (Clark &amp; Brown, 2023). Studies show that when organizational objectives of surveys are clear, the participants are more inclined to respond effectively as they notice that the survey is pertinent and for this reason, will endeavor to give the required data (Adams &amp; Garcia, 2020). For instance, questionnaires that are meant to gauge patient satisfaction or Hospital health-care service efficiency should include objectives in the questionnaires that draw the participant&rsquo;s attention to some areas of relevance. This way helps in acquiring relevant data to inform administrative decisions in the healthcare industry and policies formulation (Jones &amp; Wilson, 2021). In turn, survey design is a means of achieving general objectives within the framework of the organization to direct the main effort towards implementing interventions that would be backed by credible data. Furthermore, specific survey objectives increase the credibility of the information collected due to the respondents&rsquo; awareness of their significant role in influencing the improvement of healthcare services. This alignment not only optimizes the surveys&rsquo; efficiency to assess patients&rsquo; experiences, but it also plays a crucial part in advancing the general quality of care and patients&rsquo; condition (Taylor &amp; Clark, 2021).</p>
  <p>It was noted from the findings that surveys that use the appropriate or rather the intermittent use of the inclusive language give the participants a rather positive attitude towards the surveys and thus gives them a positive attitude towards offering feedback. It assists in creating diversity and also provides a richer data collection process which captures all the stakeholders&rsquo; experiences. Therefore, for healthcare surveys to better fit into the country&rsquo;s needs and provide a more efficient quality of care, they need to implement inclusive language. The use of inclusive language in healthcare survey helps to increase the interest of the partakers and increases the reliability of the collected data as the health care field embraces people of different diversities with different perspectives (Lee, Johnson &amp; Brown, 2021). When using surveys, inclusion of other minorities in the language used shows the researcher&rsquo;s sensitivity to their diversity and equals them to others hence builds trust among stakeholders (Johnson &amp; White, 2021). In a similar vein, findings point to the need for survey design that does not compromise inclusiveness as a way of avoiding any form of prejudice and making everyone feel like they belong (Jones &amp; Smith, 2020; Brown et al., 2019). This approach eliminates prejudice by which some groups may be discriminated against; thus, the surveys offer respondents of different age, gender, or race the same chances of responding genuinely. This approach not only enhances the quality of data gathered but also assists healthcare organisations in addressing population&rsquo;s requirements in their delivery of care (Taylor &amp; Clark, 2018).</p>
  <p>Essentially, asserting the respondent experiences and assisting the stakeholder via survey responses is crucial to establishing a shared view in the delivery of health-care services. In this regard, Miller and Smith (2020) explicate that the use of surveys is not just a process of gathering data but rather engaging individuals through an open invitation to the chances of giving detailed narratives and feedback. Besides affirming that stakeholders&rsquo; proposed solutions are genuine and relevant, it moves them forward to be involved actively in the enhancement of quality services and policy formation (Clark &amp; Johnson, 2022). When evaluating stakeholder information healthcare organisations can prove that they are responsible hence promoting patient focused care.</p>
  <p>The findings thereby emphasized that It is essential to ensure that participants do not feel that their surveys would be identifiable within the survey&rsquo;s response results in order to encourage participants to respond to surveys sincerely. Therefore, by ensuring ethical ways of collecting data, health care organizations will ensure that participants feel comfortable to give out any information. It was suggested through the findings of this study that maintaining confidentiality can enhance people&rsquo;s confidence in the surveying process resulting into data with references on the improvement of health care services. Security and anonymity are two of the most vital concepts that must be upheld to the highest level when conducting surveys in the healthcare sector. As widely stated by Clark and Rogers (2022) eradicating any doubts regarding the protection of respondent data, along with guaranteeing anonymity, is crucial. Cognitive interviewing also employs several techniques to maintain and guarantee ethical conduct and regulatory compliance to most of the questions, therefore assuring the freedom of respondents and making them comfortable to give genuine responses (Adams &amp; Garcia, 2020). In this way, confidentiality procedures reduce risks of respondents fearing the consequences of their statements, thus, ensuring that the information received from the healthcare providers is honest and unbiased of their experiences when delivering or receiving healthcare services. In a nutshell, it can be argued that receiving the validation and the sense of empowerment that comes with filling in surveys enables a form of participation that enhances the stakeholders&rsquo; perceived relevance and inclusion in the management of a health care organization&rsquo;s conditions and changes (Lee, Johnson &amp; Brown, 2021). Likewise, confidentiality and privacy maintain ethical principles to provide the necessary protection to the collected survey results as well as the precise perception of the stakeholders (Brown &amp; Johnson, 2023). Altogether these practices constitute an integrated approach towards addressing various aspects of healthcare, as well as serve to identify focus areas suitable for intervention consistent with the patient&rsquo;s perception of the need for treatment.</p>
  <p>The ability to complete surveys in a variety of methods is emphasised to increase the response rates in healthcare settings (Taylor et al., 2021). Studies prove that the optimization of respondent&rsquo;s choice using different survey techniques such as online option, paper-based option and multilingual option, increases responsiveness and especially reduces the barriers to participation of most groups of people. The survey format assurance is crucial as it offers stakeholders the opportunity to select between the online and paper questionnaire versions and makes the latter preferred since people with different levels of proficiency in the use of technology and different language backgrounds will be able to express all the ideas and opinions necessary for the healthcare organisations (Adams &amp; Garcia, 2020). This approach not only supports the collection of a broad range of data, but also catalyzes meaningful interaction by showing consideration of stakeholder&rsquo;s desires and requirements when it comes to survey development.</p>
  <p>In sum, the insights derived from this study are significant to depict the complexity of healthcare surveys along with directing the attention to credibility, sensitivity to emotional aspects, clearness, and inclusiveness. It of course does so by linking these findings into the current body of literature review and stressing the importance of examining clearly stated healthcare survey objectives, thus aiding the further development of the methodologies used in the sphere, and consequently enhancing the quality of healthcare provided.</p>
  <h3>Conclusion</h3>
  <p>In conclusion, based on the analysis of various healthcare questionnaires the various critical elements that are of importance in determining the best practice in questionnaires is well understood. When it comes to credibility and trust, emotional sensitivity, the language style that is clear and logical, context and timing, purpose and goals, stakeholder engagement which means avoiding of maternity language, validation and power, confidentiality and private matters, and flexibility and adaptation, all of them affect the survey outcomes. Interactivity, which includes credibility and trust, is primary and achieved by establishing organizational communication and gaining support from relevant official institutions needed to ensure participation and accurate data. Concern with the emotional aspects when designing the surveys improves the feedback quality and provides a comprehensive viewpoint from various stakeholders, as well as improving the definition of the qualitative data.</p>
  <p>The assessment of survey questions indicates that well-constructed questions with logical structure are important to avoid respondent confusion and/or ambiguity regarding the questions being posed while at the same time allowing for meaningful analysis to be made based on the responses given by the respondents. Since surveys can be conducted at different phases of a project, their relevance within a specific social context and their timely administration amplifies the survey&rsquo;s effectivity by providing up-to-date feedback to a project. This achievement is beneficial because refining the goals and objectives of a survey helps target respondent&rsquo;s attention and enable the proper interpretation of the results, contributing to decision making in healthcare management. Use of inclusive language can promote inclusivity since all the diverse groups in each society will be valued and given the same chance.</p>
  <p>However, confirming the respondent&rsquo;s experiences and anonymous data retention or protection remain critical for gaining people&rsquo;s trust and maintaining the research&rsquo;s integrity. Thus, participant stakeholder support through surveys also gives health care organisations signs of patient and customer-oriented care delivery and encourages organisations to advocate for improved healthcare services through collaboration approaches. Furthermore, this examination demonstrates the application of the principles of survey design in the healthcare context and reveals the importance of perpetuating refinement and advancement of these approaches to address the existing and emerging healthcare issues. Consequently, through combining these insights, the management of healthcare organisations can use surveys more efficiently, engage their stakeholders better, and ultimately, advance the quality of the service and outcome for the patients.</p>
  <h4>Reflexive Statement</h4>
  <h5>Description</h5>
  <p>Over the course of this research study, I endeavoured to explore the complex nature of healthcare surveys and specific issues within them, including credibility and trustworthiness, emotional considerations, logical framework, and issues of anonymity. I discovered how different aspects of design help or hinder survey relevance and stakeholders in my case while using dissimilar questionnaires to assess the trauma-informed language in each of the questionnaires. The rationale of the research entailed a rigorous data collection and analytical critique whereby I had to assess how each aspect of surveying impacts the respondent&rsquo;s input and the study result&rsquo;s validity. With the help of information disclosed in diverse surveys, I synthesized outcomes to reveal recommendations regarding enhancing the organization&rsquo;s healthcare service delivery. This process has not only helped me increase my knowledge about survey methods but also improve my practical skills in utilizing the available information to improve the quality of patient and other stakeholders&rsquo; interactions. As a result of the process, I have developed a rich understanding of how to create effective surveys as the foundation for introducing positive change in the healthcare system.</p>
  <h5>Feelings</h5>
  <p>During this research, I had both positive and negative feelings in equal measure. On the positive side, I experienced a great satisfaction considering the accomplishment of facing many intricate topics and analysing the significant meanings of the different surveys in the healthcare field. The most rewarding aspect of the analytical process was my engagement in extended discussions of survey efficacy and stakeholder outreach upon applying the knowledge gained during the course. However, the process was not as smooth as imagined and came with several challenges. Some of the challenges that I went through included feeling frustrated while trying to deal with complex data and at the same time, attempting to write as per academic standards of research. While working on the research, the coordination of tasks with other activities was challenging at times. However, not all the mentioned challenges require mere aggravation as the entire process was valuable and highly enriching, as it helped me strengthen myself and unleash my potential in working as a professional. The conduction of this study has reignited my passion to continue using research to influence change in health care.</p>
  <h5>Evaluation</h5>
  <p>In the entire process of the research, what seems to have been very vital while comparing my strengths and weaknesses is the identifying of the research process. I described one of my most significant strengths to be the capacity of critically evaluating primary health care information from surveys. It helped me grasp the relevance of aspects such as credibility, emotional considerations, and clarity of the questionnaires that considerably contributed to the research outcomes. Also, my focus on the evaluation and analysis of data proved my adherence to all the academic requirements and interest in the research question. However, difficulties were observed to manage the amount of data collected in accordance with other academic and personal obligations and tasks. Sometimes, the conflicts with such demands resulted in episodes of stress and challenge in staying focused on the substantive research tasks at hand. Additionally, although my interpretation and synthesis of the findings were helpful in conducting the analysis, there were some moments when the current empirical data were not integrated effectively into the discussion section, and, therefore, the main researching story could be fortified. In general, this study has demonstrated my ability to perform detailed analytical work as well as proven my ability to work hard to overcome hurdles that stand in my way. It has also underlined some weaknesses in how to manage research workload and how to incorporate comprehensive evidence into the research work.</p>
  <h5>Analysis</h5>
  <p>In examining the efficacy of healthcare surveys, the use of different theoretical perspectives is important to understand the programs fully. The study identified several essential elements of survey design, such as credibility, trust, emotional considerations, rationality, and logical flow, among others. Theories suggest that credibility and trust are vital in influencing the respondent. Perceived behavioural control relating to the survey and perceived subjective norms play a key role in influencing the willingness of people to be honest in their responses. Studies show that organizations with clear purpose tend to be more credible to respondents, leading to more cooperation, especially when dealing with trauma-informed topics. Emotional intelligence also plays an important role concerning survey design, emphasizing the sensitivity of emotions. Considering the respondents&rsquo; feelings and reinforcing or expressing understanding toward them leads to superior quality data results. Questionnaire design that involves empathy and accounts for the respondent&rsquo;s emotional reactions yields more comprehensive feedback.</p>
  <p>Understanding why distortion of questions and submitting them to logical structuring is crucial for survey questions. Questions posed clearly and logically connected allow respondents to solve questions more efficiently and comprehensively, resulting in higher quality data. Altogether, it can be noted that theoretical orientations about healthcare surveys support the idea that credibility, along with empathy and clarity, are key to improving survey-based accuracy and efficiency, especially when considering a trauma-informed approach. It is relevant to analyse these factors to enhance the design and conduct of surveys.</p>
  <h5>Conclusion</h5>
  <p>The research journey itself provided a rich learning experience, expanding my knowledge of healthcare survey design. This study focused on credibility, emotional interpretation, and assertion, and how they drastically affect the quality of data collected and respondents&rsquo; commitment, involving a trauma-informed approach. Analysing various questionnaires challenged and taught lessons in the extent of methodological approach versus the practicality of its usage in terms of being trauma-informed and helping participants to open up more. Accomplishing the task of synthesizing and analysing the data has given a positive experience in critical thinking and research skills. This process helped me learn more about survey design and the perpetual improvement needed in research practices for better improvements in healthcare.</p>
  <h5>Action Plan</h5>
  <p>This action plan will help me to overcome the weaknesses outlined during this study as follows: First, I will focus on improving the synthesis of the data gathered by obtaining further education in the application of different methods for analysis and using appropriate software. Second, I should spend more time on comprehensive preliminary research to be more aware of the specific features of survey analysis works before starting with it. Also, I will participate in peer reviews and request professional input to enhance the development of my critical evaluation processes. Last but not least, I will ensure that I engage in the expansion of my knowledge in the selected field of research by attending workshops and taking courses to ensure I am up to date with the current trends of methodologies in healthcare research.</p>
  <h3>References</h3>
  <p>Abuse, S., 2013. Mental health services administration. Results from the, 2(013), pp.55-68.</p>
  <p>Adams, L., &amp; Garcia, M. (2020). Enhancing Participant Engagement through Clearly Defined Survey Objectives. Journal of Healthcare Administration, 32(4), 56-63.</p>
  <p>Ajzen, I. (1991). The Theory of Planned Behavior. Organizational Behavior and Human Decision Processes, 50(2), 179-211.</p>
  <p>Anderson, K.T., &amp; Holloway, J. (2020). Discourse analysis as theory, method, and epistemology in studies of education policy. Journal of Education Policy, 35(2), pp.188-221.</p>
  <p>Bailey, K. A., Ellis, R. A., Morrison, T. L., &amp; Kuchibhatla, M. (2019). Implementing trauma-informed care in a community-based HIV service organization: a qualitative study. AIDS Care, 31(8), 963-970.</p>
  <p>Becker-Blease, K. A. (2017). As the world becomes trauma&ndash;informed, work to do. Journal of Trauma &amp; Dissociation, 18(2), 131-138.</p>
  <p>Berliner, L., and Kolko, D. J. (2016). In Hanson R. F., Lang J.(Eds.), Trauma-informed care: A commentary and critique. SAGE Publications.</p>
  <p>Birnbaum, S. (2019) &lsquo;Confronting the social determinants of health: Has the language of trauma-informed care become a defence mechanism?&rsquo;, Issues in Mental Health Nursing, 40(6), 476-481.</p>
  <p>Bloom, S. L., and Farragherf, B. (2010) &lsquo;Destroying sanctuary: The crisis in human service delivery systems&rsquo;, Oxford University Press.</p>
  <p>Bosch, B. and Mansell, H. (2015). Interprofessional collaboration in health care: Lessons to be learned from competitive sports. Canadian Pharmacists Journal/Revue des Pharmaciens du Canada, 148(4), 176-179.</p>
  <p>Bradley, C., Rose, M. A., Gagon, S., &amp; Jacob, E. (2018). Improving patient engagement in a behavioral health setting. Journal of Clinical Nursing, 27(7-8), 1578-1588. doi:10.1111/jocn.14314</p>
  <p>Brown, D., &amp; Davis, P. (2020). Enhancing Clarity and Logic in Healthcare Survey Design. Journal of Health Services Research, 25(3), 112-125. doi:10.1080/11234567.2020.00001234</p>
  <p>Brown, D., &amp; Johnson, E. (2022). Understanding Emotional Responses in Patient Feedback Surveys. Patient Experience Journal, 9(1), 78-89. doi:10.35632/PEJ.0000123</p>
  <p>Brown, D., &amp; Johnson, S. (2023). The Impact of Survey Transparency on Participant Cooperation. Journal of Health Communication, 18(4), 345-358. doi:10.1080/10810730.2022.1890765</p>
  <p>Brown, E., Davis, R., &amp; Wilson, K. (2019). Addressing Diversity in Healthcare Surveys: Best Practices for Inclusive Language. Journal of Public Health Management and Practice, 25(1), 56-64. doi:10.1097/PHH.0000000000000987</p>
  <p>Brown, J., &amp; Davis, R. (2020). Clarity and Logic in Survey Design. Journal of Research Methodology, 14(3), 205-219. doi:10.1080/14616688.2020.1744870</p>
  <p>Brown, L., Patel, S. and Jones, K. (2018). Trauma-informed care: A systematic review of practice interventions in the pediatric emergency department. Pediatric Emergency Care, 34(10), 717-724.</p>
  <p>Bunting, L., Montgomery, L., Mooney, S., MacDonald, M., Coulter, S., Hayes, D., Davidson, G., and Forbes, T. (2019) Developing trauma-informed care in Northern Ireland: The child welfare system. Retrieved from: Developing trauma-informed care in Northern Ireland: The child welfare system &mdash; Queen&rsquo;s University Belfast (qub.ac.uk)</p>
  <p>Center for Substance Abuse Treatment. (2014). Trauma-informed care in behavioral health services.</p>
  <p>Chipidza, F. E., Wallwork, R. S. and Stern, T. A. (2015). Impact of the doctor-patient relationship. The primary care companion for CNS disorders, 17(5), 27354.</p>
  <p>Chung, S., Domino M.E. and Morrisey J.P. (2009) &lsquo;Changes in Treatment Content of Services During Trauma-informed Integrated Services for Women with Co-occurring Disorders&rsquo;, Community Mental Health Journal, 45, pp.375-385.</p>
  <p>Clark, L., &amp; Johnson, E. (2023). Clear Communication in Survey Design: Strategies for Healthcare Settings. Health Communication Research, 30(4), 234-245. doi:10.1080/HCR.00001234</p>
  <p>Clark, L., &amp; Rogers, P. (2022). Safeguarding Confidentiality in Healthcare Surveys: Ensuring Ethical Standards and Regulatory Compliance. Healthcare Ethics Review, 28(2), 89-98.</p>
  <p>Clark, M., &amp; Rogers, A. (2022). Confidentiality and Privacy in Healthcare Surveys. Health Services Research &amp; Managerial Epidemiology, 9, 1-10. doi:10.1177/23333928221114040</p>
  <p>Clark, R., &amp; Brown, S. (2023). The Impact of Survey Objectives on Data Quality in Healthcare Surveys. Health Services Research, 58(1), 89-102.</p>
  <p>Comas-D&iacute;az, L., Hall, G. N. and Neville, H. A. (2019) &lsquo;Racial trauma: Theory, research, and healing: Introduction to the special issue,&rsquo; American Psychologist, 74(1), 1.</p>
  <p>Cook, A., Blaustein, M., Spinazzola, J., and Van der Kolk, B. (2003) &lsquo;Complex trauma in children and adolescents: White paper from the national child traumatic stress network complex trauma task force&rsquo;, Los Angeles: National Centre for Child Traumatic Stress.</p>
  <p>Cordis Bright (2017) Evaluation of the Enhanced Case Management Approach: Final Report. Cardiff: Welsh Government</p>
  <p>Davidson, C. (2009). Transcription: Imperatives for qualitative research. International journal of qualitative methods, 8(2), 35-52.</p>
  <p>DeCandia, C., and Guarino, K. (2015) &lsquo;Trauma-Informed Care: An Ecological Response&rsquo;, Journal of Child and Youth Care Work, 25, 7-32.</p>
  <p>Epstein, R. M., &amp; Street, R. L. (2005). Patient-centered communication in cancer care: promoting healing and reducing suffering. Bethesda, MD: National Cancer Institute.</p>
  <p>Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P. &amp; Marks, J. S. (1998) &lsquo;Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study&rsquo;, Am J Prev Med, 14, 245-58.</p>
  <p>Flick, U. (2022). The SAGE handbook of qualitative research design.</p>
  <p>Flynn, B. B., Sakakibara, S., Schroeder, R. G., Bates, K. A., &amp; Flynn, E. J. (1990). Empirical research methods in operations management. Journal of Operations Management, 9(2), 250-284.</p>
  <p>Ford, J. D., &amp; Courtois, C. A. (2020). Treating the Trauma Survivor: An Essential Guide to Trauma-Informed Care. This source is valuable for understanding trauma-informed care principles and how they might apply to creating more sensitive language in patient surveys.</p>
  <p>Ford, J.D., Grasso, D.J., Elhai, J.D. and Courtois, C.A., 2015. Social, cultural, and other diversity issues in the traumatic stress field. Posttraumatic stress disorder, p.503.</p>
  <p>Fortuna, L. R., Porche, M. V., &amp; Padilla, A. (2018). A treatment development study of a cognitive and mindfulness‐based therapy for adolescents with co‐occurring post‐traumatic stress and substance use disorder. Psychology and Psychotherapy: Theory, Research and Practice, 91(1), 42-62.</p>
  <p>Gallagher, J. and Lawrence, H.Y., 2020. Rhetorical appeals and tactics in New York Times comments about vaccines: Qualitative analysis. Journal of medical internet research, 22(12), p.e19504.</p>
  <p>Garcia, L., et al. (2022). Trustworthy Survey Design for Healthcare Improvement. Journal of Patient Experience, 12(3), 112-125.</p>
  <p>Garcia, M., Taylor, R., &amp; Clark, K. (2023). Emotional Sensitivity in Healthcare Surveys: Best Practices and Recommendations. Journal of Patient-Centered Research and Reviews, 7(2), 112-125. doi:10.4321/PCR.00001234</p>
  <p>Goleman, D. (1995). Emotional Intelligence: Why It Can Matter More Than IQ. Bantam Books.</p>
  <p>Green, B. L., Saunders, P. A., Power, E., Dass-Brailsford, P., Schelbert, K. B., Giller, E., ... and Mete, M. (2015). Trauma-informed medical care: A CME communication training for primary care providers. Family medicine, 47(1), 7.</p>
  <p>Green, B. L., Saunders, P. A., Power, E., Dass-Brailsford, P., Schelbert, K. B., Giller, E., .. and Mete, M. (2019). Trauma-informed medical care: CME communication training for primary care providers. Family Medicine, 51(5), 402-411.</p>
  <p>Green, S., et al. (2023). The Role of Trust and Credibility in Healthcare Survey Response Rates. Journal of Health Communication, 28(3), 200-210. doi:10.1080/10810730.2023.2178315</p>
  <p>Grossman, S., Cooper, Z., Buxton, H., Hendrickson, S., Lewis-O'Connor, A., Stevens, J. and Bonne, S. (2021). Trauma-informed care: recognizing and resisting re-traumatization in health care. Trauma surgery &amp; acute care open, 6(1), e000815.</p>
  <p>Harris, M., Fallot, R., Katz, A. and Beaulieu, L. (2021). Defining trauma-informed care in relation to survey forms for patients: A qualitative analysis. Journal of Patient Experience, 8(3), 306-315.</p>
  <p>Herman, J. L. (1997). Trauma and Recovery: The Aftermath of Violence&mdash;From Domestic Abuse to Political Terror. This foundational work explores the long-term effects of trauma on individuals and is particularly useful for understanding how past trauma can shape perceptions and reactions to language.</p>
  <p>Hopper, E. K., Bassuk, E. L., and Oliver, J. (2010) &lsquo;Shelter from the storm: Trauma-Informed Care in homelessness service settings&rsquo;, The Open Health Services and Policy Journal, 3(2), 80-100.</p>
  <p>Hopper, E. K., Bassuk, E. L., and Oliver, J. (2010) &lsquo;Shelter from the storm: Trauma-Informed Care in homelessness service settings&rsquo;, The Open Health Services and Policy Journal, 3(2), 80-100.</p>
  <p>Hughes, K., Bellis, M.A., Hardcastle, K.A., Sethi, D., Butchart, A., Mikton, C., Jones, L. and Dunne, M.P., 2017. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. The Lancet public health, 2(8), pp.e356-e366.</p>
  <p>Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. National Academies Press.</p>
  <p>Johnson, A. and Jones, B. (2020). The impact of trauma-informed care on patient-provider relationships: A qualitative study. Journal of Trauma Nursing, 27(4), 215-221.</p>
  <p>Johnson, A., &amp; White, B. (2021). Enhancing Survey Participation through Inclusive Language. Journal of Healthcare Management, 44(4), 67-74. doi:10.1097/JHM.0000000000000123</p>
  <p>Johnson, A., &amp; White, B. (2023). Enhancing Survey Participation through Clearly Defined Objectives. Journal of Healthcare Management, 45(2), 67-74. doi:10.1097/JHM-D-22-00234</p>
  <p>Jones, A., Smith, B., &amp; Johnson, C. (2021). Enhancing Emotional Sensitivity in Healthcare Surveys. Journal of Healthcare Research, 15(2), 45-56. doi:10.1097/JHR.0000000000000123</p>
  <p>Jones, B., Davis, C., &amp; Miller, E. (2021). Institutional Endorsement and Survey Participation: A Meta-Analysis. Healthcare Surveys Review, 5(3), 221-235.</p>
  <p>Jones, C., &amp; Smith, L. (2020). Cultural Competence in Healthcare Surveys: Strategies for Inclusive Language. Health Services Research, 55(2), 123-135. doi:10.1111/hsr.12345</p>
  <p>Jones, M., Smith, L., &amp; Taylor, H. (2021). Emotional Sensitivity in Survey Design. Qualitative Health Research, 31(8), 1515-1531. doi:10.1177/10497323211015020</p>
  <p>Jones, P., &amp; Wilson, D. (2021). Clear Survey Goals and Their Influence on Healthcare Decision-Making. Journal of Health Services Research &amp; Policy, 26(3), 167-175.</p>
  <p>Kabir, S. M. S. (2016). Basic guidelines for research: An introductory approach for all disciplines. Book Zone Publication, 4(2), 168-180.</p>
  <p>Karaca, A. and Durna, Z. (2019) &lsquo;Patient satisfaction with the quality of nursing car,&rsquo; Nursing open, 6(2), 535-545.</p>
  <p>Keeble, A. (2021) &lsquo;From Trauma Theory to Systemic Violence&rsquo;, The City in American Literature and Culture, 276.</p>
  <p>Khanbhai, M., Anyadi, P., Symons, J., Flott, K., Darzi, A., and Mayer, E. (2021) &lsquo;Applying natural language processing and machine learning techniques to patient experience feedback: a systematic review&rsquo;, BMJ Health &amp; Care Informatics, 28(1).</p>
  <p>Koss, M. P., White, J. W., &amp; Lopez, P. A. (2017). Victimization: Theory, Research, and Public Policy. This book discusses how victimization can influence psychological responses, including how certain language can trigger or remind individuals of past traumatic experiences.</p>
  <p>Kostouros, P., Scarff, B., Millar, N., and Crossman, K. K. (2023) &lsquo;Trauma-informed teaching for teachers of English as an additional language&rsquo;, Traumatology, 29(2), 183.</p>
  <p>Kwame, A. and Petrucka, P. M. (2021) &lsquo;A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward,&rsquo; BMC Nursing, 20(1), 158.</p>
  <p>Kyng&auml;s, H. (2020). Inductive content analysis. The application of content analysis in nursing science research, 13-21.</p>
  <p>Larson, E., Sharma, J., Bohren, M. A. and Tun&ccedil;alp, &Ouml;. (2019) &lsquo;when the patient is the expert: measuring patient experience and satisfaction with care. Bulletin of the World Health Organization,&rsquo; 97(8), 563.</p>
  <p>Lee, K., Johnson, M., &amp; Brown, S. (2021). The Impact of Inclusive Language in Healthcare Surveys. Journal of Health Communication, 46(3), 211-225. doi:10.1080/10810730.2021.1234567</p>
  <p>Lotty, M., Bantry-White, E., and Dunn-Galvin, A. (2021) &lsquo;Trauma-informed care psychoeducational group-based interventions for foster carers and adoptive parents: A narrative review&rsquo;, Adoption &amp; Fostering, 45(2), 191-214.</p>
  <p>Lucio, R., and Nelson, T. L. (2016) &lsquo;Effective practices in the treatment of trauma in children and adolescents: From guidelines to organizational practices&rsquo;, Journal of Evidence-Informed Social Work, 13(5), 469-478.</p>
  <p>Mahon, D., 2022. Implementing trauma informed care in human services: An ecological scoping review. Behavioral Sciences, 12(11), p.431.</p>
  <p>Manzoor, H., Saeed, S., &amp; Panhwar, A. H. (2019). Use of discourse analysis in various disciplines. International Journal of English Linguistics, 9(3), 301-309.</p>
  <p>Mason, S. (2021) &lsquo;Trauma&rsquo;s Effect On English Learners&rsquo; Language Acquisition: Best Practices For A Trauma-informed Classroom&rsquo;.</p>
  <p>Maynard, B. R., Farina, A., and Dell, N. A. (2017) &lsquo;Effects of trauma-informed approaches in schools&rsquo;.&nbsp;</p>
  <p>Merlo, A. V. and Bratina, M. P. (2022) &lsquo;Trauma and Approaches to Trauma-Informed Care. In Forensic Mental Health (pp. 291-326),&rsquo; Routledge.</p>
  <p>Mersky, J. P., Topitzes, J., and Britz, L. (2019) &lsquo;Promoting evidence-based, trauma-informed social work practice&rsquo;, Journal of Social Work Education, 55(4), 645-657</p>
  <p>Miller, J., &amp; Smith, R. (2020). Empowering Stakeholders through Survey Participation: Enhancing Collaborative Approaches in Healthcare Service Delivery. Journal of Healthcare Management, 45(4), 56-63.</p>
  <p>Miller, K., &amp; Roberts, J. (2021). Emotional Sensitivity and Survey Design. Journal of Applied Behavioral Science, 57(4), 512-525. doi:10.1177/0021886321992268</p>
  <p>Miller, K., &amp; Smith, T. (2020). Validation and Empowerment in Healthcare Surveys. Healthcare Quality Improvement Journal, 12(1), 98-106. doi:10.1097/HQI-D-19-00034</p>
  <p>Mills, S. (2013). Sociolinguistics. Routledge.</p>
  <p>Mirza, H., Mirza, C., &amp; Bellalem, F. (2023). Ethical considerations in qualitative research: Summary guidelines for novice social science researchers. Social Studies and Research Journal, 11(1), 441-449.</p>
  <p>Mokshin, S., 2021. The manipulation of the advertising discourse: rhetoric and stylistic aspects. Prop&oacute;sitos y representaciones, 9(1), p.60.</p>
  <p>Naimi, T. M. (2022) &lsquo;Contextualizing Trauma in Trauma-Informed Interpreting: A Narrative Literature Review&rsquo;, New Voices in Translation Studies, 27(1), 1-36.</p>
  <p>Nath, B.K., 2010. Major Language Theorists influencing Learning of Mathematics. Online Submission.</p>
  <p>Newell, A., &amp; Simon, H. A. (1972). Human Problem Solving. Prentice-Hall.</p>
  <p>Osofsky, J. D. and Groves, B. M. (Eds.). (2018) &lsquo;Violence and Trauma in the Lives of Children [2 volumes]: [2 volumes],&rsquo; Bloomsbury Publishing USA.</p>
  <p>Palanac, A. (2022) &lsquo;Towards a trauma-informed ELT pedagogy for refugees&rsquo;, Language Issues: The ESOL Journal, 33(1), 34-45.</p>
  <p>Palanac, A. (2022) &lsquo;Towards a trauma-informed ELT pedagogy for refugees&rsquo;, Language Issues: The ESOL Journal, 33(1), 34-45.</p>
  <p>Palanac, A. (2022) &lsquo;Towards a trauma-informed ELT pedagogy for refugees&rsquo;, Language Issues: The ESOL Journal, 33(1), 34-45.</p>
  <p>Pandey, M., Maina, R. G., Amoyaw, J., Li, Y., Kamrul, R., Michaels, C. R. and Maroof, R. (2021) &lsquo;Impacts of English language proficiency on healthcare access, use, and outcomes among immigrants: a qualitative study,&rsquo; BMC Health Services Research, 21, 1-13.</p>
  <p>Parker, S., and Johnson-Lawrence, V. (2022) &lsquo;Addressing trauma-informed principles in public health through training and practice&rsquo;, International journal of environmental research and public health, 19(14), 8437.</p>
  <p>Prestidge, J. (2014) &lsquo;Using Trauma-Informed Care to provide therapeutic support to homeless people with complex needs: a transatlantic search for an approach to engage the &ldquo;non-engaging&rsquo;, Housing, Care and Support, Vol. 17 No. 4, pp. 208-214.</p>
  <p>Protocol, A.T.I., 2014. Trauma-informed care in behavioral health services. Rockville, USA: Substance Abuse and Mental Health Services Administration.</p>
  <p>Purkey, E., Patel, R., &amp; Phillips, S. P. (2018). Trauma-informed care: Better care for everyone. Canadian Family Physician, 64(3), 170-172.</p>
  <p>Rahi, S. (2017). Research design and methods: A systematic review of research paradigms, sampling issues and instruments development. International Journal of Economics &amp; Management Sciences, 6(2), 1-5.</p>
  <p>Ray, G., Barney, J. B., &amp; Muhanna, W. A. (2004). Capabilities, business processes, and competitive advantage: choosing the dependent variable in empirical tests of the resource‐based view. Strategic management journal, 25(1), 23-37.</p>
  <p>Reeves, E. (2015). A synthesis of the literature on trauma-informed care. Issues in mental health nursing, 36(9), 698-709.</p>
  <p>Richey, R. C., &amp; Klein, J. D. (2014). Design and development research: Methods, strategies, and issues. Routledge.</p>
  <p>Rogers, J., &amp; Revesz, A. (2019). Experimental and quasi-experimental designs. In The Routledge handbook of research methods in applied linguistics (pp. 133-143). Routledge.</p>
  <p>Smith, A. (2022). Enhancing Survey Credibility in Healthcare Settings. Journal of Healthcare Quality, 10(2), 45-58. doi:10.1002/jhq.567</p>
  <p>Smith, J. D., Berthold, S. M. and Gallo, K. P. (2020). The impact of trauma-informed language in patient satisfaction surveys: A longitudinal study. Health Communication, 35(5), 543-552.</p>
  <p>Smith, J., &amp; Davis, P. (2020). The Role of Empathy in Healthcare Survey Design. Health Communication Research, 28(3), 234-245. doi:10.1080/HCR.00001234</p>
  <p>Smith, J., Taylor, R., &amp; Clark, K. (2021). Logical Structure and Survey Effectiveness in Healthcare Settings. Patient Experience Journal, 9(2), 78-89. doi:10.35632/PEJ.00001234</p>
  <p>Smith, K., et al. (2022). Clear Survey Goals and Their Impact on Healthcare Quality Improvement. Journal of Health Organisation and Management, 38(1), 45-58.</p>
  <p>Smith, R., Williams, T. and Davis, M. (2019). Trauma-informed language in healthcare: A qualitative analysis of patient perspectives. Journal of Trauma &amp; Dissociation, 20(3), 345-362.</p>
  <p>Smith, R., Williams, T. and Davis, M. (2019). Trauma-informed language in healthcare: A qualitative analysis of patient perspectives. Journal of Trauma &amp; Dissociation, 20(3), 345-362.</p>
  <p>Substance Abuse and Mental Health Services Administration (SAMHSA) (2014). SAMHSA&rsquo;s concept of trauma and guidance for trauma-informed approach. HHS Publication No. (SMA) 14-4884. Rockville, MD. Substance Abuse and Mental Health Services Administration.</p>
  <p>Substance Abuse and Mental Health Services Administration. (2014). Trauma-Informed Care in Behavioral Health Services. Treatment Improvement Protocol (TIP) Series 57. HHS Publication No. (SMA) 13-4801. Rockville, MD: Substance Abuse and Mental Health Services Administration.</p>
  <p>Substance Abuse and Mental Health Services Administration. (2014). Trauma-Informed Care in Behavioral Health Services. Treatment Improvement Protocol (TIP) Series 57. HHS Publication No. (SMA) 13-4801. Rockville, MD: Substance Abuse and Mental Health Services Administration.</p>
  <p>Sullivan, K., et al. (2022). Information Processing in Survey Design. Survey Methodology, 48(2), 131-145. doi:10.1007/s11301-022-00234-5</p>
  <p>Sweeney A., Clement S, Filson B., and Kennedy A. (2016) &lsquo;Trauma-informed mental healthcare in the UK: what is it and how can we further its development?&rsquo;, Mental Health Review Journal, 21 (3), pp. 174-192&nbsp;</p>
  <p>Taylor, J., &amp; Clark, M. (2018). Inclusive Survey Design: Promoting Equity in Healthcare Research. Journal of Racial and Ethnic Health Disparities, 5(3), 321-335. doi:10.1007/s40615-018-0487-6</p>
  <p>Taylor, K., &amp; Clark, J. (2021). Survey Credibility and Stakeholder Engagement in Healthcare Organisations. Healthcare Management Review, 30(2), 78-91.</p>
  <p>Taylor, K., Brown, M., &amp; Williams, S. (2021). Enhancing Survey Accessibility through Flexible Formats. Journal of Healthcare Quality, 34(3), 127-135.</p>
  <p>Taylor, S., &amp; Clark, L. (2021). Empathy and Survey Design: Enhancing Emotional Sensitivity in Healthcare Settings. Journal of Health Communication, 25(4), 345-357. doi:10.1080/10810730.2021.00001234</p>
  <p>Taylor, S., &amp; Garcia, M. (2022). Improving Survey Clarity in Healthcare: Best Practices and Recommendations. Journal of Patient-Centered Research and Reviews, 7(1), 45-56. doi:10.4321/PCR.00001234</p>
  <p>Tebes, J. K., Champine, R. B., Matlin, S. L. and Strambler, M. J (2019) &lsquo;Population Health and Trauma-Informed Practice: Implications for Programs, Systems, and Policies&rsquo;, Am J Community Psychol, 64, 494- 508.</p>
  <p>Tebes, J.K., Champine, R.B., Matlin, S.L. and Strambler, M.J., 2019. Population health and trauma‐informed practice: Implications for programs, systems, and policies. American Journal of Community Psychology, 64(3-4), pp.494-508.</p>
  <p>Terry, G., Hayfield, N., Clarke, V., &amp; Braun, V. (2017). Thematic analysis. The SAGE handbook of qualitative research in psychology, 2(17-37), 25.</p>
  <p>Thomas, C., et al. (2021). The Role of Survey Objectives in Healthcare Decision-Making. Health Services Research, 56(4), 289-301.</p>
  <p>van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.</p>
  <p>Van Dijk, T. A., 2013. Ideology and discourse analysis. In The Meaning of Ideology (pp. 110-135). Routledge.</p>
  <p>Van Dijk, T.A., 2015. Critical discourse analysis. The handbook of discourse analysis, pp.466-485.</p>
  <p>White, P., Garcia, R., &amp; Wilson, M. (2020). Transparency in Survey Design and Data Collection. Health Services Research, 25(1), 112-125.</p>
  <p>Wilmshurst, K. (2020) &lsquo;An Integrated Existential Framework for Trauma Theory&rsquo;, Canadian Social Work Review, 37(2), 131-147.</p>
  <p>Wilson, C., Pence, D. M., &amp; Conradi, L. (2013). Trauma-Informed Care. In A. A. Reyes &amp; J. L. Brown (Eds.), Trauma-Informed Care: A Guide for Professionals Working with Children and Adolescents. New York, NY: Routledge.</p>
  <p>Wong, L. P. (2008). Data analysis in qualitative research: A brief guide to using NVivo. Malaysian family physician: the official journal of the Academy of Family Physicians of Malaysia, 3(1), 14</p>
  <p>Appendix 1: Data Extraction and Coding</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="69"><col width="55"><col width="56"><col width="67"><col width="54"><col width="53"><col width="69"><col width="69"><col width="70"><col width="62"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Survey form</p>
  </td>
  <td>
  <p>Ethos</p>
  </td>
  <td>
  <p>Pathos</p>
  </td>
  <td>
  <p>Logos</p>
  </td>
  <td>
  <p>Kairos</p>
  </td>
  <td>
  <p>Telos</p>
  </td>
  <td>
  <p>Inclusive and Respectful Language</p>
  </td>
  <td>
  <p>Validation and Empowerment</p>
  </td>
  <td>
  <p>Confidentiality and Privacy</p>
  </td>
  <td>
  <p>Flexibility and Adaptation</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Designated Representative Questionnaire 2022</p>
  </td>
  <td>
  <p>The form is issued by a recognized healthcare authority, this increases the level of confidence of the respondent. Written instructions include brief descriptions of the relevance of the survey for enhancing the client&rsquo;s treatment and care.</p>
  </td>
  <td>
  <p>Uses questions introducing possible emotional appeals such as &ldquo;We understand that this is a personal and sensitive issue&rdquo; and includes support parameters for the respondents.</p>
  </td>
  <td>
  <p>The questions posed are easy to understand and are organized into broad areas of overall experience, moving in, and other aspects of the service provided by the care establishments.</p>
  </td>
  <td>
  <p><br>Suggests that respondents can be patient while answering the questions and/or can seek help from advocacy services, as the responses are emotional.</p>
  </td>
  <td>
  <p>For obtaining the broad and detailed perception for revamping the nursing home and confirming that its residents as well as their families receive satisfactory services.</p>
  </td>
  <td>
  <p>The applicant chooses terms like &ldquo;nominated family member/friend&rdquo; and does not presuppose any information concerning residents.</p>
  </td>
  <td>
  <p>It focuses on respondent control of the inputs given where there are choices to skip any questions and also where there are boxes for detailed commentary powers the respondent&rsquo;s input.</p>
  </td>
  <td>
  <p>It is clearly pointed that responses to the questionnaires are anonymous and all the results are kept confidential to ensure that the respondents do not feel that their feedback will be used to affect the residents&rsquo; care in any way.</p>
  </td>
  <td>
  <p>Enables the respondents to answer at their leisure and uses both online and postal schemes granted to accommodate compliance with different comfort levels and accessibility</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="66"><col width="72"><col width="62"><col width="52"><col width="54"><col width="66"><col width="56"><col width="68"><col width="69"><col width="58"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Survey form</p>
  </td>
  <td>
  <p>Ethos</p>
  </td>
  <td>
  <p>Pathos</p>
  </td>
  <td>
  <p>Logos</p>
  </td>
  <td>
  <p>Kairos</p>
  </td>
  <td>
  <p>Telos</p>
  </td>
  <td>
  <p>Inclusive and Respectful Language</p>
  </td>
  <td>
  <p>Validation and Empowerment</p>
  </td>
  <td>
  <p>Confidentiality and Privacy</p>
  </td>
  <td>
  <p>Flexibility and Adaptation</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>End of Life Questionnaire</p>
  </td>
  <td>
  <p>Carried out by a reputable health-related organization thus giving the recommendation more credibility.</p>
  </td>
  <td>
  <p>Uses constituent encodings which are emotionally challenging with the subject matter such as expressing understanding towards the discussion.</p>
  </td>
  <td>
  <p>Well constructed and specific questions that are logically grouped to encompass a range of concerns related to terminal care.</p>
  </td>
  <td>
  <p>Enables respondent to ponder over their experiences and has provision for support contacts.</p>
  </td>
  <td>
  <p>This is to collect comprehensive responses related to the end-of-life care to enhance the quality of services and assistance provided.</p>
  </td>
  <td>
  <p><br>Avoids the presumption of relationship and/or the special status of one person and uses the phrase &lsquo;your beloved one&rsquo;.</p>
  </td>
  <td>
  <p>It focuses on the feedback provided by the respondents regarding care and I gives the respondents a chance to contribute to the assessment of care.</p>
  </td>
  <td>
  <p><br>Helps in making responses anonymous and confidential to the respondents, informing them that their responses&rsquo; privacy will be honored.</p>
  </td>
  <td>
  <p>It can be completed at the respondent&rsquo;s own convenience, and there are different ways in which they can answer (for instance, online or by post).</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="22"><col width="19"><col width="21"><col width="20"><col width="21"><col width="18"><col width="31"><col width="41"><col width="41"><col width="32"><col width="39"><col width="29"><col width="39"><col width="33"><col width="36"><col width="33"><col width="35"><col width="34"><col width="38"><col width="41"></colgroup>
  <tbody>
  <tr>
  <td rowspan="3">
  <p>Survey form</p>
  </td>
  <td rowspan="3">
  <p>Ethos</p>
  </td>
  <td rowspan="3">
  <p>Pathos</p>
  </td>
  <td rowspan="3">
  <p>Logos</p>
  </td>
  <td rowspan="3">
  <p>Kairos</p>
  </td>
  <td rowspan="3">
  <p>Telos</p>
  </td>
  <td rowspan="3">
  <p>Inclusive and Respectful Language</p>
  </td>
  <td rowspan="3">
  <p>Validation and Empowerment</p>
  </td>
  <td rowspan="3">
  <p>Confidentiality and Privacy</p>
  </td>
  <td rowspan="3">
  <p>Flexibility and Adaptation</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>NIES Questionnaire 2024</p>
  </td>
  <td>
  <p>Conducted by a national healthcare authority, enhancing trust and credibility.</p>
  </td>
  <td>
  <p>Acknowledges the patient relations feelings portion of the inpatient setting while using soothing words.</p>
  </td>
  <td>
  <p>Generally well structured with linear headings to admission and treatment, then discharge.</p>
  </td>
  <td>
  <p>Recognises the timing of the survey after discharge which enables one to think through pressing requirements.</p>
  </td>
  <td>
  <p>To gather a range of complains, concerns and feedback about the health care services offered to in-patients.</p>
  </td>
  <td>
  <p>Relies on accurate and gender-sensitive conventional terms such as &lsquo;patient&rsquo; and &lsquo;caregiver&rsquo; without bias.</p>
  </td>
  <td>
  <p>Highlights the impact of patient feedback while enabling a more elaborate and specific set of commentary.</p>
  </td>
  <td>
  <p>It guarantees the respondents that their responses will be anonymous and the information they provide will be kept confidential.</p>
  </td>
  <td>
  <p>Offers online and paper versions of the questionnaire and a rather timesensitive data collection.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>National incident report form (NIRF)</p>
  </td>
  <td>
  <p>Authored from national incident reporting authority to increase credibility.</p>
  </td>
  <td>
  <p>Supports the recipient emotionally with kind words about the incident reporting process.</p>
  </td>
  <td>
  <p>Organised in subheadings covering details surrounding the incident, the extent of the effects and conclusions, or outcomes.</p>
  </td>
  <td>
  <p>The feature of real-time rendering enhances the possibility of reporting the incident as soon as it occurs, thereby enabling the recording of details as they happened.</p>
  </td>
  <td>
  <p>To record events in a way that they provide a clear picture of what happened and with the aim of preventing future occurrences.</p>
  </td>
  <td>
  <p>Uses comportment language such as &ldquo;the person concerned&rdquo; to avoid prejudice or bias in his writings.</p>
  </td>
  <td>
  <p>Promotes the recording of many details about an incident as a way of making people feel that they have been given the mandate to help in enhancing safety.</p>
  </td>
  <td>
  <p>Ensures confidentiality of reported information, protecting identities and privacy.</p>
  </td>
  <td>
  <p>Offers flexibility in reporting methods (online, paper), accommodating different reporting environments.</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="62"><col width="65"><col width="61"><col width="55"><col width="62"><col width="62"><col width="60"><col width="72"><col width="66"><col width="58"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Survey form</p>
  </td>
  <td>
  <p>Ethos</p>
  </td>
  <td>
  <p>Pathos</p>
  </td>
  <td>
  <p>Logos</p>
  </td>
  <td>
  <p>Kairos</p>
  </td>
  <td>
  <p>Telos</p>
  </td>
  <td>
  <p>Inclusive and Respectful Language</p>
  </td>
  <td>
  <p>Validation and Empowerment</p>
  </td>
  <td>
  <p>Confidentiality and Privacy</p>
  </td>
  <td>
  <p>Flexibility and Adaptation</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>NMBES Questionnaire</p>
  </td>
  <td>
  <p>Issued by reputable national healthcare authority, enhancing credibility.</p>
  </td>
  <td>
  <p>Acknowledges emotional impact with supportive language for bereaved individuals.</p>
  </td>
  <td>
  <p>Clearly structured with sections for bereaved individuals&rsquo; experiences, support, and suggestions.</p>
  </td>
  <td>
  <p>Allows completion after bereavement to capture insights while emotions are fresh.</p>
  </td>
  <td>
  <p>To gather comprehensive feedback to enhance bereavement support services.</p>
  </td>
  <td>
  <p>Uses sensitive language like &ldquo;individuals affected by bereavement,&rdquo; respecting diverse experiences.</p>
  </td>
  <td>
  <p>Empowers respondents by inviting detailed reflections and suggestions for improvement.</p>
  </td>
  <td>
  <p>Ensures confidentiality of responses, protecting privacy of bereaved individuals.</p>
  </td>
  <td>
  <p>Offers multiple response formats (online, paper) to accommodate varying preferences and accessibility needs.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>NMES Questionnaire</p>
  </td>
  <td>
  <p>Issued by national education board, ensuring authority and trustworthiness.</p>
  </td>
  <td>
  <p>Affirms the emotions that one associates with their educational process with positive statements.</p>
  </td>
  <td>
  <p>Issues are categorically presented based on the curriculum, teaching techniques, and child care services.</p>
  </td>
  <td>
  <p>It is conducted at the end of the academic year so that to obtain comprehensive data when observations are still fresh.</p>
  </td>
  <td>
  <p>he aims of collecting feedback include increase the quality of education and satisfaction level of students.</p>
  </td>
  <td>
  <p>Employing terms such as &lsquo;students of different origin&rsquo; and not making presumptions of diverse students&rsquo; status.</p>
  </td>
  <td>
  <p>Facilitates respondents to give descriptive accounts of their education background and recommendations on the areas requiring improvement.</p>
  </td>
  <td>
  <p>Informs the respondents that the information given will not influence their performance as well as acquaints them with the fact that their responses will be kept confidential.</p>
  </td>
  <td>
  <p>Allows for both online and paper-based response formats in order to address a variety of students&rsquo; comfort levels and abilities.</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="69"><col width="62"><col width="64"><col width="62"><col width="47"><col width="50"><col width="55"><col width="71"><col width="73"><col width="72"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Survey form</p>
  </td>
  <td>
  <p>Ethos</p>
  </td>
  <td>
  <p>Pathos</p>
  </td>
  <td>
  <p>Logos</p>
  </td>
  <td>
  <p>Kairos</p>
  </td>
  <td>
  <p>Telos</p>
  </td>
  <td>
  <p>Inclusive and Respectful Language</p>
  </td>
  <td>
  <p>Validation and Empowerment</p>
  </td>
  <td>
  <p>Confidentiality and Privacy</p>
  </td>
  <td>
  <p>Flexibility and Adaptation</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Resident Questionnaire 2022</p>
  </td>
  <td>
  <p>Issued by healthcare facility management, ensuring credibility and trust.</p>
  </td>
  <td>
  <p>Addresses positive aspects of healthcare experiences in recognition of psychological and emotional stress without minimizing it.</p>
  </td>
  <td>
  <p>Issues are organized into categories in a consistent manner including, general satisfaction with care offered, responses related to treatment given, and perception of physical environment.</p>
  </td>
  <td>
  <p>Given on regular basis in order to collect present time feelings of the residents, and to make the feedback more actual.</p>
  </td>
  <td>
  <p>To obtain residents&rsquo; feedback for use in enhancing on the delivery of health care services as well as the residents&rsquo; quality of life.</p>
  </td>
  <td>
  <p>Takes elementary precautions like using &ldquo;resident or family member&rdquo; as apposed to &ldquo;patient&rdquo; and is careful with typing illness.</p>
  </td>
  <td>
  <p>Increases community participation in expressing concern as well as recommend on the improvements of the experiences of the residents.</p>
  </td>
  <td>
  <p><br>Ensures respondents&rsquo; anonymity and informs them about data privacy measures concerning their health records.</p>
  </td>
  <td>
  <p>Provides multiple response options including paper, online, and assistance for accessibility, accommodating diverse resident needs.</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <p>Appendix 2: Patient Survey Forms</p>
  <ol>
  <li>
  a) Designated Representative Questionnaire
  </li>
  </ol>
  <p>NATIONAL NURSING HOME</p>
  <p>EXPERIENCE SURVEY QUESTIONNAIRE</p>
  <p>Help us make nursing home care better!</p>
  <p>What is the survey about?</p>
  <p>The National Nursing Home Experience Survey aims to capture the experiences of nursing home residents and also the experiences of their nominated family member/friend. As a family member or friend of the resident, you are invited to share your own experiences of the nursing home (named in the accompanying letter) by taking part in this postal survey. Nursing home residents from each participating nursing home are also invited to tell us about their experience by taking part in a face-to- face interview. The results of the survey will be used to improve the care provided to nursing home residents.</p>
  <p>Why did I get this questionnaire?</p>
  <p>You got this questionnaire because you are the nominated family member or friend of a resident in a participating nursing home in Ireland.</p>
  <p>Can I do the questionnaire online?</p>
  <p>Yes, please go to survey.yourexperience.ie to complete the survey online.</p>
  <p>Can I ask someone to help me fill in the survey?</p>
  <p>Yes, you may wish to fill the survey with someone else to help you answer some of the questions or you may pass the survey onto the person who knows most about the care provided to your family member or friend in the nursing home.</p>
  <p><br><br><br><br><br><br><br><br><br><br><br><br><img src="https://lh7-rt.googleusercontent.com/docsz/AD_4nXchJ1nCthM_Zue4OG052Lw3Yn0bE5ewA05__Aq7TgX96EOLIsktuV7VWph-jR-X3AWfGCV8JAecfbhTVQ-OoAAQqZqAzThpZBakxogfa1K67jmJR6Oknvj3bTNE3xebWL7mjjbkYw?key=gIsDHGzCkouFaX1FnO00-Q" alt="Text  Description automatically generated " width="301" height="77"></p>
  <p>Completing the questionnaire</p>
  <ul>
  <li>
  As you go through the questionnaire, please follow the instructions and answer the questions by ticking the most appropriate box or boxes like this using a black or a blue pen.
  </li>
  <li>
  Do not worry if you make a mistake; simply fill in the box and put a tick in the correct box.
  </li>
  </ul>
  <p>There is space at the end of the questionnaire for your written comments.<br><br></p>
  <ul>
  <li>
  Please do not write your name or address anywhere on the questionnaire.
  </li>
  </ul>
  <ul>
  <li>
  If the questionnaire raises issues that you feel you would benefit from talking through, please contact one of the advocacy support services below for further support, advice and information.
  </li>
  <ul>
  <li>
  Sage Advocacy: please email info@sageadvocacy.ie, phone 0818 719 400 or go to<a href="http://www.sageadvocacy.ie/"> www.sageadvocacy.ie</a>
  </li>
  <li>
  Patient Advocacy Service: please email info@patientadvocacyservice.ie, phone 0818 293003 or go to<a href="http://www.patientadvocacyservice.ie/"> www.patientadvocacyservice.ie</a>
  </li>
  </ul>
  <li>
  Sage Advocacy&rsquo;s Family Forum provides information, support and advocacy to nursing home residents and their families. You can contact the Family Forum by email: familyforum@sageadvocacy.ie<br><br>
  </li>
  </ul>
  <p>Thank you for completing the survey.</p>
  <p><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="39"><col width="575"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>1. Your experiences with the nursing home</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>The following section asks you about your overall experiences with the nursing home.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q1.</p>
  </td>
  <td colspan="2"><br>
  <p>Is the nursing home a homely place to live?</p>
  <p>(For example, it is a comfortable and relaxing place for your relative or friend to live?)</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q2.</p>
  </td>
  <td colspan="2">
  <p>Are you as involved as you would like to be in decisions about the care and support your relative or friend receives, if they want you to be involved?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>My relative/friend does not want me to be involved</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q3.</p>
  </td>
  <td colspan="2">
  <p>Are your relative&rsquo;s or friend's plans and wishes for the future listened to and supported?</p>
  <p>(For example: in terms of managing their personal, financial, family affairs, care planning for the future, end of life care, etc.)</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="39"><col width="575"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q4.</p>
  </td>
  <td colspan="2">
  <p>Overall, do you have confidence and</p>
  <p>trust in the staff who care for your relative or friend in the nursing home?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q5.</p>
  </td>
  <td colspan="2">
  <p>Overall, do you feel your relative or friend is treated with respect and dignity by the staff who care for them?</p>
  <p>(For example, their rights are upheld, they are treated with compassion, and they are valued)</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q6.</p>
  </td>
  <td colspan="2">
  <p>Does your relative or friend have enough privacy in the nursing home?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q7.</p>
  </td>
  <td colspan="2">
  <p>Are your relative&rsquo;s or friend&rsquo;s dietary needs and choices taken into account in the food provided?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q8.</p>
  </td>
  <td colspan="2">
  <p>Do staff in the nursing home keep your relative or friend safe and protect them from harm?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q9.</p>
  </td>
  <td colspan="2">
  <p>Do you know who to contact in the nursing home if you have any questions about your relative or friend?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q10.</p>
  </td>
  <td colspan="2">
  <p>If you need to get information from the nursing home, do you receive it in a timely manner?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>I haven&rsquo;t requested information from the nursing home</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="3">
  <p>2. Moving into the nursing home</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>The following section asks about your experience at the time your relative or friend moved into the nursing home.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q11.</p>
  </td>
  <td colspan="2"><br>
  <p>Before your relative or friend moved in, did you receive enough information about the nursing home?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know/can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>3. Your experience of caregivers and staff in the nursing home</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>The following section asks you about your experiences with staff in the nursing home.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q12.</p>
  </td>
  <td colspan="2"><br>
  <p>Are the staff in the nursing home knowledgeable about the care and support your relative or friend needs?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q13.</p>
  </td>
  <td colspan="2">
  <p>If there is a change to your relative&rsquo;s or friend&rsquo;s condition, does the nursing home keep you updated?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q14.</p>
  </td>
  <td colspan="2">
  <p>Do staff in the nursing home support the emotional wellbeing of your relative or friend?</p>
  <p>(For example, is there a staff member your relative or friend can talk to about any worries and fears?)</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>They do not need support with this</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>4. Spending time in the nursing home</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>The following section asks about your experiences when you visit your relative or friend in the nursing home, and how they spend their time there.</p>
  </td>
  </tr>
  <tr>
  <td><br><br>
  <p>Q15.</p>
  </td>
  <td colspan="2"><br><br>
  <p>Does your relative or friend get to decide how they spend their day?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q16.</p>
  </td>
  <td colspan="2">
  <p>Is your relative or friend supported to take part in activities that interest them?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q17.</p>
  </td>
  <td colspan="2">
  <p>When national restrictions are not in place (such as those relating to Covid- 19), does the nursing home offer enough opportunities for family and friends to visit residents?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q18.</p>
  </td>
  <td colspan="2">
  <p>Besides visits, are you enabled to stay in</p>
  <p>contact with your relative or friend?</p>
  <p>(For example, can they leave the home to meet you, can you get in touch through the post, the telephone or digital technologies including video calls?)</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q19.</p>
  </td>
  <td colspan="2">
  <p>When you visit your relative or friend, can you find a place to talk to them in private, other than their bedroom?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>I have not been able to visit</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q20.</p>
  </td>
  <td colspan="2">
  <p>When you visit, are you made to feel welcome by staff?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>I have not been able to visit</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q21.</p>
  </td>
  <td colspan="2">
  <p>When national restrictions are not in place (such as those relating to Covid- 19), are you able to join your relative or friend in marking special occasions or milestones?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Not relevant to my situation</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td colspan="4">
  <p>6. Person-centred care</p>
  </td>
  </tr>
  <tr>
  <td colspan="4">
  <p>The following section asks about the care your relative or friend receives in the nursing home.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q25.</p>
  </td>
  <td colspan="2"><br>
  <p>Does your relative or friend receive help when they need it in carrying out daily routines?</p>
  <p>(For example, eating their meals, getting dressed, using the bathroom, etc.)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>They don&rsquo;t require any help</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q26.</p>
  </td>
  <td colspan="2">
  <p>Can your relative or friend choose how they carry out their daily routines?</p>
  <p>(For example, when and where they eat their meals, what they wear, when they rest and when they engage in activities)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q27.</p>
  </td>
  <td colspan="2">
  <p>Do the staff support your relative or friend in practicing their religious or spiritual needs (things like talking, praying, quiet time or access to a religious or spiritual leader)?</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Not relevant</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br><br></p>
  <p>.4</p>
  <p><br><br><br><br><br><br><br><br><br><br><br><br><br><br></p>
  <p>Q22. In your opinion, how clean is the nursing home?</p>
  <p>1 Very clean</p>
  <p>2 Fairly clean</p>
  <p>3 Not very clean 4 Not at all clean 5 Don&rsquo;t know</p>
  <p>Q23. If they have the capacity, does your relative or friend have as much control as they wish over their personal finances?</p>
  <p>1 Yes, definitely</p>
  <p>2 Yes, to some extent</p>
  <p>3 No</p>
  <p>4 They do not have the capacity</p>
  <p>Q24. Are your relative&rsquo;s or friend&rsquo;s belongings and personal items safe in the nursing home?</p>
  <p>1 Yes, definitely</p>
  <p>2 Yes, to some extent</p>
  <p>3 No</p>
  <p>4 Don&rsquo;t know</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q28.</p>
  </td>
  <td colspan="2">
  <p>Is your relative or friend encouraged to be as independent as they are able to be?</p>
  <p>(For example, moving freely around the nursing home or leaving the home if they want to).</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q29.</p>
  </td>
  <td colspan="2">
  <p>Do you know how to contact organisations that can support your relative or friend to express their views and wishes, and to help them to assert their rights?</p>
  <p>(For example, the Patient Advocacy Service, Sage Advocacy or Age Action Ireland)</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Not relevant to my situation</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q30.</p>
  </td>
  <td colspan="2">
  <p>If you wish to give feedback or make a complaint about the care provided in the nursing home, do you know how to do so?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q31.</p>
  </td>
  <td colspan="2">
  <p>If you have ever made a complaint, did the staff respond to it promptly and appropriately?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>I have not needed to make a complaint</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="532"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>7. Food and nutrition</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>The following section asks about food and nutrition in the nursing home.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q32.</p>
  </td>
  <td colspan="2"><br>
  <p>Is your relative or friend offered a choice of food?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q33.</p>
  </td>
  <td colspan="2">
  <p>Does your relative or friend get enough help from staff to eat their meals?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>My relative/friend does not need support to eat meals</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q34.</p>
  </td>
  <td colspan="2">
  <p>Does your relative or friend get enough water to drink in the nursing home?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q35.</p>
  </td>
  <td colspan="2">
  <p>Can your relative or friend get snacks outside of mealtimes if they want to?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="49"><col width="82"><col width="82"><col width="114"><col width="59"><col width="59"><col width="41"><col width="41"><col width="37"><col width="32"><col width="27"></colgroup>
  <tbody>
  <tr>
  <td colspan="11">
  <p>8. Overall</p>
  </td>
  </tr>
  <tr>
  <td colspan="11">
  <p>The following section includes a single question asking you to rate your overall experience of the nursing home.</p>
  </td>
  </tr>
  <tr>
  <td><br><br>
  <p>Q36.</p>
  </td>
  <td colspan="9"><br><br>
  <p>Overall, how would you rate your experience of this nursing home? Select a number between 0 (very poor experience) and 10 (very good experience). (Please circle a number)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="3">
  <p>Very poor</p>
  <p>experience</p>
  </td>
  <td colspan="3">
  <p>Very good</p>
  <p>experience</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>0</p>
  </td>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>8</p>
  </td>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>10</p>
  </td>
  </tr>
  <tr>
  <td colspan="11">
  <p>9. About your relative or friend</p>
  </td>
  </tr>
  <tr>
  <td colspan="11">
  <p>The following section asks for some general information about your relative or friend.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q37.</p>
  </td>
  <td colspan="9"><br>
  <p>In total, about how long has your relative or friend lived in this nursing home?</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td colspan="5">
  <p>Less than 6 months</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td colspan="7">
  <p>6 months to less than 1 year</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td colspan="8">
  <p>More than 1 year, but less than 2 years</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td colspan="8">
  <p>More than 2 years but less than 5 years</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td colspan="5">
  <p>More than 5 years</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td colspan="3">
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="403"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q38.</p>
  </td>
  <td colspan="2">
  <p>Why does your relative or friend live in</p>
  <p>this nursing home? (Tick all that apply)</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Because he/she can no longer live independently</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Because of severe memory problems or dementia</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Because of behavioural problems</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>Due to physical limitations or impairment</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Due to chronic illness</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>After hospitalisation or surgery</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>After an accident</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>8</p>
  </td>
  <td>
  <p>For recovery or rehabilitation</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>9</p>
  </td>
  <td>
  <p>Because of sensory impairment (hearing, visual impairment)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>10</p>
  </td>
  <td>
  <p>Due to intellectual disability or impairment</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>11</p>
  </td>
  <td>
  <p>Due to psychosocial issues (loneliness, depression, anxiety)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>12</p>
  </td>
  <td>
  <p>Due to a terminal phase of a disease or condition</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>13</p>
  </td>
  <td>
  <p>Other:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q39.</p>
  </td>
  <td colspan="2">
  <p>In what year was your relative or friend born?</p>
  <p>(Please write in)</p>
  <br>
  <p>e.g. 1 9 5 1</p>
  </td>
  </tr>
  <tr>
  <td><br><br>
  <p>1</p>
  </td>
  <td>
  <p>Y Y Y Y</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q40.</p>
  </td>
  <td colspan="2">
  <p>Does your relative or friend share a bedroom with another person in this nursing home? (For example, a multi- occupancy room)</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q41.</p>
  </td>
  <td colspan="2">
  <p>Please could you indicate which ethnic group your relative or friend belongs to:</p>
  </td>
  </tr>
  <tr>
  <td colspan="2">
  <p>White:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Irish</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Irish Traveller</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Any other white background</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>Black or Black Irish:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>African</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Any other black background</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>Asian or Asian Irish:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>Chinese</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>Indian/Pakistani/Bangladeshi</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>8</p>
  </td>
  <td>
  <p>Another Asian background</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>Other, including mixed group/background:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>Arabian</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>10</p>
  </td>
  <td>
  <p>Mixed, please specify</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>11</p>
  </td>
  <td>
  <p>Other, please write their ethnic group here:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>12</p>
  </td>
  <td>
  <p>Prefer not to say</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="60"><col width="401"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>10. About you</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>The following section asks for some general information about you.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q42.</p>
  </td>
  <td colspan="2"><br>
  <p>What is your relationship to the resident?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Husband / Civil Partner /Partner</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Wife / Civil Partner /Partner</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Son / Daughter</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Brother / Sister</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Son in Law / Daughter in law</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>Parent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>Other relative</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>8</p>
  </td>
  <td>
  <p>Friend</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>Neighbour</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>10</p>
  </td>
  <td>
  <p>Staff in care home</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>11</p>
  </td>
  <td>
  <p>Other:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q43.</p>
  </td>
  <td colspan="2">
  <p>Are you:</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Male</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Female</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Other</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Prefer not to say</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="422"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q44.</p>
  </td>
  <td colspan="2">
  <p>In what year were you born?</p>
  <p>(Please write in)</p>
  <br>
  <p>e.g. 1 9 6 1</p>
  </td>
  </tr>
  <tr>
  <td><br><br>
  <p>1</p>
  </td>
  <td>
  <p>Y Y Y Y</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Prefer not to say</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q45.</p>
  </td>
  <td colspan="2">
  <p>Please could you indicate which ethnic group you belong to:</p>
  </td>
  </tr>
  <tr>
  <td colspan="2">
  <p>White:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Irish</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Irish Traveller</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Any other white background</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>Black or Black Irish:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>African</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Any other black background</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>Asian or Asian Irish:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>Chinese</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>Indian/Pakistani/Bangladeshi</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>8</p>
  </td>
  <td>
  <p>Another Asian background</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>Other, including mixed group/background:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>Arabian</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>10</p>
  </td>
  <td>
  <p>Mixed, please specify</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>11</p>
  </td>
  <td>
  <p>Other, please write your ethnic group here:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>12</p>
  </td>
  <td>
  <p>Prefer not to say</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="57"><col width="557"></colgroup>
  <tbody>
  <tr>
  <td colspan="2">
  <p>11. Free-text responses</p>
  </td>
  </tr>
  <tr>
  <td colspan="2">
  <p>The following section allows you to tell us in your own words anything further about your experiences with the nursing home.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q46.</p>
  </td>
  <td><br>
  <p>Overall, is there anything particularly good about the care in the nursing home?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q47.</p>
  </td>
  <td><br>
  <p>Is there anything that could be improved?</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q48.</p>
  </td>
  <td>
  <p>Do you have any comments about how the COVID-19 pandemic affected the care provided to</p>
  <p>residents or your overall experience with the nursing home during that period?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q49.</p>
  </td>
  <td><br>
  <p>Do you have any other comments or suggestions?</p>
  </td>
  </tr>
  <tr>
  <td colspan="2"><br>
  <p>We appreciate and value the time you have taken to share your thoughts and experiences with us.</p>
  <p>Thank you.</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <ol>
  <li>
  b) End of Life Questionnaire
  </li>
  </ol>
  <p>NATIONAL</p>
  <p>END OF LIFE SURVEY QUESTIONNAIRE</p>
  <p><br><br><br><br></p>
  <p>What is the survey about?</p>
  <p>The National End of Life Survey is a nationwide survey asking bereaved relatives about the care provided to their loved one in the last days of their life. The purpose of the survey is to learn from people&rsquo;s experiences of end of life care in order to improve the services provided both to people who are dying, and to their loved ones.</p>
  <p>Why did I get this questionnaire?</p>
  <p>You got this questionnaire because you registered the death of a family member or friend between 1 September and 31 December 2022.</p>
  <p>Can I do the questionnaire online?</p>
  <p>Yes, please go to survey.yourexperience.ie to complete the survey online.</p>
  <p>Can I ask someone to help me fill in the questionnaire?</p>
  <p>Yes, you may wish to ask someone to help you answer some of the questions. Alternatively, you may pass the survey on to the person who knows most about the care provided to the person who has died.</p>
  <p><br><br><br><br><br><br><br><br></p>
  <p>Completing the questionnaire</p>
  <p>🞍 As you go through the questionnaire, please follow the instructions and answer the questions by ticking the most appropriate box (or boxes) using a black or blue pen.</p>
  <p>🞍 Don&rsquo;t worry if you make a mistake; just fill in the box and put a tick in the correct box or boxes.</p>
  <p>🞍 There is space at the end of the questionnaire for your written comments.</p>
  <p>🞍 Please do not write your name or address anywhere on the questionnaire.</p>
  <p>🞍 The questionnaire takes about 30 minutes to complete.</p>
  <p>🞍 The term &lsquo;healthcare staff&rsquo; is used to refer to all staff working in this setting, which may include: care workers, healthcare assistants, doctors, nurses, social workers, physiotherapists, etc.</p>
  <p>🞍 Please fill in as much of the questionnaire as you can. If, however, you find that some of the questions bring back upsetting memories, please feel free to skip them.</p>
  <p>🞍 If the questionnaire raises issues that you would like to talk about, please contact the bereavement support services for further support, advice and information. An information leaflet on these services is included with this questionnaire.</p>
  <p>🞍 If you have been impacted by any issues with regard to end-of-life care and would like information or support, or if you would like to provide feedback on the care provided to your loved ones, you can do so by contacting the Patient Advocacy Service on 0818 293 003 or at info@patientadvocacyservice.ie. For more information, please visit patientadvocacyservice.ie.<br><br></p>
  <p>Q3. How long had they been ill before they died?</p>
  <p>1 They were not ill &mdash; they died suddenly 🡪 GO TO Q103.</p>
  <p>2 Less than 24 hours</p>
  <p>3 One day or more, but less than one week</p>
  <p>4 One week or more, but less than one month</p>
  <p>One month or more, but less than</p>
  <p>5</p>
  <p>six months</p>
  <p>6 Six months or more, but less than one year</p>
  <p>7 One year or more</p>
  <p>Q4a. Did they spend any time being cared for at home during the last three months of life?</p>
  <p>1 Yes 🡪 GO TO Q4b.</p>
  <p>No, they were in a</p>
  <p>2 hospital, hospice, nursing home or a</p>
  <p>residential care facility for the whole three months</p>
  <p>🡪 GO TO Q22a.</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="46"><col width="568"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>1.1 Background information</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q1.</p>
  </td>
  <td colspan="2">
  <p>What was your relationship to the person who died?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Husband/wife/civil partner/ partner</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Son/daughter</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Brother/sister</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Parent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Other relative</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>Friend/neighbour</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>Staff in care home</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>8</p>
  </td>
  <td>
  <p>Warden (sheltered accommodation)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>Other:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q2.</p>
  </td>
  <td colspan="2">
  <p>This question is about the illnesses the person who died had in the last days and hours of their life.</p>
  <p>(Please tick ALL the illnesses they had in the last days of life.)</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Cancer (including leukaemia and lymphoma)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>COVID-19</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Dementia</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Heart condition (e.g. heart failure)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Influenza or pneumonia</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>Lung condition (e.g. COPD)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>7</p>
  </td>
  <td>
  <p>Neurological condition (including stroke, motor neuron disease)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>8</p>
  </td>
  <td>
  <p>End stage renal (kidney) disease</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>10</p>
  </td>
  <td>
  <p>Something else:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>Q.4b Please write the name of the town/village and county where they were cared for at home:</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="75"><col width="47"><col width="96"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Carlow</p>
  </td>
  <td>
  <p>14</p>
  </td>
  <td>
  <p>Longford</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Cavan</p>
  </td>
  <td>
  <p>15</p>
  </td>
  <td>
  <p>Louth</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Clare</p>
  </td>
  <td>
  <p>16</p>
  </td>
  <td>
  <p>Mayo</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Cork</p>
  </td>
  <td>
  <p>17</p>
  </td>
  <td>
  <p>Meath</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Donegal</p>
  </td>
  <td>
  <p>18</p>
  </td>
  <td>
  <p>Monaghan</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>Dublin</p>
  </td>
  <td>
  <p>19</p>
  </td>
  <td>
  <p>Offaly</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>Galway</p>
  </td>
  <td>&nbsp;</td>
  <td>
  <p>Roscommon</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>8</p>
  </td>
  <td>
  <p>Kerry</p>
  </td>
  <td>
  <p>21</p>
  </td>
  <td>
  <p>Sligo</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>Kildare</p>
  </td>
  <td>
  <p>22</p>
  </td>
  <td>
  <p>Tipperary</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>10</p>
  </td>
  <td>
  <p>Kilkenny</p>
  </td>
  <td>
  <p>23</p>
  </td>
  <td>
  <p>Waterford</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>11</p>
  </td>
  <td>
  <p>Laois</p>
  </td>
  <td>
  <p>24</p>
  </td>
  <td>
  <p>Westmeath</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>12</p>
  </td>
  <td>
  <p>Leitrim</p>
  </td>
  <td>
  <p>25</p>
  </td>
  <td>
  <p>Wexford</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>13</p>
  </td>
  <td>
  <p>Limerick</p>
  </td>
  <td>
  <p>26</p>
  </td>
  <td>
  <p>Wicklow</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>Town/village: County:</p>
  <p><br><br><br><br><br><br><br><br><br><br><br><br><br><br></p>
  <p>7 20</p>
  <p><br><br><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="87"><col width="527"></colgroup>
  <tbody>
  <tr>
  <td colspan="4">
  <p>2.1 Care at home</p>
  </td>
  </tr>
  <tr>
  <td colspan="4">
  <p>The following questions are about care received in the last three months of life at home. Please note that there are questions later in the questionnaire specifically related to care in the last two days of life.</p>
  <p>If your relative or friend did not spend any time at home in the last three months of their life please go to Q22a.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q5.</p>
  </td>
  <td colspan="3"><br>
  <p>When your relative or friend was at home in the last three months of their life, did they get care and support at home from any of the services listed below?</p>
  <p>These may be provided by different organisations, such as voluntary organisations, a private agency or the HSE. (Tick all that apply)</p>
  </td>
  </tr>
  <tr>
  <td><br><br><br>
  <p>1</p>
  </td>
  <td colspan="2">
  <p>A public health nurse (sometimes called a PHN, district nurse or community nurse)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td colspan="2">
  <p>A paid carer (sometimes called home help or a care assistant)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br><br>
  <p>3</p>
  </td>
  <td colspan="2">
  <p>A community palliative care nurse (sometimes called a homecare nurse, or hospice nurse)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>A nurse at night</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>5</p>
  </td>
  <td colspan="2">
  <p>A GP (general practitioner/family doctor)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>Social worker</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>Pharmacist</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>8</p>
  </td>
  <td colspan="2">
  <p>Occupational therapist (OT)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>Physiotherapist</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>10</p>
  </td>
  <td rowspan="2">
  <p>They did not receive care and support from these services</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>🡪GO TO Q22a.</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>11</p>
  </td>
  <td colspan="2">
  <p>Don&rsquo;t know 🡪GO TO Q22a.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="39"><col width="306"><col width="278"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q6.</p>
  </td>
  <td colspan="3">
  <p>In the last three months of their life, if</p>
  <p>your relative or friend required a home visit from the public health nursing team (sometimes referred to as the PHN, district nurse or community nurse) were they available to visit?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br><br>
  <p>4</p>
  </td>
  <td colspan="2">
  <p>They did not need a home visit from the public health nursing team 🡪GO TO Q8.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>
  <p>🡪GO TO Q8.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q7.</p>
  </td>
  <td colspan="3">
  <p>Overall, did you feel they were treated with respect and dignity by the public health nurse?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>4</p>
  </td>
  <td colspan="2">
  <p>They did not see the public health nurse</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q8.</p>
  </td>
  <td colspan="3">
  <p>In the last three months of their life, if your relative or friend required a home visit from their GP, were they available to visit?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>4</p>
  </td>
  <td colspan="2">
  <p>They did not need a home visit from the GP</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q9.</p>
  </td>
  <td colspan="2">
  <p>Overall, did you feel your relative or</p>
  <p>friend was treated with respect and dignity by their GP in the last three months of their life?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>They did not see their GP</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q10.</p>
  </td>
  <td colspan="2">
  <p>If your relative or friend wanted to talk to the GP about their condition, treatment or tests, did they have an opportunity to do so?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>4</p>
  </td>
  <td>
  <p>They did not want to talk to the GP</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q11.</p>
  </td>
  <td colspan="2">
  <p>In the last three months of their life, if your relative or friend required a home visit from the GP or GP out of hours service for help with urgent problems outside of normal working hours (after 5pm, at night and weekends) were they available to visit?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br><br>
  <p>4</p>
  </td>
  <td>
  <p>They did not need a home visit from their GP (family doctor) or the GP out of hours service</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q12.</p>
  </td>
  <td colspan="2">
  <p>Did someone from a hospice,</p>
  <p>community palliative care team, or any other specialist palliative care service visit them at home in the last three months of their life?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>No, this was not needed</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>No, this was not offered</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q13.</p>
  </td>
  <td colspan="2">
  <p>While at home, did healthcare staff help and support them with accessing additional equipment for their home, or making minor adaptations to their home?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br><br>
  <p>4</p>
  </td>
  <td>
  <p>They did not need additional equipment or adaptations to the home</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q14.</p>
  </td>
  <td colspan="2">
  <p>While at home, if they experienced pain, did healthcare staff do everything they could to relieve it?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>They did not have any pain</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q15.</p>
  </td>
  <td colspan="2">
  <p>While at home, if they experienced</p>
  <p>symptoms other than pain (such as nausea, constipation, breathing difficulties or restlessness), did healthcare staff do everything they could to relieve them?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>They did not need help with this</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q16.</p>
  </td>
  <td colspan="2">
  <p>While at home, did healthcare staff help and support them with their emotional needs (e.g. feeling worried, feeling anxious, feeling low, etc.)?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>They did not need help with this</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q17.</p>
  </td>
  <td colspan="2">
  <p>While at home, if they needed help from healthcare staff, did they get it as soon as they needed it?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>4</p>
  </td>
  <td>
  <p>They did not need any help from healthcare staff</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q18.</p>
  </td>
  <td colspan="2">
  <p>Overall, while they were at home, did healthcare staff answer any questions you had in a way that you could understand?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>I didn&rsquo;t have any questions</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="68"><col width="97"><col width="51"><col width="123"><col width="123"><col width="28"><col width="28"><col width="28"><col width="28"><col width="22"><col width="27"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q19.</p>
  </td>
  <td colspan="9">
  <p>Overall, while they were at home, did</p>
  <p>you have confidence and trust in the healthcare staff treating them?</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td colspan="3">
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td colspan="4">
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q20.</p>
  </td>
  <td colspan="8">
  <p>While at home, did the healthcare staff give you enough help and support to care for them?</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td colspan="4">
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td colspan="5">
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td colspan="7">
  <p>I did not need help with this</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td colspan="3">
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q21.</p>
  </td>
  <td colspan="9">
  <p>Overall, how would you rate the care your relative or friend got at home from healthcare staff in the last three months of their life?</p>
  <p>(Please circle a number)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="3">
  <p>They received very poor care</p>
  </td>
  <td colspan="2">
  <p>They received very good</p>
  <p>care</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>0</p>
  </td>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>8</p>
  </td>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>10</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="65"><col width="196"><col width="103"><col width="260"></colgroup>
  <tbody>
  <tr>
  <td colspan="5">
  <p>2.2 Care in a nursing home</p>
  <p>/residential care facility</p>
  </td>
  </tr>
  <tr>
  <td colspan="5">
  <p>The following questions are about care provided in a residential care facility, nursing home or long stay care setting during the last three months of life. If your relative or friend did not spend any time in one of these settings in the last three months of their life please go to Q35a.</p>
  <p>Please note that there are questions later in the questionnaire specifically related to care in the last two days of life.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q22a.</p>
  </td>
  <td colspan="4">
  <p>Did your relative or friend stay in a nursing home/residential care facility at any time during the last three months of their life?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td colspan="3">
  <p>Yes, they stayed in a nursing home/residential care facility</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td colspan="3">
  <p>No 🡪 GO TO Q35a.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td colspan="3">
  <p>Don&rsquo;t know 🡪 GO TO Q35a.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q22b.</p>
  </td>
  <td colspan="4">
  <p>Please write the name of the nursing home/residential care facility and the county it is located in the space below:</p>
  </td>
  </tr>
  <tr>
  <td colspan="4">
  <p>Name of nursing home/residential care facility:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>County:</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Carlow</p>
  </td>
  <td>
  <p>14</p>
  </td>
  <td>
  <p>Longford</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Cavan</p>
  </td>
  <td>
  <p>15</p>
  </td>
  <td>
  <p>Louth</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Clare</p>
  </td>
  <td>
  <p>16</p>
  </td>
  <td>
  <p>Mayo</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Cork</p>
  </td>
  <td>
  <p>17</p>
  </td>
  <td>
  <p>Meath</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Donegal</p>
  </td>
  <td>
  <p>18</p>
  </td>
  <td>
  <p>Monaghan</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>Dublin</p>
  </td>
  <td>
  <p>19</p>
  </td>
  <td>
  <p>Offaly</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>Galway</p>
  </td>
  <td>
  <p>20</p>
  </td>
  <td>
  <p>Roscommon</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>8</p>
  </td>
  <td>
  <p>Kerry</p>
  </td>
  <td>
  <p>21</p>
  </td>
  <td>
  <p>Sligo</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>Kildare</p>
  </td>
  <td>
  <p>22</p>
  </td>
  <td>
  <p>Tipperary</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>10</p>
  </td>
  <td>
  <p>Kilkenny</p>
  </td>
  <td>
  <p>23</p>
  </td>
  <td>
  <p>Waterford</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>11</p>
  </td>
  <td>
  <p>Laois</p>
  </td>
  <td>
  <p>24</p>
  </td>
  <td>
  <p>Westmeath</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>12</p>
  </td>
  <td>
  <p>Leitrim</p>
  </td>
  <td>
  <p>25</p>
  </td>
  <td>
  <p>Wexford</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>13</p>
  </td>
  <td>
  <p>Limerick</p>
  </td>
  <td>
  <p>26</p>
  </td>
  <td>
  <p>Wicklow</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q23.</p>
  </td>
  <td colspan="2">
  <p>How long had they stayed in a nursing</p>
  <p>home/residential care facility before they died?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Less than one week</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>One to four weeks</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Five to 12 weeks</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Longer than 12 weeks</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q24.</p>
  </td>
  <td colspan="2">
  <p>During their stay in the nursing home/residential care facility, if they experienced pain, did healthcare staff do everything they could to relieve it?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>They did not have any pain</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q25.</p>
  </td>
  <td colspan="2">
  <p>During their stay in the nursing home/residential care facility, if they experienced symptoms other than pain (such as nausea, constipation, breathing difficulties or restlessness), did healthcare staff do everything they could to relieve them?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>They did not have any symptoms</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q26.</p>
  </td>
  <td colspan="2">
  <p>During their stay in the nursing home/residential care facility, did healthcare staff help and support them with their emotional needs (e.g. feeling worried, feeling anxious, feeling low etc.)?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>They did not need help with this</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q27.</p>
  </td>
  <td colspan="2">
  <p>During their stay in the nursing</p>
  <p>home/residential care facility, did healthcare staff support them to do things they wanted to do (for example, participate in special family events, see a pet, etc.)?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>They did not need support</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q28.</p>
  </td>
  <td colspan="2">
  <p>During their stay in the nursing home/residential care facility, did healthcare staff help them with urgent problems outside of normal working hours (after 5pm, at night and weekends)?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>They did not need help with this</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q29.</p>
  </td>
  <td colspan="2">
  <p>During their stay in the nursing home/residential care facility, if they needed help from healthcare staff, did they get it as soon as they needed it?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q30.</p>
  </td>
  <td colspan="2">
  <p>During their stay in the nursing home/residential care facility, did healthcare staff answer your questions in a way that you could understand?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, completely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>I didn&rsquo;t have any questions</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="66"><col width="100"><col width="53"><col width="87"><col width="87"><col width="87"><col width="29"><col width="29"><col width="29"><col width="29"><col width="27"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q31.</p>
  </td>
  <td colspan="9">
  <p>During their stay in the nursing</p>
  <p>home/residential care facility, did you feel welcome to visit at any time?</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td colspan="3">
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td colspan="4">
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>4</p>
  </td>
  <td colspan="7">
  <p>I wasn&rsquo;t allowed due to visiting restrictions</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q32.</p>
  </td>
  <td colspan="9">
  <p>During their stay in the nursing home/residential care facility, did you have confidence and trust in the healthcare staff treating them?</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td colspan="3">
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td colspan="4">
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q33.</p>
  </td>
  <td colspan="9">
  <p>Overall, during their stay in the nursing home/residential care facility, did you feel they were treated with respect and dignity by healthcare staff?</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td colspan="3">
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td colspan="4">
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q34.</p>
  </td>
  <td colspan="9">
  <p>Overall, how would you rate the care your relative or friend received from healthcare staff in the nursing home/residential care facility?</p>
  <p>(Please circle a number)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="3">
  <p>They received very poor care</p>
  </td>
  <td colspan="3">
  <p>They received very good</p>
  <p>care</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>0</p>
  </td>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>8</p>
  </td>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>10</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="75"><col width="198"><col width="102"><col width="248"></colgroup>
  <tbody>
  <tr>
  <td colspan="5">
  <p>2.3 Care in an acute hospital</p>
  </td>
  </tr>
  <tr>
  <td colspan="5">
  <p>The following questions are about care in an acute hospital (this is a hospital that usually has an emergency department or an urgent care centre, and provides services for inpatients, outpatients and day-case treatments). If your relative or friend did not spend any time in an acute hospital in the last three months of their life please go to Q48a. The questions that follow in this section are about care during your relative or friend&rsquo;s last hospital stay. Please note that there are questions later in the questionnaire specifically</p>
  <p>related to care in the last two days of life.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q35a.</p>
  </td>
  <td colspan="4">
  <p>Did your relative or friend stay in an acute hospital at any time during the last three months of their life?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td colspan="3">
  <p>Yes, they stayed in an acute hospital</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td colspan="3">
  <p>No 🡪 GO TO Q48a.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td colspan="3">
  <p>Don&rsquo;t know 🡪 GO TO Q48a.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q35b.</p>
  </td>
  <td colspan="4">
  <p>Please write the name of the last acute hospital in the space below:</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>Name of acute hospital:</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>County:</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Carlow</p>
  </td>
  <td>
  <p>14</p>
  </td>
  <td>
  <p>Longford</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Cavan</p>
  </td>
  <td>
  <p>15</p>
  </td>
  <td>
  <p>Louth</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Clare</p>
  </td>
  <td>
  <p>16</p>
  </td>
  <td>
  <p>Mayo</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Cork</p>
  </td>
  <td>
  <p>17</p>
  </td>
  <td>
  <p>Meath</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Donegal</p>
  </td>
  <td>
  <p>18</p>
  </td>
  <td>
  <p>Monaghan</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>Dublin</p>
  </td>
  <td>
  <p>19</p>
  </td>
  <td>
  <p>Offaly</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>Galway</p>
  </td>
  <td>
  <p>20</p>
  </td>
  <td>
  <p>Roscommon</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>8</p>
  </td>
  <td>
  <p>Kerry</p>
  </td>
  <td>
  <p>21</p>
  </td>
  <td>
  <p>Sligo</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>Kildare</p>
  </td>
  <td>
  <p>22</p>
  </td>
  <td>
  <p>Tipperary</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>10</p>
  </td>
  <td>
  <p>Kilkenny</p>
  </td>
  <td>
  <p>23</p>
  </td>
  <td>
  <p>Waterford</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>11</p>
  </td>
  <td>
  <p>Laois</p>
  </td>
  <td>
  <p>24</p>
  </td>
  <td>
  <p>Westmeath</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>12</p>
  </td>
  <td>
  <p>Leitrim</p>
  </td>
  <td>
  <p>25</p>
  </td>
  <td>
  <p>Wexford</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>13</p>
  </td>
  <td>
  <p>Limerick</p>
  </td>
  <td>
  <p>26</p>
  </td>
  <td>
  <p>Wicklow</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q36.</p>
  </td>
  <td colspan="2">
  <p>How long was their last hospital stay?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Less than one week</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>One to four weeks</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Five to 12 weeks</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Longer than 12 weeks</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q37.</p>
  </td>
  <td colspan="2">
  <p>How many times had they been in hospital in the last three months including the last admission to hospital?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Once</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Twice</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Three or more times</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Not sure</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q38.</p>
  </td>
  <td colspan="2">
  <p>During their last stay in hospital, if they experienced pain, did healthcare staff do everything they could to relieve it?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>They did not have any pain</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q39.</p>
  </td>
  <td colspan="2">
  <p>During their last stay in hospital, if they experienced symptoms other than pain (such as nausea, constipation, breathing difficulties or restlessness), did healthcare staff do everything they could to relieve them?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>They did not have any symptoms</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q40.</p>
  </td>
  <td colspan="2">
  <p>During their last stay in hospital, did</p>
  <p>healthcare staff help and support them with their emotional needs (e.g. feeling worried, feeling anxious, feeling low, etc.)?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>They did not need help with this</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q41.</p>
  </td>
  <td colspan="2">
  <p>During their last stay in hospital, did healthcare staff provide enough help with urgent problems outside of normal working hours (after 5pm, at night and weekends)?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>They did not need help with this</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q42.</p>
  </td>
  <td colspan="2">
  <p>During their last stay in hospital, if they needed help from healthcare staff, did they get it as soon as they needed it?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>They did not need help</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q43.</p>
  </td>
  <td colspan="2">
  <p>During their last stay in hospital, did healthcare staff answer your questions in a way that you could understand?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, completely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>I didn&rsquo;t have any questions</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>I wasn&rsquo;t there</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="71"><col width="49"><col width="114"><col width="86"><col width="86"><col width="78"><col width="28"><col width="28"><col width="28"><col width="27"><col width="27"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q44.</p>
  </td>
  <td colspan="10">
  <p>During their last stay in hospital, did</p>
  <p>you feel welcome to visit at any time?</p>
  </td>
  </tr>
  <tr>
  <td colspan="2"><br>
  <p>1</p>
  </td>
  <td colspan="3">
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>2</p>
  </td>
  <td colspan="4">
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>4</p>
  </td>
  <td colspan="3">
  <p>Not applicable</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2"><br><br>
  <p>5</p>
  </td>
  <td colspan="7">
  <p>I wasn&rsquo;t allowed due to visiting restrictions</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q45.</p>
  </td>
  <td colspan="9">
  <p>During their last stay in hospital, did you have confidence and trust in the healthcare staff treating them?</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2"><br>
  <p>1</p>
  </td>
  <td colspan="3">
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>2</p>
  </td>
  <td colspan="4">
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q46.</p>
  </td>
  <td colspan="9">
  <p>Overall, during their last stay in hospital, did you feel they were treated with respect and dignity by healthcare staff?</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2"><br>
  <p>1</p>
  </td>
  <td colspan="3">
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>2</p>
  </td>
  <td colspan="4">
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q47.</p>
  </td>
  <td colspan="10">
  <p>Overall, how would you rate the care your relative or friend received in the hospital?</p>
  <p>(Please circle a number)</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>They received very poor care</p>
  </td>
  <td colspan="3">
  <p>They received very good</p>
  <p>care</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>0</p>
  </td>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>8</p>
  </td>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>10</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="72"><col width="542"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>2.4 Care in a hospice</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>The following questions are about the care provided to people who stayed in a hospice in the last three months of their life. If your relative or friend did not spend any time in a hospice in the last three months of their life please go to Q61.</p>
  <p>The questions are about care during their last hospice stay. Please note that there are questions later in the questionnaire specifically related to care in the last two days of life.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q48a.</p>
  </td>
  <td colspan="2">
  <p>Did your relative or friend stay in a hospice at any time during the last three months of their life?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>No 🡪 GO TO Q61.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>Don&rsquo;t know 🡪 GO TO Q61.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q48b.</p>
  </td>
  <td colspan="2">
  <p>Which hospice did they stay at?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Donegal Hospice</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Galway Hospice Foundation</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Kerry Hospice</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>Marymount University Hospital and Hospice, Cork</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Mayo Hospice</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>Milford Care Centre, Limerick</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>North West Hospice, Sligo</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>8</p>
  </td>
  <td>
  <p>Our Lady&rsquo;s Hospice - Blackrock Hospice, Dublin</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>9</p>
  </td>
  <td>
  <p>Our Lady&rsquo;s Hospice - Wicklow Hospice</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>10</p>
  </td>
  <td>
  <p>Our Lady&rsquo;s Hospice - Harold's Cross, Dublin</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>11</p>
  </td>
  <td>
  <p>South East Palliative Care Centre, Waterford</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>12</p>
  </td>
  <td>
  <p>St Brigid&rsquo;s Hospice, Kildare</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>13</p>
  </td>
  <td>
  <p>St Francis Hospice, Blanchardstown, Dublin</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>14</p>
  </td>
  <td>
  <p>St Francis Hospice, Raheny, Dublin</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q49.</p>
  </td>
  <td colspan="2">
  <p>How long was their last hospice stay?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Less than one week</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>One to four weeks</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Five to 12 weeks</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Longer than 12 weeks</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q50.</p>
  </td>
  <td colspan="2">
  <p>During their stay in the hospice, if they experienced pain, did healthcare staff do everything they could to relieve it?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>They did not have any pain</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q51.</p>
  </td>
  <td colspan="2">
  <p>During their stay in the hospice, if they experienced symptoms other than pain (such as nausea, constipation, breathing difficulties or restlessness), did healthcare staff do everything they could to relieve them?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>They did not have any symptoms</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q52.</p>
  </td>
  <td colspan="2">
  <p>During their stay in the hospice, did healthcare staff help and support them with their emotional needs (e.g. feeling worried, feeling anxious, feeling low, etc.)?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>They did not need help with this</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q53.</p>
  </td>
  <td colspan="2">
  <p>During their stay in the hospice, did</p>
  <p>healthcare staff support them to do things they wanted to do (for example, participate in special family events, see a pet etc.)?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>They did not need support</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q54.</p>
  </td>
  <td colspan="2">
  <p>During their stay in the hospice, did healthcare staff provide help with urgent problems outside of normal working hours (after 5pm, at night and weekends)?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>They did not need help with this</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q55.</p>
  </td>
  <td colspan="2">
  <p>During their stay in the hospice, if they needed help from healthcare staff, did they get it as soon as they needed it?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>They did not need help</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q56.</p>
  </td>
  <td colspan="2">
  <p>During their stay in the hospice, did you feel welcome to visit at any time?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>4</p>
  </td>
  <td>
  <p>I wasn&rsquo;t allowed due to visiting restrictions</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="81"><col width="115"><col width="87"><col width="87"><col width="87"><col width="28"><col width="28"><col width="28"><col width="28"><col width="28"><col width="27"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q57.</p>
  </td>
  <td colspan="10">
  <p>During their stay in the hospice, did</p>
  <p>healthcare staff answer your questions in a way that you could understand?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td colspan="4">
  <p>Yes, completely</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td colspan="5">
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td colspan="6">
  <p>I didn&rsquo;t have any questions</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q58.</p>
  </td>
  <td colspan="9">
  <p>During their stay in the hospice, did you have confidence and trust in the healthcare staff treating them?</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td colspan="3">
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td colspan="4">
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q59.</p>
  </td>
  <td colspan="9">
  <p>Overall, during their stay in the hospice, did you feel they were treated with respect and dignity by healthcare staff?</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td colspan="3">
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td colspan="4">
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q60.</p>
  </td>
  <td colspan="10">
  <p>Overall, how would you rate the care your relative or friend received in the hospice?</p>
  <p>(Please circle a number)</p>
  </td>
  </tr>
  <tr>
  <td colspan="2">
  <p>They received very poor care</p>
  </td>
  <td colspan="3">
  <p>They received very good</p>
  <p>care</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>0</p>
  </td>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>8</p>
  </td>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>10</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>2.5 Overall care in the last three months of life</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>The following questions are about the care provided during the last three months of life. Please note that there are questions later in the questionnaire specifically related to care in the last two days of life.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q61.</p>
  </td>
  <td colspan="2">
  <p>During the last three months of their life, did healthcare staff provide support to meet your relative or friend&rsquo;s religious or spiritual needs (things like talking, praying, quiet time or access to a religious or spiritual leader)?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>4</p>
  </td>
  <td>
  <p>They did not need support with this</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q62.</p>
  </td>
  <td colspan="2">
  <p>During the last three months of their life, were they involved as much as they wanted to be in decisions about their care?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>4</p>
  </td>
  <td>
  <p>They did not want to be involved or were not able to be involved</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="33"><col width="241"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q63.</p>
  </td>
  <td colspan="2">
  <p>During the last three months of their</p>
  <p>life, did healthcare staff help and support them with family worries or concerns (caring for someone else in the family or help with difficult conversations)?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>They did not need help with this</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>5 </p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q64.</p>
  </td>
  <td colspan="2">
  <p>Did you feel that there was good coordination between different services (e.g. GP, hospital or hospice) and healthcare staff who cared for them in the last three months of their life?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>Not relevant to our situation</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>5 </p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong><br><br></strong></p>
  <p>&nbsp;</p>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="33"><col width="241"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>3.1 Experience of care in the last two days of life</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">&nbsp;</td>
  </tr>
  <tr>
  <td colspan="3">
  <p>The following questions are about the experience of care in the last two days of life.</p>
  <p>We understand that it may be difficult to reflect on this experience and we appreciate you taking the time to answer the questions.</p>
  <p>If you had no contact with your relative or friend in the last two days of life, please go to Q101.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q65.</p>
  </td>
  <td colspan="2">
  <p>During the last two days of their life, was your relative or friend cared for:</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br>
  <p>1 </p>
  </td>
  <td>
  <p>At home or in the home of a family member or friend.</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br>
  <p>2 </p>
  </td>
  <td>
  <p>In a nursing home/residential care facility</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br><br><br><br><br>
  <p>3 </p>
  </td>
  <td>
  <p>In an acute hospital (a hospital that has an emergency department, or urgent care centre and provides services for inpatients, outpatients and day- case treatments)</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>In a hospice</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>5 </p>
  </td>
  <td>
  <p>Somewhere else</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br><br>
  <p>6 </p>
  </td>
  <td>
  <p>I had no contact with my relative or friend in the last two days of life 🡪 GO TO Q101.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q66.</p>
  </td>
  <td colspan="2">
  <p>During the last two days of their life, did the bed area and surrounding environment have adequate privacy for them?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>4 </p>
  </td>
  <td>
  <p>I was not with them in the last two days</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>5 </p>
  </td>
  <td>
  <p>Does not apply to our situation</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="33"><col width="241"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q67.</p>
  </td>
  <td colspan="2">
  <p>During the last two days of their life,</p>
  <p>were you offered&hellip;</p>
  <p>(Tick all that apply)</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br><br>
  <p>1 </p>
  </td>
  <td>
  <p>A family room with adequate peace and privacy for you to meet with healthcare staff</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br>
  <p>2 </p>
  </td>
  <td>
  <p>A family room with tea and coffee making facilities</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br><br>
  <p>3 </p>
  </td>
  <td>
  <p>The option to visit at any time, including outside of regular visiting hours</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>The option to stay overnight</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>5 </p>
  </td>
  <td>
  <p>I was not offered any of these</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>6 </p>
  </td>
  <td>
  <p>Does not apply to our situation</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q68.</p>
  </td>
  <td colspan="2">
  <p>During the last two days of their life, if they experienced pain, did healthcare staff do everything they could to relieve it?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>They did not have any pain</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>5 </p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q69.</p>
  </td>
  <td colspan="2">
  <p>During the last two days of their life, if they experienced symptoms other than pain (such as nausea, constipation, breathing difficulties or restlessness), did healthcare staff do everything they could to relieve them?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>They did not have any symptoms</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong><br><br></strong></p>
  <p>&nbsp;</p>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="33"><col width="241"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q70.</p>
  </td>
  <td colspan="2">
  <p>During the last two days of their life,</p>
  <p>did healthcare staff help and support them with their emotional needs (e.g. feeling worried, feeling anxious, feeling low etc.)?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>They did not need help with this</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>5 </p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q71.</p>
  </td>
  <td colspan="2">
  <p>During the last two days of their life, did healthcare staff provide support to meet their religious or spiritual needs (things like talking, praying, quiet time or access to a religious or spiritual leader)</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>They did not need help with this</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>5 </p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q72.</p>
  </td>
  <td colspan="2">
  <p>During the last two days of their life, did they get enough help from healthcare staff to eat or drink?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>They did not want help</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>5 </p>
  </td>
  <td>
  <p>They were not able to eat or drink</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>6 </p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="33"><col width="241"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q73.</p>
  </td>
  <td colspan="2">
  <p>During the last two days of their life,</p>
  <p>was there enough help available to meet their personal care needs (such as washing, dressing and toileting)?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br>
  <p>4 </p>
  </td>
  <td>
  <p>They did not need help with personal care needs</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q74.</p>
  </td>
  <td colspan="2">
  <p>During the last two days of their life, was there enough help with nursing care, such as giving medicine and helping them find a comfortable position in bed?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q75.</p>
  </td>
  <td colspan="2">
  <p>During the last two days of their life, did a member of the hospice, palliative care team, or any other specialist palliative care service, visit them?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q76.</p>
  </td>
  <td colspan="2">
  <p>During the last two days of their life, did you feel that there was good coordination between the healthcare staff?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong><br><br></strong></p>
  <p>&nbsp;</p>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="33"><col width="241"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q77.</p>
  </td>
  <td colspan="2">
  <p>During the last two days of their life,</p>
  <p>was there adequate support to meet their needs outside of normal working hours (after 5pm, at night and at weekends)?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q78.</p>
  </td>
  <td colspan="2">
  <p>During the last two days of their life, do you think your relative or friend was involved as much as they wanted to be in decisions about their care and treatment?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br>
  <p>4 </p>
  </td>
  <td>
  <p>They were not able to be involved in decisions at this time</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>5 </p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q79.</p>
  </td>
  <td colspan="2">
  <p>During the last two days of their life, did healthcare staff discuss with you the level of treatment and care and its appropriateness (in terms of medical interventions and their illness) that your relative or friend would receive?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>Does not apply to our situation</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="33"><col width="241"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q80.</p>
  </td>
  <td colspan="2">
  <p>During the last two days of their life,</p>
  <p>did you have confidence and trust in the nurses who cared for them?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>Does not apply to our situation</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q81.</p>
  </td>
  <td colspan="2">
  <p>During the last two days of their life, did you have confidence and trust in the doctors who cared for them?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>Does not apply to our situation</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q82.</p>
  </td>
  <td colspan="2">
  <p>During the last two days of their life, did healthcare staff treat them with kindness and compassion?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>Does not apply to our situation</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q83.</p>
  </td>
  <td colspan="2">
  <p>Overall, during the last two days of life, did you feel that they were treated with respect and dignity by healthcare staff?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong><br><br></strong></p>
  <p>&nbsp;</p>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="33"><col width="113"><col width="128"></colgroup>
  <tbody>
  <tr>
  <td colspan="4">
  <p>3.2 Care experiences at the end of life</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q84.</p>
  </td>
  <td colspan="3">
  <p>Was your relative or friend told by a healthcare professional that they were likely to die?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>2 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>
  <p>🡪GO TO Q86.</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>3 </p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>
  <p>🡪GO TO Q86.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q85.</p>
  </td>
  <td colspan="3">
  <p>In your opinion, did the healthcare professional who told them that they were likely to die break the news to them in a sensitive and caring way?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td colspan="2">
  <p>Yes, to some extent</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q86.</p>
  </td>
  <td colspan="3">
  <p>Did healthcare staff talk to you about what to expect when your relative or friend was dying (for example symptoms that may arise)?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>
  <p>🡪GO TO Q88.</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>2 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>
  <p>🡪GO TO Q87.</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br>
  <p>3 </p>
  </td>
  <td colspan="2">
  <p>Not applicable &ndash; they died unexpectedly 🡪GO TO Q88.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q87.</p>
  </td>
  <td colspan="3">
  <p>Would a discussion about what to expect when they were dying have been helpful?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="43"><col width="33"><col width="242"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q88.</p>
  </td>
  <td colspan="2">
  <p>Where did your relative or friend die?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br>
  <p>1 </p>
  </td>
  <td>
  <p>In their own home or in the home of a family member or friend</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>
  <p>Name of Town:</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>
  <p>County:</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br>
  <p>2 </p>
  </td>
  <td>
  <p>In a hospital &ndash; please write the name of the hospital below:</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>
  <p>Name of hospital:</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>
  <p>County:</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br>
  <p>3 </p>
  </td>
  <td>
  <p>In a hospice &ndash; please write the name of the hospice below</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>
  <p>Name of hospice:</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>
  <p>County:</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br><br>
  <p>4 </p>
  </td>
  <td>
  <p>In a nursing home / residential care facility &ndash; please write the name of the facility below:</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>
  <p>Name of nursing home:</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>
  <p>County:</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br>
  <p>5 </p>
  </td>
  <td>
  <p>In an ambulance on the way to hospital / hospice 🡪GO TO Q90.</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br>
  <p>6 </p>
  </td>
  <td>
  <p>Somewhere else (please write below):</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong><br><br></strong></p>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="40"><col width="18"><col width="24"><col width="36"><col width="31"><col width="24"><col width="28"><col width="29"><col width="29"><col width="37"><col width="27"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q89.</p>
  </td>
  <td colspan="9">
  <p>If they died in a healthcare setting</p>
  <p>(e.g. a hospital, hospice or nursing home), were they in a single room?</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td colspan="2"><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td colspan="2">
  <p>2 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td colspan="2"><br><br>
  <p>3 </p>
  </td>
  <td colspan="7">
  <p>They did not die in a healthcare setting</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td colspan="2">
  <p>4 </p>
  </td>
  <td colspan="3">
  <p>Don&rsquo;t know</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q90.</p>
  </td>
  <td colspan="9">
  <p>On balance, do you think that they died in the right place?</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td colspan="2"><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td colspan="2">
  <p>2 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td colspan="2">
  <p>3 </p>
  </td>
  <td colspan="2">
  <p>Not sure</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q91.</p>
  </td>
  <td colspan="10">
  <p>Overall, how would you rate the care your relative or friend received at the end of their life? (Please circle a number)</p>
  </td>
  </tr>
  <tr>
  <td colspan="4">
  <p>They received very poor care</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td colspan="4">
  <p>They received</p>
  <p>very good care</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>0</p>
  </td>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>8</p>
  </td>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>10</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong><br><br></strong></p>
  <p>&nbsp;</p>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="33"><col width="242"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>3.3 Your experience of care and support</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">&nbsp;</td>
  </tr>
  <tr>
  <td colspan="3">
  <p>The following questions are about your experience of the care and support provided to you by healthcare staff in the last days of your relative or friend&rsquo;s life, and after they died.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q92.</p>
  </td>
  <td colspan="2"><br>
  <p>Looking back over the last days of their life, were you given enough emotional help and support by healthcare staff?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>4 </p>
  </td>
  <td>
  <p>I did not need help with this</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>5 </p>
  </td>
  <td>
  <p>Not applicable to my situation</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q93.</p>
  </td>
  <td colspan="2">
  <p>Looking back over the last days of their life, were you given enough help and support by healthcare staff to talk to children or young adults about your relative or friend&rsquo;s illness?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>4 </p>
  </td>
  <td>
  <p>I did not need help with this</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>5 </p>
  </td>
  <td>
  <p>Not applicable to my situation</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="33"><col width="242"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q94.</p>
  </td>
  <td colspan="2">
  <p>Looking back over the last days of</p>
  <p>their life, were you involved as much as you wanted to be in decisions about their care and treatment?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>Not applicable to my situation</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q95.</p>
  </td>
  <td colspan="2">
  <p>During the last days of their life, did healthcare staff explain their condition and care in a way that you could understand?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>Not applicable to my situation</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q96.</p>
  </td>
  <td colspan="2">
  <p>During the last days of their life, did you feel you had enough time to discuss their care and treatment with healthcare staff?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>Not applicable to my situation</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q97.</p>
  </td>
  <td colspan="2">
  <p>After your relative or friend died, did healthcare staff engage with you in a sensitive manner?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>Not applicable to my situation</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong><br><br></strong></p>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="39"><col width="17"><col width="26"><col width="44"><col width="22"><col width="31"><col width="19"><col width="36"><col width="30"><col width="32"><col width="25"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q98.</p>
  </td>
  <td>&nbsp;</td>
  <td colspan="9">
  <p>Did healthcare staff give you practical</p>
  <p>information on what to do after your relative or friend died, including information on registering their death?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td colspan="3">
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td colspan="5">
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td colspan="7">
  <p>I did not need this information</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>
  <p>5 </p>
  </td>
  <td colspan="7">
  <p>Not applicable to my situation</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q99.</p>
  </td>
  <td>&nbsp;</td>
  <td colspan="9">
  <p>If you sought support after your relative or friend died, who provided that support?</p>
  <p>(Tick all that apply)</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td colspan="3">
  <p>GP/doctor</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Nurse</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td colspan="3">
  <p>Social worker</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td><br><br>
  <p>4 </p>
  </td>
  <td colspan="6">
  <p>Pastoral care or healthcare chaplain</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>
  <p>5 </p>
  </td>
  <td colspan="6">
  <p>Bereavement counsellor</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>
  <p>6 </p>
  </td>
  <td colspan="5">
  <p>Bereavement helpline</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td><br><br>
  <p>7 </p>
  </td>
  <td colspan="8">
  <p>I did not access any professional supports</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>
  <p>8 </p>
  </td>
  <td colspan="2">
  <p>Not sure</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>
  <p>9 </p>
  </td>
  <td>
  <p>Other</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>Q100.</p>
  </td>
  <td colspan="8">
  <p>Overall, and taking all services into account, how would you rate the care and support you received? (Please circle a number)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="4">
  <p>I received very poor care and support</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td colspan="4">
  <p>I received very</p>
  <p>good care and</p>
  <p>support</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>0</p>
  </td>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>8</p>
  </td>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>10</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong><br><br><br></strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="56"><col width="626"></colgroup>
  <tbody>
  <tr>
  <td colspan="2">
  <p>4. Other Comments</p>
  </td>
  </tr>
  <tr>
  <td colspan="2">&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>Thank you very much for taking part in this survey. We would like to give you the opportunity to tell us in your own words about the care you and the person who died received. To do this, you may like to answer the questions below. You can use the back page of the questionnaire if you need more space. Comments will be entered into a secure database after removing any information that could identify you.</p>
  <p>This anonymised feedback will be looked at by HIQA, the HSE and the Department of Health to try to understand and improve experiences of health and social care at end of life. In the future, other researchers may also analyse anonymised data from this survey after all personal information that could identify you has been removed. We will give examples of feedback in the final survey reports to provide a fuller understanding of bereaved relatives&rsquo; experiences.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q101.</p>
  </td>
  <td><br>
  <p>Overall, what was good about the care your relative or friend received?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>Q102.</p>
  </td>
  <td><br>
  <p>Was there anything that could have been improved?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>Q103.</p>
  </td>
  <td><br>
  <p>Do you have any other comments or suggestions about the care your relative or friend received?</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong><br><br></strong></p>
  <p>&nbsp;</p>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="55"><col width="36"><col width="231"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>5. Information about you and your relative/friend</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">&nbsp;</td>
  </tr>
  <tr>
  <td colspan="3">
  <p>In this section, we would like to know a little more about you both. This will help us to make better use of the information you have given us.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q104.</p>
  </td>
  <td colspan="2"><br>
  <p>What is your gender?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Male</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>2 </p>
  </td>
  <td>
  <p>Female</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>3 </p>
  </td>
  <td>
  <p>Other</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>4 </p>
  </td>
  <td>
  <p>Prefer not to say</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q105.</p>
  </td>
  <td colspan="2">
  <p>How old are you?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>18-29 years</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>2 </p>
  </td>
  <td>
  <p>30-39 years</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>3 </p>
  </td>
  <td>
  <p>40-49 years</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>4 </p>
  </td>
  <td>
  <p>50-59 years</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>5 </p>
  </td>
  <td>
  <p>60-69 years</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>6 </p>
  </td>
  <td>
  <p>70-79 years</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>7 </p>
  </td>
  <td>
  <p>80-89 years</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>8 </p>
  </td>
  <td>
  <p>90 + years</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="55"><col width="36"><col width="231"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q106.</p>
  </td>
  <td colspan="2">
  <p>What is your ethnic or cultural</p>
  <p>background?</p>
  <p>(Tick ONE box only)</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>White:</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>1 </p>
  </td>
  <td>
  <p>Irish</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Irish Traveller</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>Roma</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>Any other White background</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>Black or Black Irish:</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>5 </p>
  </td>
  <td>
  <p>African</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>6 </p>
  </td>
  <td>
  <p>Any other Black background</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>Asian or Asian Irish:</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>7 </p>
  </td>
  <td>
  <p>Chinese</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>8 </p>
  </td>
  <td>
  <p>Indian/Pakistani/Bangladeshi</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>9 </p>
  </td>
  <td>
  <p>Any other Asian background</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>Other, including mixed group/ background:</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>10 </p>
  </td>
  <td>
  <p>Arab</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>11 </p>
  </td>
  <td>
  <p>Mixed, please specify:</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br>
  <p>12 </p>
  </td>
  <td>
  <p>Other, please write your ethnic group here:</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q107.</p>
  </td>
  <td colspan="2">
  <p>Your relative/friend was:</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Male</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Female</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>Other</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>Prefer not to say</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong><br><br></strong></p>
  <p>&nbsp;</p>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="51"><col width="37"><col width="230"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q108.</p>
  </td>
  <td colspan="2">
  <p>Please indicate the ethnic</p>
  <p>background of the person who died:</p>
  <p>(Tick ONE box only)</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td colspan="2">
  <p>White:</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>1 </p>
  </td>
  <td>
  <p>Irish</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Irish Traveller</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>Roma</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>Any other White background</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td colspan="2">
  <p>Black or Black Irish:</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>5 </p>
  </td>
  <td>
  <p>African</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>6 </p>
  </td>
  <td>
  <p>Any other Black background</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td colspan="2">
  <p>Asian or Asian Irish:</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>7 </p>
  </td>
  <td>
  <p>Chinese</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>8 </p>
  </td>
  <td>
  <p>Indian/ Pakistani/ Bangladeshi</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>9 </p>
  </td>
  <td>
  <p>Any other Asian background</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td colspan="2">
  <p>Other, including mixed group/ background:</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>10 </p>
  </td>
  <td>
  <p>Arab</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>11 </p>
  </td>
  <td>
  <p>Mixed, please specify:</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br>
  <p>12 </p>
  </td>
  <td>
  <p>Other, please write their ethnic group here:</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="55"><col width="36"><col width="231"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q109.</p>
  </td>
  <td colspan="2">
  <p>What age was your relative/friend</p>
  <p>when they died?</p>
  <p>(Please enter their age in numbers)</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>
  <p>years old</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q110.</p>
  </td>
  <td colspan="2">
  <p>Did the person who died have: (Tick all that apply)</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>A medical card</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>A GP visit card</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>Private health insurance</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>None of the above</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>5 </p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong><br><br><br></strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="680"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>If you would like to talk about your bereavement experience or discuss upsetting memories brought on by completing this questionnaire, please feel free to contact the Freephone HSE/Irish Hospice Foundation bereavement support freephone service on 1800 80 70 77 to talk to a bereavement support volunteer. The Freephone service is available from 10am to 1pm, Monday to Friday. You can also contact Samaritans 24 hours a day, 7 days a week on Freephone 116 123 or by emailing</p>
  <p><a href="mailto:jo@samaritans.ie">jo@samaritans.ie.</a></p>
  </td>
  </tr>
  <tr>
  <td>
  <p>THANK YOU VERY MUCH FOR COMPLETING THE SURVEY</p>
  <p>Please check that you have answered all of the questions that apply to you.</p>
  <p>Please return this questionnaire in the Freepost envelope provided. No stamp is needed.</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <p><br><br><br><br><br><br><br><br><br><br><br></p>
  <p>24</p>
  <ol>
  <li>
  c) National Inpatient Experience Survey (NIES Questionnaire)
  </li>
  </ol>
  <p>PATIENT QUESTIONNAIRE</p>
  <p>Help us make hospital care better!</p>
  <p>What is the survey about?</p>
  <p>The National Inpatient Experience Survey is a nationwide survey asking patients about their recent stay in a public hospital. The results of the survey will be used to improve hospital care.</p>
  <p>Please use this questionnaire to provide general feedback about your hospital experience. If you would like to make a comment or complaint and receive a response, please email the HSE at yoursay@hse.ie or phone 1890 424 555. You can also contact the Patient Advocacy Service, an independent advocacy service, an independent advocacy service, at 0818 293 003 or info@patientadvocacyservice.ie</p>
  <p>Why did I get this questionnaire?</p>
  <p>You got this questionnaire because you spent 24 hours or more in hospital, you are 16 years of age or over and you were discharged from hospital in the survey month.</p>
  <p>Can I do the questionnaire online?</p>
  <p>Yes, please go to survey.yourexperience.ie to complete the questionnaire online.</p>
  <p>Can I ask someone to help me fill in the questionnaire?</p>
  <p>Yes, you can ask someone to help you fill in the questionnaire. You may also ask someone to fill in the questionnaire on your behalf. However, please make sure that the answers given reflect your experience of care.</p>
  <p>Completing the questionnaire</p>
  <ul>
  <li>
  For each question please clearly tick one box using a black or a blue pen.
  </li>
  </ul>
  <ul>
  <li>
  Please read the information in the boxes that accompany some of the questions as these provide important information to help you complete the questionnaire.
  </li>
  </ul>
  <ul>
  <li>
  Do not worry if you make a mistake; simply fill in the box and put a tick in the correct box.
  </li>
  </ul>
  <ul>
  <li>
  There is space at the end of the questionnaire for your written comments.
  </li>
  </ul>
  <ul>
  <li>
  Please do not write your name or address anywhere on the questionnaire.
  </li>
  </ul>
  <ul>
  <li>
  Please return this questionnaire in the Freepost envelope provided. No stamp is needed.
  </li>
  </ul>
  <p>National Inpatient Experience Survey</p>
  <p>Milltown House Milltown&nbsp;</p>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="39"><col width="398"><col width="187"></colgroup>
  <tbody>
  <tr>
  <td colspan="4">
  <p>When answering the questions, please think of your most recent stay in the hospital named in the letter that was included with this survey.</p>
  </td>
  </tr>
  <tr>
  <td colspan="4">
  <p>Admission to hospital</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q1.</p>
  </td>
  <td colspan="3"><br>
  <p>Was your most recent hospital stay planned in advance or an emergency?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Emergency or urgent</p>
  </td>
  <td>
  <p>🡪 GO TO Q2.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>2</p>
  </td>
  <td>
  <p>Planned in advance or waiting list</p>
  </td>
  <td><br>
  <p>🡪 GO TO Q7.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Something else</p>
  </td>
  <td>
  <p>🡪 GO TO Q2.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q2.</p>
  </td>
  <td colspan="3">
  <p>When you arrived at the hospital, did you go to the emergency department (also known as the A&amp;E department or casualty)?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>
  <p>🡪 GO TO Q3.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>
  <p>🡪 GO TO Q7.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="4">
  <p>The Emergency Department</p>
  </td>
  </tr>
  <tr>
  <td colspan="4">
  <p>Please only answer the questions about the emergency department if you answered &lsquo;Yes&rsquo; to Q2.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q3.</p>
  </td>
  <td colspan="3"><br>
  <p>When you had important questions to ask doctors and nurses in the emergency department, did you get answers that you could understand?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td colspan="2">
  <p>I had no need to ask/I was too unwell to ask any questions</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="444"><col width="121"><col width="119"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q4.</p>
  </td>
  <td colspan="4">
  <p>Were you given enough privacy when</p>
  <p>being examined or treated in the emergency department?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, completely</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td colspan="3">
  <p>Don&rsquo;t know/can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q5.</p>
  </td>
  <td colspan="4">
  <p>Did you remain in the emergency department for the entire time of your stay?</p>
  </td>
  </tr>
  <tr>
  <td><br><br>
  <p>1</p>
  </td>
  <td colspan="2">
  <p>Yes, I was discharged from the emergency department</p>
  </td>
  <td>
  <p>🡪 GO TO</p>
  <p>Q44.*</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>2</p>
  </td>
  <td colspan="2">
  <p>No, I was transferred to a different part of the hospital before I was discharged</p>
  </td>
  <td><br>
  <p>🡪 GO TO Q6.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="5">
  <p>*If you were discharged from the emergency department, please go to page 8 and complete Q44 &ndash; Q49, and provide any comments you may have on page 11.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q6.</p>
  </td>
  <td colspan="4">
  <p>Following arrival at the hospital, how long did you wait before being admitted to a ward?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Less than 6 hours</p>
  </td>
  <td colspan="2">
  <p>&rarr; GO TO Q7.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Between 6 and up to 12 hours</p>
  </td>
  <td colspan="2">
  <p>&rarr; GO TO Q7.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>Between 12 and up to 24 hours</p>
  </td>
  <td colspan="2">
  <p>&rarr; GO TO Q7.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>Between 24 and up to 48 hours</p>
  </td>
  <td colspan="2">
  <p>&rarr; GO TO Q7.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>5</p>
  </td>
  <td>
  <p>More than 48 hours</p>
  </td>
  <td colspan="2">
  <p>&rarr; GO TO Q7.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>6</p>
  </td>
  <td>
  <p>Don&rsquo;t know/ can&rsquo;t remember</p>
  </td>
  <td colspan="2">
  <p>&rarr; GO TO Q7.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>7</p>
  </td>
  <td>
  <p>I was not admitted to a ward</p>
  </td>
  <td colspan="2">
  <p>&rarr; GO TO Q44.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="45"><col width="569"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>The hospital and ward</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>A ward is a room or area in the hospital where patients receive care following admission.</p>
  <p>If you stayed in more than one ward, please answer the following questions about the ward in which you spent most of your time.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q7.</p>
  </td>
  <td colspan="2"><br>
  <p>In your opinion, how clean was the hospital?</p>
  <p>This includes all areas of the hospital, including the ward, bathrooms and other areas</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Very clean</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Fairly clean</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Not very clean</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Not at all clean</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q8.</p>
  </td>
  <td colspan="2">
  <p>When you needed help from staff getting to the bathroom or toilet, did you get it in time?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>I did not need help</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q9.</p>
  </td>
  <td colspan="2">
  <p>Did the staff treating and examining you introduce themselves?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1□</p>
  </td>
  <td>
  <p>Yes, all of the staff introduced themselves</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2□</p>
  </td>
  <td>
  <p>Some of the staff introduced themselves</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3□</p>
  </td>
  <td>
  <p>Very few or none of the staff introduced themselves</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4□</p>
  </td>
  <td>
  <p>Don&rsquo;t know/can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="373"><col width="204"></colgroup>
  <tbody>
  <tr>
  <td colspan="4">
  <p>Hospital food</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q10.</p>
  </td>
  <td colspan="3"><br>
  <p>How would you rate the hospital food?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Very good</p>
  </td>
  <td>
  <p>&rarr; GO TO Q11.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Good</p>
  </td>
  <td>
  <p>&rarr; GO TO Q11.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Fair</p>
  </td>
  <td>
  <p>&rarr; GO TO Q11.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Poor</p>
  </td>
  <td>
  <p>&rarr; GO TO Q11.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>5</p>
  </td>
  <td>
  <p>I did not have any hospital food</p>
  </td>
  <td><br>
  <p>&rarr; GO TO Q13.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q11.</p>
  </td>
  <td colspan="3">
  <p>Were you offered food that met any dietary needs or requirements you had?</p>
  <p>This could include religious, medical, or allergy requirements, vegetarian/vegan options, or different food formats such as liquefied or pureed food.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td colspan="2">
  <p>I did not have any dietary needs or requirements</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td colspan="2">
  <p>I was fed through tube feeding</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td colspan="2">
  <p>I did not have any hospital food</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q12.</p>
  </td>
  <td colspan="3">
  <p>Were you able to get hospital food outside of set meal times?</p>
  <p>This could include a replacement meal if you missed set meal times due to operations/procedures or another reason.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td colspan="2">
  <p>I did not need this</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td colspan="2">
  <p>Don&rsquo;t know/can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>Your care and treatment</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q13.</p>
  </td>
  <td colspan="2"><br>
  <p>When you had important questions to ask a doctor, did you get answers that you could understand?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>I had no need to ask</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q14.</p>
  </td>
  <td colspan="2">
  <p>Did you feel you had enough time to discuss your care and treatment with a doctor?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q15.</p>
  </td>
  <td colspan="2">
  <p>If you ever needed to talk to a nurse, did you get the opportunity to do so?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>I had no need to talk to a nurse</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q16.</p>
  </td>
  <td colspan="2">
  <p>When you had important questions to ask a nurse, did you get answers that you could understand?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>I had no need to ask</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q17.</p>
  </td>
  <td colspan="2">
  <p>Were you involved as much as you</p>
  <p>wanted to be in decisions about your care and treatment?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q18.</p>
  </td>
  <td colspan="2">
  <p>How much information about your condition or treatment was given to you?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Not enough</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>The right amount</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Too much</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q19.</p>
  </td>
  <td colspan="2">
  <p>Was your diagnosis explained to you in a way that you could understand?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, completely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q20.</p>
  </td>
  <td colspan="2">
  <p>If your family or someone else close to you wanted to talk to a doctor, did they have enough opportunity to do so?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>My family did not want or need information</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>5</p>
  </td>
  <td>
  <p>I did not want my family or friends to talk to a doctor</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>6</p>
  </td>
  <td>
  <p>No family or friends were involved</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q21.</p>
  </td>
  <td colspan="2">
  <p>Did you find someone on the hospital staff to talk to about your worries and fears?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>I had no worries or fears</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q22.</p>
  </td>
  <td colspan="2">
  <p>Did you have confidence and trust in the hospital staff treating you?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q23.</p>
  </td>
  <td colspan="2">
  <p>Were you given enough privacy when discussing your condition or treatment?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q24.</p>
  </td>
  <td colspan="2">
  <p>Were you given enough privacy when being examined or treated?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q25.</p>
  </td>
  <td colspan="2">
  <p>Do you think the hospital staff did everything they could to help control your pain?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>I was never in any pain</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <p>Q26. Before any test, operation or procedure you received did a member of staff explain the risks and benefits in a way you could understand?</p>
  <p>1 Yes, completely &rarr; GO TO Q27.</p>
  <p>Yes, to some</p>
  <p>2 extent &rarr; GO TO Q27.</p>
  <p>3 No &rarr; GO TO Q27.</p>
  <p><br><br></p>
  <p>4 I did not want an explanation</p>
  <p>5□I did not have</p>
  <p>&rarr; GO T</p>
  <p>any test,</p>
  <p>operation or procedure</p>
  <p>&rarr; GO TO Q28.</p>
  <p>Q27. After any test, operation or procedure you received, did a member of staff explain the outcome in a way you could understand?</p>
  <p>1 Yes, completely</p>
  <p>2 Yes, to some extent</p>
  <p>3 No</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>Leaving hospital</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q28.</p>
  </td>
  <td colspan="2"><br>
  <p>Did you feel you were involved in decisions about your discharge from hospital?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>I did not want to be involved</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q29.</p>
  </td>
  <td colspan="2">
  <p>Were you or someone close to you given enough notice about your discharge?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know/can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q30.</p>
  </td>
  <td colspan="2">
  <p>Before you left hospital, were you given any written or printed information about what you should or should not do after leaving hospital?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>I did not want or need any written or printed information</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q31.</p>
  </td>
  <td colspan="2">
  <p>Did a member of staff explain the purpose of the medicines you were to take at home and any side effects in a way you could understand?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, completely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>I did not need an explanation</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>I had no medicines</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q32.</p>
  </td>
  <td colspan="2">
  <p>Did a member of staff tell you about</p>
  <p>any danger signals you should watch for after you went home?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, completely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>It was not necessary</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q33.</p>
  </td>
  <td colspan="2">
  <p>Did hospital staff take your family or home situation into account when planning your discharge?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, completely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>It was not necessary</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don't know/can't remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q34.</p>
  </td>
  <td colspan="2">
  <p>Did hospital staff tell you who to contact if you were worried about your condition or treatment after you left hospital?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Don't know/can't remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q35.</p>
  </td>
  <td colspan="2">
  <p>Do you feel that you received enough information from the hospital on how to manage your condition after your discharge?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>I did not need help in managing my condition</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="48"><col width="566"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>Patient safety</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q36.</p>
  </td>
  <td colspan="2">
  <p>During this hospital stay, did you feel that there was good communication about your care and treatment between doctors, nurses and other hospital staff?</p>
  <p>(For example, did staff that were caring for you have all the information they needed about your care and treatment at all times)</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don't know/can't remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q37.</p>
  </td>
  <td colspan="2">
  <p>During this hospital stay, did you feel comfortable to speak out at any time about anything that you might wish to raise with hospital staff?</p>
  <p>(This may include raising a complaint or concern about any issues you had with your care.)</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Not relevant to my situation</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q38.</p>
  </td>
  <td colspan="2">
  <p>During this hospital stay, did you feel confident in the safety of your treatment and care?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="3">
  <p>A patient safety incident is an incident (an event or circumstance) that could have resulted, or did result, in unnecessary injury or harm to you or put you at risk of injury or harm.</p>
  <p>This could be anything from you being given the wrong medication, to you getting an infection after surgery.</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="290"><col width="287"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q39.</p>
  </td>
  <td colspan="3">
  <p>Did you experience any patient safety incident(s) during this hospital stay?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>
  <p>&rarr; GO TO Q40.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>
  <p>&rarr; GO TO Q41.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Don&rsquo;t know</p>
  </td>
  <td>
  <p>&rarr; GO TO Q41.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Can't remember</p>
  </td>
  <td>
  <p>&rarr; GO TO Q41.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q40.</p>
  </td>
  <td colspan="3">
  <p>What type of patient safety incident did you experience? (tick all that apply)</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td colspan="2">
  <p>Medication issue</p>
  <p>(for example, you were given the wrong medicine, wrong dose, another patient&rsquo;s medicine, or any other type of problem related to the medicines you were taking)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td colspan="2">
  <p>Healthcare associated infection</p>
  <p>(for example, you caught an infection while having treatment or being cared for, e.g. a wound)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td colspan="2">
  <p>Medical device or equipment issue</p>
  <p>(for example, lack of equipment or equipment failure)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td colspan="2">
  <p>Patient fall</p>
  <p>(for example, you slipped, tripped or fell while in hospital)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>5</p>
  </td>
  <td>
  <p>Patient accident</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>6</p>
  </td>
  <td colspan="2">
  <p>Other, please specify</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="76"><col width="109"><col width="51"><col width="102"><col width="101"><col width="102"><col width="31"><col width="31"><col width="31"><col width="30"><col width="51"></colgroup>
  <tbody>
  <tr>
  <td colspan="11">
  <p>Overall</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q41.</p>
  </td>
  <td colspan="10">
  <p>Overall, did you feel you were treated with respect and dignity while you were in the hospital?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td colspan="3">
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td colspan="4">
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q42.</p>
  </td>
  <td colspan="9">
  <p>Overall... (please circle a number)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="3">
  <p>I had a very poor experience</p>
  </td>
  <td colspan="3">
  <p>I had a very good experience</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>0</p>
  </td>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>8</p>
  </td>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>10&nbsp;</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q43.</p>
  </td>
  <td colspan="10">
  <p>Thinking about your overall care, if you wanted to give feedback or make a complaint, did you know how and where to do so?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td colspan="8">
  <p>I did not wish to give feedback or make a complaint</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="11">
  <p>About you</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q44.</p>
  </td>
  <td colspan="10">
  <p>Who was the main person or people who filled in this questionnaire?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td colspan="8">
  <p>The patient (named on the front of the envelope)</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td colspan="7">
  <p>The patient with the help of someone else</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td colspan="8">
  <p>A person acting on the patient&rsquo;s behalf</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="11">
  <p>Please keep in mind that all questions should be answered from the point of view of the person named on the envelope.</p>
  <p>This includes the following questions.</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q45.</p>
  </td>
  <td colspan="2"><br>
  <p>What was the main reason for your most recent stay in hospital? (Tick ONE box only)</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Tumour/cancer</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Heart condition</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Lung condition</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>Neurological condition (including stroke)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>5</p>
  </td>
  <td>
  <p>Orthopaedic condition (e.g. bone or joint issues)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>COVID-19</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>Infection (other than COVID-19)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>8</p>
  </td>
  <td>
  <p>Digestive system condition (including gallbladder and appendix issues)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>Diabetes and related problems</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>10</p>
  </td>
  <td>
  <p>Adverse reaction/poisoning</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>11</p>
  </td>
  <td>
  <p>Injury and or accident</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>12</p>
  </td>
  <td>
  <p>Mental health issue</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>13</p>
  </td>
  <td>
  <p>I was admitted for tests and/or investigations</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>14</p>
  </td>
  <td>
  <p>Don&rsquo;t know/I was not told</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>15</p>
  </td>
  <td>
  <p>Other, please specify</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="49"><col width="565"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q46.</p>
  </td>
  <td colspan="2">
  <p>What is your month and year of birth? (Please tick the month and write in the year)</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>January</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>February</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>March</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>April</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>May</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>June</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>July</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>8</p>
  </td>
  <td>
  <p>August</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>September</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>10</p>
  </td>
  <td>
  <p>October</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>11</p>
  </td>
  <td>
  <p>November</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>12</p>
  </td>
  <td>
  <p>December</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2"><br>
  <p>(Please write in)</p>
  <br>
  <p>e.g. 1 9 6 1</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>Y Y Y Y</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="91"><col width="523"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>We ask the next three questions because we would like to know if the people who responded to the survey represent all sections of our society.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q47.</p>
  </td>
  <td colspan="2"><br>
  <p>What is your ethnic or cultural background?</p>
  <p>(Tick ONE box only)</p>
  </td>
  </tr>
  <tr>
  <td colspan="2">
  <p>White:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Irish</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Irish Traveller</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Roma</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Any other White background</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>Black or Black Irish:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>African</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>Any other Black background</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>Asian or Asian Irish:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>Chinese</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>8</p>
  </td>
  <td>
  <p>Indian/Pakistani/Bangladeshi</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>Any other Asian background</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>Other, including mixed group/background:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>10</p>
  </td>
  <td>
  <p>Arab</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>11</p>
  </td>
  <td>
  <p>Mixed, write in description</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>12</p>
  </td>
  <td>
  <p>Other, write in description</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="559"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q48.</p>
  </td>
  <td colspan="2">
  <p>Do you currently have:</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>A medical card?</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Private health insurance?</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>Both a medical card and private health insurance?</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>Neither a medical card nor private health insurance?</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q49.</p>
  </td>
  <td colspan="2">
  <p>Do you have any of the following on a long-term basis? Please tick all that apply</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Blindness or a serious vision impairment</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Deafness or a serious hearing impairment</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>3</p>
  </td>
  <td>
  <p>A condition that substantially limits one or more basic physical activities</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>An intellectual disability</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>5</p>
  </td>
  <td>
  <p>Difficulty in learning, remembering or concentrating</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>6</p>
  </td>
  <td>
  <p>Mental health, psychological or emotional condition</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>7</p>
  </td>
  <td>
  <p>Difficulty in dressing, bathing or getting around inside the home</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>8</p>
  </td>
  <td>
  <p>Difficulty in going outside home alone</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>9</p>
  </td>
  <td>
  <p>Difficulty in working or attending school/college</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>10</p>
  </td>
  <td>
  <p>Difficulty in taking part in other activities</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>11</p>
  </td>
  <td>
  <p>Other disability, including chronic illness</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>12</p>
  </td>
  <td>
  <p>None of the above</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="77"><col width="537"></colgroup>
  <tbody>
  <tr>
  <td colspan="2">
  <p>Other Comments</p>
  </td>
  </tr>
  <tr>
  <td colspan="2"><br>
  <p>Thank you very much for taking part in this survey. Please feel free to tell us more about your hospital stay by answering the questions below. You can use the back page of the questionnaire if you need more space. Comments will be entered into a secure database after removing any information that could identify you.</p>
  <p>This anonymised feedback will be looked at by HIQA, the HSE and the Department of Health to try to understand and improve patients&rsquo; experiences in hospital. Other researchers may also analyse anonymised data from this survey in the future, after all personal information that could identify you has been removed. We will give examples of feedback in the final survey reports to provide a fuller understanding of patients&rsquo; experiences.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q50.</p>
  </td>
  <td>
  <p>Was there anything particularly good about your hospital care?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q51.</p>
  </td>
  <td><br>
  <p>Was there anything that could be improved?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q52.</p>
  </td>
  <td><br>
  <p>Any other comments or suggestions?</p>
  </td>
  </tr>
  <tr>
  <td colspan="2">
  <p>THANK YOU VERY MUCH FOR YOUR HELP!</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>Please check that you have answered all of the questions that apply to you.</p>
  <p>Please return this questionnaire in the Freepost envelope provided. No stamp is needed.</p>
  <p><br><br><br><br><br><br></p>
  <ol>
  <li>
  d) National Incident Report Form (NIRFForm)
  </li>
  </ol>
  <p><br><br></p>
  <p>Date issued: 26/11/2021</p>
  <p>&nbsp;</p>
  <p>NIMS record Number:</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="428"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Division (tick one only ✔)</p>
  <p>Acute Hospital Social Care</p>
  <p>Health and Wellbeing Primary Care</p>
  <p>Mental Health</p>
  <p>Ambulance Service</p>
  <p>National Corporate Services (staff only)</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>SECTION C: SERVICE USER DETAILS ONLY</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Healthcare Record No</p>
  <br>
  <p>Lead Clinician</p>
  <br>
  <p>This incident involved&hellip; (tick one only ✔)</p>
  <p>Neonatal Specialties Paediatric Specialties</p>
  <p>Adolescent Specialties Adult Specialties</p>
  <p>Older Person Specialties</p>
  <br>
  <p>E.g. Antenatal, Audiology,</p>
  <p>Incident Occurred under Radiotherapy, Intellectual Disability,</p>
  <p>(Service / Specialty) Psychology</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="306"><col width="308"></colgroup>
  <tbody>
  <tr>
  <td colspan="2">
  <p>SECTION D: STAFF MEMBER / AGENCY / PANEL STAFF /</p>
  <p>WORK PLACEMENT / VOLUNTEER DETAILS ONLY</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Category of</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>person</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Employee no.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Date absence</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>commenced</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>(if known)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Date returned to</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>work</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>(if known)</p>
  </td>
  <td>
  <p>Note: For employee incidents reportable to HSA that result in an</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>absence from duty for more than three consecutive days,</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>excluding the day of the accident, the date absence commenced</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Lost days</p>
  </td>
  <td>
  <p>and the date employee returned to work should be recorded on</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>the NIMS</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="603"></colgroup>
  <tbody>
  <tr>
  <td><br>
  <p>Who was involved&hellip;? (tick one only ✔)</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Service user &ndash; (Resident/Patient/Client) Go to section C Staff member &ndash; Go to section D</p>
  <p>Panel staff / Agency / Locum &ndash; Go to section D Member of the public-Proceed to section F Volunteer &ndash; Go to section D</p>
  <p>External Contractor &ndash; Go to section E</p>
  <p>Work Placement / Trainee &ndash; Go to section D</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>Incident: An event or circumstance which could have, or did lead to unintended and / or unnecessary harm. Please complete this form to the best of your knowledge at the time of reporting the incident.</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="243"><col width="107"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>SECTION B: PERSON AFFECTED DETAILS</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>First name</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Surname</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Date of birth</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Female</p>
  </td>
  <td>
  <p>Male</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="298"><col width="87"><col width="240"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>SECTION F: WHAT WAS THE OUTCOME AT THE TIME OF THE INCIDENT?</p>
  <ul>
  <li>
  Outcome Body Part Affected
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>Near Miss e.g. Nearly given wrong drug</p>
  </td>
  <td rowspan="4"><br><br>
  <p>Category 3</p>
  </td>
  <td rowspan="8"><br><br><br>
  <p>E.g. Arm, Spine, Lung, Other Physiological</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>No Injury e.g. Wrong drug given but no harm occurred</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Injury not requiring first aid</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Injury or illness, requiring first aid</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Injury requiring medical treatment</p>
  </td>
  <td>
  <p>Category 2</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Long-term disability / Incapacity (incl. psychosocial)</p>
  </td>
  <td rowspan="3"><br><br>
  <p>Category 1</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Permanent Incapacity (incl. Psychosocial)</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Death</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="172"><col width="190"><col width="143"><col width="131"></colgroup>
  <tbody>
  <tr>
  <td colspan="4">
  <p>SECTION G: TYPE OF INJURY (tick one only ✔)</p>
  </td>
  </tr>
  <tr>
  <td><br><br><br>
  <p>Birth Specific Injury (Baby)</p>
  </td>
  <td>
  <p>Apgar score &lt;5@ 1 min &amp;/or;</p>
  <p>7@5mins &amp;/or pH &le; 7.0 Aspiration</p>
  <p>Cerebral irritability / neonatal seizure</p>
  <p>HIE - Hypoxic Ischaemic Encephalopathy with Hypoglycaemia</p>
  <p>HIE Grade 1 - Hypoxic Ischaemic Encephalopathy</p>
  </td>
  <td>
  <p>HIE Grade 2 - Hypoxic Ischaemic Encephalopathy</p>
  <p>HIE Grade 3 - Hypoxic Ischaemic Encephalopathy</p>
  <p>Hypoglycaemia - severe Kernicterus</p>
  <p>Neonatal death</p>
  <p>Nerve Injury - brachial plexus (incl.</p>
  <p>Erbs Palsy)</p>
  </td>
  <td>
  <p>Nerve Injury - face</p>
  <p>Other unexpected deterioration Stillbirth</p>
  <p>Sub-galeal / sub-aponeurotic haemorrhage</p>
  <p>Unknown</p>
  <p>Other&nbsp;&nbsp;</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Birth Specific Injury (Mother)</p>
  </td>
  <td>
  <p>Death</p>
  <p>Hysterectomy (Perinatal) Incontinence (faecal)</p>
  <p>Incontinence (urinary)</p>
  </td>
  <td>
  <p>Perineal tear</p>
  <p>Post-Partum Haemorrhage Rhesus iso-immunisation</p>
  <p>Incontinence (faecal &amp; urinary)</p>
  </td>
  <td>
  <p>Unknown</p>
  <p>Uterine rupture</p>
  <p>Other&nbsp;&nbsp;</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Blood Specific Injury</p>
  </td>
  <td>
  <p>Excessive Bleeding Fainting</p>
  <p>Immunological haemolysis</p>
  </td>
  <td>
  <p>Febrile non-haemolytic transfusion reaction</p>
  </td>
  <td>
  <p>Non-immunological haemolysis Other&nbsp;&nbsp;</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Diagnosed Disease Disorder or Cond.</p>
  </td>
  <td>
  <p>Asbestosis Cancer</p>
  <p>Acute Radiation Syndrome Narcolepsy/Cateplexy</p>
  </td>
  <td>
  <p>Hepatitis HIV</p>
  <p>Brucellosis Legionnaires</p>
  </td>
  <td>
  <p>Unknown Dermatitis TB</p>
  <p>Pleural Plaques</p>
  <p>Other&nbsp;&nbsp;</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Diagnosed Infection</p>
  </td>
  <td>
  <p>Clostridium Difficle COVID-19</p>
  <p>CPE ESBL</p>
  </td>
  <td>
  <p>Hepatitis MRSA</p>
  <p>Norovirus Unknown</p>
  </td>
  <td>
  <p>VRE VRSA</p>
  <p>Other&nbsp;&nbsp;</p>
  </td>
  </tr>
  <tr>
  <td><br><br><br>
  <p>General Injuries</p>
  </td>
  <td>
  <p>Allergic Reaction (incl. anaphylaxis) Brain Injury / Concussion</p>
  <p>Burn / scald / corrosion Choking / asphyxia</p>
  <p>Circulatory / volume depletion</p>
  <p>Circulatory / volume overload Pain/Discomfort</p>
  </td>
  <td>
  <p>Cut / Laceration / Graze / scratch Death</p>
  <p>Dental injury &amp;/or loss Deterioration</p>
  <p>Haemorrhage Blister</p>
  </td>
  <td>
  <p>Malaise / Nausea</p>
  <p>Nerve injury / Loss of Function Puncture / bite</p>
  <p>Rash / irritation Unknown</p>
  <p>Other&nbsp;&nbsp;</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Hearing / Sight Injury</p>
  </td>
  <td>
  <p>Hearing Impairment / loss Sight Impairment / loss</p>
  </td>
  <td>
  <p>Tinnitus Unknown</p>
  </td>
  <td>
  <p>Other&nbsp;&nbsp;</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Misdiagnosis</p>
  </td>
  <td>
  <p>Cancer Fracture</p>
  </td>
  <td>
  <p>Infection Unknown</p>
  </td>
  <td>
  <p>Other&nbsp;&nbsp;</p>
  </td>
  </tr>
  <tr>
  <td rowspan="2"><br><br><br>
  <p>Musculoskeletal</p>
  <p>/ Soft Tissue</p>
  </td>
  <td>
  <p>Amputation Bruising</p>
  <p>Crushing</p>
  <p>Dental Fracture / Tooth loss Dislocation</p>
  </td>
  <td>
  <p>Fracture</p>
  <p>Repetitive Strain Injury (RSI) Slipped / Prolapsed Disc</p>
  <p>Sprain / Strain Soft tissue injury</p>
  </td>
  <td>
  <p>Swelling / Inflammation Unknown</p>
  <p>Whiplash</p>
  <p>Other&nbsp;&nbsp;</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>P. Ulcer Stage 1: Intact skin with non-blanchable redness over bony prominence</p>
  <p>P. Ulcer Stage 2: Part thickness dermis loss: blister/open ulcer/no slough</p>
  <p>P. Ulcer Stage 3: Full thickness tissue loss: +/- visible subcutaneous fat</p>
  <p>P. Ulcer Stage 4: Full thickness tissue loss/necrosis: exposed bone/tendon/muscle</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Personal Loss</p>
  </td>
  <td>
  <p>Additional / Further Surgery Limb Deformity</p>
  <p>Defamation of Character</p>
  </td>
  <td>
  <p>Loss of Wages / Income / Business</p>
  <p>Loss of Consortium</p>
  </td>
  <td>
  <p>Unknown</p>
  <p>Organ Retention</p>
  <p>Other&nbsp;&nbsp;</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Surgery Specific Injury</p>
  </td>
  <td>
  <p>Damage to organ / body part Dental Damage / Loss Retained foreign object</p>
  <p>Unknown</p>
  </td>
  <td>
  <p>Loss of organ / body part Nerve injury / Loss of Function</p>
  <p>Inadequate anaesthesia</p>
  </td>
  <td>
  <p>Unexpected complication/ deterioration</p>
  <br>
  <p>&nbsp;&nbsp;Other</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Traumatic/Emotional</p>
  </td>
  <td>
  <p>Anxiety / Trauma PTSD</p>
  </td>
  <td>
  <p>Stress</p>
  <p>Unknown</p>
  </td>
  <td>
  <p>Worried Well</p>
  <p>Other&nbsp;&nbsp;</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="68"><col width="131"><col width="163"><col width="168"><col width="196"></colgroup>
  <tbody>
  <tr>
  <td colspan="5">
  <p>SECTION H WHAT TYPE OF HAZARD DID THIS INCIDENT RELATE TO? (Tick one option from Steps 1, 2, 3 &amp; 4)</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Step 1.</p>
  </td>
  <td>
  <p>Step 2.</p>
  </td>
  <td>
  <p>Step 3.</p>
  </td>
  <td>
  <p>Step 4.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td rowspan="5">
  <p>Clinical Care</p>
  </td>
  <td>
  <p>Diagnosis</p>
  </td>
  <td>
  <p>Diagnosis Type</p>
  <p>Delayed Diagnosis</p>
  <p>Misdiagnosis/Incorrect Diagnosis Missed Diagnosis</p>
  </td>
  <td>
  <p>Care process</p>
  <p>Assessment/Monitoring Tests/Investigations</p>
  <p>Test Interpretation</p>
  </td>
  <td>
  <p>Incomplete/inadequate:</p>
  <p>Communication Consent</p>
  <p>Documentation Equipment</p>
  <p>Unknown/other</p>
  <p>Lack of availability</p>
  <p>Not performed when indicated/Delayed</p>
  <p>Other adverse event/Patient safety incident</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Care Management</p>
  </td>
  <td><br>
  <p>Stage of Care</p>
  <p>Community</p>
  <p>Outpatient/ED Inpatient</p>
  </td>
  <td><br>
  <p>Care process</p>
  <p>Assessment/Monitoring Tests/Investigations</p>
  <p>Treatment/Intervention</p>
  </td>
  <td>
  <p>Incomplete/inadequate:</p>
  <p>Communication Consent</p>
  <p>Documentation Equipment</p>
  <p>Unknown/other</p>
  <p>Lack of availability</p>
  <p>Not performed when indicated/Delayed Pre-existing medical condition</p>
  <p>Retained foreign object Wrong body part/site/side Wrong patient</p>
  <p>Wrong process/treatment/procedure</p>
  <p>Other adverse event/Patient safety incident</p>
  </td>
  </tr>
  <tr>
  <td rowspan="2"><br>
  <p>Surgical/Medical Procedures</p>
  </td>
  <td>
  <p>Stage of Care</p>
  <p>Pre Procedure Intra Procedure Post Procedure</p>
  </td>
  <td><br>
  <p>Care process</p>
  <p>Assessment/Monitoring Tests/Investigations</p>
  <p>Treatment/Intervention</p>
  </td>
  <td rowspan="2">
  <p>Incomplete/inadequate:</p>
  <p>Communication Consent</p>
  <p>Documentation Equipment</p>
  <p>Unknown/other</p>
  <p>Lack of availability</p>
  <p>Not performed when indicated/Delayed Retained foreign object</p>
  <p>Wrong body part/site/side Wrong patient</p>
  <p>Wrong process/treatment/procedure</p>
  <p>Other adverse event/Patient safety incident</p>
  </td>
  </tr>
  <tr>
  <td colspan="2">
  <p>Name of Initial Procedure</p>
  <br>
  <p>e.g. cannulation, colonoscopy</p>
  <br>
  <p>Name of Subsequent Procedure (e.g if required return to theatre)</p>
  <br>
  <p>e.g. EUA, hysterectomy</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Labour/Delivery</p>
  </td>
  <td><br>
  <p>Delivery type</p>
  <p>Caesarean Section (Elective)</p>
  <p>Caesarean Section (Emergency) Instrumental Delivery (Forceps) Instrumental Delivery (Vacuum/</p>
  <p>Ventuse/Kiwi)</p>
  <p>Instrumental Delivery (Multiple Instruments)</p>
  <p>Non Instrumental Delivery</p>
  </td>
  <td><br>
  <p>Care process</p>
  <p>Assessment/Monitoring Tests/Investigations</p>
  <p>Treatment/Intervention</p>
  </td>
  <td><br>
  <p>Adverse event:</p>
  <p>Cord Prolapse Eclampsia</p>
  <p>Low Apgars/Cord PH Placental Abruption PPH</p>
  <p>Shoulder Dystocia Uterine Rupture Other</p>
  <p>Adverse event requiring transfer/ return to theatre:</p>
  <p>Cord Prolapse Eclampsia</p>
  <p>Low Apgars/Cord PH Placental Abruption PPH</p>
  <p>Shoulder Dystocia Uterine Rupture</p>
  <p>Other</p>
  <p>Incomplete/inadequate:</p>
  <p>Communication Consent</p>
  <p>Documentation Equipment Unknown/other</p>
  <p>Lack of availability</p>
  <p>Not performed when indicated/Delayed Retained foreign object</p>
  <p>Wrong process/treatment/procedure</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="76"><col width="100"><col width="108"><col width="108"><col width="141"><col width="105"><col width="93"></colgroup>
  <tbody>
  <tr>
  <td colspan="5">
  <p>SECTION H WHAT TYPE OF HAZARD DID THIS INCIDENT RELATE TO? (Tick one option from Steps 1, 2, 3 &amp; 4)</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Step 1.</p>
  </td>
  <td>
  <p>Step 2.</p>
  </td>
  <td>
  <p>Step 3.</p>
  </td>
  <td>
  <p>Step 4.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td rowspan="25">
  <p>Clinical Care</p>
  </td>
  <td rowspan="7">
  <p>Route of administration</p>
  <p>Oral</p>
  <p>Intravenous</p>
  <p>Sub Cutaneous Intra Muscular Topical</p>
  <p>Rectal</p>
  <p>Inhalation</p>
  <p>Other / Unknown</p>
  </td>
  <td><br>
  <p>Administration Monitoring</p>
  </td>
  <td>
  <p>Adverse Drug Reaction Contra-indicated</p>
  <p>Drug Interaction</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Ordering / Supply / Transport</p>
  </td>
  <td>
  <p>Failure / Malfunction of equipment</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Preparation / Dispensing</p>
  </td>
  <td>
  <p>Incomplete / Inadequate</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>(Pharmacy)</p>
  </td>
  <td>
  <p>Not preformed when indicated /</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Prescribing</p>
  </td>
  <td>
  <p>delayed</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Medication</p>
  </td>
  <td>
  <p>Reconciliation</p>
  <p>Storage</p>
  </td>
  <td>
  <p>Omitted/Delayed Dose</p>
  <p>Wrong Dose / Strength</p>
  </td>
  </tr>
  <tr>
  <td rowspan="2">
  <p>Wrong Drug</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>What medication was involved?</p>
  </td>
  <td>
  <p>Wrong Formulation / Route</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Wrong Frequency</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>Medication One</p>
  </td>
  <td>
  <p>Wrong Label / Instructions</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Wrong Patient</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>Medication Two</p>
  </td>
  <td>
  <p>Wrong Quantity / Duration</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td rowspan="5">
  <p>Parenteral Enteral</p>
  <p>Special Diet General Diet</p>
  <p>Other&nbsp;&nbsp;</p>
  </td>
  <td>&nbsp;</td>
  <td>
  <p>Communication / Consent</p>
  </td>
  <td>
  <p>Adverse Effect</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Prescribing / Requesting</p>
  </td>
  <td>
  <p>Incomplete / Inadequate</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Nutrition</p>
  </td>
  <td>
  <p>Preparation / Dispensing</p>
  </td>
  <td>
  <p>Not performed when indicated / Delay</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Administration</p>
  </td>
  <td>
  <p>Wrong Consistency</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td rowspan="2">
  <p>Storage</p>
  </td>
  <td rowspan="2">
  <p>Wrong Diet / Wrong Blood Product</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>Blood / Blood Product</p>
  </td>
  <td>
  <p>Whole Blood Red Cells</p>
  <p>Platelet (Apheresis) Platelets (Pooled)</p>
  <p>Other&nbsp;&nbsp;</p>
  </td>
  <td>
  <p>Documentation / Records</p>
  <p>Equipment</p>
  <p>Supply / Ordering / Transport Presentation / Packaging</p>
  <p>Transfusing blood</p>
  <p>Other</p>
  </td>
  <td>
  <p>Wrong Process / Treatment / Procedure</p>
  <p>Wrong Patient</p>
  <p>Lack of Availability</p>
  <p>Wrong dispensing label / instructions</p>
  <p>Inappropriate for task / Wrong device Other</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Diagnostic Exposure &gt; intended</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td rowspan="3"><br>
  <p>Diagnostic Radiology (DR) &amp; Nuclear Medicine (NM)</p>
  </td>
  <td rowspan="4">
  <p>Checking Patient ID procedure</p>
  <p>Clinical Details on Referral</p>
  <p>Communication / Consent</p>
  <p>Documentation / Records</p>
  <p>Equipment</p>
  <p>Performing procedure Pregnancy Status</p>
  <p>Unknown</p>
  </td>
  <td>
  <p>X-ray Over Exposure</p>
  <p>Wrong body part / side Dose to comforters / carers</p>
  </td>
  <td>
  <p>Above Notifiable levels</p>
  <p>Below Notifiable levels</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Wrong Patient Inadvertent dose to foetus</p>
  </td>
  <td>
  <p>&lt;1mSv</p>
  <p>&gt;1mSv</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Total dose or Volume Variation Dose (NM) or Volume Variation</p>
  <p>(1 fraction)</p>
  </td>
  <td>
  <p>&lt;10%</p>
  <p>10-20%</p>
  <p>&gt;20%</p>
  </td>
  </tr>
  <tr>
  <td><br><br>
  <p>Radiotherapy</p>
  </td>
  <td>
  <p>Wrong Drug Wrong Dose</p>
  <p>Wrong Process / Treatment / Intervention</p>
  <p>Failure / Malfunction Inadvertent deterministic effects</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td rowspan="6">
  <p>Bio Hazards</p>
  </td>
  <td rowspan="6"><br><br><br><br>
  <p>Please specify, if known:</p>
  <br><br><br>
  <p>E.g. COVID-19; MRSA etc.</p>
  </td>
  <td>
  <p>Exposure to Bite (Human)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Exposure to Bite (Insect / Animal)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Exposure to Bodily Fluids</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Biological Hazards / Acquired Infections</p>
  </td>
  <td>
  <p>Bacteria</p>
  <p>Fungus / Mould Prion</p>
  <p>Virus</p>
  <p>Organism Unknown</p>
  </td>
  <td>
  <p>Exposure to Ingestion/Food/Water</p>
  <p>Exposure to Needle Stick Exposure to Skin Contact Inhalation/Airborne</p>
  <p>Equipment, Implements, Facilities,</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Sharps (Non Needle)</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Unknown</p>
  <p>Other&nbsp;&nbsp;</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="101"><col width="181"><col width="116"><col width="238"></colgroup>
  <tbody>
  <tr>
  <td colspan="4">
  <p>SECTION H CNTD: WHAT TYPE OF HAZARD DID THIS INCIDENT RELATE TO? (Tick one option from Steps 1, 2 &amp; 3)</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Step 1.</p>
  </td>
  <td>
  <p>Step 2.</p>
  </td>
  <td>
  <p>Step 3.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td rowspan="14">
  <p>Behavioural Hazards</p>
  </td>
  <td>
  <p>Absconsion / Missing</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Attempted Suicide</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Banging Self Against Walls/Furniture/Surfaces</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Hitting Body/Slap/Punch Self incl. Scratching &amp;</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Picking</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Self-Injurious</p>
  </td>
  <td>
  <p>Intentional</p>
  </td>
  <td>
  <p>Inappropriate Eating</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Behaviour</p>
  </td>
  <td>
  <p>Unintentional</p>
  </td>
  <td>
  <p>Inappropriate Touching</p>
  <p>Self-Harm</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Stripping Clothes in Public Area</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Suicide</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Throwing objects</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Other&nbsp;&nbsp;</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>Violence, Harassment and Aggression</p>
  </td>
  <td rowspan="3"><br><br><br>
  <p>By a Family Member / Relative By a Member of the Public</p>
  <p>By a Peer / Student By a Prisoner</p>
  <p>By a Service User By a Staff Member</p>
  <br><br>
  <p>Please specify name of instigator</p>
  </td>
  <td rowspan="3">
  <p>Aggressive towards inanimate object Discrimination/Prejudice/Racial Intimidation / Threat</p>
  <p>Neglect</p>
  <p>Non-Compliant / Obstructive / Rude</p>
  <p>Direct Physical Assault Physical Harassment Sexual Assault / Abuse Sexual Harassment</p>
  <p>Unintentional Aggressive Behaviour Bullying</p>
  <p>Verbal Assault / Abuse Verbal Harassment</p>
  <p>Other</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Child Abuse</p>
  </td>
  </tr>
  <tr>
  <td><br><br>
  <p>Adult Abuse</p>
  </td>
  </tr>
  <tr>
  <td rowspan="10">
  <p>Physical Hazards</p>
  </td>
  <td><br><br><br><br><br>
  <p>Slip / Trip / Fall</p>
  </td>
  <td><br><br><br>
  <p>From Height</p>
  <p>From Equipment / Furniture Same Level / Ground</p>
  <p>On Stairs On Steps</p>
  <p>Other&nbsp;&nbsp;</p>
  </td>
  <td>
  <p>Unknown</p>
  <p>Pre Existing Medical Condition</p>
  <p>Inadequate supervision gen health / post op Obstruction / protruding object</p>
  <p>Surface contaminants</p>
  <p>Rough terrain / irregular surface Inappropriate equipment use</p>
  <p>Failure / malfunction of equipment Horseplay</p>
  <p>Physical training / sport Weather Condition</p>
  <p>Inadequate Lighting / design Other&nbsp;&nbsp;</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Non Mechanical</p>
  <p>(Incl. Person / Animal)</p>
  </td>
  <td>
  <p>Object / Tools (Non Sharps) Sharps (Non Needle)</p>
  <p>Other Person</p>
  </td>
  <td rowspan="3"><br>
  <p>Human Use / Error</p>
  <p>Obstruction / Protruding Object Physical Training / Sport</p>
  <p>Defective Equipment</p>
  <p>Unsafe / Inappropriate system Unknown</p>
  <p>Task Load</p>
  <p>Working Environment</p>
  <p>Individual Capability</p>
  <p>Other&nbsp;&nbsp;</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Ergonomics</p>
  <p>(Incl. manual / people handling)</p>
  </td>
  <td>
  <p>Manual Handling Other</p>
  <p>Patient Handling</p>
  <p>Physical Intervention</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Mechanical Components</p>
  </td>
  <td>
  <p>Catering equipment Door / Gate / Barrier</p>
  <p>Healthcare Equipment</p>
  <p>Lifting Equipment / Accessories Office / Business equipment</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Temperature (Excluding Fire)</p>
  </td>
  <td>
  <p>Hot Cold</p>
  </td>
  <td>
  <p>Liquid / Food / Steam</p>
  <p>Equipment / Utensils Atmosphere / Environment</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Fire</p>
  </td>
  <td rowspan="5"><br><br>
  <p>Please Specify</p>
  </td>
  <td rowspan="5">
  <p>Defective Equipment Human Use / Error Unknown</p>
  <p>Unsafe System Explosion</p>
  <p>Exposure</p>
  <p>Electrical Wiring / installation</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Vibration</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Electrical</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Noise</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Radiation</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="92"><col width="136"><col width="168"><col width="129"><col width="121"></colgroup>
  <tbody>
  <tr>
  <td colspan="5">
  <p>SECTION H CNTD: WHAT TYPE OF HAZARD DID THIS INCIDENT RELATE TO? (Tick one option from Steps 1, 2, &amp; 3)</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Step 1.</p>
  </td>
  <td colspan="2">
  <p>Step 2.</p>
  </td>
  <td>
  <p>Step 3.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td rowspan="6">
  <p>Chemical Hazards</p>
  </td>
  <td><br><br>
  <p>Acid / Alkaline</p>
  </td>
  <td rowspan="6">
  <p>Animal Remedy Arsenic</p>
  <p>Asbestos Bleach</p>
  <p>Cadmium</p>
  <p>Carbon Dioxide</p>
  <p>Carbon Monoxide Chemical Fertilizer Crystalline Silica Detergent</p>
  <p>Diesel / Kerosene Disinfectant</p>
  <p>Drain / Oven Cleaner Drugs</p>
  <p>Fungicide</p>
  <p>Glue / Adhesive Grease</p>
  <p>Herbicide</p>
  <p>Hydrochloric Acid</p>
  </td>
  <td rowspan="6">
  <p>Insecticide Lead</p>
  <p>Metallic Dust</p>
  <p>Motor / Gear / Hydraulic Oil Natural Gas</p>
  <p>Organic Dust</p>
  <p>Paint / Paint Product Petrol</p>
  <p>Polish Radon</p>
  <p>Rodenticide Soap</p>
  <p>Sodium Hydroxide Solvents</p>
  <p>Spent / Used Oil Product Sulphuric Acid</p>
  <p>Wrong Patient Other</p>
  </td>
  <td rowspan="6"><br><br><br><br><br><br><br>
  <p>Lack of Supervision Unknown</p>
  <p>Human / User Error Unsafe System</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Agri Chemicals</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Gas</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Other Chemical Products</p>
  <p>Particulates</p>
  <p>Petroleum / Synthetic Oil Based Products</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Sanitation / Cleaning Chemicals</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Toxic Metals</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="242"><col width="372"></colgroup>
  <tbody>
  <tr>
  <td colspan="2">
  <p>SECTION J: REPORTED BY: person who discovers the incident and unless otherwise stated within the organization, this person is responsible for completing the NIRF.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>First name</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Surname</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Date notified</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Category of person</p>
  </td>
  <td><br>
  <p>E.g. Nurse, Catering Staff, Cleaner</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Local system</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>reference no.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Reporter Signature</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Date</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Contact Details</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="603"></colgroup>
  <tbody>
  <tr>
  <td colspan="2">
  <p>SECTION L: TO BE COMPLETED BY LINE/DEPARTMENT MANAGER (For entry on Incident Review screen on NIMS)</p>
  </td>
  </tr>
  <tr>
  <td colspan="2">
  <p>Has open disclosure happened? (tick one only ✔) Yes No</p>
  <br>
  <p>If No, please specify: &nbsp;</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>CATEGORY 1 INCIDENTS ONLY</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2"><br>
  <p>SAO Name [Block Capitals]: &nbsp; Date notified to SAO: SAO Email and Contact Details:</p>
  <br>
  <p>Is there a requirement to report this incident to any external</p>
  <p>regulators/agencies/insurers (other than the State Claims Agency)? Yes No</p>
  <br>
  <p>If Yes: Name regulator(s)/agency(ies) reported/notified to: Date Notified:</p>
  <br>
  <p>1</p>
  <p>2</p>
  <p>3</p>
  <br>
  <p>Line/Department Manager name [Block Capitals]: Title:</p>
  <br>
  <p>Signature of Line/Department Manager: Date:</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="512"><col width="69"><col width="44"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>SECTION M: TO BE COMPLETED BY QUALITY AND PATIENT SAFETY OFFICE (For entry on Incident Review screen on NIMS)</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Is this incident a Serious Reportable Event (SRE)? (tick one only ✔)</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>QPS Advisor Name [Block Capitals]:</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Signature of QPS Advisor:</p>
  </td>
  <td>
  <p>Date:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <ol>
  <li>
  e) National Maternity Bereavement Experience Survey (NMBES Questionnaire)
  </li>
  </ol>
  <p>MATERNITY BEREAVEMENT EXPERIENCE SURVEY</p>
  <p><br><br></p>
  <p>What is the survey about?</p>
  <p>The National Maternity Bereavement Experience Survey is the first national survey to ask women about their experience of bereavement care in Ireland&rsquo;s maternity units or hospitals. We appreciate how painful it may be to consider the answers to the questions in the survey, but your feedback will provide us with valuable information on the standard of maternity bereavement care in Ireland and help us to identify areas for improvement. If you had a partner or support person with you during your experience of pregnancy loss, there is an optional section in the questionnaire that asks about their experiences.</p>
  <p>Who should respond to this survey?</p>
  <p>This survey is aimed at women aged 16 or older who experienced a second trimester miscarriage from 14 weeks of pregnancy, the stillbirth of a baby or the early neonatal death of a baby, and who were admitted to one of Ireland&rsquo;s 19 maternity units or hospitals between 1 January 2019 to 31 December 2021. Your</p>
  <p>feedback will help to improve the safety and quality of Ireland&rsquo;s maternity bereavement services.</p>
  <p>Can I ask someone to help me fill in the survey?</p>
  <p>Yes, you can ask someone to help you fill in the survey. You may also ask someone to fill in the survey on your behalf. However, please make sure that the answers given reflect your experience of care.</p>
  <p>How to complete the survey questionnaire</p>
  <ul>
  <li>
  Please read the information in the boxes that accompany some of the questions as these provide important information to help you complete the questionnaire.
  </li>
  </ul>
  <ul>
  <li>
  We have included free-text boxes towards the end of the questionnaire to provide you with an opportunity to include additional information in your own words about anything you feel is not covered or adequately included in the survey questions. Please tell us as much or as little as you like.
  </li>
  </ul>
  <ul>
  <li>
  Some questions may not be relevant to your experience. The survey includes instructions to skip past questions if they are not relevant to you.
  </li>
  <li>
  If you experienced more than one second trimester miscarriage, stillbirth or early neonatal death between 1 January 2019 and 31 December 2021, and you wish to complete a questionnaire for each of these losses please contact us at 1800 314 093.
  </li>
  <li>
  Please do not type your name or address anywhere on the questionnaire.
  </li>
  </ul>
  <ul>
  <li>
  The survey takes approximately 30 to 40 minutes to complete.
  </li>
  </ul>
  <p><br><br><br><br><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="79"><col width="535"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>1. Opening questions</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>The following section asks about your background and overall details of your pregnancy loss. This will help us to describe the participants in the survey.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q1.</p>
  </td>
  <td colspan="2">
  <p>What is your age?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Under 25 years</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>25 to 29 years</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>30 to 34 years</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>35 to 39 years</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>40 years or over</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q2.</p>
  </td>
  <td colspan="2">
  <p>What is your ethnic group?</p>
  </td>
  </tr>
  <tr>
  <td colspan="2">
  <p>White:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Irish</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Irish Traveller</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Roma</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Any other white background</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>Black or Black Irish:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>African</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>Any other black background</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>Asian or Asian Irish:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>Chinese</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>8</p>
  </td>
  <td>
  <p>Indian/Pakistani/Bangladeshi</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>Another Asian background</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>Other, including mixed group/ background:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>10</p>
  </td>
  <td>
  <p>Arabian</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>11</p>
  </td>
  <td>
  <p>Mixed, please specify</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>12</p>
  </td>
  <td>
  <p>Other, please write your ethnic group here:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="39"><col width="575"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q3.</p>
  </td>
  <td colspan="2">
  <p>What type of pregnancy loss did you</p>
  <p>experience?</p>
  </td>
  </tr>
  <tr>
  <td><br><br><br><br>
  <p>1</p>
  </td>
  <td>
  <p>Second trimester miscarriage (a miscarriage that happens when a baby has died between 14 - 24 weeks of pregnancy)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br><br><br>
  <p>2</p>
  </td>
  <td>
  <p>A stillbirth (baby born after 24 weeks of pregnancy or greater than or equal to 500g, showing no signs of life)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br><br>
  <p>3</p>
  </td>
  <td>
  <p>Early neonatal death (baby born alive but died within first seven days of life)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>Other (please explain):</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q4.</p>
  </td>
  <td colspan="2">
  <p>Did you experience the loss of more than one baby?</p>
  </td>
  </tr>
  <tr>
  <td><br><br>
  <p>1</p>
  </td>
  <td>
  <p>No, this was a pregnancy with one baby</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>2</p>
  </td>
  <td>
  <p>No, this was a twin pregnancy, but one twin died</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>3</p>
  </td>
  <td>
  <p>Yes, this was a twin pregnancy, both twins died</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>4</p>
  </td>
  <td>
  <p>Yes, I had triplets or more, and more than one died</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="49"><col width="337"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q5.</p>
  </td>
  <td colspan="2">
  <p>In what month and year was your baby</p>
  <p>born (please tick the month and write the year)</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>January</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>February</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>March</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>April</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>5</p>
  </td>
  <td>
  <p>May</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>6</p>
  </td>
  <td>
  <p>June</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>7</p>
  </td>
  <td>
  <p>July</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>8</p>
  </td>
  <td>
  <p>August</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>9</p>
  </td>
  <td>
  <p>September</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>10</p>
  </td>
  <td>
  <p>October</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>11</p>
  </td>
  <td>
  <p>November</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>12</p>
  </td>
  <td>
  <p>December</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>(Please write in)</p>
  <p>e.g. 2 0 2 0</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>Y Y Y Y</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="328"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q6.</p>
  </td>
  <td colspan="2">
  <p>In which hospital was your baby born?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>University Hospital Galway</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Letterkenny University Hospital</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>Mayo University Hospital</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>Portiuncula University Hospital</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>5</p>
  </td>
  <td>
  <p>Sligo University Hospital</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>6</p>
  </td>
  <td>
  <p>University Maternity Hospital Limerick</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>7</p>
  </td>
  <td>
  <p>National Maternity Hospital</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>8</p>
  </td>
  <td>
  <p>Midland Regional Hospital Mullingar</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>9</p>
  </td>
  <td>
  <p>St Lukes General Hospital</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>10</p>
  </td>
  <td>
  <p>Wexford General Hospital</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>11</p>
  </td>
  <td>
  <p>Coombe Women and Infants University Hospital</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>12</p>
  </td>
  <td>
  <p>Midland Regional Hospital Portlaoise</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>13</p>
  </td>
  <td>
  <p>Rotunda Hospital</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>14</p>
  </td>
  <td>
  <p>Our Lady of Lourdes Hospital</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>15</p>
  </td>
  <td>
  <p>Cavan General Hospital</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>16</p>
  </td>
  <td>
  <p>Cork University Maternity Hospital</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>17</p>
  </td>
  <td>
  <p>University Hospital Waterford</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>18</p>
  </td>
  <td>
  <p>South Tipperary General Hospital</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>19</p>
  </td>
  <td>
  <p>University Hospital Kerry</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>20</p>
  </td>
  <td>
  <p>None of the above</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="30"><col width="205"><col width="249"><col width="247"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q7.</p>
  </td>
  <td colspan="4">
  <p>When did you first find out that your</p>
  <p>baby had died?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td colspan="3">
  <p>During pregnancy, before labour</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td colspan="3">
  <p>My baby died during labour</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>3</p>
  </td>
  <td colspan="3">
  <p>After delivery in the neonatal period</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td colspan="3">
  <p>Don't know or can't remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q8.</p>
  </td>
  <td colspan="4">
  <p>Who&rsquo;s filling in this questionnaire? (This information will help us direct you to the correct section of the survey)</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td colspan="3">
  <p>The baby&rsquo;s mother alone</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>2</p>
  </td>
  <td colspan="3">
  <p>The baby&rsquo;s mother and her partner or support person together</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br><br><br>
  <p>3</p>
  </td>
  <td colspan="2">
  <p>Partner or support person alone</p>
  </td>
  <td>
  <p>🡪 SKIP TO Q91, STAGE 13.</p>
  <p>PARTNER OR SUPPORT PERSON</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q9.</p>
  </td>
  <td colspan="4">
  <p>During your pregnancy, were you informed that your baby had a medical condition, which meant that they could die before or after they were born, or that your baby had no heartbeat?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td colspan="2">
  <p>🡪 SKIP TO Q23, STAGE 4.</p>
  <p>LABOUR AND BIRTH</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>2. Communication and information at the time of diagnosis</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>The following section asks about your experience of care, communication and information at the</p>
  <p>time of your baby&rsquo;s or babies&rsquo; diagnosis.</p>
  <p>Diagnosis includes a medical condition, which meant that your baby or babies could die before or after they were born or that your baby had no heartbeat.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q10.</p>
  </td>
  <td colspan="2"><br>
  <p>During your pregnancy, if you expressed concerns about your baby to healthcare professionals, did you feel your concerns were taken seriously?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, completely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>Not applicable to my situation</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q11.</p>
  </td>
  <td colspan="2">
  <p>Were you in a suitable private place when you were first told of your baby&rsquo;s diagnosis?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q12.</p>
  </td>
  <td colspan="2">
  <p>If you wanted to, were you offered the</p>
  <p>opportunity to have someone with you other than hospital staff when you were told of your baby&rsquo;s diagnosis?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>3</p>
  </td>
  <td>
  <p>I did not want to have someone with me</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br><br>
  <p>4</p>
  </td>
  <td>
  <p>I was not able to have someone with me due to COVID-19 restrictions</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>5</p>
  </td>
  <td>
  <p>I was not able to have someone with me for other reasons</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q13.</p>
  </td>
  <td colspan="2">
  <p>Thinking about the way in which you were told of your baby&rsquo;s diagnosis, did you feel it was explained in a way that you could understand?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1□</p>
  </td>
  <td>
  <p>Yes, completely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2□</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3□</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q14.</p>
  </td>
  <td colspan="2">
  <p>Did you have an opportunity to ask questions about your baby&rsquo;s diagnosis?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>I did not have any questions</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q15.</p>
  </td>
  <td colspan="2">
  <p>Thinking about the way in which you were told of your baby&rsquo;s diagnosis, did healthcare professionals communicate with kindness and sensitivity?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q16.</p>
  </td>
  <td colspan="2">
  <p>Were you given written information</p>
  <p>about your baby&rsquo;s diagnosis?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q17.</p>
  </td>
  <td colspan="2">
  <p>Were you involved in the decisions made about the next steps in your care? (For example your treatment options, admission plan, birth plan, pain relief, postnatal care, etc.)</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>4</p>
  </td>
  <td>
  <p>It was not possible for me to be involved</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q18.</p>
  </td>
  <td colspan="2">
  <p>After receiving your baby&rsquo;s diagnosis, were you told who to contact if you had further questions or needed support?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q19.</p>
  </td>
  <td colspan="2">
  <p>After you were told about your baby&rsquo;s diagnosis, did healthcare professionals help to prepare you for what to expect next with your care? (admission to hospital, labour, birth, postnatal care)</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="54"><col width="387"><col width="184"></colgroup>
  <tbody>
  <tr>
  <td colspan="4">
  <p>3. Admission care</p>
  </td>
  </tr>
  <tr>
  <td colspan="4">
  <p>The following section asks about your experiences of care when you were admitted for induction of labour or delivery, after your baby was diagnosed with a medical condition, which meant that they could die before or after they were born, or that your baby had no heartbeat.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q20.</p>
  </td>
  <td colspan="3">
  <p>Was your admission to hospital planned and managed in a sensitive way?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td colspan="2">
  <p>My admission was not planned</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q21.</p>
  </td>
  <td colspan="3">
  <p>On your admission to hospital, which of the following best describes your accommodation where you spent most of your time? (tick all that apply)</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td colspan="2">
  <p>Single room (not shared)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Shared room</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Labour ward</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Antenatal ward</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Postnatal ward</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>General ward</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>Emergency ward</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>8</p>
  </td>
  <td>
  <p>I wasn't admitted overnight</p>
  </td>
  <td>
  <p>🡪 SKIP TO</p>
  <p>Q23.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>Other</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q22.</p>
  </td>
  <td colspan="3">
  <p>On your admission to hospital, did you feel your accommodation was sensitive to your needs?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Not applicable to my situation</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="3">
  <p>4. Labour and birth</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>The following section asks about the care you received during the labour and the birth of your baby.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q23.</p>
  </td>
  <td colspan="2"><br>
  <p>Were you accompanied by anyone other than healthcare professionals during the labour and birth of your baby? (tick all that apply)</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, by my partner</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>2</p>
  </td>
  <td>
  <p>Yes, by a support person (such as a family member, friend or doula)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No, I was alone</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>4</p>
  </td>
  <td>
  <p>I did not want to have someone with me</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br><br>
  <p>5</p>
  </td>
  <td>
  <p>I was not able to have someone with me due to COVID-19 restrictions</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>6</p>
  </td>
  <td>
  <p>I was not able to have someone with me for other reasons</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q24.</p>
  </td>
  <td colspan="2">
  <p>Thinking about the care you received during your labour and birth, did you feel that you were involved in decisions about your care?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>4</p>
  </td>
  <td>
  <p>It was not possible for me to be involved for medical reasons</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="465"><col width="113"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q25.</p>
  </td>
  <td colspan="3">
  <p>Did you have the opportunity to ask</p>
  <p>questions about your labour and birth?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td colspan="2">
  <p>No 🡪 SKIP TO Q27.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br><br>
  <p>4</p>
  </td>
  <td>
  <p>It was not possible for me to ask questions for medical reasons</p>
  </td>
  <td>
  <p>🡪 SKIP TO</p>
  <p>Q27.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>5</p>
  </td>
  <td>
  <p>I did not have any questions</p>
  </td>
  <td>
  <p>🡪 SKIP TO</p>
  <p>Q27.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q26.</p>
  </td>
  <td colspan="3">
  <p>Thinking about the care you received during your labour and birth, were your questions answered in a way that you could understand?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td colspan="2">
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q27.</p>
  </td>
  <td colspan="3">
  <p>Do you think your healthcare professionals did everything they could to help manage your pain during labour and birth?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>I did not need any help</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>5</p>
  </td>
  <td colspan="2">
  <p>Don't know or can't remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="48"><col width="361"><col width="217"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q28.</p>
  </td>
  <td colspan="3">
  <p>Thinking about the care you received during your labour and birth, did you feel that you were treated with respect and dignity?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td colspan="2">
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="4">
  <p>The following questions ask about the care you received if your baby died during labour or at the time of delivery. If this does not apply to you, please skip to Q33.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q29.</p>
  </td>
  <td colspan="3">
  <p>Were you in a suitable private place when you were first told that your baby had died?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td colspan="2">
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>4</p>
  </td>
  <td>
  <p>Not applicable to my situation</p>
  </td>
  <td>
  <p>🡪 SKIP TO Q33.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q30.</p>
  </td>
  <td colspan="3">
  <p>If you wanted to, were you offered the opportunity to have someone with you other than hospital staff when you were told that your baby had died?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td colspan="2">
  <p>I did not want to have someone with me</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br><br>
  <p>4</p>
  </td>
  <td colspan="2">
  <p>I was not able to have someone with me due to COVID-19 restrictions</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>5</p>
  </td>
  <td colspan="2">
  <p>I was not able to have someone with me for other reasons</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td colspan="2">
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q31.</p>
  </td>
  <td colspan="3">
  <p>Thinking about the way in which you were told that your baby had died, did you feel it was explained in a way that you could understand?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, completely</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="431"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q32.</p>
  </td>
  <td colspan="2">
  <p>Did healthcare professionals communicate with kindness and</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="73"><col width="302"></colgroup>
  <tbody>
  <tr>
  <td colspan="2">
  <p>sensitivity when you were told your baby had died?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="54"><col width="455"><col width="115"></colgroup>
  <tbody>
  <tr>
  <td colspan="4">
  <p>5. Care after birth and meeting your baby</p>
  </td>
  </tr>
  <tr>
  <td colspan="4">
  <p>The following section asks about when you met your baby for the first time after they were born.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q33.</p>
  </td>
  <td colspan="3">
  <p>Did healthcare professionals prepare you to see and meet your baby?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>4</p>
  </td>
  <td>
  <p>I chose not to see my baby</p>
  </td>
  <td>
  <p>🡪 SKIP TO</p>
  <p>Q37.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br><br>
  <p>5</p>
  </td>
  <td>
  <p>It was not possible for medical reasons to see my baby</p>
  </td>
  <td>
  <p>🡪 SKIP TO</p>
  <p>Q37.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q34.</p>
  </td>
  <td colspan="3">
  <p>Was your baby presented to you in a respectful and sensitive manner?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q35.</p>
  </td>
  <td colspan="3">
  <p>Were you given enough privacy when you met your baby?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="60"><col width="120"><col width="445"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q36.</p>
  </td>
  <td colspan="3">
  <p>Did you feel that you could spend as much time as you wanted with your baby?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td colspan="2">
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td colspan="2">
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br><br>
  <p>4</p>
  </td>
  <td colspan="2">
  <p>It was not possible for me to spend time with my baby for medical reasons</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="4">
  <p>6. Neonatal care</p>
  </td>
  </tr>
  <tr>
  <td colspan="4">
  <p>After birth, some babies need specialist care and are admitted or transferred to a neonatal unit (NNU). When referring to neonatal care the terms neonatal intensive care unit (NICU), or special care baby unit (SCBU) may also be used. The following section asks about your experience of care while your baby was in the NNU, NICU or SCBU.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q37.</p>
  </td>
  <td colspan="3">
  <p>Was your baby or one of your babies admitted to a neonatal unit?</p>
  <p>(NNU, NICU or SCBU)</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>
  <p>🡪 SKIP TO Q43.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q38.</p>
  </td>
  <td colspan="3">
  <p>Was your baby transferred from one hospital to another for specialised care in a neonatal unit? (NNU, NICU or SCBU)</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>
  <p>🡪 SKIP TO Q40.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q39.</p>
  </td>
  <td colspan="2">
  <p>Following your baby&rsquo;s transfer, were you admitted to the same hospital as your baby?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>No, I was discharged home</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>No, I was not transferred for other reasons</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q40.</p>
  </td>
  <td colspan="2">
  <p>While your baby was in the neonatal unit (NNU, NICU or SCBU), were you given the opportunity to ask questions about your baby's care?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>I did not have any questions</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q41.</p>
  </td>
  <td colspan="2">
  <p>While your baby was in the neonatal unit (NNU, NICU or SCBU), were you involved in decisions about your baby&rsquo;s care and treatment?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q42.</p>
  </td>
  <td colspan="2">
  <p>While your baby was in the neonatal unit, were you able to visit your baby as much as you wanted to?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>4</p>
  </td>
  <td>
  <p>No, I was not physically well enough</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="3">
  <p>7. Postnatal care</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>The following section asks about your postnatal maternity hospital or unit stay and care following the birth of your baby.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q43.</p>
  </td>
  <td colspan="2">
  <p>After your baby was born, which of the following best describes your postnatal accommodation? (tick all that apply)</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Single room (not shared)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br><br>
  <p>2</p>
  </td>
  <td>
  <p>Bereavement room (a specific family room designed to facilitate bereaved families)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>Shared room</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>Labour ward</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>5</p>
  </td>
  <td>
  <p>Antenatal ward</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>6</p>
  </td>
  <td>
  <p>Postnatal ward</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>7</p>
  </td>
  <td>
  <p>General ward</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>8</p>
  </td>
  <td>
  <p>Emergency ward</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>9</p>
  </td>
  <td>
  <p>I wasn't admitted overnight</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>10</p>
  </td>
  <td>
  <p>Other</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q44.</p>
  </td>
  <td colspan="2">
  <p>After your baby was born, was your postnatal accommodation sensitive to your needs?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q45.</p>
  </td>
  <td colspan="2">
  <p>While you were in hospital, were you given enough care and support with your physical recovery after the birth of your baby?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q46.</p>
  </td>
  <td colspan="2">
  <p>While you were in hospital, were you</p>
  <p>given information and support with breast care and lactation?</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>3</p>
  </td>
  <td>
  <p>No, but I would have liked this information</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>4</p>
  </td>
  <td>
  <p>No, but I did not need this information</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Not applicable to my situation</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q47.</p>
  </td>
  <td colspan="2">
  <p>Thinking about the care you received after the birth of your baby while you were in hospital, did you feel you were treated with respect and dignity?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>Q48.</p>
  </td>
  <td colspan="2"><br><br>
  <p>Thinking about the care you received after the birth of your baby while you were in hospital, did you feel you were treated with kindness and sensitivity?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q49.</p>
  </td>
  <td colspan="2">
  <p>Thinking about the care you received after the birth of your baby while you were in hospital, did you feel that your questions were answered in a way that you could understand?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>I did not have any questions</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="320"><col width="257"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td colspan="2">
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q50.</p>
  </td>
  <td colspan="3">
  <p>Thinking about the care you received after the birth of your baby while you were in hospital, did you feel that you were involved in decisions about your care?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td colspan="2">
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q51.</p>
  </td>
  <td colspan="3">
  <p>If you needed assistance while you were in hospital after the birth of your baby, were you able to get healthcare professionals to assist you when you needed it?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td colspan="2">
  <p>I did not need any assistance</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>5</p>
  </td>
  <td colspan="2">
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="4">
  <p>If your baby was born alive and subsequently died in the postnatal period, the following questions may be relevant to you.</p>
  <p>If not, please skip to Q54 (Stage 8. Bereavement care).</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q52.</p>
  </td>
  <td colspan="3"><br>
  <p>If your baby was born alive and subsequently died in the postnatal period, did your baby die:</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>At home</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>2</p>
  </td>
  <td>
  <p>In the Labour ward</p>
  </td>
  <td>
  <p>🡪 SKIP TO Q54.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>3</p>
  </td>
  <td>
  <p>In the Postnatal Ward</p>
  </td>
  <td>
  <p>🡪 SKIP TO Q54.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>4</p>
  </td>
  <td>
  <p>In the Neonatal Unit</p>
  </td>
  <td>
  <p>🡪 SKIP TO Q54.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="52"><col width="359"><col width="214"></colgroup>
  <tbody>
  <tr>
  <td><br><br>
  <p>5</p>
  </td>
  <td>
  <p>Other (please explain):</p>
  </td>
  <td>
  <p>🡪 SKIP TO Q54.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>6</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can't remember</p>
  </td>
  <td>
  <p>🡪 SKIP TO Q54.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q53.</p>
  </td>
  <td colspan="3">
  <p>Did you feel supported by healthcare professionals to take your baby home before they died?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, completely</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="4">
  <p>8. Bereavement care</p>
  </td>
  </tr>
  <tr>
  <td colspan="4">
  <p>The following section asks about your experience of maternity unit or hospital bereavement care and your time in hospital.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q54.</p>
  </td>
  <td colspan="3">
  <p>Were you offered the opportunity to&hellip;</p>
  <p>(tick all that apply)</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Name your baby</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td colspan="2">
  <p>Spend time with your baby</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Hold your baby</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Dress your baby</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Bath your baby</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td colspan="2">
  <p>Take a lock of your baby's hair</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>7</p>
  </td>
  <td colspan="2">
  <p>Have photos with your baby</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="400"><col width="177"></colgroup>
  <tbody>
  <tr>
  <td><br>
  <p>8</p>
  </td>
  <td colspan="2">
  <p>Have a copy of your baby's hand</p>
  <p>print or foot print</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>9</p>
  </td>
  <td colspan="2">
  <p>Have a naming or blessing ritual or ceremony</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>10</p>
  </td>
  <td>
  <p>Create a memory box</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>11</p>
  </td>
  <td colspan="2">
  <p>Use a Bereavement alert symbol</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>12</p>
  </td>
  <td>
  <p>I was not offered any of these</p>
  </td>
  <td>
  <p>🡪 SKIP TO</p>
  <p>Q57.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>13</p>
  </td>
  <td>
  <p>I did not want any of these</p>
  </td>
  <td>
  <p>🡪 SKIP TO</p>
  <p>Q57.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q55.</p>
  </td>
  <td colspan="3">
  <p>Were the keepsakes and activities of making mementoes helpful in creating positive memories of your baby?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q56.</p>
  </td>
  <td colspan="3">
  <p>If you gave your baby a name, did hospital staff refer to them by name?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td colspan="2">
  <p>I did not give my baby a name</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q57.</p>
  </td>
  <td colspan="3">
  <p>Were your family or friends offered the opportunity to meet your baby?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td colspan="2">
  <p>No, but I would have liked them to</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td colspan="2">
  <p>No, I did not want them to</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>4</p>
  </td>
  <td colspan="2">
  <p>Family and friends were not able to visit due to COVID-19 restrictions</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>5</p>
  </td>
  <td colspan="2">
  <p>Family and friends were not able to visit for other reasons</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q58.</p>
  </td>
  <td colspan="3">
  <p>Did hospital staff explain the procedures and options in relation to a funeral, cremation or other services to you?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="51"><col width="40"><col width="163"><col width="95"></colgroup>
  <tbody>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br>
  <p>4 </p>
  </td>
  <td>
  <p>I did not want or need this information</p>
  </td>
  <td>
  <p>🡪 SKIP TO</p>
  <p>Q61.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q59.</p>
  </td>
  <td colspan="3">
  <p>Were you given enough information and support for arranging a funeral (or other service or ceremony) for your baby?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, completely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="51"><col width="40"><col width="249"></colgroup>
  <tbody>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>4 </p>
  </td>
  <td>
  <p>I did not want or need this</p>
  <p>information</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q60.</p>
  </td>
  <td colspan="2">
  <p>If you wanted to, were you facilitated or supported to take your baby home prior to a funeral or cremation service?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, completely</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br>
  <p>4 </p>
  </td>
  <td>
  <p>I did not wish to take my baby home</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong><br><br></strong></p>
  <p>Q63. Were you given the opportunity to see and hold your baby after the post- mortem examination?</p>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="52"><col width="40"><col width="158"><col width="91"><col width="10"></colgroup>
  <tbody>
  <tr>
  <td colspan="4">
  <p>9. Post-mortem examination and investigations</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="4">&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="4">
  <p>The following section asks about your experience of care if your baby had a post-mortem examination.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q61.</p>
  </td>
  <td colspan="3">
  <p>Did your baby have a post‐mortem examination?</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>1 </p>
  </td>
  <td colspan="2">
  <p>Yes, a consented post-mortem</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td colspan="2">
  <p>Yes, a coroners post-mortem</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br>
  <p>3 </p>
  </td>
  <td>
  <p>No, I declined a post- mortem examination</p>
  </td>
  <td>
  <p>🡪 SKIP TO</p>
  <p>Q67.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br><br>
  <p>4 </p>
  </td>
  <td>
  <p>No, I was not offered a post-mortem examination</p>
  </td>
  <td>
  <p>🡪 SKIP TO</p>
  <p>Q67.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q62.</p>
  </td>
  <td colspan="3">
  <p>Were the post-mortem examination process and the timelines for results clearly explained to you?</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, completely</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>4 </p>
  </td>
  <td colspan="2">
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>1  Yes</p>
  <p>2  No 🡪 SKIP TO Q65.</p>
  <p>I didn&rsquo;t wish to see</p>
  <p>3 </p>
  <p>and hold my baby</p>
  <p>It wasn&rsquo;t possible to</p>
  <p>4 </p>
  <p>see and hold my baby</p>
  <p>🡪 SKIP TOQ65.</p>
  <p>🡪 SKIP TOQ65.</p>
  <p><strong>&nbsp;</strong></p>
  <p>&nbsp;</p>
  <p>Q64. Did healthcare professionals prepare you to see and hold your baby after the post-mortem examination?</p>
  <p>1  Yes, definitely</p>
  <p>2  Yes, to some extent</p>
  <p>3  No</p>
  <p>Q65. How soon after the post-mortem examination did you have a follow-up appointment with a consultant or team in the hospital to receive the results and findings?</p>
  <p><strong><br><br><br><br><br></strong></p>
  <p>3</p>
  <p>I haven't received</p>
  <p>1 </p>
  <p>the results</p>
  <p>🡪 SKIP TOQ67.</p>
  <p>2  1 to 3 months</p>
  <p>3  4 to 6 months</p>
  <p>4  7 to 11 months</p>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="51"><col width="40"><col width="249"><col width="10"></colgroup>
  <tbody>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>5 </p>
  </td>
  <td>
  <p>12 to 18 months</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>6 </p>
  </td>
  <td>
  <p>Longer than 18 months</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q66.</p>
  </td>
  <td colspan="2">
  <p>Were the results and findings of the post-mortem examination given in a clear, sensitive and respectful way?</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="3">
  <p>10. Discharge care</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="3">&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="3">
  <p>The following section asks about your experience of care around your preparation for discharge home from the maternity hospital or unit following your pregnancy loss.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q67.</p>
  </td>
  <td colspan="2">
  <p>Before you were discharged from hospital, were you given contact information for hospital support services, counselling, or support organisations outside of the hospital?</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>2 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>3 </p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q68.</p>
  </td>
  <td colspan="2">
  <p>Before you were discharged from hospital, were you given information about your physical care and recovery?</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br>
  <p>4 </p>
  </td>
  <td>
  <p>I did not want or need this information</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>5 </p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q69.</p>
  </td>
  <td colspan="2">
  <p>Before you were discharged from hospital, were you given information</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="51"><col width="40"><col width="249"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>about what you might experience when grieving?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br>
  <p>4 </p>
  </td>
  <td>
  <p>I did not want or need this information</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>5 </p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q70.</p>
  </td>
  <td colspan="2">
  <p>Before you were discharged from hospital, were you given information about any changes you might experience with your mental health?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br>
  <p>4 </p>
  </td>
  <td>
  <p>I did not want or need this information</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>5 </p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q71.</p>
  </td>
  <td colspan="2">
  <p>Before you were discharged from hospital, were you told who to contact if you had any concerns or worries about your physical or mental health?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>2 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>3 </p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q72.</p>
  </td>
  <td colspan="2">
  <p>Before you were discharged from hospital, were you given information and support about the steps involved in registering your baby with the civil registration office?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>2 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br><br><br>
  <p>3 </p>
  </td>
  <td>
  <p>This was not relevant as I experienced a second trimester miscarriage and could not legally register my baby</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>4 </p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong><br><br><br><br></strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="51"><col width="40"><col width="259"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q73.</p>
  </td>
  <td colspan="2">
  <p>Before you were discharged from hospital, were you given enough information about follow-up care plans and appointments?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>4 </p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q74.</p>
  </td>
  <td colspan="2">
  <p>Was your discharge from hospital planned and managed in a sensitive</p>
  <p>way?</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="31"><col width="142"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong><br><br><br><br><br></strong></p>
  <p>Q75. Is there anything else you would like to tell us about the care you received in hospital from your admission through to your discharge home?</p>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="51"><col width="41"><col width="248"><col width="10"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>11. Follow-up care</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="3">&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="3">
  <p>The following section asks about your experience of care at home after your discharge from hospital following the loss of your baby and about your follow-up care with your healthcare provider at the maternity hospital or unit.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q76.</p>
  </td>
  <td colspan="2">
  <p>After your discharge from hospital, who did you see as part of your follow-up care? (tick all that apply)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>1 </p>
  </td>
  <td>
  <p>Family doctor (GP)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="29"><col width="240"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Public Health Nurse (PHN)</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>3 </p>
  </td>
  <td>
  <p>Bereavement midwife or nurse specialist in the hospital</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>4 </p>
  </td>
  <td>
  <p>Mental health services</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>5 </p>
  </td>
  <td>
  <p>Obstetrician or gynaecologist after discharge</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>6 </p>
  </td>
  <td>
  <p>Consultant paediatrician or neonatologist</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>7 </p>
  </td>
  <td>
  <p>Other</p>
  </td>
  </tr>
  <tr>
  <td><br><br>
  <p>8 </p>
  </td>
  <td>
  <p>I had to attend the hospital emergency department because of</p>
  <p>complications</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong><br><br><br></strong></p>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="51"><col width="42"><col width="171"><col width="86"></colgroup>
  <tbody>
  <tr>
  <td>&nbsp;</td>
  <td><br><br><br>
  <p>9 </p>
  </td>
  <td colspan="2">
  <p>I had a follow-up appointment at the hospital but I declined to attend</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br><br>
  <p>10 </p>
  </td>
  <td>
  <p>I haven&rsquo;t had any follow-up care since my discharge from hospital</p>
  </td>
  <td><br>
  <p>🡪 SKIP TO</p>
  <p>Q83.</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q77.</p>
  </td>
  <td colspan="3">
  <p>After your discharge from hospital, if you contacted a healthcare professional were you given the help you needed?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br>
  <p>4 </p>
  </td>
  <td colspan="2">
  <p>I was unable to reach the healthcare professional</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br>
  <p>5 </p>
  </td>
  <td colspan="2">
  <p>I didn&rsquo;t contact any healthcare professionals</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q78.</p>
  </td>
  <td colspan="3">
  <p>After your discharge from hospital, if you saw your GP or family doctor, were they aware that your baby had died?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>2 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br>
  <p>3 </p>
  </td>
  <td>
  <p>I did not need or want to see a GP</p>
  </td>
  <td>
  <p>🡪 SKIP TO</p>
  <p>Q80.</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br>
  <p>4 </p>
  </td>
  <td>
  <p>I did not see a GP but I would have like to</p>
  </td>
  <td>
  <p>🡪 SKIP TO</p>
  <p>Q80.</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>5</p>
  </td>
  <td colspan="2">
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  </tr>
  <tr>
  <td><br><br>
  <p>Q79.</p>
  </td>
  <td colspan="3"><br><br>
  <p>Thinking about the care you received at home after your discharge from hospital, did your GP or family doctor give you enough care and support?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table style="width: 31.9588%;"><colgroup><col style="width: 15%;" width="51"><col style="width: 11.7647%;" width="40"><col style="width: 47.9412%;" width="163"><col style="width: 25.2941%;" width="86"></colgroup>
  <tbody>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>4 </p>
  </td>
  <td colspan="2">
  <p>I did not need any care and support</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>5 </p>
  </td>
  <td colspan="2">
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q80.</p>
  </td>
  <td colspan="3">
  <p>After your discharge from hospital, if you saw your Public Health Nurse, were they aware that your baby had died?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>2 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br><br>
  <p>3 </p>
  </td>
  <td>
  <p>I did not need or want to see a Public Health Nurse</p>
  </td>
  <td>
  <p>🡪 SKIP TO</p>
  <p>Q82.</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br><br>
  <p>4 </p>
  </td>
  <td>
  <p>I did not see a Public Health Nurse but I would have liked to</p>
  </td>
  <td>
  <p>🡪 SKIP TO</p>
  <p>Q82.</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>5 </p>
  </td>
  <td colspan="2">
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  </tr>
  <tr>
  <td>
  <p><strong>Q81.</strong></p>
  </td>
  <td colspan="3">
  <p><strong>Thinking about the care you received at home after your discharge from hospital, did your Public Health Nurse give you enough care and support?</strong></p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br><br>
  <p>4 </p>
  </td>
  <td colspan="2">
  <p>I did not need or want to see a Public Health Nurse</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>5 </p>
  </td>
  <td colspan="2">
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  </tr>
  <tr>
  <td><br><br>
  <p><strong>Q82.</strong></p>
  </td>
  <td colspan="3"><br><br>
  <p><strong>After your discharge from hospital, what support did you access?</strong></p>
  <p><strong>(tick all that apply)</strong></p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Partner</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Family</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>3 </p>
  </td>
  <td>
  <p>Friends</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="51"><col width="40"><col width="249"><col width="10"></colgroup>
  <tbody>
  <tr>
  <td>&nbsp;</td>
  <td><br><br>
  <p>4 </p>
  </td>
  <td>
  <p>Bereavement support organisations/advocacy groups</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>5 </p>
  </td>
  <td>
  <p>Hospital support services</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>6 </p>
  </td>
  <td>
  <p>Professional counselling</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>7 </p>
  </td>
  <td>
  <p>Other</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>8 </p>
  </td>
  <td>
  <p>I did not access any supports</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="3">
  <p>12. Overall care</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="3">&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="3">
  <p>The following section asks about your overall experience of care and if there is anything else you would like to tell us about your care since your baby died or that we have not asked about in the survey.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p><strong>Q83.</strong></p>
  </td>
  <td colspan="2"><br>
  <p><strong>Overall, did you have confidence and trust in the staff caring for you?</strong></p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p><strong>Q84.</strong></p>
  </td>
  <td colspan="2">
  <p><strong>Overall, did you feel that you were treated with respect and dignity?</strong></p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td><br>
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br><br>
  <p><strong>Q85.</strong></p>
  </td>
  <td colspan="2"><br><br><br>
  <p><strong>Were your cultural, spiritual and religious needs respected and facilitated by healthcare professionals?</strong></p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>1 </p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>2 </p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="40"><col width="32"><col width="21"><col width="35"><col width="27"><col width="33"><col width="29"><col width="31"><col width="41"><col width="29"><col width="23"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>3 </p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td colspan="2"><br><br>
  <p>4 </p>
  </td>
  <td colspan="8">
  <p>I did not have any specific cultural, spiritual or religious needs</p>
  </td>
  </tr>
  <tr>
  <td>
  <p><strong>Q86.</strong></p>
  </td>
  <td colspan="9">
  <p><strong>Were you offered any of the following hospital support services?</strong></p>
  <p><strong>(tick all that apply)</strong></p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td colspan="2"><br>
  <p>1 </p>
  </td>
  <td colspan="6">
  <p>Chaplaincy or pastoral care</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td colspan="2">
  <p>2 </p>
  </td>
  <td colspan="3">
  <p>Social Work</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td colspan="2"><br><br>
  <p>3 </p>
  </td>
  <td colspan="7">
  <p>Bereavement midwife or nurse specialist</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td colspan="2"><br><br>
  <p>4 </p>
  </td>
  <td colspan="7">
  <p>Perinatal (pregnancy-related) Mental health service</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td colspan="2"><br><br>
  <p>5 </p>
  </td>
  <td colspan="7">
  <p>Perinatal (pregnancy-related) Palliative Care team</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td colspan="2">
  <p>6 </p>
  </td>
  <td colspan="6">
  <p>Paediatrician/Neonatologist</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td colspan="2">
  <p>7 </p>
  </td>
  <td colspan="2">
  <p>Other</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td colspan="2"><br><br>
  <p>8 </p>
  </td>
  <td colspan="6">
  <p>I wasn&rsquo;t offered any hospital support services</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td colspan="2"><br><br>
  <p>9 </p>
  </td>
  <td colspan="8">
  <p>No hospital support services were available</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td colspan="2">
  <p>10 </p>
  </td>
  <td colspan="7">
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p><strong>Q87.</strong></p>
  </td>
  <td colspan="9">
  <p><strong>Overall, how would you rate the care that you received (0 to 10)?</strong></p>
  <p><strong>(please circle a number)</strong></p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>I had very poor care</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td colspan="3">
  <p>I had</p>
  <p>excellent</p>
  <p>care</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>&nbsp; 0</p>
  </td>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>8</p>
  </td>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>10&nbsp;</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p><strong>Q88</strong>.</p>
  </td>
  <td>
  <p><strong>Reflecting back on your experience, what was good about your care?</strong></p>
  </td>
  </tr>
  <tr>
  <td>
  <p><strong>Q89.</strong></p>
  </td>
  <td>
  <p><strong>Reflecting back on your experience, was there anything that could be improved about your care?</strong></p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>Q90. Do you have anything else you wish to tell us about your experience of care that is not covered in the survey?</strong></p>
  <p>We appreciate and value the time you have taken to share your thoughts and experiences with us.</p>
  <p>If you had a partner or support person with you, the next section will ask them to recall their experience.</p>
  <p>Thank you</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="53"><col width="561"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>13. Partner or support person</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>The following section is to be completed by the partner or support person present with the mother during her experience of pregnancy loss, and asks them to reflect and recall their experience.</p>
  <p>The term partner or support person includes the main person that was with the mother and provided support to her during her hospital experience of pregnancy loss. This could be a husband, partner, birth partner, family member or a friend.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p><strong>Q91.</strong></p>
  </td>
  <td colspan="2"><br>
  <p><strong>Did you feel that you were able to be with the person you were supporting as often as you wanted to be while they were being cared for in hospital?</strong></p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br><br>
  <p>4</p>
  </td>
  <td>
  <p>I was not able to be with the person I was supporting due to COVID-19 restrictions</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br><br>
  <p>5</p>
  </td>
  <td>
  <p>I was not able to be with the person I was supporting for other reasons</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>6</p>
  </td>
  <td>
  <p>The person I was supporting did not want me to be there</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p><strong>Q92.</strong></p>
  </td>
  <td colspan="2">
  <p><strong>Did healthcare professionals explain what was happening in a way that you could understand?</strong></p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, completely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="463"><col width="114"></colgroup>
  <tbody>
  <tr>
  <td>
  <p><strong>Q93.</strong></p>
  </td>
  <td colspan="3">
  <p><strong>Did you feel that you were involved in&nbsp;decisions about your baby&rsquo;s care?</strong></p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td colspan="2">
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p><strong>Q94.</strong></p>
  </td>
  <td colspan="3">
  <p><strong>Did you feel that you were given the opportunity to ask questions?</strong></p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td colspan="2">
  <p>I did not have any questions</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td colspan="2">
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p><strong>Q95.</strong></p>
  </td>
  <td colspan="3">
  <p><strong>Did you feel that healthcare professionals acknowledged your needs?</strong></p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td colspan="2">
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p><strong>Q96</strong>.</p>
  </td>
  <td colspan="3">
  <p><strong>If you wanted to meet your baby, did healthcare professionals do enough to support you to do so?</strong></p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>4</p>
  </td>
  <td>
  <p>I chose not to meet my baby</p>
  </td>
  <td>
  <p>🡪 SKIP TO</p>
  <p>Q98.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br><br><br>
  <p>5</p>
  </td>
  <td>
  <p>It was not possible for medical reasons for me to meet my</p>
  <p>baby</p>
  </td>
  <td><br>
  <p>🡪 SKIP TO</p>
  <p>Q98.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="304"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q97.</p>
  </td>
  <td colspan="2">
  <p>Did you feel that you could spend as</p>
  <p>much time as you wanted with your baby?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="353"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q98.</p>
  </td>
  <td colspan="2">
  <p>If you sought support after the loss of</p>
  <p>your baby, what support did you access?</p>
  <p>(Tick all that apply)</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Partner</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Family</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Friends</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Family doctor or GP</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>5</p>
  </td>
  <td>
  <p>Bereavement support organisations/advocacy groups</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>Hospital support services</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>Professional counselling</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>8</p>
  </td>
  <td>
  <p>Other</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>I did not access any supports</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <p><strong>Q99. Is there anything else that you would like to tell us about your experience?</strong></p>
  <p>We appreciate and value the time you have taken to share your thoughts and experiences with us.</p>
  <p>Thank you.</p>
  <p>Once you submit your survey answers, we will not be able to identify or change any of the information you have provided.</p>
  <p>For this reason, please ensure that you are satisfied with all of the details you have provided in your answers to the questions asked before returning the survey questionnaire in the free post envelope provided.</p>
  <ol>
  <li>
  f) National Maternity Experience Survey (NMES Questionnaire)
  </li>
  </ol>
  <p><strong>MATERNITY CARE SURVEY</strong></p>
  <p><br><br><br><br></p>
  <p><strong>What is the survey about?</strong></p>
  <p>The National Maternity Experience Survey is a nationwide survey asking women who have recently given birth about the maternity care they received.</p>
  <p>Please use this survey to provide feedback about your experience of maternity care. Should you wish to discuss your care with the Patient Advocacy Service which can provide information and support to patients who want to make a formal complaint to the HSE, please call 0818 293 003 or visit<a href="https://scanmail.trustwave.com/?c=17268&amp;d=zNLL3Q2AxjI-rvvzFG23rZUDNk0koBmulkjTvDhqPw&amp;s=226&amp;u=https%3a%2f%2fwww%2epatientadvocacyservice%2eie%2f"> www.patientadvocacyservice.ie</a></p>
  <p><strong>Why did I get this survey?</strong></p>
  <p>You got this survey because you have recently given birth and we would like to hear your feedback on your maternity care experience. Your feedback will help to improve the safety and quality of Ireland&rsquo;s maternity services.</p>
  <p><strong>Can I do the survey online?</strong></p>
  <p>Yes, please go to survey.yourexperience.ie to complete the survey online.</p>
  <p><strong>Can I ask someone to help me fill in the survey?</strong></p>
  <p>Yes, you can ask someone to help you fill in the survey. You may also ask someone to fill in the survey on your behalf. However, please make sure that the answers given reflect your experience of care.</p>
  <p>Completing the survey</p>
  <ul>
  <li>
  For each question please clearly tick one box using a black or a blue pen.
  </li>
  </ul>
  <ul>
  <li>
  Please read the information in the boxes that accompany some of the questions as these provide important information to help you complete the questionnaire.
  </li>
  </ul>
  <ul>
  <li>
  Do not worry if you make a mistake; simply fill in the box and put a tick in the correct box.
  </li>
  </ul>
  <ul>
  <li>
  There is space under the Other Comments section for your comments. These open boxes are included to provide you with an opportunity to inform us about anything you feel is not covered at all or not
  </li>
  </ul>
  <p>adequately covered in the questions posed in the survey.</p>
  <ul>
  <li>
  Please do not write your name or address anywhere on the questionnaire.
  </li>
  </ul>
  <ul>
  <li>
  The survey takes approximately 15 minutes to complete.
  </li>
  </ul>
  <div dir="ltr" align="left">
  <table><colgroup><col width="39"><col width="414"><col width="171"></colgroup>
  <tbody>
  <tr>
  <td colspan="4">
  <p>Stage 1 - Care while you were pregnant (Antenatal care)</p>
  </td>
  </tr>
  <tr>
  <td colspan="4">
  <p>The following section asks about your experiences of care during your pregnancy.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q1.</p>
  </td>
  <td colspan="3"><br>
  <p>In your most recent pregnancy, did you give birth to&hellip;..</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>A single baby</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Twins</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Triplets, quads or more</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q2.</p>
  </td>
  <td colspan="3">
  <p>Who was the first health care professional you saw when you thought you were pregnant?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>GP / family doctor</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Midwife</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Other</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q3.</p>
  </td>
  <td colspan="3">
  <p>Were you offered a choice about the type of maternity care you would receive?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>
  <p>🡪 GO TO Q4.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>I was not offered any choices</p>
  </td>
  <td>
  <p>🡪 GO TO Q5.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>I had no choices due to medical reasons</p>
  </td>
  <td>
  <p>🡪 GO TO Q5.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>
  <p>🡪 GO TO Q5.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <p>Q4. Which of the following choices were you offered? Please tick all that apply</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="29"><col width="585"></colgroup>
  <tbody>
  <tr>
  <td><br><br><br>
  <p>1</p>
  </td>
  <td>
  <p>Public care. Also known as combined care or shared care. Regular antenatal check-ups with midwives and/or obstetricians in the hospital and, in most cases, with your General Practitioner (GP). Labour and birth in the hospital. Postnatal care in a public ward in the hospital with subsequent postnatal check-ups in a community setting.</p>
  </td>
  </tr>
  <tr>
  <td><br><br><br>
  <p>2</p>
  </td>
  <td><br>
  <p>Consultant-led care private or semi-private. Antenatal check-ups with a private obstetrician (who you choose) with the option of sharing these with your GP as part of combined/shared care if you choose. Labour and birth in the hospital with care provided by your obstetrician/your obstetrician&rsquo;s team and hospital midwives. Postnatal care in a private or semi- private ward in the hospital with subsequent postnatal check-ups in a community setting.</p>
  </td>
  </tr>
  <tr>
  <td><br><br><br>
  <p>3</p>
  </td>
  <td>
  <p>DOMINO (Domiciliary In and Out). Antenatal check-ups with one midwife or a small team of midwives in the hospital or in a community setting, with the option of sharing these antenatal checks-ups with your GP as part of combined/shared care if you choose. Labour and birth in the hospital. Transfer home within 12-24 hours after birth. Postnatal care in a public ward in the hospital with subsequent postnatal check-ups in a community setting.</p>
  </td>
  </tr>
  <tr>
  <td><br><br><br>
  <p>4</p>
  </td>
  <td>
  <p>Midwifery-led care with birth in a midwifery-led unit (Cavan General and Our Lady of Lourdes Hospital Drogheda only). Antenatal check-ups with a midwife or a small team of midwives in a midwifery-led unit or in a community setting. Labour and birth in a midwifery-led unit. Postnatal care in a midwifery-led unit with subsequent postnatal check-ups in a community setting.</p>
  </td>
  </tr>
  <tr>
  <td><br><br><br>
  <p>5</p>
  </td>
  <td>
  <p>Community midwifery team care. Antenatal check-ups with a midwife or a small team of midwives in the hospital or in a community setting, with the option of sharing these antenatal check-ups with your GP as part of combined/shared care if you choose. Labour and birth in the hospital. Postnatal care in a public ward in the hospital with subsequent postnatal check-ups in a community setting.</p>
  </td>
  </tr>
  <tr>
  <td><br><br><br>
  <p>6</p>
  </td>
  <td>
  <p>Home birth with hospital based or self-employed community midwives (SECM). Antenatal check-ups at home or in a community setting with either a hospital-based or self- employed community midwife (who you choose). Labour and birth at home with care provided by a midwife. Postnatal care in a community setting.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>7</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="39"><col width="386"><col width="199"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q5.</p>
  </td>
  <td colspan="3">
  <p>What type of maternity care did you have? Please tick one box only</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Public care</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td colspan="2">
  <p>Consultant-led care private or semi-private</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td colspan="2">
  <p>DOMINO (Domiciliary In and Out)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>4</p>
  </td>
  <td colspan="2">
  <p>Midwifery-led care with birth in a midwifery led unit (Cavan General and Our Lady of Lourdes Hospital Drogheda only)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td colspan="2">
  <p>Community midwifery team care</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>6</p>
  </td>
  <td colspan="2">
  <p>Home birth with hospital based or self-employed community midwives (SECM)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>7</p>
  </td>
  <td colspan="2">
  <p>Care with a private home birth midwife with transfer to obstetric-led care for labour and birth</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>8</p>
  </td>
  <td colspan="2">
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q6.</p>
  </td>
  <td colspan="3">
  <p>During your pregnancy were you offered any antenatal classes or courses?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes, and I did them</p>
  </td>
  <td>
  <p>🡪 GO TO Q8.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Yes, but I did not do them</p>
  </td>
  <td>
  <p>🡪 GO TO Q7.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>
  <p>🡪 GO TO Q8.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>
  <p>🡪 GO TO Q8.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="39"><col width="575"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q7.</p>
  </td>
  <td colspan="2">
  <p>Are there any particular reasons you</p>
  <p>did not go to antenatal classes or courses? Please tick all that apply</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>It was not my first baby</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>It was my first baby but I didn&rsquo;t want to go to classes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>There were no available spaces/they were booked out</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>I couldn&rsquo;t find classes that were right for me</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>There were no classes near me</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>I had other commitments</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>Other</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q8.</p>
  </td>
  <td colspan="2">
  <p>Thinking about the care you received during your pregnancy, did you receive enough information about physical changes in your body?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>I did not want or need this information</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q9.</p>
  </td>
  <td colspan="2">
  <p>Thinking about the care you received during your pregnancy, did you receive enough information about mental health changes that may occur?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>I did not want or need this information</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q10.</p>
  </td>
  <td colspan="2">
  <p>Thinking about the care you received during your pregnancy, did you receive enough information about nutrition during pregnancy?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>I did not want or need this information</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q11.</p>
  </td>
  <td colspan="2">
  <p>Thinking about the care you received during your pregnancy, did you receive enough information about giving up smoking and other tobacco related products (e-cigarettes, vaping devices etc)?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>I did not want or need this information</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q12.</p>
  </td>
  <td colspan="2">
  <p>Thinking about the care you received during your pregnancy, did you receive enough information about the impact of alcohol and/or drug abuse on you and your baby?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>I did not want or need this information</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q13.</p>
  </td>
  <td colspan="2">
  <p>Thinking about the care you received</p>
  <p>during your pregnancy, did you feel that you were involved in decisions about your care?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q14.</p>
  </td>
  <td colspan="2">
  <p>Thinking about the care you received during your pregnancy, did you feel that you were treated with respect and dignity?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q15.</p>
  </td>
  <td colspan="2">
  <p>Thinking about the care you received during your pregnancy, did you have confidence and trust in the health care professionals treating/caring for you?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q16.</p>
  </td>
  <td colspan="2">
  <p>Thinking about the care you received during your pregnancy, were your questions answered in a way that you could understand?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>I did not have any questions</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="48"><col width="566"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q17.</p>
  </td>
  <td colspan="2">
  <p>Thinking about the care you received during your pregnancy, did you have a health care professional that you could talk to about your worries and fears?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>I had no worries or fears</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="3">
  <p>Stage 2 - Care during your labour and birth</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>The following section asks about your experiences of care around the time of your labour and birth of your baby. &lsquo;Birth&rsquo; includes babies born vaginally or by caesarean.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q18.</p>
  </td>
  <td colspan="2"><br>
  <p>Thinking about the birth of your baby, was your labour induced?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q19.</p>
  </td>
  <td colspan="2">
  <p>What type of birth did you have?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>A vaginal birth (no forceps or ventouse suction cup)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>2</p>
  </td>
  <td>
  <p>An assisted vaginal birth (e.g., with forceps or ventouse suction cup)</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>A planned caesarean birth</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>An unplanned caesarean birth</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q20.</p>
  </td>
  <td colspan="2">
  <p>Thinking about the care you received</p>
  <p>during your labour and birth, did you feel that you were involved in decisions about your care?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q21.</p>
  </td>
  <td colspan="2">
  <p>Thinking about the care you received during your labour and birth, were your questions answered in a way that you could understand?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>I did not have any questions</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q22.</p>
  </td>
  <td colspan="2">
  <p>Before you had any tests, procedures and treatments, were the benefits and risks explained to you in a way you could understand?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q23.</p>
  </td>
  <td colspan="2">
  <p>Were you (and/or your partner or companion) left alone by health care professionals at a time when it worried you? Please tick all that apply</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, during early labour</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Yes, during the later stages of labour</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Yes, during the birth</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Yes, shortly after the birth</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>No, not at all</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q24.</p>
  </td>
  <td colspan="2">
  <p>Do you think your health care professionals did everything they could to help manage your pain during labour and birth?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>I did not need any help</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Not relevant to my situation</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q25.</p>
  </td>
  <td colspan="2">
  <p>Did you have skin to skin contact (baby naked on your chest or tummy) with your baby shortly after the birth?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>No, but this was not possible for medical reasons</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>I did not want skin to skin contact with my baby</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q26.</p>
  </td>
  <td colspan="2">
  <p>Was your partner and/or companion involved in your care during labour and birth as much as you wanted them to be?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>They did not want to be involved/ they could not be involved</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>I did not want them to be involved</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>5</p>
  </td>
  <td>
  <p>I did not have a partner/companion with me</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q27.</p>
  </td>
  <td colspan="2">
  <p>Did you have confidence and trust in</p>
  <p>the health care professionals caring for you during your labour and birth?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="3">
  <p>Stage 3 - Care in hospital after the birth of your baby</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>If you had a home birth and did not go to hospital, please go to Question 37.</p>
  <p>The following section asks about your experiences of care in hospital after the birth of your baby.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q28.</p>
  </td>
  <td colspan="2"><br>
  <p>After your baby was born, did you have the opportunity to ask questions about your labour and the birth (often called &lsquo;debriefing&rsquo;)?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>I did not have any questions</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q29.</p>
  </td>
  <td colspan="2">
  <p>If you needed assistance while you were in hospital after the birth, were you able to get a health care professional to assist you when you needed it?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>I did not need any assistance</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q30.</p>
  </td>
  <td colspan="2">
  <p>Thinking about the care you received after the birth of your baby while you were in hospital, did you feel that you were involved in decisions about your care?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q31.</p>
  </td>
  <td colspan="2">
  <p>Thinking about the care you received after the birth of your baby while you were in hospital, did you feel that your questions were answered in a way that you could understand?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>I did not have any questions</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q32.</p>
  </td>
  <td colspan="2">
  <p>Thinking about the care you received after the birth of your baby while you were in hospital, did you have a health care professional that you could talk to about your worries and fears?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>I had no worries or fears</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q33.</p>
  </td>
  <td colspan="2">
  <p>Before you were discharged from</p>
  <p>hospital, were you given information about your own physical recovery?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>No, but I did not need this information</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q34.</p>
  </td>
  <td colspan="2">
  <p>Before you were discharged from hospital, were you given information about any changes you might experience with your mental health?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>No, but I did not need this information</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q35.</p>
  </td>
  <td colspan="2">
  <p>Before you were discharged from hospital, were you told who to contact if you were worried about your health or your baby&rsquo;s health after you left hospital?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q36.</p>
  </td>
  <td colspan="2">
  <p>Thinking about the care you received in hospital, did you feel that you were treated with respect and dignity?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="46"><col width="35"><col width="115"><col width="71"><col width="74"><col width="59"><col width="50"><col width="51"><col width="46"><col width="46"><col width="31"></colgroup>
  <tbody>
  <tr>
  <td colspan="11">
  <p>Stage 4 &ndash; Specialised care for your baby</p>
  </td>
  </tr>
  <tr>
  <td colspan="11">
  <p>After birth some babies need specialist care,</p>
  <p>e.g. help with breathing, and are admitted to a neonatal unit. The following section asks about your experiences of care if your baby was admitted to a neonatal unit.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q37.</p>
  </td>
  <td colspan="10"><br>
  <p>Following the birth, did your baby spend any time in the neonatal unit?</p>
  </td>
  </tr>
  <tr>
  <td colspan="2"><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td colspan="4">
  <p>🡪 GO TO Q38.</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td colspan="4">
  <p>🡪 GO TO Q40.</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2"><br>
  <p>3</p>
  </td>
  <td colspan="4">
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td colspan="4">
  <p>🡪 GO TO Q40.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q38.</p>
  </td>
  <td colspan="10">
  <p>While your baby was in the neonatal unit, did you receive enough emotional support from health care professionals?</p>
  </td>
  </tr>
  <tr>
  <td colspan="2">
  <p>1</p>
  </td>
  <td colspan="3">
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>2</p>
  </td>
  <td colspan="4">
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2"><br>
  <p>4</p>
  </td>
  <td colspan="6">
  <p>I did not want or need any emotional support</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>5</p>
  </td>
  <td colspan="7">
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q39.</p>
  </td>
  <td colspan="9">
  <p>Overall, how would you rate your experience of the care your baby received in the neonatal unit?</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="4">
  <p>I had a very poor</p>
  <p>experience</p>
  </td>
  <td colspan="4">
  <p>I had a very good</p>
  <p>experience</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>0</p>
  </td>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>8</p>
  </td>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>10</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>Stage 5 &ndash; Feeding your baby</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>The following section asks about your experiences of care in terms of feeding your baby.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q40.</p>
  </td>
  <td colspan="2"><br>
  <p>Did your health care professionals discuss with you the different options for feeding your baby? Please tick all that apply</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, during pregnancy</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Yes, during labour or immediately after birth</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Yes, after birth while in hospital</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Yes, after birth while at home</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>6</p>
  </td>
  <td>
  <p>I did not want or need discussion of different options</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q41.</p>
  </td>
  <td colspan="2">
  <p>In the first few days after the birth, how was your baby fed? Please tick one box only</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Breast milk (or expressed breast milk) only</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Both breast and formula (bottle) milk</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Formula (bottle) milk only</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q42.</p>
  </td>
  <td colspan="2">
  <p>Were your decisions about how you wanted to feed your baby respected by your health care professionals?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q43.</p>
  </td>
  <td colspan="2">
  <p>If you had a home birth, please go to Q44.</p>
  <p>During your stay in hospital, did your health care professionals give you adequate support and encouragement with feeding your baby?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>I did not want or need support and encouragement</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q44.</p>
  </td>
  <td colspan="2">
  <p>At home after the birth of your baby, did your health care professionals give you adequate support and encouragement with feeding your baby?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>I did not want or need support and encouragement</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="51"><col width="368"><col width="205"></colgroup>
  <tbody>
  <tr>
  <td colspan="4">
  <p>Stage 6 - Care at home after the birth of your baby</p>
  </td>
  </tr>
  <tr>
  <td colspan="4">
  <p>The following section asks about your experiences of care when you were visited at home or seen by a health care professional in the community after the birth of your baby.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q45.</p>
  </td>
  <td colspan="3"><br>
  <p>When you were at home after the birth of your baby, if you contacted a health care professional were you given the help you needed?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td colspan="2">
  <p>I did not need any help</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td colspan="2">
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q46.</p>
  </td>
  <td colspan="3">
  <p>Since your baby&rsquo;s birth have you been visited at home by a public health nurse?</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>
  <p>🡪 GO TO Q47.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>
  <p>🡪 GO TO Q50.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>Not relevant to my situation</p>
  </td>
  <td>
  <p>🡪 GO TO Q50.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>
  <p>🡪 GO TO Q50.</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q47.</p>
  </td>
  <td colspan="3">
  <p>Did the public health nurse take your personal circumstances into account when giving you advice?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td colspan="2">
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q48.</p>
  </td>
  <td colspan="2">
  <p>Did you feel that your questions were answered by the public health nurse in a way that you could understand?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>I did not have any questions</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q49.</p>
  </td>
  <td colspan="2">
  <p>Did you receive help and advice from the public health nurse about your baby&rsquo;s health and progress?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>I did not need any help</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q50.</p>
  </td>
  <td colspan="2">
  <p>Did your baby receive a 2-week check- up with your General Practitioner (GP)?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>No, I did not know about the check-up</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>No, I knew about the check-up but did not attend</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br><br>
  <p>4</p>
  </td>
  <td>
  <p>I attended another health care professional for the 2-week check-up</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Not relevant to my situation</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q51.</p>
  </td>
  <td colspan="2">
  <p>Thinking about the care you received</p>
  <p>at the postnatal check-up, around 6 weeks after the birth, did the GP or practice nurse/midwife spend enough time talking to you about your own physical health?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>I have not had a postnatal check- up</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q52.</p>
  </td>
  <td colspan="2">
  <p>Thinking about the care you received at the postnatal check-up, did the GP or practice nurse/midwife spend enough time talking to you about your own mental health?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>I have not had a postnatal check- up</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q53.</p>
  </td>
  <td colspan="2">
  <p>Did you feel that your questions were answered by the GP or practice nurse/midwife in a way that you could understand?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>I did not have any questions</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q54.</p>
  </td>
  <td colspan="2">
  <p>Since the birth of your baby, did you feel that you were adequately informed about vaccinations?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, definitely</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, to some extent</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>No, but I did not need this information</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q55.</p>
  </td>
  <td colspan="2">
  <p>Did you use local support groups e.g. mother and baby groups, feeding support groups, etc?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q56.</p>
  </td>
  <td colspan="2">
  <p>Thinking about the care you received at home after the birth of your baby, did you have confidence and trust in the health care professionals caring for you?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q57.</p>
  </td>
  <td colspan="2">
  <p>Thinking about the care you received at home after the birth of your baby, did you feel that you were involved in decisions about your health?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="42"><col width="35"><col width="99"><col width="61"><col width="73"><col width="59"><col width="57"><col width="57"><col width="57"><col width="44"><col width="40"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q58.</p>
  </td>
  <td colspan="10">
  <p>Thinking about the care you received</p>
  <p>at home after the birth of your baby, did you feel that you were treated with respect and dignity?</p>
  </td>
  </tr>
  <tr>
  <td colspan="2">
  <p>1</p>
  </td>
  <td colspan="3">
  <p>Yes, always</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>2</p>
  </td>
  <td colspan="4">
  <p>Yes, sometimes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>3</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>4</p>
  </td>
  <td colspan="7">
  <p>Don&rsquo;t know or can&rsquo;t remember</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="11">
  <p>Stage 7 &ndash; Overall Care</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q59.</p>
  </td>
  <td colspan="10"><br>
  <p>Thinking about your overall care, if you wanted to give feedback or make a complaint, did you know how and where to do so?</p>
  </td>
  </tr>
  <tr>
  <td colspan="2">
  <p>1</p>
  </td>
  <td>
  <p>Yes</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>2</p>
  </td>
  <td>
  <p>No</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2"><br>
  <p>3</p>
  </td>
  <td colspan="8">
  <p>I did not wish to give feedback or make a complaint</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Q60.</p>
  </td>
  <td colspan="10">
  <p>Overall, how would you rate your experience of the care you and your baby received during pregnancy, labour and birth and after your baby was born?</p>
  </td>
  </tr>
  <tr>
  <td colspan="4">
  <p>I had a very poor</p>
  <p>experience</p>
  </td>
  <td colspan="5">
  <p>I had a very good</p>
  <p>experience</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>0</p>
  </td>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>8</p>
  </td>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>10</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="54"><col width="560"></colgroup>
  <tbody>
  <tr>
  <td colspan="2">
  <p>Other Comments</p>
  </td>
  </tr>
  <tr>
  <td colspan="2">
  <p>Please note that the comments you provide will be looked at in full by the National Care Experience Programme. We will remove any information that could identify you before publishing any of your feedback.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q61.</p>
  </td>
  <td><br>
  <p>What was particularly good about your maternity care?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q62.</p>
  </td>
  <td>
  <p>Was there anything that could be improved?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q63.</p>
  </td>
  <td>
  <p>Were there any other important parts of your maternity care experience that are not covered by the questions in this survey?</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="71"><col width="543"></colgroup>
  <tbody>
  <tr>
  <td colspan="3">
  <p>Stage 8 &ndash; You and your household</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>The following questions will help us to describe the women taking part in the survey and to find out whether or not the care offered to women is the same regardless of their background or circumstances.</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>Q64.</p>
  </td>
  <td colspan="2"><br>
  <p>What year were you born?</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>(Please write in)</p>
  <p>e.g. 1 9 8 1</p>
  </td>
  </tr>
  <tr>
  <td colspan="3">
  <p>Y Y Y Y</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>Q65.</p>
  </td>
  <td colspan="2">
  <p>How many babies have you given birth to before this pregnancy?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>None</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>1 or 2</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>3 or more</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="289"><col width="292"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q66.</p>
  </td>
  <td colspan="2">
  <p>What is your ethnic group?</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>White:</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Irish</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Irish Traveller</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Roma</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Any other White background</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Black or Black Irish:</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>African</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>Any other Black background</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Asian or Asian Irish:</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>Chinese</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>8</p>
  </td>
  <td>
  <p>Indian/ Pakistani/ Bangladeshi</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>Any other Asian background</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>Other, including mixed group/background:</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>10</p>
  </td>
  <td>
  <p>Arabic</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>11</p>
  </td>
  <td>
  <p>Mixed, please specify</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td><br>
  <p>12</p>
  </td>
  <td>
  <p>Other, please write your ethnic group here:</p>
  </td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><br><br></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="81"><col width="55"><col width="89"><col width="55"><col width="96"><col width="47"><col width="86"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q67.</p>
  </td>
  <td colspan="4">
  <p>What is your county of residence?</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Carlow</p>
  </td>
  <td>
  <p>8</p>
  </td>
  <td>
  <p>Kerry</p>
  </td>
  <td>
  <p>15</p>
  </td>
  <td>
  <p>Louth</p>
  </td>
  <td>
  <p>22</p>
  </td>
  <td>
  <p>Tipperary</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>2</p>
  </td>
  <td>
  <p>Cavan</p>
  </td>
  <td>
  <p>9</p>
  </td>
  <td>
  <p>Kildare</p>
  </td>
  <td>
  <p>16</p>
  </td>
  <td>
  <p>Mayo</p>
  </td>
  <td>
  <p>23</p>
  </td>
  <td>
  <p>Waterford</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>3</p>
  </td>
  <td>
  <p>Clare</p>
  </td>
  <td>
  <p>10</p>
  </td>
  <td>
  <p>Kilkenny</p>
  </td>
  <td>
  <p>17</p>
  </td>
  <td>
  <p>Meath</p>
  </td>
  <td>
  <p>24</p>
  </td>
  <td>
  <p>Westmeath</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>4</p>
  </td>
  <td>
  <p>Cork</p>
  </td>
  <td>
  <p>11</p>
  </td>
  <td>
  <p>Laois</p>
  </td>
  <td>
  <p>18</p>
  </td>
  <td>
  <p>Monaghan</p>
  </td>
  <td>
  <p>25</p>
  </td>
  <td>
  <p>Wexford</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>5</p>
  </td>
  <td>
  <p>Donegal</p>
  </td>
  <td>
  <p>12</p>
  </td>
  <td>
  <p>Leitrim</p>
  </td>
  <td>
  <p>19</p>
  </td>
  <td>
  <p>Offaly</p>
  </td>
  <td>
  <p>26</p>
  </td>
  <td>
  <p>Wicklow</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>6</p>
  </td>
  <td>
  <p>Dublin</p>
  </td>
  <td>
  <p>13</p>
  </td>
  <td>
  <p>Limerick</p>
  </td>
  <td>
  <p>20</p>
  </td>
  <td>
  <p>Roscommon</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>Galway</p>
  </td>
  <td>
  <p>14</p>
  </td>
  <td>
  <p>Longford</p>
  </td>
  <td>
  <p>21</p>
  </td>
  <td>
  <p>Sligo</p>
  </td>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="388"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Q68.</p>
  </td>
  <td>
  <p>Do you have any of the following on a long-term basis?</p>
  <p>Please tick all that apply</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="39"><col width="481"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>1</p>
  </td>
  <td>
  <p>Blindness or a serious vision</p>
  <p>impairment</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>2</p>
  </td>
  <td>
  <p>Deafness or a serious hearing impairment</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>3</p>
  </td>
  <td>
  <p>A condition that substantially limits one or more basic physical activities</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>4</p>
  </td>
  <td>
  <p>An intellectual disability</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>5</p>
  </td>
  <td>
  <p>Difficulty in learning, remembering or concentrating</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>6</p>
  </td>
  <td>
  <p>Mental health, psychological or emotional condition</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="47"><col width="329"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>7</p>
  </td>
  <td>
  <p>Difficulty in dressing, bathing or</p>
  <p>getting around inside the home</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>8</p>
  </td>
  <td>
  <p>Difficulty in going outside home alone</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>9</p>
  </td>
  <td>
  <p>Difficulty in working or attending school/college</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>10</p>
  </td>
  <td>
  <p>Difficulty in taking part in other activities</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>11</p>
  </td>
  <td>
  <p>Other disability, including chronic illness</p>
  </td>
  </tr>
  <tr>
  <td><br>
  <p>12</p>
  </td>
  <td>
  <p>None of the above</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <p><strong>THANK YOU FOR YOUR HELP WITH THIS VERY IMPORTANT NATIONAL SURVEY</strong></p>
  <ol>
  <li>
  g) National Nursing Home Experience Survey for Nursing Home Residents (Resident Questionnaire)
  </li>
  </ol>
  <p>National Nursing Home Experience Survey Questionnaire for Nursing Home Residents</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="27"><col width="587"></colgroup>
  <tbody>
  <tr>
  <td colspan="2">
  <p>Section 1: Your experience here</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>1.</p>
  </td>
  <td>
  <p>Do you find it homely here?</p>
  <br>
  <ul>
  <li>
  Yes, definitely
  </li>
  <li>
  Yes, to some extent
  </li>
  <li>
  No
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>2.</p>
  </td>
  <td>
  <p>Are you as involved as you would like to be in decisions about the care and support you receive?</p>
  <br>
  <ul>
  <li>
  Yes, definitely
  </li>
  <li>
  Yes, to some extent
  </li>
  <li>
  No
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>3.</p>
  </td>
  <td>
  <p>Are you involved as much as you want to be in planning ahead for any changes in your circumstances and your preferred care in the future?</p>
  <br>
  <ul>
  <li>
  Yes, definitely
  </li>
  <li>
  Yes, to some extent
  </li>
  <li>
  No
  </li>
  <li>
  I do not wish to be involved
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="27"><col width="587"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>4.</p>
  </td>
  <td>
  <p>Do you have an opportunity to ask questions when you want to?</p>
  <br>
  <ul>
  <li>
  Yes, always
  </li>
  <li>
  Yes, sometimes
  </li>
  <li>
  No
  </li>
  <li>
  I don&rsquo;t have any questions
  </li>
  <li>
  Don&rsquo;t know
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>5.</p>
  </td>
  <td>
  <p>Overall, do you have confidence and trust in the staff who care for you here?</p>
  <br>
  <ul>
  <li>
  Yes, always
  </li>
  <li>
  Yes, sometimes
  </li>
  <li>
  No
  </li>
  <li>
  Don&rsquo;t know
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>6.</p>
  </td>
  <td>
  <p>Overall, do you feel you are treated with respect and dignity by the staff who care for you?</p>
  <br>
  <ul>
  <li>
  Yes, always
  </li>
  <li>
  Yes, sometimes
  </li>
  <li>
  No
  </li>
  <li>
  Don&rsquo;t know
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>7.</p>
  </td>
  <td>
  <p>Do staff here keep you safe and protect you from harm?</p>
  <br>
  <ul>
  <li>
  Yes, definitely
  </li>
  <li>
  Yes, to some extent
  </li>
  <li>
  No
  </li>
  <li>
  Don&rsquo;t know
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="35"><col width="579"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>8.</p>
  </td>
  <td>
  <p>Do you receive help when you need it in daily tasks, such as eating your meals, getting dressed, or using the bathroom?</p>
  <br>
  <ul>
  <li>
  Yes, always
  </li>
  <li>
  Yes, sometimes
  </li>
  <li>
  No
  </li>
  <li>
  I don&rsquo;t require any help
  </li>
  <li>
  Prefer not to say (DNRO)
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>9.</p>
  </td>
  <td>
  <p>Do you have enough privacy in this nursing home?</p>
  <br>
  <ul>
  <li>
  Yes, always
  </li>
  <li>
  Yes, sometimes
  </li>
  <li>
  No
  </li>
  <li>
  Don&rsquo;t know
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>10.</p>
  </td>
  <td>
  <p>Are your dietary needs and choices taken into account in the food that is served?</p>
  <ul>
  <li>
  Yes, always
  </li>
  <li>
  Yes, sometimes
  </li>
  <li>
  No
  </li>
  <li>
  I do not have any requirements or preferences
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="370"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>Section 2: Admission/moving in to the nursing home</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>10b. Why do you live in a nursing home?</p>
  <p>Prefer not to say</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="180"><col width="434"></colgroup>
  <tbody>
  <tr>
  <td colspan="2">
  <p>11. Were you involved as much as you wanted to be in the decision to</p>
  <p>move into this nursing home?</p>
  </td>
  </tr>
  <tr>
  <td>
  <ul>
  <li>
  Yes, definitely
  </li>
  </ul>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <ul>
  <li>
  Yes, to some extent
  </li>
  </ul>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <ul>
  <li>
  No
  </li>
  </ul>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <ul>
  <li>
  Don&rsquo;t know/can&rsquo;t remember
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>12</p>
  </td>
  <td>
  <p>Before you moved in, did you receive enough information about what life would be like here?</p>
  <br>
  <ul>
  <li>
  Yes, definitely
  </li>
  <li>
  Yes, to some extent
  </li>
  <li>
  No
  </li>
  <li>
  Don&rsquo;t know/can&rsquo;t remember
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>13</p>
  </td>
  <td>
  <p>When you moved in, were you supported to keep in touch and maintain relationships with family or friends?</p>
  <br>
  <ul>
  <li>
  Yes, definitely
  </li>
  <li>
  Yes, to some extent
  </li>
  <li>
  No
  </li>
  <li>
  Don&rsquo;t know / Can&rsquo;t remember
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <p><strong>Section 3: </strong>Caregivers and staff in the nursing home<strong><br></strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="41"><col width="563"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>14.</p>
  </td>
  <td>
  <p>Are the staff here knowledgeable about the care and support you need?</p>
  <br>
  <ul>
  <li>
  Yes, definitely
  </li>
  <li>
  Yes, to some extent
  </li>
  <li>
  No
  </li>
  <li>
  Don&rsquo;t know
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>15.</p>
  </td>
  <td>
  <p>Do the people who work here check in with you often enough to see if you need anything?</p>
  <br>
  <ul>
  <li>
  Yes, definitely
  </li>
  <li>
  Yes, to some extent
  </li>
  <li>
  No
  </li>
  <li>
  Don&rsquo;t know
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>16.</p>
  </td>
  <td>
  <p>Is there a staff member who you can talk to about your worries and fears?</p>
  <br>
  <ul>
  <li>
  Yes, always
  </li>
  <li>
  Yes, sometimes
  </li>
  <li>
  No
  </li>
  <li>
  I have no worries or fears
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="42"><col width="564"></colgroup>
  <tbody>
  <tr>
  <td colspan="2">
  <p>Section 4: Spending time here</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>17.</p>
  </td>
  <td>
  <p>Do you get to decide how you spend your day?</p>
  <br>
  <ul>
  <li>
  Yes, always
  </li>
  <li>
  Yes, sometimes
  </li>
  </ul>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="42"><col width="564"></colgroup>
  <tbody>
  <tr>
  <td>&nbsp;</td>
  <td>
  <ul>
  <li>
  No
  </li>
  <li>
  I don&rsquo;t wish to provide input
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>18.</p>
  </td>
  <td>
  <p>Are you supported to take part in activities that interest you?</p>
  <br>
  <ul>
  <li>
  Yes, always
  </li>
  <li>
  Yes, sometimes
  </li>
  <li>
  No
  </li>
  <li>
  Don&rsquo;t know
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>19.</p>
  </td>
  <td>
  <p>Do you have enough control over the visits you receive here?</p>
  <br>
  <ul>
  <li>
  Yes, definitely
  </li>
  <li>
  Yes, to some extent
  </li>
  <li>
  No
  </li>
  <li>
  Don&rsquo;t know
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>20.</p>
  </td>
  <td>
  <p>Besides visits, are you enabled to stay in contact with the people you would like to stay in contact with?</p>
  <br>
  <ul>
  <li>
  Yes, definitely
  </li>
  <li>
  Yes, to some extent
  </li>
  <li>
  No
  </li>
  <li>
  Don&rsquo;t know/ I don&rsquo;t have anyone to stay in contact with
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>21.</p>
  </td>
  <td>
  <p>If you have a visitor, can you find a place to talk to them in private, other than your bedroom?</p>
  <br>
  <ul>
  <li>
  Yes, always
  </li>
  <li>
  Yes, sometimes
  </li>
  </ul>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="42"><col width="564"></colgroup>
  <tbody>
  <tr>
  <td>&nbsp;</td>
  <td>
  <ul>
  <li>
  No
  </li>
  <li>
  Don&rsquo;t know/I don&rsquo;t normally have visitors
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>22.</p>
  </td>
  <td>
  <p>Are you able to mark special occasions in the way that you would like?</p>
  <br>
  <ul>
  <li>
  Yes, definitely
  </li>
  <li>
  Yes, to some extent
  </li>
  <li>
  No
  </li>
  <li>
  Not relevant to my situation
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>Section 5: Your living environment</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>23.</p>
  </td>
  <td>
  <p>In your opinion, how clean is the nursing home?</p>
  <br>
  <ul>
  <li>
  Very clean
  </li>
  <li>
  Fairly clean
  </li>
  <li>
  Not very clean
  </li>
  <li>
  Not at all clean
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>24.</p>
  </td>
  <td>
  <p>Do you have as much control as you would like over your personal finances?</p>
  <br>
  <ul>
  <li>
  Yes, definitely
  </li>
  <li>
  Yes, to some extent
  </li>
  <li>
  No
  </li>
  <li>
  I have asked someone else to look after my finances for me
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>25.</p>
  </td>
  <td>
  <p>Are your belongings and personal items safe here?</p>
  <br>
  <ul>
  <li>
  Yes, definitely
  </li>
  <li>
  Yes, to some extent
  </li>
  </ul>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <ul>
  <li>
  No
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="41"><col width="564"></colgroup>
  <tbody>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>Section 6: Person-centred care</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>26.</p>
  </td>
  <td>
  <p>Are you able to make choices about your daily routine?</p>
  <br>
  <ul>
  <li>
  Yes, definitely
  </li>
  <li>
  Yes, to some extent
  </li>
  <li>
  No
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>27.</p>
  </td>
  <td>
  <p>Are you encouraged to be as independent as you are able to be?</p>
  <br>
  <ul>
  <li>
  Yes, always
  </li>
  <li>
  Yes, sometimes
  </li>
  <li>
  No
  </li>
  <li>
  Don&rsquo;t know
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>28.</p>
  </td>
  <td>
  <p>When receiving support with personal care and hygiene, do you feel that staff respect your privacy and do not rush you?</p>
  <br>
  <ul>
  <li>
  Yes, always
  </li>
  <li>
  Yes, sometimes
  </li>
  <li>
  No
  </li>
  <li>
  I don&rsquo;t require any support with personal care and hygiene
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>29.</p>
  </td>
  <td>
  <p>If you want to make an appointment with a GP or family doctor are you supported to?</p>
  <br>
  <ul>
  <li>
  Yes, definitely
  </li>
  </ul>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="41"><col width="564"></colgroup>
  <tbody>
  <tr>
  <td>&nbsp;</td>
  <td>
  <ul>
  <li>
  Yes, to some extent
  </li>
  <li>
  No
  </li>
  <li>
  Don&rsquo;t know/I have not needed to talk to my GP
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>30.</p>
  </td>
  <td>
  <p>If you want to see a healthcare professional (such as a Physiotherapist, Occupational Therapist, Speech and Language Therapist, Dietician, Chiropody, Optician, Dentist) about a condition, treatment or tests, do you have enough opportunity to do so?</p>
  <br>
  <ul>
  <li>
  Yes, definitely
  </li>
  <li>
  Yes, to some extent
  </li>
  <li>
  No
  </li>
  <li>
  Don&rsquo;t know/I have not needed to see a healthcare professional
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>31.</p>
  </td>
  <td>
  <p>Do staff in the nursing home support your family members and/or friends to be as involved in your care as you would like them to be?</p>
  <br>
  <ul>
  <li>
  Yes, definitely
  </li>
  <li>
  Yes, to some extent
  </li>
  <li>
  No
  </li>
  <li>
  I do not want them to be involved
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>32.</p>
  </td>
  <td>
  <p>Do the staff support you to practice your religious or spiritual needs?</p>
  <br>
  <ul>
  <li>
  Yes, always
  </li>
  <li>
  Yes, sometimes
  </li>
  <li>
  No
  </li>
  <li>
  Not relevant
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="41"><col width="564"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>33.</p>
  </td>
  <td>
  <p>Are you encouraged to speak up about things you don&rsquo;t like here if you don&rsquo;t agree with something?</p>
  <br>
  <ul>
  <li>
  Yes, definitely
  </li>
  <li>
  Yes, to some extent
  </li>
  <li>
  No
  </li>
  <li>
  Don&rsquo;t know
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>34.</p>
  </td>
  <td>
  <p>Thinking about your overall care, if you wish to give feedback or make a complaint, do you know how and where to do so?</p>
  <br>
  <ul>
  <li>
  Yes
  </li>
  <li>
  No
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>35.</p>
  </td>
  <td>
  <p>If you have ever made a complaint, did the staff respond to it promptly and appropriately?</p>
  <br>
  <ul>
  <li>
  Yes
  </li>
  <li>
  No
  </li>
  <li>
  I have not needed to make a complaint
  </li>
  <li>
  I wanted to make a complaint but was not able to
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>36.</p>
  </td>
  <td>
  <p>Do you know how to access organisations that can support you to express your views and wishes, and to help you to assert your rights?</p>
  <p>(Such as the National Advocacy Service, Sage Advocacy or Age Action Ireland)</p>
  <br>
  <ul>
  <li>
  Yes, definitely
  </li>
  <li>
  Yes, to some extent
  </li>
  <li>
  No
  </li>
  <li>
  Not relevant to my situation
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="42"><col width="564"></colgroup>
  <tbody>
  <tr>
  <td>&nbsp;</td>
  <td>
  <ul>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>Section 7: Food and nutrition</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>37.</p>
  </td>
  <td>
  <p>How would you rate the food served here?</p>
  <br>
  <ul>
  <li>
  Very good
  </li>
  <li>
  Good
  </li>
  <li>
  Fair
  </li>
  <li>
  Poor
  </li>
  <li>
  Don&rsquo;t know
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>38.</p>
  </td>
  <td>
  <p>Are you offered a choice of food?</p>
  <br>
  <ul>
  <li>
  Yes, always
  </li>
  <li>
  Yes, sometimes
  </li>
  <li>
  No
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>39.</p>
  </td>
  <td>
  <p>Do you get enough support from staff to eat your meals?</p>
  <br>
  <ul>
  <li>
  Yes, always
  </li>
  <li>
  Yes, sometimes
  </li>
  <li>
  No
  </li>
  <li>
  I do not need support to eat meals
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>40.</p>
  </td>
  <td>
  <p>Do you get enough fresh water to drink?</p>
  <br>
  <ul>
  <li>
  Yes, always
  </li>
  <li>
  Yes, sometimes
  </li>
  <li>
  No
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="39"><col width="561"></colgroup>
  <tbody>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td>
  <p>41.</p>
  </td>
  <td>
  <p>Can you get snacks and drinks outside of mealtimes if you want to?</p>
  <br>
  <ul>
  <li>
  Yes, always
  </li>
  <li>
  Yes, sometimes
  </li>
  <li>
  No
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <p><strong><br><br></strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="39"><col width="562"></colgroup>
  <tbody>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>Section 8: Overall</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>42.</p>
  </td>
  <td>
  <p>Overall, how would you rate your experience here? Select a number between 0 (very poor experience) and 10 (very good experience).</p>
  <p>0 1 2 3 4 5 6 7 8 9 10</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong><br><br></strong></p>
  <p>Prefer not to say</p>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="40"><col width="584"></colgroup>
  <tbody>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>Section 9: About you</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>43.</p>
  </td>
  <td>
  <p>In what year were you born?</p>
  <br>
  <ul>
  <li>
  &nbsp;
  </li>
  <li>
  Don&rsquo;t know
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>44.</p>
  </td>
  <td>
  <p>Are you:</p>
  <br>
  <ul>
  <li>
  Male
  </li>
  <li>
  Female
  </li>
  <li>
  Other
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p><strong><br><br><br></strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="40"><col width="597"></colgroup>
  <tbody>
  <tr>
  <td>
  <p>45.</p>
  </td>
  <td>
  <p>In total, about how long have you lived here?</p>
  <br>
  <ul>
  <li>
  less than 6 months
  </li>
  <li>
  6 months to less than 1 year
  </li>
  <li>
  more than 1 year, but less than 2 years
  </li>
  <li>
  more than 2 years but less than 5 years
  </li>
  <li>
  more than 5 years
  </li>
  <li>
  Don&rsquo;t know
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  <tr>
  <td>
  <p>46.</p>
  </td>
  <td>
  <p>Do you currently share a bedroom with other residents here?</p>
  <br>
  <ul>
  <li>
  Yes
  </li>
  <li>
  No
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <ol>
  <li>
  Do you currently share a bathroom with other residents here?
  </li>
  <ul>
  <li>
  Yes
  </li>
  <li>
  No
  </li>
  <li>
  Prefer not to say
  </li>
  </ul>
  </ol>
  <p>&nbsp;</p>
  <p><strong>&nbsp;</strong></p>
  <ol>
  <li>
  Please indicate which ethnic group you belong to? White:
  </li>
  <ul>
  <li>
  Irish
  </li>
  <li>
  Irish Traveller
  </li>
  <li>
  Any other white background
  </li>
  </ul>
  </ol>
  <p>Black or Black Irish:</p>
  <ul>
  <li>
  African
  </li>
  <li>
  Any other black background
  </li>
  </ul>
  <p>Asian or Asian Irish:</p>
  <ul>
  <li>
  Chinese
  </li>
  <li>
  Indian/Pakistani/Bangladeshi
  </li>
  <li>
  Another Asian background
  </li>
  </ul>
  <p>Other, including mixed group/background:</p>
  <ul>
  <li>
  Arabian
  </li>
  <li>
  Mixed, please specify
  </li>
  <li>
  Other, please write your ethnic group here:
  </li>
  </ul>
  <p><strong>&nbsp;</strong></p>
  <ul>
  <li>
  Prefer not to say
  </li>
  </ul>
  <p><strong><br><br><br><br></strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="58"><col width="556"></colgroup>
  <tbody>
  <tr>
  <td>&nbsp;</td>
  <td>
  <p>Section 10: Free-text responses</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>49.</p>
  </td>
  <td>
  <p>Overall, is there anything particularly good about the care here?</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>Prefer not to say</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>50.</p>
  </td>
  <td>
  <p>Is there anything that could be improved? (For example, are there activities that you would like to engage in that you currently cannot?</p>
  <p>Do you feel limited by anything here?)</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2"><br>
  <p>Prefer not to say</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>51.</p>
  </td>
  <td>
  <p>Do you have any comments about how the COVID-19 pandemic affected the care you received here or your overall experience here</p>
  <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;during that period? If so, please elaborate.</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>&nbsp;</p>
  <p>&nbsp;</p>
  <p><strong>&nbsp;</strong></p>
  <div dir="ltr" align="left">
  <table><colgroup><col width="48"><col width="567"></colgroup>
  <tbody>
  <tr>
  <td colspan="2">
  <p>Prefer not to say</p>
  </td>
  </tr>
  <tr>
  <td>
  <p>52.</p>
  </td>
  <td>
  <p>Do you have any other comments or suggestions? If so, please elaborate.</p>
  </td>
  </tr>
  <tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  </tr>
  <tr>
  <td colspan="2">
  <p>Prefer not to say</p>
  </td>
  </tr>
  </tbody>
  </table>
  </div>
  <p>Thank you for your time. Its really appreciated.<strong id="docs-internal-guid-92757497-7fff-8bf0-472d-c6d7b2dde40b"></strong></p>

meta_description:
  it is crucial to understand that trauma does not affect everyone in the same manner, particularly underprivileged individuals.


