1 New Mother Quality of Care questionnaire (NEMOQC ) Your opinion is of fundamental importance to the continuing improvement of the health service. Please take a few minutes to fill out this questionnaire. Thank you Central / Quality Services
2 This questionnaire addresses the natural stages of your stay in a maternity ward: Admission to hospital and maternity ward, labour and delivery, stay in mothers and baby units, discharge. A scale like the one illustrated in the following example is used to rate your level of satisfaction: please place a cross on the scale to indicate your level of satisfaction. Example: My level of satisfaction is Very low x Very high This kind of questionnaire is an instrument that will help us to achieve our main objective: PATIENT SATISFACTION Knowing what our patients need and how well our hospital is organised will enable us to redesign and optimise hospital procedure.
3 ADMISSION TO HOSPITAL AND MATERNITY WARD 1. How would you rate your first impression of: - the car park Very satisfactory Suggestions / comments 2. - the reception area Very satisfactory Suggestions / comments 3. - the signs Very satisfactory Suggestions / comments
GENERAL QUESTIONS 4 4. Have you been to our hospital before? NO YES If yes, How would you rate the hospital s current organisation? Very bad Very good 5. Was your stay in our hospital recommended by: an obstetrician friends/relatives a paediatrician a family doctor 6. Have you given birth before (including in other maternity wards)? NO YES 7. When you arrived in the delivery room, what was your first impression? 8. How much pain would you say you felt? None Unbearable 9. How would you rate the performance of the midwife? 10. Have you given birth in our maternity ward before? NO YES 11. Was your admission to hospital: planned (induced birth, planned Caesarean section) on going into labour 12. Were you admitted: during the day (8.00 am 8.00 pm) during the night (8.00 pm 8.00 am)
5 LABOUR AND DELIVERY 1. How would you rate the teamwork between the midwife and the obstetrician during labour and delivery? 2. How would you rate the information you received from the nursing staff? 3. State the degree of empathy created with the nursing staff: 4. How would you rate the information you received from the obstetrician? Perfect 5. State the degree of empathy created with the obstetrician: 6. State to what extent your overall expectations from labour to delivery were met:
7. If your overall expectations were not met, in your opinion, what was the cause? lack of time lack of mutual understanding other 6 8. Were you given an epidural anaesthetic? YES NO 9. How did you feel during labour? Very bad Very well 10. Were you satisfied with how your labour went? 11. How many hours were you in the delivery room? 12. How secure (feeling of being protected) did you feel in the delivery room? 13. What positions did you use during labour? lying on a bed seated in a pool on a birthing ball on a Maya birthing stool 14. How satisfied would you say you were with the guidance you received during labour from: - the nursing staff? - the obstetrician? - the anaesthetist?
15. What general procedure was used for delivery? spontaneous vaginal induced vaginal planned Caesarean section unplanned Caesarean section use of ventouse cap use of forceps 7 16. How satisfied were you with the pain-relief treatments? 17. How would you rate the explanations given to you about the instrumental delivery (ventouse cap, forceps, Caesarean section) by: - the nursing staff - the medical staff 18. How would you rate the health of your baby when s/he was born? 19. When your baby was born, were you worried about his/her health? Extremely 20. Do you remember the procedures used by the medical/nursing staff when your baby was born? Perfectly 21. After your baby was born, how would you rate the time you spent in the delivery room before you were taken to your room? satisfactory Very satisfactory
8 STAY IN MOTHERS AND BABY UNITS 1. When you arrived at your room in the mothers unit, how satisfied were you with your experience in the delivery room? 2. How would you rate your reception in: - the mothers unit: - the baby unit: 3. How satisfied were you with the care you received from: - the nursing staff - the nursing staff in the baby unit - the paediatric medical staff Suggestions:
4. How well were you looked after by the nursing staff during breast-feeding? 9 ly Very well 5. How would you rate the information you received from: - the paediatrician - the nursing staff - the baby unit Suggestions: 6. How would you rate your privacy during your stay? 7. How would you rate your baby s health during your stay?
DISCHARGE 10 1. How would you rate your health when you were discharged? 2. How would you rate the idea of a future pregnancy? good Very good 3. On being discharged, how would you rate the information you received from: - the mothers unit staff - the baby unit staff - the paediatrician - the obstetrician - the administrative staff
4. How would you rate: - the hygiene? 11 - the telephone service? - the accommodation? - the food? 5. How satisfied would you say you were overall when you were discharged? satisfied satisfied 6. Would you recommend our hospital to your relatives/friends? YES NO Observations / comments: We have taken the first steps together We wish you all the best for the future