Questionnaires

There are 4 questionnaires to complete on nutritionDay. The unit staff completes 2 questionnaires about nutritional care and the patients’ illnesses. Patients have to complete 2 pages about their food intake history, appetite and any weight change.


Hospitals questionnaires

Hospital Questionnaires

 

Questions and variables

1. unit sheet: asks for nutrition related organisational and structural information on the ward. This questionnaire has to be completed once per ward by the unit staff. (1 page per unit - Duration 1x10min)


2. Patient description: asks for disease specific information and the nature of the patient's hospital stay. This questionnaire has to be completed by unit staff. 8 patients can be included on one sheet (1 line/15 items per patient - Duration 5min/patient)


3a. patient questionnaire: includes questions on weight monitoring, nutrition intake, mobility and social contacts. This questionnaire has to be completed by the patient. (One page - Duration 5min)


3b. patient questionnaire: asks about appetite as well as about the nutrition and liquids which were consumed on nutritionDay. This questionnaire has to be completed by the patient. Please assist the patients if needed. (One page - Duration 5min)


Outcome Evaluation: This re-assesses the patient's outcome 30 days after nutritionDay (discharged, still in hospital, transferred, death...). This questionnaire has to be completed 30 days after nutritionDay by the unit staff. (Duration 2min per patient)


If cancer patients are present on your ward we recommend that you also use the 3 optional oncology related questionnaires:

1. onco unit sheet: asks for nutrition related organisational and structural information which is essential for the cancer patients on your ward . This questionnaire has to be completed once per ward by unit staff. (1 page - Duration 1x10min)


2. onco patient description: asks for cancer diagnosis, cancer staging, cancer therapy and nutrition treatment. This questionnaire has to be completed by the unit staff. 8 patients with cancer can be included on one sheet (1 line per cancer patient - Duration 5min/patient)


3. onco patient description includes questions on weight loss, reasons for change in appetite,food intake, physical activity, mental status and the use of any alternative therapies. This questionnaire has to be completed by each cancer patient on the ward. Please assist the patients if needed. (1 page - Duration 5min/patient)

You will receive one unit report for all patients and two additional oncology reports for your cancer patients!


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