Evaluatieformulier voor cliënten van Midwifery practice Vita Nova.

Questionnaire for clients of Midwifery practice Vita Nova.
The midwives and assistants of midwifery practice Vita Nova have guided you throughout your pregnancy, childbirth and/or first week post childbirth. Our aim is to adjust our care to the wishes and needs of our clients as much as possible. To make this happen your opinion as our client is important. With this survey we would like to ask you about your opinion of the care provided by us and what might be improved. It takes about 8 minutes to fill out this survey, you will be able to give your opinion on different subjects. When a subject does not apply to you, you can fill out ‘n.a’ (‘not applicable’). If you wish you can explain your answers in your own words at the end of each block of questions. You can choose whether you want to fill out the survey anonymously or not. When there is written she/her this can also be read as he/him. Based on this survey our care as midwives will be evaluated and will be adapted when necessary. You are able to find the adjustments on our website: www.verloskundigedenbosch.nl. If you have any questions in response to this survey, please feel free to contact us, telephone number 073-6124569. We’d like to thank you for filling out this survey, we appreciate your input! Team Vita Nova

Questionnaire for clients of Midwifery practice Vita Nova.

logo verloskundigenpraktijk Vita Nova
The midwives and assistants of midwifery practice Vita Nova have guided you throughout your pregnancy, childbirth and/or first week post childbirth. Our aim is to adjust our care to the wishes and needs of our clients as much as possible. To make this happen your opinion as our client is important. With this survey we would like to ask you about your opinion of the care provided by us and what might be improved.

It takes about 8 minutes to fill out this survey, you will be able to give your opinion on different subjects. When a subject does not apply to you, you can fill out ‘n.a’ (‘not applicable’). If you wish you can explain your answers in your own words at the end of each block of questions.
You can choose whether you want to fill out the survey anonymously or not.

When there is written she/her this can also be read as he/him.

Based on this survey our care as midwives will be evaluated and will be adapted when necessary. You are able to find the adjustments on our website: www.verloskundigedenbosch.nl.

If you have any questions in response to this survey, please feel free to contact us, telephone
number 073-6124569.

We’d like to thank you for filling out this survey, we appreciate your input!

Team Vita Nova

Evaluation questionnaire:

FACILITIES IN THE PRACTICE
1.	The practice is accessible (also for buggies and wheelchairs).	Completely disagree	Completely agree	n/a
2.	The practice appears clean and tidy.	Completely disagree	Completely agree	n/a
3.	There is enough seating space in the waiting room.	Completely disagree	Completely agree	n/a
4.	There are sufficient and safe toys in the waiting room for children of different ages.	Completely disagree	Completely agree	n/a
5.	Magazines in the waiting room are updated regularly.	Completely disagree	Completely agree	n/a
6.	The waiting room has plenty of useful information (brochures, TV screen, etc).	Completely disagree	Completely agree	n/a
7.	In the consulting room I experienced a safe environment.	Completely disagree	Completely agree	n/a

Which subject from the questions above is most important to you:
Comments on facilities in the practice:

ORGANISATION OF THE PRACTICE
8.	Normally I was able to make an appointment for a date/time which suited me.	Completely disagree	Completely agree	n/a
9.	The assistant was helpful and able to inform me well.	Completely disagree	Completely agree	n/a
10.	I was well informed about the organisation of the practice (telephone numbers, opening hours etc.).	Completely disagree	Completely agree	n/a
11.	Practical information (brochure, website) is consistent with my experience in practice.	Completely disagree	Completely agree	n/a
12.	The weekly email about my pregnancy is a good addition to the information I received during my consultations.	Completely disagree	Completely agree	n/a
13.	I know how I can make use of the complaints procedure of the practice.	Completely disagree	Completely agree	n/a

Which subject from the questions above is most important to you:
Comments on organisation of the practice:

THE MIDWIVES
14.	I could discuss my questions and worries with the midwife.	Completely disagree	Completely agree	n/a
15.	The midwife took sufficient time for me.	Completely disagree	Completely agree	n/a
16.	The midwife took personal interest.	Completely disagree	Completely agree	n/a
17.	The midwife kept her promises and appointments.	Completely disagree	Completely agree	n/a
18.	The midwife supported me well during pregnancy.	Completely disagree	Completely agree	n/a
19.	To my knowledge my personal details were treated confidentially.	Completely disagree	Completely agree	n/a
20.	The midwife gave me understandable information.	Completely disagree	Completely agree	n/a
21.	The midwife gave me information about what I could expect from her, and her colleagues, concerning care and guidance.	Completely disagree	Completely agree	n/a
22.	The midwife respected my vision and wishes for my pregnancy, labour and the first week post childbirth and gave me sufficient space to influence these.	Completely disagree	Completely agree	n/a
23.	The midwife involved my partner well, and where relevant my children, in my pregnancy, labour and the first week post childbirth.	Completely disagree	Completely agree	n/a

Which subject from the questions above is most important to you:
Comments on the midwives:

PREGNANCY
24.	The midwife gave me sufficient information about pregnancy, I knew what to expect.	Completely disagree	Completely agree	n/a
25.	The midwife encouraged me to make a birth plan.	Completely disagree	Completely agree	n/a
26.	The midwife spent sufficient time discussing my expectations and wishes regarding my pregnancy.	Completely disagree	Completely agree	n/a
27.	I was well informed about prenatal screening.	Completely disagree	Completely agree	n/a
28.	It was pleasant for me to have a choice to be consulted by the full team of midwives or (temporarily) by half of the team of midwives.	Completely disagree	Completely agree	n/a
29.	All the midwives on the team were well informed about my personal situation.	Completely disagree	Completely agree	n/a

Which subject from the questions above is most important to you:
Comments on pregnancy:

CHILDBIRTH
30.	The midwife gave me sufficient information about childbirth.	Completely disagree	Completely agree	n/a
31.	The midwife spent sufficient time, discussed my expectations and wishes regarding childbirth. (potentially with a Birthplan)	Completely disagree	Completely agree	n/a
32.	The midwife informed me sufficiently about the advantages and disadvantages of pain relief during childbirth.	Completely disagree	Completely agree	n/a
33.	The information I received about the advantages and disadvantages of childbirth in the hospital or at home was sufficient.	Completely disagree	Completely agree	n/a
34.	I trusted that the midwife would support me well during childbirth.	Completely disagree	Completely agree	n/a
35.	During childbirth the midwife was clear on when she would come for a visit and about the moment she would stay with me.	Completely disagree	Completely agree	n/a
36.	The midwife was present at the birth as much as I wanted.	Completely disagree	Completely agree	n/a
37.	The midwife supported me well when I was in labour.	Completely disagree	Completely agree	n/a

Which subject from the questions above is most important to you:
Comments on childbirth:

REFERRAL TO THE GYNAECOLOGIST OR CLINICAL MIDWIFE
38.	Were you referred to a gynaecologist or a midwife at the hospital, during pregnancy or childbirth? Yes No

FIRST WEEK POST CHILDBIRTH
41.	The midwife prepared me well for the time after childbirth.	Completely disagree	Completely agree	n/a
42.	The midwife informed me well on the physical and mental changes after childbirth.	Completely disagree	Completely agree	n/a
43.	The midwife provided me with good information about the health and wellbeing of my baby.	Completely disagree	Completely agree	n/a
44.	The midwife supported me well during the first weeks after childbirth.	Completely disagree	Completely agree	n/a
45.	The information I received about the advantages and disadvantages of breast feeding and bottle feeding was sufficient.	Completely disagree	Completely agree	n/a
46.	The midwife gave me enough support in (breast) feeding.	Completely disagree	Completely agree	n/a
47.	The midwife and the postnatal care nurse were in agreement regarding their advice and the way they treated clients.	Completely disagree	Completely agree	n/a
48.	I was able to discuss and evaluate my experiences of childbirth with the midwife.	Completely disagree	Completely agree	n/a
49.	I appreciated the opportunity for a postnatal check-up six weeks after giving birth.	Completely disagree	Completely agree	n/a
50.	The information I received about the advantages and disadvantages of the different methods of birth control was sufficient.	Completely disagree	Completely agree	n/a
51.	The midwife helped me to choose the type of birth control that best suits me.	Completely disagree	Completely agree	n/a
52.	I could start at a suitable moment with birth control.	Completely disagree	Completely agree	n/a

Which subject from the questions above is most important to you:
Comments on first week post childbirth:

ACCESSIBILITY AND AVAILABILITY OF THE MIDWIVES
53.	I knew in which situations I had to call the midwife or the assistant instead.	Completely disagree	Completely agree	n/a
54.	I could contact the midwives or the assistant easily by telephone.	Completely disagree	Completely agree	n/a
55.	When I had concerns, the midwife was able to come and visit me or she was able to see me during practice hours.	Completely disagree	Completely agree	n/a
56.	In case of emergency I was able to get a hold of the midwife quickly.	Completely disagree	Completely agree	n/a
57.	In general all the midwives were in agreement on the advices they gave.	Completely disagree	Completely agree	n/a

Which subject from the questions above is most important to you:
Comments on accessibility and availability of the midwives:

WHAT DID YOU THINK WAS GOOD ABOUT THE PRACTICE AND WHAT ARE IMPROVEMENTS?

Good:

Improvements:

How did you learn about this practice :

If you selected "Other" please specify how:

Why did you choose this practice :

If you selected "Other" please specify why:

Do you allow us to use your comments in this survey for social media?

Ja
Nee

What grade would you give the practice? (Select the answer of your choice, where 10 stands for excellent and 1 stands for poor)

PRIVACYSTATEMENT
We are the only ones who use your given data to measure customer satisfaction. Perhaps there is a reason for us to contact you in response to your answers. We also like to see who filled in the survey. You can therefore enter your name below.
Yes, I have taken note of the privacy regulations (link opens in new window) and enter my name below . I want to participate anonymously.

My name:

These questions only apply if you have been referred to a gynecologist or midwife at the hospital!
39.	The midwife discussed with me the reasons for my referral.	Completely disagree	Completely agree	n/a
40.	The gynecologist or midwife in the hospital was well aware of my data and situation.	Completely disagree	Completely agree	n/a