1
What category of patients are admitted to your workplace(department)?
Select one answer
2
What kind of children's hospitalizations are most often at your workplace?
Select one answer
3
Which medical areas can your workplace be included in?
Select one answer
4
Your health care facility is
Select one answer
5
What country do you work in?
Select one answer or specify the country
6
How long have you been working as a proffesional?
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7
What is your highest achieved education?
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8
Are you a nurse–specialist in a paediatrics or neonatology field?
Select one answer
9
In your health care facility, do you have a quality management system?
Select one answer
10
Does your department allow children with multiple guardians (a parent, legal representative, relative, etc.)?
Select one answer
11
What kind of stay does your workplace allow for a child's companion?
Select one or more answers
12
How is a child's companion accommodated in case of a hospitalization with the child?
Select one or more answers
13
In case there is a male child's companion who wants to be hospitalized, what possibilities of accommodation have you got?
Select one or more answers
14
In your opinion, what are the benefits of a child's companion present during hospitalization?
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15
In your opinion, what are disadvantages of a child's companion present during hospitalization?
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16
Do you have "Charter on Children's Rights in Hospital" available in your workplace?
Select one answer in each line
17
Do you make children's companions familiar with "Charter on Children's Rights in Hospital" after admission to hospitalization, or eventually children (accordingly to their mental abilities)?
Select one answer in each line
18
Are children and their companions instructed before hospitalization on conditions of hospitalization, character of treatment procedure and assumed time of hospitalization?
select one answer
19
Do you allow children and their companion to visit in-patient departments and familiarize with the run of the department before the start of hospitalization (so called pre-hospitalization preparation)?
select one answer
20
In your workplace, do you have elaborated educational material for accompanying persons (aimed e.g. on safety of a child during stay in hospital, serving food during hospitalization, administration of medicines during hospitalization, manipulation with room furnishing, and so on)?
select one answer
21
Do children in your workplace have secured
Select one answer in each line
22
Does your workplace cooperate with a voluntary organization that helps make time spent in hospital more pleasant for children?
select one answer
23
If you know what voluntary organization does your workplace cooperate with, write its name:
24
Is there an outdoor area within your hospital complex, e.g. park, where hospitalized children can stay if their health condition enables that?
select one answer
25
Do children have available a common room/ game room (other space where they can meet other children and spend their free time there) during hospitalization?
select one answer
26
Do you have available for children of various age categories:
Select one answer in each line
27
Where do you serve food to hospitalized children?
Select one or more answers
28
How the children have food (dairies, additional food) secured at night?
Select one or more answers
29
How do you administer medicines to children?
Select one or more answers
30
In your workplace, do you have aids and devices for solving immediate conditions in children available?
select one answer
31
Are you regularly (at least 1x in two years) re-trained in solving immediate conditions in child patients?
select one answer
32
How is a child patient identified in your workplace?
Select one or more answers
33
When do you perform the process of safe child's identification?
Select one or more answers
34
In your workplace, do you have elaborated special procedures for treating pain in children?
select one answer
35
Do you use at you work special scales for evaluating pain in children?
select one answer
36
Do you feel safe when providing health care to children at your work?
select one answer
37
In your opinion, what are the greatest risks when providing health care to children in wards for adult patients?
select one or more answer
38
In your workplace, have you elaborated internal rules regarding:
Select one answer in each line
In the following items, please rate the adjustment of your workplace to hospitalization of child patients (most stars given = best rating)
39
Esthetical adjustment to child patients (colours, lights, pictures, wallpapers, toys...)
Rate with number of stars (most stars = best rating)
40
Spatial adjustment to child patients (furniture allocation, no sharp edges of furniture, removal of devices from a child's field of view, space for play, playing mats, ...)
Rate with number of stars (most stars = best rating)
41
Ergonomic adjustment to child patients (child table, chairs, dining set...)
Rate with number of stars (most stars = best rating)
42
Schedule adjustment to child patients hospitalizations (adjustment of treating interventions - e.g. morning BP measuring, elimination of disturbing impulses at time of children's sleep, and so on)
Rate with number of stars (most stars = best rating)
43
Equipment of workplace with beds for various age categories of children
Rate with number of stars (most stars = best rating)
44
Adjusting of hygienic facilities to child patients (placing sinks in a suitable height for children, diapers change desktops, baby troughs, and so on)
Rate with number of stars (most stars = best rating)
45
Securing electric appliances (electric appliances are out of children's reach, or they are secured – electric plugs blinded, electric appliances in a safe height, and so on)
Rate with number of stars (most stars = best rating)
46
Securing dangerous areas against children's entry (stores, technical rooms, drugs storage rooms ...)
Rate with number of stars (most stars = best rating)
47
Safe disposal of chemical substances (disinfection solution, disinfection dozers on walls, and other chemical substances)
Rate with number of stars (most stars = best rating)
48
Securing windows in the areas accessible to children (so that children can't manipulate them independently)
Rate with number of stars (most stars = best rating)
49
Securing all lockers and drawers reachable to children (they are locked or secured so that children can't open them independently)
Rate with number of stars (most stars = best rating)
50
What possibilities of improvement in treating care of children in the adult patients’ wards would you suggest? From your point of view, what needs to be changed/added?