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  Your Survey for the Beata Clasp® Products are most Welcome.
   
  Improving the Safety of Medical Tubing Maintenance
with the Beata Clasp® 		 
 
Thank you for taking our Survey! Your feedback is greatly appreciated!
 
Dear Study Participant:

As inventor of the Beata Clasp® and a fellow nurse professional, I want to thank you for participating in the Beata Clasp® study. This project could not have been conducted without your help.

Please help me understand your opinions of the Beata Clasp® by completing this short survey.

If you have any comments or questions on the survey process or the study in general, please feel free to contact me directly.

I may be reached at 630-936-9663 or beataclasp@gmail.com.

Thank you for your time and your dedication to the nursing profession.

Respectfully,

Lenore Henning RN
President and Founder of The Beate Clasp

 
*************** OVERALL IMPRESSION of the BEATA CLASP ***************
 
1. How favorable was your overall impression of the Beata Clasp®?
 
Excellent
Good
Neutral
Poor
Very Poor
 
2. Overall, how satisfied were you with the Beata Clasp®?
 
Very satisfied
 Satisfied
 Neutral
Dissatisfied
 Very dissatisfied
 
3. Based on your experience with the Beata Clasp®, how interested are you in having it available for use with your patients?
 
Very interested
Somewhat interested
Not sure
Not very interested
 Not at all interested
 
4. If interested, what is the main reason you want to use the Beata Clasp® with your patients?
 
 
 
*************** GENERAL ATTRIBUTES of the BEATA CLASP ***************
 
 
5. With how many patients have you used the Beata Clasp® during this study?
 
<10
11-20
21-40
41-50
>50
 
6. How effective would you judge the Beata Clasp® to be in improving patient safety?
 
Very effective
Effective
Neutral
Ineffective
Very ineffective
 
7. How strongly do you believe the patient benefits from the Beata Clasp?
 
Strongly agree
Agree
Not Sure
Disagree
Strongly disagree
 
8. How strongly you believe that you, the nurse or caregiver, benefits from the Beata Clasp®?
 
Strongly agree
Agree
Not Sure
Disagree
Strongly disagree
 
 
*************** OUR EXPERIENCE ***************
 
9. What is your job function?
 
Staff nurse
Nursing Asst or Patient Care Tech
Charge Nurse or Nurse Supervisor
Nurse Practitioner or Clinical Nurse Specialist
Other
 
10. How many years have you worked at your current job on this nursing unit?
 
<1 year
1-4 years
5-10 years
11-20 years
>20 years
 
11. How many years have you worked in this role or a similar role at any hospital?
 
<1 year
1-4 years
5-10 years
11-20 years
>20 years
 
 
*************** SPECIFIC ATTRIBUTES of the BEATA CLASP ***************
 
How would you rate the following?
 
12. The concept of a line separator system
Excellent
Good
Neutral
Poor
Very Poor
 
13.The effectiveness of the Beata Clasp® in keeping lines separated
 
Excellent
Good
Neutral
Poor
Very Poor
 
14.The effectiveness of the Beata Clasp® versus an alternative solution
 
Excellent
Good
Neutral
Poor
Very Poor
 
15.The impact of the Beata Clasp® on improving patient safety
 
Excellent
Good
Neutral
Poor
Very Poor
 
16.The impact of the Beata Clasp® on improving your work efficiency or workload
 
Excellent
Good
Neutral
Poor
Very Poor
 
17.The overall quality of the Beata Clasp®
 
Excellent
Good
Neutral
Poor
Very Poor
 
18.The ease of using the Beata Clasp®
 
Excellent
Good
Neutral
Poor
Very Poor
 
19.Would you recommend the Beata Clasp® to other nurses?
 
Excellent
Good
Neutral
Poor
Very Poor
Others
 
If no, why not?
 
 
20. Which of the following statements best describes your reaction to the Beata Clasp®? CHOOSE ONE
 
I really want to use the Beata Clasp® with my patients because it effectively solves the problem of "spaghetti lines".
The Beata Clasp® is a minor improvement in the "spaghetti line" problem.
I'm not sure that the Beata Clasp® does anything to help the "spaghetti line" problem.
I am not at all interested in using the Beata Clasp® because I do not see any benefit to me or the patient.
 
21. The "spaghetti syndrome" of tangled, impinged or falling lines/tubing is not a problem for me.
 

The "spaghetti syndrome" of tangled, impinged or falling lines/tubing is not a problem for me.
 I have not tried to solve the "spaghetti syndrome" of multiple lines and tubing with any solution other than the Beata        Clasp®.
Compared to other methods or products I have tried, the Beata Clasp® is more effective at solving the problem of         "spaghetti lines".
Compared to other methods or products I have tried, the Beata Clasp® is less effective or equally effective at solving         the problem of "spaghetti lines".

 
22. If you have tried other products or methods, please list or describe them:
 
 
23.What is it you liked most about the Beata Clasp®?
 
 
24.If you could change something about the Beata Clasp®, what would it be?
 
 
25.Are there any other comments you have about your experience using the Beata Clasp®?
 
 
 
First Name:
 
Last Name:
 
Hospital     :
 
 
 

THANK YOU
 
   
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