Gait Belt Usage Knowledge Survey
Please complete this survey to help us assess knowledge and practices related to gait belt usage.
Full Name
First Name
Last Name
Your Role/Position
*
Please Select
Nurse
Physical Therapist
Occupational Therapist
Nursing Assistant
Other
How often do you use a gait belt when assisting patients with mobility?
*
Always
Often
Sometimes
Rarely
Never
When is it appropriate to use a gait belt? (Select all that apply)
*
When transferring a patient from bed to chair
When ambulating a patient
When lifting heavy objects
When a patient is at risk of falling
Other
Rate your confidence in correctly applying a gait belt.
*
1
2
3
4
5
Have you received formal training on gait belt usage?
*
Yes
No
Barriers to Gait Belt Usage: Please indicate how much you agree with the following statements.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Using a gait belt takes too much time.
1
2
3
4
5
Gait belts are not always available.
6
7
8
9
10
Patients refuse the use of gait belts.
11
12
13
14
15
I feel confident assisting without a gait belt.
16
17
18
19
20
In your opinion, how important is gait belt use for patient safety?
*
Not important
1
2
3
4
Extremely important
5
1 is Not important, 5 is Extremely important
Would you like additional training or information about gait belt usage?
*
Yes
No
Please provide any comments or suggestions regarding gait belt usage.
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