Gait Belt Training Survey
Please complete this survey to help us evaluate and improve our gait belt training program.
Full Name
*
First Name
Last Name
Role/Position
*
Please Select
Nurse
Physical Therapist
Occupational Therapist
Nursing Assistant
Student
Other
Have you used a gait belt before this training?
*
Yes
No
How confident are you in using a gait belt safely after this training?
*
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
Please rate your agreement with the following statements:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I understand when to use a gait belt.
1
2
3
4
5
I know how to properly fit a gait belt.
6
7
8
9
10
I feel comfortable assisting a patient with a gait belt.
11
12
13
14
15
I can recognize unsafe situations for gait belt use.
16
17
18
19
20
In which situations would you use a gait belt? (Select all that apply)
*
Transferring a patient from bed to chair
Ambulating a patient in the hallway
Moving a patient up in bed
Assisting a patient to stand
Other
What barriers, if any, do you face when using a gait belt? (Select all that apply)
Lack of availability
Patient refusal
Time constraints
Lack of confidence
Not sure when to use
Other
How would you rate the quality of the gait belt training?
*
1
2
3
4
5
What did you find most helpful about the training?
What suggestions do you have to improve the gait belt training?
Would you recommend this gait belt training to others?
*
Yes
No
Submit Survey
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