LRI Adult ITU therapy dog: patient & visitor questionnaire

This questionnaire should be completed if you are either:

the patient who was visited by a therapy dog whilst you were on ITU

if you were visiting the patient at the time when a therapy dog visited the patient.

Please complete all questions giving as much detail as possible.

Your answers are anonymous.

Thank you

Question Title

1. What is your gender and age range? (If you are a visitor please complete for the patients age / gender)

	age 16-29	30-49	50-69	70-89	90+
male	male age 16-29	male 30-49	male 50-69	male 70-89	male 90+
Female	Female age 16-29	Female 30-49	Female 50-69	Female 70-89	Female 90+

Question Title

2. How long were you / was your friend or relative in hospital for? (please state in days)

Question Title

3. How did you or your friend/relative interact with the therapy dog?

a visit seeing but not stroking the dog

a visit seeing and stroking the dog

Other (please give details)

Question Title

4. What activities was the dog involved in?

Dog visited during visiting hours when the patient was resting / inactive

Dog visited during a blood test

Dog visited whilst medication was given

Dog visited during physiotherapy

Dog visited during occupational therapy

Dog visited during Speech and language therapy

Other (please provide details)

Question Title

5. Please indicate level of enjoyment that you or your friend/relative had as a result of the Therapy dog visiting.

1 - not at all enjoyable

10 -extremely enjoyble

1 - not at all enjoyable

10 -extremely enjoyble

comments:

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6. What was your impression of the benefit of the dog visit?

1 - not at all beneficial

10 - extremely beneficial

1 - not at all beneficial

10 - extremely beneficial

comments:

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7. Do you have concerns about seeing dogs on the ward?

Yes

comments:

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8. Do you have any concerns about the cleanliness and presentation of the dog that visited?

Yes

comments:

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9. Did you have any concerns about the welfare or handling of the dog during the visit?

Yes

comments:

Question Title

10. would you recommend other wards or hospitals to have therapy dogs as part of their team?

Yes

If you have any comments on any of the questions please state them here.
We would like to share comments anonymously on social media or at promotional events, if you don't wish for this please make it clear here.

LRI Adult ITU therapy dog: patient & visitor questionnaire

Question Title

* 1. What is your gender and age range? (If you are a visitor please complete for the patients age / gender)

Question Title

* 2. How long were you / was your friend or relative in hospital for? (please state in days)

Question Title

* 3. How did you or your friend/relative interact with the therapy dog?

Question Title

* 4. What activities was the dog involved in?

Question Title

* 5. Please indicate level of enjoyment that you or your friend/relative had as a result of the Therapy dog visiting.

Question Title

* 6. What was your impression of the benefit of the dog visit?

Question Title

* 7. Do you have concerns about seeing dogs on the ward?

Question Title

* 8. Do you have any concerns about the cleanliness and presentation of the dog that visited?

Question Title

* 9. Did you have any concerns about the welfare or handling of the dog during the visit?

Question Title

* 10. would you recommend other wards or hospitals to have therapy dogs as part of their team?

1. What is your gender and age range? (If you are a visitor please complete for the patients age / gender)

2. How long were you / was your friend or relative in hospital for? (please state in days)

3. How did you or your friend/relative interact with the therapy dog?

4. What activities was the dog involved in?

5. Please indicate level of enjoyment that you or your friend/relative had as a result of the Therapy dog visiting.

6. What was your impression of the benefit of the dog visit?

7. Do you have concerns about seeing dogs on the ward?

8. Do you have any concerns about the cleanliness and presentation of the dog that visited?

9. Did you have any concerns about the welfare or handling of the dog during the visit?

10. would you recommend other wards or hospitals to have therapy dogs as part of their team?