Bed Rest Basket Survey

bed rest surveys

Have you received a Bed Rest Basket from High Risk Hope? Please take 5 minutes to fill out this survey. HRH receives grant funding and surveys measuring the impact of HRH’s programs help us to secure future grants as well as report to funders. This survey will allow High Risk Hope to continue supporting moms with high risk pregnancies.

Measurable Outcomes | HROB Patient Survey

Did you receive a Bed Rest Basket™ from High Risk Hope while you were in the hospital?*
Yes No
The educational materials provided by High Risk Hope while we were in the hospital helped me/my family to learn about the following. Check all that apply.*
- Stress management skills to help cope with the stress of hospital bed rest
- Ways to better navigate and understand my hospital stay through the Hospital Bed Rest Check List
- The importance of involvement of family and friends
- The importance of advocating for my and my baby's health

Please rate the impact of the physical support items listed below that were provided by High Risk Hope on a scale of 1 to 5 with 1 being not helpful and 5 being most helpful.*

	Strongly Disagree (1)	Disagree (2)	Neutral (3)	Agree (4)	Strongly Agree (5)
Cup for hydration
Shampoo \| Conditioner \| Soap
Adult Wipes
Lotion
Lip balm
Tissues
Toothbrush \| Toothpaste \| Dental Floss
Gum
Antibacterial wet wipes
Hairbrush \| Hair ties
Manicure set
Satin pillow case
Eye mask
Ear plugs
Fleece blanket

The materials and services listed below provided by High Risk Hope during our hospital stay helped to improve our family’s GENERAL well-being.*

	True	False	Did not receive
HRH Calendar with encouraging stories
Facebook Support Group
Adult coloring book with pens
Journal to record notes, questions, and thoughts
Blogs providing information and hopeful patient stories
Information on reducing stress
Information on social supports and community resources for mothers, babies and families

The materials and services listed below provided by High Risk Hope during our hospital stay helped to improve my/my family’s MENTAL well-being during that time.*

	True	False	Did not receive
HRH Calendar with encouraging stories
Facebook Support Group
Adult coloring book with pens
Journal to record notes, questions, and thoughts
Blogs providing information and hopeful patient stories
Information on reducing stress
Information on social supports and community resources for mothers, babies and families

High Risk Hope materials and services helped me identify resources available for me and my family during our time in the hospital.*
True False
Services and materials provided by HRH during my time in the hospital helped me and my family to feel more supported.*
True False
Services and materials provided by HRH during my time in the hospital helped me and my family to feel a greater sense of community.*
True False

Bed Rest Basket Survey

bed rest surveys

Measurable Outcomes | HROB Patient Survey

HRH Headlines

What We Do

Take Action

Patient Resources

Contact Us

Latest Tweets

Facebook Likes