Beads of Courage Programs - Clinical Experience Survey

Beads of Courage would love to hear from you! We value our partnership in caring with you and look forward to your comments and suggestions to help us shape the future of Beads of Courage programs. All entries are kept confidential.

What Beads of Courage programs have you implemented in your clinical practice?
(Please mark all that apply) *

What Beads of Courage programs have you implemented in your clinical practice?
(Please mark all that apply) BOC Flagship Program BOC Sibling Program BOC Bead Strong Program BOC Bead Mindful for Clinicians BOC Strand for Strength & Remembrance Workshop BOC Ambassador Workshop BOC DREAM Workshop BOC I'm Fine Workshop BOC Camp Program I have not used BOC programs but would like more information on:
Please indicate the discipline(s) that best describe your clinical practice.
(Please mark all that apply): *

Please indicate the discipline(s) that best describe your clinical practice.
(Please mark all that apply): Child Life Specialist Child Life Assistant Social Worker Nurse Nurse Practitioner Physician Physician's Assistant Medical Resident Student Intern Pastoral Care Art Therapist Recreational Therapist Music Therapist Physical/Occupational Therapist Other Other
How many years have you been in your clinical practice? *
Please indicate where/what setting you use the Beads of Courage Programs.
(Please mark all that apply) *

Please indicate where/what setting you use the Beads of Courage Programs.
(Please mark all that apply) Hospital (inpatient units) Hospital (outpatient clinics) Medical/doctor's office Non-profit/community based organization Support group setting Individual session Private practice Other Other

Please indicate your experience using Beads of Courage Programs with the following scale:
1 (extremely unlikely) to 5 (extremely likely)
Please select NA if you have not used BOC programs *
	1	2	3	4	5	NA
How likely are you to recommend BOC Programs to a collegue?	How likely are you to recommend BOC Programs to a collegue?1	How likely are you to recommend BOC Programs to a collegue?2	How likely are you to recommend BOC Programs to a collegue?3	How likely are you to recommend BOC Programs to a collegue?4	How likely are you to recommend BOC Programs to a collegue?5	How likely are you to recommend BOC Programs to a collegue?NA
How likely are you able to achieve your clinical goals using BOC programs?	How likely are you able to achieve your clinical goals using BOC programs?1	How likely are you able to achieve your clinical goals using BOC programs?2	How likely are you able to achieve your clinical goals using BOC programs?3	How likely are you able to achieve your clinical goals using BOC programs?4	How likely are you able to achieve your clinical goals using BOC programs?5	How likely are you able to achieve your clinical goals using BOC programs?NA
How likely are you to continue to use BOC programs in your clinical practice?	How likely are you to continue to use BOC programs in your clinical practice?1	How likely are you to continue to use BOC programs in your clinical practice?2	How likely are you to continue to use BOC programs in your clinical practice?3	How likely are you to continue to use BOC programs in your clinical practice?4	How likely are you to continue to use BOC programs in your clinical practice?5	How likely are you to continue to use BOC programs in your clinical practice?NA

Could you elaborate on the scores that were given based on your experience above? *

Please rate your level of satisfaction of the Beads of Courage Programs.
1 (extremely unsatisfied) to 5 (extremely satisfied)
Please select NA if you have not used BOC programs. *
	1	2	3	4	5	NA
Overall clinician satisfaction	Overall clinician satisfaction1	Overall clinician satisfaction2	Overall clinician satisfaction3	Overall clinician satisfaction4	Overall clinician satisfaction5	Overall clinician satisfactionNA
Ease of use with materials/facilitation	Ease of use with materials/facilitation1	Ease of use with materials/facilitation2	Ease of use with materials/facilitation3	Ease of use with materials/facilitation4	Ease of use with materials/facilitation5	Ease of use with materials/facilitationNA
Overall participant satisfaction	Overall participant satisfaction1	Overall participant satisfaction2	Overall participant satisfaction3	Overall participant satisfaction4	Overall participant satisfaction5	Overall participant satisfactionNA
Quality of materials as an arts-in-medicine program	Quality of materials as an arts-in-medicine program1	Quality of materials as an arts-in-medicine program2	Quality of materials as an arts-in-medicine program3	Quality of materials as an arts-in-medicine program4	Quality of materials as an arts-in-medicine program5	Quality of materials as an arts-in-medicine programNA
Overall satisfaction in meeting your clinical goals	Overall satisfaction in meeting your clinical goals1	Overall satisfaction in meeting your clinical goals2	Overall satisfaction in meeting your clinical goals3	Overall satisfaction in meeting your clinical goals4	Overall satisfaction in meeting your clinical goals5	Overall satisfaction in meeting your clinical goalsNA
Overall satisfaction with ordering/shipment of materials	Overall satisfaction with ordering/shipment of materials1	Overall satisfaction with ordering/shipment of materials2	Overall satisfaction with ordering/shipment of materials3	Overall satisfaction with ordering/shipment of materials4	Overall satisfaction with ordering/shipment of materials5	Overall satisfaction with ordering/shipment of materialsNA
Support provided/offered by BOC program clinicians	Support provided/offered by BOC program clinicians1	Support provided/offered by BOC program clinicians2	Support provided/offered by BOC program clinicians3	Support provided/offered by BOC program clinicians4	Support provided/offered by BOC program clinicians5	Support provided/offered by BOC program cliniciansNA

Could you elaborate on the scores that were given based on you level of satisfaction above? *
What clinical goals did the program(s) help to reach and were you able to achieve them? (or what clinical goals do you hope to achieve?) *
Is there anything that Beads of Courage can do to improve the experience or satisfaction for those that facilitate and participate in Beads of Courage programs or do you have any additional comments, questions, or suggestions? *
Do you have any photos of the program in action? Please share.

Attach Files
Would it be ok if we followed up with you? If so, please include your email address here:
Name (optional): Name (optional): First Last
Name of Hospital/Organization (optional)
Name of hospital/organization (optional): Name of hospital/organization (optional): First Last
Mailing Address Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Thank you for providing feedback on the Beads of Courage Programs.

Your feedback will be kept confidential and used with the Beads of Courage program staff in order to evaluate, improve, and tailor the program to meet the needs of the participants and facilitators. We greatly appreciate your honesty regardless of the kind of experience that you had with the program. Beads of Courage is grateful for your partnership and is available to support you with any of our programs. For specific questions or concerns about our programs, please email krista@beadsofcourage.org.

Beads of Courage Programs - Clinical Experience Survey

Beads of Courage Programs - Clinical Experience Survey

Thank you for providing feedback on the Beads of Courage Programs.