Questionnaires

Hospital Questionnaires

Questions and variables

1a/b. Unit sheet: asks for nutrition related organisational and structural information on the ward. This questionnaire has to be completed once per ward by the unit staff. (2 pages per unit - Duration 1x10min)

1c. Hospital sheet: asks about capacity and structural information of the hospital, to be filled in by the hospital management (1 page per unit - Duration 1x5min)

2a/b. About your patient: asks for disease specific information and the nature of the patient's hospital stay. This questionnaire has to be completed by unit staff. (2 sheets per patient - Duration 5min/patient)

3a/b. Patient questionnaire: each patient is asked to fill a questionnaire about changes in nutritional habits and reasons for decreased nutritional intake from the patient’s perspective and health status now and before admission to be filled by the patients themselves (2 pages - Duration 5min)

Outcome Evaluation: This re-assesses the patient's outcome 30 days after nutritionDay (discharged, still in hospital, transferred, death...). This questionnaire has to be completed 30 days after nutritionDay by the unit staff. (Duration 2min per patient)

If cancer patients are present on your ward we recommend that you also use the 3 optional oncology related questionnaires:

1. onco unit sheet: asks for nutrition related organisational and structural information which is essential for the cancer patients on your ward . This questionnaire has to be completed once per ward by unit staff. (1 page - Duration 1x10min)

2. onco patient description: asks for cancer diagnosis, cancer staging, cancer therapy and nutrition treatment. This questionnaire has to be completed by the unit staff. 8 patients with cancer can be included on one sheet (1 line per cancer patient - Duration 5min/patient)

3. onco patient description includes questions on weight loss, reasons for change in appetite,food intake, physical activity, mental status and the use of any alternative therapies. This questionnaire has to be completed by each cancer patient on the ward. Please assist the patients if needed. (1 page - Duration 5min/patient)

You will receive one unit report for all patients and two additional oncology reports for your cancer patients!