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The Jacki Program Breast Health Center Survey
Name
Name of Breast Health Center
Job Title
Caregiver
Hospital Staff Member
Nurse
Nurse Navigator
Nurse Practitioner
Office Manager
Patient Navigator
Doctor/Surgeon
Director
PHYSICAL WELL BEING
PHYSICAL WELL BEING
Not At All
A Little Bit
Somewhat
Quite a Bit
Very Much
The Jacki Program improved the participant's post surgical status
The Jacki helped with the participant's range of motion
The Jacki enabled the participant to do more activities
The Jacki enabled the participant to attend social situations
The Jacki helped the participant self manage their post surgical drains
The Jacki made the participant comfortable
EMOTIONAL WELL BEING
EMOTIONAL WELL BEING
Not At All
A Little Bit
Somewhat
Quite a Bit
Very Much
The Jacki enabled the participant to feel better, do more
The Jacki increased the participant's self esteem/dignity
The Jacki insured the participant felt more cared for
The Jacki improved the participant's overall quality of life during a difficult time
The Jacki impacted the participant's experience in a positive way
I would recommend this program to others
I feel grateful to be a part of this program
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