PI Survey Request

PI Survey Request

The purpose of this survey is to better understand healthcare providers’ perceptions, experiences and practices related to patient mobility in the inpatient setting. Your feedback will help identify opportunities to improve patient mobilization processes, education, communication and support across the organization.

For each statement, select the one response that best reflects your opinion or experience. There are no right or wrong answers, and honest feedback is encouraged.

Thank you for taking the time to share your insights and support our efforts to enhance patient care and outcomes.

PI Survey Request

MM slash DD slash YYYY
Name
What is your clinical role?(Required)

If physician, please note your training level(Required)

INSTRUCTIONS:

For each statement below, please fill in only ONE response that most accurately reflects your opinion based on experience over the past 1 -2 weeks
1. My inpatients are too sick to be mobilized(Required)
2. I have received training on how to safely mobilize my inpatients(Required)
3. Increase mobilization of my inpatients will be harmful to them (i.e. falls, IV line removal, etc.)(Required)
4. A physical therapist or occupational therapist should be the primary care provider to mobilize my inpatients(Required)
5 & 6. I understand which inpatients are appropriate to refer to:
5. Physical Therapy(Required)
6. Occupational Therapy(Required)
7. We don't have the proper equipment and/or furnishings to mobilize my inpatients(Required)
8. The physical functioning of my inpatients is regularly discussed between the patient's healthcare providers (nurses, physicians, physical therapists, occupational therapists).(Required)
9. Nurse-to-patient staffing is adequate to mobilize inpatients on my unit(s)(Required)
10. My inpatients often have contraindications to be mobilized(Required)
11. Unless there is a contraindication, my inpatients are mobilized at least once daily by Nurses(Required)
12 & 13. Increasing mobilization of my inpatients will be more work for:
12. Nurses(Required)
13. Physical and/or Occupational Therapists(Required)
14. My departmental leadership is very supportive of patient mobilization(Required)
15. Increasing the frequency of mobilizing my inpatients increases my risk for injury(Required)
16. Inpatients who can be mobilized usually have appropriate physician orders to do so(Required)
17. My inpatients are resistant to being mobilized(Required)
18. I believe that my inpatients who are mobilized at least three times daily will have better outcomes(Required)
19. I am not sure when it is safe to mobilize my inpatients(Required)
20. Family members of my inpatients are frequently interested to help mobilize them(Required)
21. I do not feel confident in my ability to mobilize my inpatients(Required)
22. I document the physical functioning status of my inpatients during my shift/work day(Required)
23. I do not have time to mobilize my inpatients during my shift/work day(Required)
24. Unless there is a contraindication, I mobilize my inpatients at least once during my shift/work day(Required)
25. Unless there is a contraindication, I educate my inpatients to exercise or increase their physical activity while on my hospital unit(Required)
26. My patients have time during their day to be mobilized at least three times daily(Required)
Last updated: June 25, 2026