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Daisy Award Nomination Form

Want to Say Thank You to Your Nurse?
Share Your Story!

The DAISY (Diseases Attacking the Immune System) Award is an international recognition program that honors and celebrates the skillful, compassionate care nurses provide every day. The DAISY Foundation was established by the family of J. Patrick Barnes after he died from complications of the auto-immune disease ITP in 1999. During his hospitalization, they deeply appreciated the care and compassion shown to Patrick and his entire family. When he died, they felt compelled to say “thank you” to nurses in a very public way. Please say thank you by sharing your story of how a nurse made a difference you will never forget! 

The Daisy Award Committee will consider the following characteristics of each nurse nominated:

 

  • Models empathy and demonstrates a caring attitude in all situations.​
  • Demonstrates extraordinary clinical skills in the delivery of compassionate patient care.
  • Has a positive attitude and demonstrates professionalism in the work environment.
  • Exemplifies the mission, vision and values of Southern Coos Hospital & Health Center.
  • Establishes a special connection with the patients and families.
Daysi
On a scale of 1 to 7, with 7 being the highest:
How did this nurse demonstrate a caring attitude and model empathy?
On a scale of 1 to 7, with 7 being the highest:
How did this nurse demonstrate extraordinary clinical skills?
On a scale of 1 to 7, with 7 being the highest:
How did this nurse demonstrate a professional and positive attitude?
On a scale of 1 to 7, with 7 being the highest:
How did this nurse establish a special connection with a patient or family member?
Thank you for taking the time to nominate an extraordinary nurse for this award! We'd love to include you in the celebration if your nurse is selected for a DAISY Award. Please tell us a little about yourself.
I am (please check one):
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