Medline Restore 10 Day Challenge

SurveyScreener and Pre Test

Thank you for clicking on the Restore 10 Day Challenge survey. If you qualify, you will be invited to participate in the challenge. You will then receive a free box of Restore Nitrile Exam Gloves for testing over a period of 10 days. At the end of the 10 days, you will receive a short survey by email to tell us about your experience. 
 
Are you…?
 
Male
Female
 
 
 
Are you currently employed?*
 
a. Yes, full-time
b. Yes, part-time
c. No
 
 
 
Are you a nurse?*
 
a. Yes
b. No
 
 
 
What type of nurse are you? Please type your answer in the space below
 
 
 
 
 
 

Medline Restore 10 Day Challenge Survey

Screener and Pre Test

 
 
Where do you primarily work (e.g., spend more than 50% of your time)?*
 
a. In a hospital
b. At a doctor’s office
c. In a clinic
d. In a nursing home/skilled nursing facility/assisted living center/rehab center
e. As a home health care professional/in a private home
f. In a lab
g. In a dental office
h. In a veterinary office
i. In a pharmacy
j. In a surgical center
k. Other
 
 
 
Are you allowed to bring your own box of nitrile gloves into your workplace for your personal use?*
 
a. Yes
b. No
 
 
 
Where do you work?*
 
UK
Ireland
Spain
Portugal
France
Germany
Belgium
Netherlands
Italy
Switzerland
Austria
Other
 
 
 
How often, if at all, do you experience issues with the skin on your hands (i.e., dry, irritated and/or chapped skin)?*
 
a. Daily
b. Several times per week but not daily
c. Several times per month but not weekly
d. Several times per year but not monthly
e. 1 time per year or less
f. I never experience dry skin on my hands
 
 
 
 
 

Medline Restore 10 Day Challenge Survey

Screener and Pre Test

 
 
Approximately how many times per day do you put on a new pair of exam gloves?*
 
a. 0-5 times per day
b. 6-15 times per day
c. 16-25 times per day
d. 26-35 times per day
e. Over 35 times per day
 
 
 
In which of the following situations, if any, do you regularly wear gloves at work?*
 
a. Adjusting a patient’s position in bed
b. Changing a patient’s bed linens
c. Walking a patient to the bathroom
d. Assisting a patient in the bathroom
e. Checking a patient’s vitals
f. Fixing a patient’s IV bags
g. On rounds
h. None of the above situations
 
 
 
If you were experiencing severely dry and irritated skin, would you report it to your supervisor and/or employee health liaison?*
 
a. Yes
b. No
 
 
 
What is the approximate number of staffed beds in your hospital?*
 
a. Less than 100 beds
b. 100 to 199 beds
c. 200 to 299 beds
d. 300 to 499 beds
e. 500 beds or more
 
 
 
 
 

Medline Restore 10 Day Challenge Survey

Screener and Pre Test

Congratulations, you qualify for the Restore 10 Day Challenge. The challenge will involve you wearing test gloves at least several times per shift over a 10 day period.

Please answer the following questions to complete your enrollment in the challenge. After you answer the questions, you will be given the opportunity to provide your name and address so we can send you a box of gloves.

 
 
Why do you think you have dry, irritated and/or chapped skin on your hands? (Type your answer in the space below) *
 
 
 
 
What brand(s) of gloves do you currently wear at work? (Type your answer in the space below)
 
 
 
 

On a scale of one to ten how much do you agree or disagree with the following statements? Ten stars being fully agree and one star being strongly disagree.

 
 
a. My hands feel soft at work.*
 

 
 
 
b. I experience skin irritation on my hands (i.e., dry and/or chapped skin).*
 

 
 
 
c. After a few days off my hands feel less irritated.*
 

 
 
 
d. I am content with the condition of my hands at work.*
 

 
 
 
e. The gloves I wear make my hands feel moisturised.*
 

 
 
 
f. The condition of my hands affects my job satisfaction.*
 

 
 
 
g. The condition of my hands (i.e. dry, itchy skin) affects how often I wash my hands or use sanitiser.*
 

 
 
 
h. The condition of my hands affects my quality of life.*
 

 
 
 
 
 

Sorry!

Thank you for your interest in the Restore 10 Day Challenge.

Unfortunately, you do not qualify to take part in the challenge however if you still wish to learn more about Restore please click here.

 
 
 
 

Medline Restore 10 Day Challenge Survey

Screener and Pre Test

 
 
Do you have a skin care routine for your hands during or after a work day (i.e. apply lotion)?*
 
a. Yes
b. No
 
 
 
What do you do and when do you do it? (Type your answer in the space below)*
 
 
 
 
What do you do to relieve the dry, irritated and/or chapped skin on your hands? (Type your answer in the space below)*
 
 
 
 
Have you ever thought about leaving the healthcare field due to the condition of your hands (i.e., dry, irritated and/or chapped)?*
 
a. Yes
b. No
 
 
 
 
 

Medline Restore 10 Day Challenge Survey

Screener and Pre Test

 
 
Are you aware that there are gloves available that offer moisturising/hydrating benefits?*
 
a. Yes
b. No
 
 
 
Have you ever tried gloves that offer moisturising/hydrating benefits?*
 
Yes
No
 
 
 
How much did these gloves help your hands?
 
a. Extremely helpful
b. Very helpful
c. Moderately helpful
d. Slightly helpful
e. Not helpful at all
 
 
 
In order for you to test our Restore gloves, we would like to send you two boxes of gloves. Please tell us what size you would like to try:*
 
a. XS and S
b. S and M
c. M and L
d. L and XL
 
 
 
 
 

Medline Restore 10 Day Challenge Survey

Screener and Pre Test

So that we can send your boxes of test gloves, please provide the following contact information:

 
 
First Name*
 
 
 
 
Last Name*
 
 
 
 
Email*
 
 
 
Facility Name*
 
 
 
 
Address*
 
 
 
 
Postal Code*
 
 
 
 
City*
 
 
 
 
Country*
 
 
 
 
How did you hear about this challenge?
 
Search engine - I was searching Google
Recommended by friend/colleague
Through EAUN/EAU newsletter
Others, please specify