DAISY Nomination

DAISY Award Nomination Form

Please describe a situation in which the nurse demonstrated at least one of these PETALS principles:

P: Passion/Compassion for nursing and the care you provide – does the nomination show the nurse is passionate about nursing and compassionate in the situation?

E: Empathy in the situation – does the nurse show empathy toward the individual or situation in the nomination?

T: Trust and Teamwork of families, patient and peers – is there a sense of trust in the nurse conveyed in the nomination?

A: Admirable attributes possessed – are there some attributes that others would admire in the nurse conveyed in the nomination?

L: Love for the patient and nursing profession – with the nomination can you tell the nurse has a true love for the nursing profession?

S: Selflessness – is there any selflessness on the part of the nurse?

YOUR NAME:

YOUR PHONE NUMBER:

YOUR ADDRESS:

YOUR EMAIL ADDRESS:

I WOULD LIKE TO NOMINATE:

REASON FOR NOMINATION: