Violence in Hospitals Survey

A. Please let us know how you found out about this survey.

B. What Country do you live in?

C. Which State/Province/Territory do you live in?

D. What type of hospital do you work in? (Acute Care, Psychaitric, etc.)

E. What department do you work in? (Emergency, Surgical, etc.)

1. What is your current occupation/job title?

2. In the past month, have you experienced any verbal aggression (yelling, swearing, name calling, etc.) from any of the following:

1. A Client(s)/Patient(s)
   Yes
   No
2. A Co-worker(s)
   Yes
   No
3. A Family Member(s) / Visitor(s)
   Yes
   No
4. A Manager(s) / Supervisor(s)
   Yes
   No
5. A Union Official(s)
   Yes
   No
6. A Physician(s)
   Yes
   No

3. In the past month, have you experienced any physical aggression (hitting, kicking, spitting, etc.) from any of the following:

1. A Client(s) / Patient(s)
   Yes
   No
2. A Co-worker(s)
   Yes
   No
3. A Family Member(s) / Visitor(s)
   Yes
   No
4. A Manager(s) / Supervisor(s)
   Yes
   No
5. A Union Official(s)
   Yes
   No
6. A Physician(s)
   Yes
   No

4. Have you ever witnessed a client/patient physically assault another client/patient without an object, such as punching, kicking, pushing, etc.?
Yes
No

5. If you've ever witnessed a client/patient follow through and physically assault anyone, with an object, briefly describe the incident and the object used.

6. Do you ever have to work alone on a unit with client(s)/patient(s) who have the potential of being physically aggressive?
Yes
No

7. If after experiencing and/or witnessing an incident of aggression with a client/patient, did you fill out an incident report?
Yes
No

8. If yes to question #7, was corrective action taken to help prevent another incident?
Yes
No

9. If you experienced an aggressive incident with someone other than a client/patient, was that incident documented and reported?
Yes
No

10. If yes to question #9, was corrective action taken to help prevent another incident?
Yes
No

11. Are potentially aggressive clients/patients, clearly identified for you?
Yes
No

12. For clients/patients that have been identified as having the potential of exhibiting aggressive behaviours, are their care plans regularly evaluated and updated?
Yes
No
Unknown
No care plan for aggressive behaviours

13. If after experiencing an act of aggressive behaviour (regardless of the source) you chose not to fill out either an incident report, document, or report the incident, briefly describe why you chose not to.

14. If you've experienced aggressive behaviour from a co-worker, have you ever had to work alone on a unit with that person?
Yes
No

15. If yes to question #14, have you ever chosen to do a task that requires more than one staff to perform (such as transferring a client/patient) by yourself, rather than ask for help from the co-worker who was exhibiting aggressive behaviours?
Yes
No

16. If you have experienced and/or witnessed incident(s) of aggressive behaviour at work, did you find yourself either speaking to, doing personal care, feeding, or transferring a client/patient more aggressively than you otherwise would have?
Yes
No

17. If you've ever had to miss any time off work because of verbal aggression (regardless of the source), how much time did you miss?

18. If you've ever had to miss time off work because of physical aggression (regardless of the source), how much time did you miss?

19. Have you ever felt that you were not receiving representation from a union official(s), with regard to aggressive behaviours (regardless of the source), even after you have specifically requested it?
Yes
No
Not a union member

20. Does your collective agreement have specific workplace violence language in it?
Yes
No
Not a union member

21. Does your union official(s) provide training and support for its members with regards to incidents of aggressive behaviours in Hospitals such as yours?
Yes
No
Not a union member

22. Does your hospital have a detailed workplace violence policy, which addresses incidents of aggressive behaviour towards staff, regardless of who the alleged perpetrator of aggression might be?
Yes
No

23. Does your hospital provide ongoing training on how to safely prevent and manage aggressive behaviours?
Yes
No

24. If yes to question #23, does this training include physical intervention techniques that staff can use to protect themselves as a last resort?
Yes
No

25. If yes to question #24, does your hospital have a policy in place supporting the use of physical intervention?
Yes
No

26. Does your hospital provide non-biased conflict resolution/mediation for staff?
Yes
No

27. If after experiencing an act of aggression at work (regardless of the source) and the incident was documented and reported, did you ever feel that you were being blamed for the incident?
Yes
No

28. Does your hospital provide debriefing, or other emotional support for staff, who have experienced various incidents of aggression?
Yes
No

29. Does your hospital, by means of notices posted on walls, communicate to all that aggressive behaviours towards staff will not be tolerated?
Yes
No

30. Briefly describe what security measures, if any, that your hospital does provide with regards to safely managing aggressive behaviours (regardless of the source). For example: on duty security personnel, panic alarm pendants, paging a code white, etc.

31. If the police have ever had to be called to your hospital, briefly describe who was exhibiting the aggressive behaviour and what action, if any, was taken by the police?

32. Would you recommend your hospital to someone who was looking for a job?
Yes
No

33. If given the option, what recommendations would you give to your employer, that would make your workplace safer, with regards to aggressive behaviours?

34. We welcome any further comments that you may have on this topic