1.   How long have you been working in the health care field?

2.  What is the highest level of formal education you have completed?

Not Graduated from High School
High School Diploma or Equivalency
One to Three Years of College
Bachelor's Degree
Master's Degree
Ph.D.
Other
No Response

3.  What department do you work for?

Emergency Department
Out Patient
Medical/Surgical
Labor and Delivery
Mental Health Care Setting
School Nurse
Other Hospital Setting
Physician's Office Setting
Other
No Response

4.  What type of degree or certification do you hold?

EMT
EMT-Paramedic
Nursing Student
Licensed Practical Nurse
Registered Nurse
Nurse Practitioner
Physician
Other
No Response

5.  What was your age when the assault took place?

6.  What is your gender?

Female
Male
No Response

7.  Have you ever been assaulted while performing health care duties in the past?

Yes
No
No Response

8.  If your answer to Question 7 was YES, indicate how many times you have been assaulted..

9.  Have you ever received self defense training to defend yourself if you were physically attacked while performing you health care duties?

Yes
No
Don't Know
No Response

10.  Do you feel that you have sufficient training to defend yourself if you were physically attacked while performing your health care duties?

Yes
No
Don't Know
No Response

11.  Do you feel that your facility should provide training that prepares you for physical assaults while performing your health care duties?

Yes
No
Don't Know
No Response

12.  What types of physical assaults or violent events are you most fearful of occurring to you while performing you health care duties? (i.e., being shot, stabbed, beating, etc.)

13.  What was the time of day your assault took place? (Use military time format)

14.  What was the day of the week your assault took place?

15.  What was the month of the year the assault occurred?

16.  How many assailants attacked you?

17.  How many health care providers were present when the assault took place?

18.  What was the sex of the assailant(s)?

19.  What were the ages of the assailant(s)?

20.  Describe how you were assaulted, the extent of your injuries and any techniques you used to defend yourself.

No Response

21.  Did you require medical attention as a result of the assault?

Yes
No
No Response

22.  Did you require hospitalization as a result of the assault?

Yes
No
No Response

23.  If you were hospitalized, what was the length of time?

24.  Were you off from work due to injuries sustained from the assault?

Yes
No
No Response

25.  If you were off of work, how long?

26.  Were you taking any drugs or alcohol at the time the assault occurred?

Yes
No
No Response

27.  Where you intoxicated by drugs or alcohol at the time of the assault?

Yes
No
No Response

28.  Describe the extent of any injuries that the assailant sustained as a result of you defending yourself during the attack.

No Response

29.  Did you assailant require medical attention?

Yes
No
No Response

30.  Did you assailant require hospitalization?

Yes
No
Don't Know
No Response

31.  If the assailant was hospitalized, for how long?

32.  Was your assailant off from work due to injuries sustained during the assault?

Yes
No
Don't Know
No Response

33.  If the assailant was off from work, for how long?

34.  Was the assailant on drugs or alcohol when the assault occurred?

Yes
No
Don't Know
No Response

35.  Was the assailant intoxicated by alcohol or drugs at the time the assault occurred?

Yes
No
Don't Know
No Response

36.  Was the assailant in a disturbed state of mind at the time of the assault?

Yes
No
Don't Know
No Response

37.  If the answer to Question 36 was YES, explain the mental state of mind the assailant was in at the time of the assault.

No Response

38.  Was your assailant:

A Patient of the Hospital
A Relative of the Patient
Co-Worker
A Person Not Seeking Medical Attention
Other
No Response

39.  If the assailant was related to a patient at the hospital, what was the relationship?

40.  Were the police summoned to the hospital due to the assault?

Yes
No
No Response

41.  Did the police file a report?

Yes
No
No Response

42.  Did the police make any arrests due to the assault?

Yes
No
No Response

43.  If arrests were made, who was arrested and what were the charges?

No Response

44.  Does your facility have a written policy on using force to defend yourself?

Yes
No
Don't Know
No Response

45.  Did you complete a written narrative of the events after the assault?

Yes
No
No Response

46.  What is the size of your facility? (i.e., number of beds, number of employees, number of patients seen, size of community your facility is in, etc.)

47.  What is the geographical location of your hospital or care facility?

Urban
Suburban
Rural
Metropolitan Area
No Response

48.  What country did the assault take place in? (i.e., USA, England, Australia, Canada, etc.)

           

49.   What part of the country do you live in?  (i.e., Midwest, South, Eastern Seaboard, Great Lakes area, etc.)

Please add any other information that you feel the researchers would find beneficial to the study.

No Response

Thank you for your help.   Stay safe.