Staff Survey

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AzkyCpqIhIrFjhWy8Q3k42Jhxb8zydP6LdCJIQPquWLq

University of California at Davis

Consent to Participate in Research

Title of study: Staff Experience and Perceptions of Blackout Alert placement in People Admitted for Violent Trauma

Investigator: Heather Siefkes, MD, MSCI

Introduction and Purpose

You are being invited to join a research study.

The purpose of this study is to understand staff knowledge of the “Blackout” alert and perceptions of the effect the Blackout status may have on clinical care and patient experience when it is used during a hospitalization.

We plan to survey about 200 staff members. We estimate this survey will take 5 minutes to answer 10 questions.

The survey response will be anonymous. We will share the results with UC Davis staff members that are involved in patient policies and we plan to publish the findings.

There is no direct benefit to you from taking part in this study. We hope that this research will help us identify ways to improve care for future patients and staff.

The risks of this research are minimal. Some of the questions might make you feel uncomfortable or upset. You do not have to answer any of the questions you do not want to answer.

If you choose to be entered into a raffle to receive a $50 gift card for your time, please email ppvadlaputi@ucdavis.edu. If you receive the gift card, we would keep a record of your name and that the card was sent, but this will not be linked to any of the information you share in the survey. Completion of the survey is not needed in order to be entered into the raffle.

Confidentiality

As with all research, there is a chance that confidentiality could be compromised; however, we are taking precautions to minimize this risk. Your responses to the questions will not include information that identifies you. However, individuals from UC Davis who oversee research may access your data during audits or other monitoring activities.

To minimize the risks of breach of confidentiality, we have strict rules to protect your personal information. We will limit who has access to your name and other information that can identify you. We are trying not to collect identifiable information and will remove personally identifiable information from the data you provide.

Participation in research is completely voluntary.

You are free to decline to take part in the project. You can decline to answer any questions and you can stop taking part in the project at any time. Whether or not you choose to participate, or answer any question, or stop participating in the project, there will be no penalty to you or loss of benefits to which you are otherwise entitled.

Questions

If you have any questions about this research, please feel free to contact the investigator at hsiefkes@ucdavis.edu

If you have any questions about your rights or treatment as a research participant in this study, please contact the University of California Davis, Institutional Review Board at 916 703 9158 or HS-IRBEducation@ucdavis.edu.

If you agree to take part in the research and please continue on to complete the survey.

How many years have you worked in patient care at UC Davis Medical Center?

* must provide value

< 1

1-2

3-5

6-9

10 or more

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Which of the following best describes your position at UCDMC?

* must provide value

Nurse

Physician

Social Worker

Nurse Practitioner / Physician Assistant

Other (text response)

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What is your position at UCDMC?

What age of patients do you commonly care for at UCDMC?

* must provide value

Primarily Pediatrics

Primarily Adults

Adults and Pediatrics Equally

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Have you ever read the UCDH patient care policy 1190 "Patients Placed on Blackout Status" on Ellucid or elsewhere?

* must provide value

Yes

Not Sure

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Have you ever provided direct care for a UCDMC patient that was on Blackout Status?

* must provide value

Yes

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In your experience, which of the following best describes how Blackout status most often affects the staff's ability to provide clinical care? (Select one)

* must provide value

Very negatively

Negatively

Neutral

Positively

Very positively

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In your experience, which of the following best describes how Blackout status most often affects the patient-centered care experience? (Select one)

* must provide value

Very negatively

Negatively

Neutral

Positively

Very positively

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Have you ever experienced a patient care situation where you needed to communicate with a patient's family member but were not able to due to the patient's Blackout Status?

* must provide value

Yes

Not Sure

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Is there anything else you would like to share with us about your experiences caring for patients on Blackout Status?

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After taking this survey, how likely are you to review the patient care policy 1190 "Patients Placed on Blackout Status" on Ellucid or elsewhere?

* must provide value

Very unlikely

Unlikely

Neutral

Likely

Very likely

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You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.