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STUDY INFORMATION Hello colleague. You are being asked to take part in a research study because researchers at A.T. Still University want to learn more about organizational safety culture surveys (workplace safety) in hospitals. Research studies include only people who choose to take part. Please read this consent form and take your time in making a decision. You will not be contacted directly by study staff to discuss this consent form, but you will have access to the study staff to ask them to explain any words or information that you do not clearly understand. The nature of the study, risks, inconveniences, and other important information about the study are listed below.
A grant from the National Institute of Health (NIH) will sponsor part of this study. The persons responsible for the oversight of this study are Patrick Palmieri and his faculty advisor, Dr. XXXXX. The purpose of this study is to learn how best to ask registered nurses about workplace safety. We will assess whether two different safety questionnaires test similar ideas. About 400 acute care registered nurses will be asked to take part in this study.
There are no direct costs associated with this study. You will be asked to complete 9 multiple choice bigoraphical questions and then 73 survey multiple choice questions that should take approximately 15 to 20 minutes to answer. There will be no further follow up. We will email you a link to the survey. Your personal information will not be identifiable when the researchers obtain the survey results. There is, however, always the potential risk for loss of confidentiality. If you agree to take part in this study, there is no direct benefit to you. However, the results of this study will be published and disseminated to assist researchers seeking to better study safety in healthcare organizations.
For questions about the study, to request a paper copy of the consent form or any other concern, contact Patrick Palmieri at [email protected].
STATEMENT OF CONSENT "The purpose of this study, procedures to be followed, and risks and benefits have been explained to me. I have been provided with contact information to ask questions, and my questions have been answered to my satisfaction. I understand that I may contact the A.T. Still University Institutional Review Board (IRB) Office at (XXX) XXX-XXXX if I have questions about my rights as a research subject, to discuss problems, concerns, or suggestions related to the research, or to obtain information or offer input about the research. I have read this consent form and agree to be in this study, with the understanding that I may withdraw at any time. By accessing the next screen and electing to submit the survey titled, Organizational Safety Culture Survey Study, I agree to participate in this study.”
Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below or close the browser to exit from the survey. |
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Do you currently work in a hospital nursing unit? |
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How many years of nursing experience do you have? |
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How many years of nursing experience do you have in your current specialty area? |
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On what type of nursing unit do you work(and will answer for this survey)? |
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How many years have you worked in your current nursing unit? |
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What is the usual shift that you work? |
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For the remaining survey questions, the scale has changed to include five choices.
Please answer the following items with respect to the hosptial and the specific unit or clinical area where you primarily work. Choose your response to each question using the scale below:
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Please continue to answer the following items with respect to the hosptial and the specific unit or clinical area where you primarily work. Choose your response to each question using the scale below:
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Please continue to answer the following items with respect to the hosptial and the specific unit or clinical area where you primarily work. Choose your response to each question using the scale below:
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Please continue to answer the following items with respect to the hosptial and the specific unit or clinical area where you primarily work. Choose your response to each question using the scale below:
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Please answer the following items with respect to the hosptial and the specific unit or clinical area where you primarily work. Choose your response to each question using the scale below:
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