Ward Manager Pre-Trial Evaluation Form

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Please take the time to complete the following survey as you begin shift work within your ward. We realize your time is precious and have made this survey as short as possible; we estimate that it will take just 2 minutes to complete. Your personally identifiable information (PII) will be confidential, and we will only be analyzing aggregated results. Thank you in advance for your time in completing.
Name*
Please select the location of your trial:*
Supervisor Name
Below are statements that describe how you may think about yourself RIGHT NOW. Use the following scales to indicate your level of agreement or disagreement with each statement.
1. I feel confident contributing to discussions about the ward’s nursing strategy in preventing falls.*
2. Right now I see myself as being pretty successful in preventing patient falls while I am at work.*
3. I can think of many ways to reach my current work goals in preventing patient falls.*
4. I can get through difficult times related to patient falls at work because I’ve experienced difficulty before.*
5. I’m optimistic about what will happen to me in the future as it pertains to my ability to prevent patient falls at work.*
The next statements describe how you may think about your group & team RIGHT NOW. Please indicate your level of agreement or disagreement with each statement below using the same scale:
6. My team feels confident contributing to discussions about the ward’s nursing strategy in preventing falls.*
7. Right now my team sees itself as being pretty successful in preventing falls while at work.*
8. My team can think of many ways to reach our current work goals in preventing patient falls.*
9. My team can get through difficult times related to patient falls at work because we’ve experienced difficulty before.*
10. My team is optimistic about what will happen to us in the future as it pertains to our ability to prevent patient falls at work.*
Source for questions : Szerdahelyi, M., Paterson, T.A., Huang, L., Martos, T., Komlósi, L. (2022). Validation of the PCQ-5 : A Short Form to Measure State Positive Psychological Capital. Group & Organization Management, 0(0), 1-31.
This field is for validation purposes and should be left unchanged.

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