| Name: |
| Age (In years): |
Gender: |
| Highest Degree |
Workplace Setting: |
| Area of workplace: |
Marital status: |
| Department of residency/specialization/Working: |
| Number of years of experience after completion of MBBS/BSc: _________________ |
|
Section A- Forms of Violence: This domain intends to assess the frequency of various forms of violence experienced by healthcare workers in healthcare settings. Mark the most appropriate option. |
| A1: How often do you experience verbal altercations (e.g., threats, abuse, exaggerated arguments, offensive comments etc.) at your workplace? |
| Nearly daily |
| About once a week |
| About once a month |
| About once every six months |
| About once a year or less |
| A2: How often do you experience physical violence (e.g., slapping, beating, thrashing, vandalizing, attack with weapons etc.) at your workplace? |
| About once in a month or more |
| About once every six months |
| About once a year |
| Less than once a year |
| Never |
|
Section B- Impact of incidences of Violence: This domain assesses the impact of the episodes of violence on the various aspects of an individual’s life. |
| B1: On the basis of the episodes of violence at my workplace, I have developed the following feelings: |
| It did not/doesn’t affect me at all |
| I feel/felt that motivation/efficiency reduced at my work |
| I feel/felt like changing my workplace |
| I feel/felt like opting for an alternate career |
| I feel/felt like not working at all |
| I have/had self-harm/suicidal ideations |
| Following are the statements regarding the effect of the episodes of WPV one had on the different aspects of life. Please read the statements given below and mark the most appropriate response (based on your experience). |
| B2: Personal wellbeing and self-care include activities such as sleep schedule, eating pattern, fitness, grooming, dressing etc. How much have the episodes of violence at your workplace affected your personal wellbeing and self-care? |
| Not affected / mildly affected |
| Moderately affected |
| Severely affected |
| B3: “Family life is defined as the routine interactions and activities that a family have together especially with the members who live together with parents, spouse, children.” How much has your family been affected due to the episodes of violence at your workplace? |
| Not affected/ mildly affected |
| Moderately affected |
| Severely affected |
| B4: “Social life is defined as the part of a person's time spent doing enjoyable things with others like friends, colleagues or people living in the society other than close family members.” How much has your family been affected due to the episodes of violence at your workplace? |
| Not affected/ mildly affected |
| Moderately affected |
| Severely affected |
| B5: How much do the episodes of violence at your workplace has affected your mental and psychological well-being (increased aggressiveness, irritability, low self-esteem, etc.)? |
| Not affected/ mildly affected |
| Moderately affected |
| Severely affected |
|
Section C- Reporting of Incidence: This domain assesses how comfortable or confident the workers are about reporting the incidence of violence to the higher authorities. |
| C1: I would be comfortable in reporting the episode of violence at my workplace to competent authorities. |
| Strongly disagree |
| Disagree |
| Neutral |
| Agree |
| Strongly agree |
| The statements given below (C2-C7) are some of the reasons why the incidences of violence are not reported to the authorities. Select the most appropriate choice in your opinion. To what extent do these following reasons lead to under-reporting? |
| C2: Felt ashamed of reporting |
| Significantly |
| Somewhat significantly |
| Insignificantly |
| C3: A belief that no action will be taken against the perpetrator |
| Significantly |
| Somewhat significantly |
| Insignificantly |
| C4: Lack of organizational support |
| Significantly |
| Somewhat significantly |
| Insignificantly |
| C5: Lack of provision to report such incidences |
| Significantly |
| Somewhat significantly |
| Insignificantly |
| C6: The process was time-consuming |
| Significantly |
| Somewhat significantly |
| Insignificantly |
| C7: Fear that the appraisal or promotion avenues will be affected. |
| Significantly |
| Somewhat significantly |
| Insignificantly |
|
Section D- Mitigation Strategies: This domain focuses on the strategies that can be useful in preventing episodes of violence at the workplace. Statements given below focus on the strategies that can be useful in preventing the episodes of violence at the workplace. Select the most appropriate choice in your opinion. To what extent do the following measures will be useful in controlling WPV in healthcare settings? |
| D1: Controlling the number of attendants visiting the hospital with a patient |
| Very useful |
| Somewhat Useful |
| Not useful |
| D2: Educating patients and attendants about limitations of medical sciences and available infrastructure |
| Very useful |
| Somewhat Useful |
| Not useful |
| D3: Regular training of healthcare workers regarding soft skills (communication skills, breaking bad news, counselling skills, problem-solving skills) |
| Very useful |
| Somewhat Useful |
| Not useful |
| D4: Self-defense training of Health care workers |
| Very useful |
| Somewhat Useful |
| Not useful |
| D5:Improving healthcare facilities (like doctor-patient ratio, population-bed ratio) |
| Useful |
| Somewhat Useful |
| Not useful |
| D6: Improving facilities within a hospital (like availability of medicines and diagnostic tests) |
| Useful |
| Somewhat Useful |
| Not useful |
| D7: Improving Infrastructure facilities (like installation of CCTVs, metal detectors, alarm system) |
| Very useful |
| Somewhat Useful |
| Not useful |
| D8: Active complaint redressal system |
| Very useful |
| Somewhat Useful |
| Not useful |
| D9: Strong legislature measures like provision of significant punishment for offenders |
| Very useful |
| Somewhat Useful |
| Not useful |
| D10: Unbiased media reporting |
| Very useful |
| Somewhat Useful |
| Not useful |
| D11: Sensitizing politicians and public figures not to give immature/negative statements regarding healthcare workers |
| Very useful |
| Somewhat Useful |
| Not useful |
|
Section E- Risk factors related to incidents of Workplace violence: This domain assesses the various risk factors associated with violence in healthcare settings. What is your opinion regarding the importance of the following parameters as a reason for WPV in a healthcare setting? |
| E1: Unrealistic expectations of patients/attendants |
| Very important |
| Somewhat important |
| Not important |
| E2. Inappropriate knowledge about the disease/health condition |
| Very important |
| Somewhat important |
| Not important |
| E3: Poor communication skills |
| Very important |
| Somewhat important |
| Not important |
|
E4: Lack of resources (equipment and medicines, doctor-patient ratio) |
| Very important |
| Somewhat important |
| Not important |
| E5: Overcrowding |
| Very Important |
| Somewhat Important |
| Not Important |
| E6: Long waiting time |
| Very Important |
| Somewhat Important |
| Not Important |
| E7: Inadequate security arrangements |
| Very Important |
| Somewhat Important |
| Not Important |
| E8: Inadequate action on receiving complaints of WPV |
| Very Important |
| Somewhat Important |
| Not Important |
| E9: Lack of respect for the authority of doctors/healthcare workers |
| Very Important |
| Somewhat Important |
| Not Important |
| E10: Negative and inappropriate media reporting |
| Very Important |
| Somewhat Important |
| Not Important |
| E11: Lack of the provision of harsh punishment for aggressors/offenders |
| Very Important |
| Somewhat Important |
| Not Important |
| E12: Lack of redressal system |
| Very Important |
| Somewhat Important |
| Not Important |
