Crisis Resource Management Survey

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Have you participated in the management of a crisis since your CRM training? Yes No
This part relates to your professional experience.
If yes, how many times?
During the above crises, were you able to use what you learned in CRM training?
Which of the 5 principles of CRM did you use? (Check all that apply) Roles Resources Communication Global Assessment Support
Did your aplication of CRM principles contribute to an improvement in any patient's care or outcome?

Before answering the next group of questions, please think about your behavior in crisis events (everyday occurrences for most of you) that have occurred since your CRM training.
If yes, please explain.
Were you involved in any crisis where you attempted to implement the CRM principles but were prevented by circumstances? Yes No
If yes, please explain.
Do you think that your application of CRM principles would have contributed to an improvement in this patient's care our outcome? Yes No
If yes, please explain.
Since CRM, I have felt:
Because of CRM training, I was (check all that apply) More calm More efficient More assertive More confident Less afraid A better leader A better follower More verbally communicative More organized Better able to view the whole picture Better able to recognize my limitations Better able to work as part of a team Better able to anticipate needs/actions Better able to prioritize needed care Better able to recognize my role and the roles of others Better able to utilize available human resources (assigning tasks/errands) No change
Since your CRM training, to what extent do you think differently about your own performance during crisis situations?
Since your CRM training, to what extent do you think differently about the team as a whole performed?
During how many crises did you feel that you had a better grasp of CRM principles than most others on the team?
To what extent do you think this training has influenced or will influence your behavior during a crisis?
To what extent do you think a second session would have helped you better implement the CRM principles?
Was this training what you expected? Yes No
Please explain.
Was this training of value to you?
Would you prefer to work with others who have taken this course rather than those who have not taken this course? Yes No
Please explain.
How does where you work (OR, ED, ICU) change your perception of the value of this training?
How does your position in your unite (staff nurse vs charge nurse, intern vs attending, etc) affect your ability to use the principles of CRM?
Have you had the opportunity to apply any of the CRM principles to your daily interaction with other people outside of work? (wedding planning, relationships, etc) Yes No
This second part relates to your everyday life.
If yes, in what sort of event or occurrence did you use the principles of CRM?
What principles of CRM did you use? (Check all that apply) Roles Resources Communication Global Assessment Support
To what extent do you think that CRM training will influence your future behavior during everyday life?
Professional Title:
Years in title:
Present position:
Age
Gender Male Female
Which do you consider yourself? More extroverted More introverted
Please tell us the ethnic group with which you most identify: (optional)
How does the culture in which you were raised/trained affect your behavior in team situations?
Comments/Suggestions: