The Readiness Estimate and Deployability Index- CIVILIAN

(READI-CIV- Initial Version)


A. Please rate your level of competency according to the following scale
  • 1 = I need theory, demonstration & supervised practice
  • 2 = I would need review & supervised practice
  • 3 = I would need some review & little supervision
  • 4 = I would need review only
  • 5 = I would need no review or supervision
Please select the circle to indicate your response
  • 1 = Not Competent
  • 2 = Minimally Competent
  • 3 = Moderately Competent
  • 4 = Highly Competent
  • 5 = Totally Competent
1.
1 2 3 4 5
2.
1 2 3 4 5
3.
1 2 3 4 5
4.
1 2 3 4 5
5.
1 2 3 4 5
6.
1 2 3 4 5
7.
1 2 3 4 5
8.
1 2 3 4 5
9.
1 2 3 4 5
10.
1 2 3 4 5
11.
1 2 3 4 5
12.
1 2 3 4 5
13.
1 2 3 4 5
14.
1 2 3 4 5
15.
1 2 3 4 5
16.
1 2 3 4 5
17.
1 2 3 4 5
18.
1 2 3 4 5
19.
1 2 3 4 5
20.
1 2 3 4 5
21.
1 2 3 4 5
 
B. For the following, please indicate your level of agreement according to this scale by indicating the circle for your response:
1 = Totally Disagree
2 = Minimally Agree
3 = Moderately Agree
4 = Highly Agree
5 = Totally Agree
23.
1 2 3 4 5
24.
1 2 3 4 5
25.
1 2 3 4 5
26.
1 2 3 4 5
27.
1 2 3 4 5
28.
1 2 3 4 5
29.
1 2 3 4 5
30.
1 2 3 4 5
31.
1 2 3 4 5
32.
1 2 3 4 5
33.
1 2 3 4 5
34.
1 2 3 4 5
35.
1 2 3 4 5
36.
1 2 3 4 5
C. Demographic Data
  • Mental Health Nurse
  • Oncology Nurse
  • Perioperative Nurse
  • Rehabilitation Nurse
  • Post-Anesthesia Care Unit Nurse
  • Staff Development/Resource Management
  • Advanced Practice Nurse
  • Nurse Educator
  • Community Health Nurse
  • Critical Care Nurse - Adult
  • Medical Surgical Nurse
  • Critical Care Nurse - Neonatal or Pediatric
  • Obstetric/L&D Nurse
  • Nurse Manager/Director/Executive
  • Newborn Nursery Nurse
  • Academic Dean or Associate
  • Pediatric Nurse
  • Case Manager
  • Emergency Nurse
  • Nurse Researcher
  • Home Health Nurse
  • Ambulatory Care Nurse
  • Other (please specify below)
 

Yes No

Male Female

  • Associate Degree in Nursing
  • Associate Degree in another field
  • Diploma in Nursing
  • Bachelors in Nursing
  • Bachelors in other than nursing
  • Masters in Nursing
  • Masters in other than nursing
  • Doctorate in Nursing
  • Doctorate in other than nursing

  • More than 4 years ago
  • Within the most recent 1-4 years
  • Within the last year, but more than 6 months ago
  • Within the last 6 months
  • I have not learned about triage yet
  • Learned through formal courses
  • Learned through inservices, nursing journals, handouts, etc.
  • Practiced triage in an Emergency Department setting
  • Practiced triage in a field environment on real and/or moulaged patients


yes no

yes no

  • up to 2 weeks
  • more than 90 days
  • NA
  • more than two weeks but less than 30 days
  • 30-90 days

14. What were the dates of your most recent overseas nursing experience? From: (mm/dd/yyyy) To: (mm/dd/yyyy)

at least 3-5 times a week twice a week once a week less than once a week not at all

1-12 months ago 1-5 years ago longer than 5 years ago

yes no

yes no not applicable

yes no not applicable

  • Tobacco
  • Talking with Friends
  • Alcohol
  • Religious Faith
  • Physical Exercise
  • Eating
  • Reading
  • Sleeping
  • Relaxation/Meditation Techniques
  • Music
  • Other (please specify below)
 

yes no

You have completed the questionnaire Thank you.