Which activity did you attend *

May 23-24, 2012

June 20-21, 2012

First Name *

Last Name *

Degree

E-mail *

Do you feel the Learning Objectives were met *

	Yes	No
Incorporate principles of Advanced Illness Model into practice	Incorporate principles of Advanced Illness Model into practice - Yes	Incorporate principles of Advanced Illness Model into practice - No
Describe the principles of communication and engagement	Describe the principles of communication and engagement - Yes	Describe the principles of communication and engagement - No
Describe risk stratification process	Describe risk stratification process - Yes	Describe risk stratification process - No
Describe health outcomes of end-of-life care	Describe health outcomes of end-of-life care - Yes	Describe health outcomes of end-of-life care - No
Discuss the elements of a patient/family care planning meetings	Discuss the elements of a patient/family care planning meetings - Yes	Discuss the elements of a patient/family care planning meetings - No
Incorporate quality improvement tools into practice	Incorporate quality improvement tools into practice - Yes	Incorporate quality improvement tools into practice - No
Incorporate end-of-life communication and educational tools into practice	Incorporate end-of-life communication and educational tools into practice - Yes	Incorporate end-of-life communication and educational tools into practice - No

Please rate the following statements from Strongly Agree (1) to Strongly Disagree (5) *

	1	2	3	4	5
Information was relevant to my professional practice	Information was relevant to my professional practice - 1	Information was relevant to my professional practice - 2	Information was relevant to my professional practice - 3	Information was relevant to my professional practice - 4	Information was relevant to my professional practice - 5
My knowledge increased as a result of this activity	My knowledge increased as a result of this activity - 1	My knowledge increased as a result of this activity - 2	My knowledge increased as a result of this activity - 3	My knowledge increased as a result of this activity - 4	My knowledge increased as a result of this activity - 5
I will recommend this activity to others	I will recommend this activity to others - 1	I will recommend this activity to others - 2	I will recommend this activity to others - 3	I will recommend this activity to others - 4	I will recommend this activity to others - 5
The majority of the information presented today was new	The majority of the information presented today was new - 1	The majority of the information presented today was new - 2	The majority of the information presented today was new - 3	The majority of the information presented today was new - 4	The majority of the information presented today was new - 5
Compared with other educational activities attended, today’s activity was very effective	Compared with other educational activities attended, today’s activity was very effective - 1	Compared with other educational activities attended, today’s activity was very effective - 2	Compared with other educational activities attended, today’s activity was very effective - 3	Compared with other educational activities attended, today’s activity was very effective - 4	Compared with other educational activities attended, today’s activity was very effective - 5

What information remains unclear

Rate the following faculty on the effectiveness of their presentations from Very Effective (1) to Not Effective (4) *

	1	2	3	4
Nikki Davis, MSN, FNP-C, GNP-BC	Nikki Davis, MSN, FNP-C, GNP-BC - 1	Nikki Davis, MSN, FNP-C, GNP-BC - 2	Nikki Davis, MSN, FNP-C, GNP-BC - 3	Nikki Davis, MSN, FNP-C, GNP-BC - 4
Kathryn Kading, RN	Kathryn Kading, RN - 1	Kathryn Kading, RN - 2	Kathryn Kading, RN - 3	Kathryn Kading, RN - 4
Susan Mullaney, MS, APRN, GNP-BC	Susan Mullaney, MS, APRN, GNP-BC - 1	Susan Mullaney, MS, APRN, GNP-BC - 2	Susan Mullaney, MS, APRN, GNP-BC - 3	Susan Mullaney, MS, APRN, GNP-BC - 4
Tanya Stewart, MD, FAAHPM	Tanya Stewart, MD, FAAHPM - 1	Tanya Stewart, MD, FAAHPM - 2	Tanya Stewart, MD, FAAHPM - 3	Tanya Stewart, MD, FAAHPM - 4

Please indicate if you would like further education on the following topics *

	Yes	No
Issues facing the health care system in light of the current status of health care reform	Issues facing the health care system in light of the current status of health care reform - Yes	Issues facing the health care system in light of the current status of health care reform - No
Health Literacy	Health Literacy - Yes	Health Literacy - No
Dealing with "Difficult Families"	Dealing with "Difficult Families" - Yes	Dealing with "Difficult Families" - No
"Breaking Bad News"	"Breaking Bad News" - Yes	"Breaking Bad News" - No

As a result of this activity, I plan to make the following changes in my practice *

	Yes	No
Have face to face meetings with families	Have face to face meetings with families - Yes	Have face to face meetings with families - No
Share tools and resources with staff	Share tools and resources with staff - Yes	Share tools and resources with staff - No
Round with novice NPs	Round with novice NPs - Yes	Round with novice NPs - No
Participate in ACP discussions	Participate in ACP discussions - Yes	Participate in ACP discussions - No

Comments

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