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Fundamentals of Critical Care Support Course 2024
*
1.
Date of course
(Required.)
January 9 & 10, 2024
April 17 & 18, 2024
August 19 & 20, 2024
Other date (please specify)
2.
What is your profession?
APRN
Nurse
PA
Pharmacist
Physician
Respiratory Therapist
Other (please specify)
3.
Please rate the faculty for this course:
Excellent
Very Good
Good
Fair
Poor
Excellent
Very Good
Good
Fair
Poor
Other (please specify)
4.
Please rate the
overall quality
of this educational activity
Excellent
Very good
Average
Fair
Needs improvement
Excellent
Very good
Average
Fair
Needs improvement
5.
What was
done well
with this activity?
6.
What suggestions do you have to
improve
the activity?
7.
As a result of participating in this activity (check all that apply)
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
My communication skills with other members of the team have improved
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
I have acquired new strategies and skills to improve patient outcomes
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
There is mutual respect between members of the team
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
I better understand my role and that of the other members of the team
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
The performance of the team has improved
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
I can accurately identify sepsis, electrolyte disorders, and respiratory failure
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
I can state the indications for referrals for further evaluation and treatment of shock
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
I can list signs and symptoms of systemic allergic reactions and describe/demonstrate the appropriate emergency treatment
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
I can identify discuss sepsis guidelines
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
8.
As a result of participating in this activity, I am better able to integrate a team based approach to caring for our patients.
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
9.
An example of what our team will change is:
*
10.
Your information
(Required.)
Legal Name
Professional Credentials
NPI Number, if applicable
Email Address