Together in Care - Bereavement in the NICU | Medical College of Wisconsin

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1

In what aspect(s) do you feel satisfied with this session? (Check all that apply)

The session met my learning needs.

The content was relevant to my current practices.

The conversation was interprofessional.

The conversation was constructive.

None

Please check here and explain your choice:____________

1 Please check here and explain your choice:____________

2

This session enhanced my professional competence or ability in the following ways: (Check all that apply)

The ability to provide compassionate, appropriate, and effective Patient Care.

Medical Knowledge.

Interpersonal and Communication Skills with patients, their families, and health professionals.

Commitment to carrying out Professional responsibilities and an adherence to ethical principles.

The ability to investigate and evaluate patient care, to appraise and assimilate scientific evidence, and to improve patient care based on self-evaluation and life-long learning.

The awareness of and the ability to call effectively on other resources in the larger context and system of health care.

None of above

Please check here and explain your choice:____________

2 Please check here and explain your choice:____________

3

My practice was/will be changed and improved in the following way(s) as a result of the content presented in the session? (Check all that apply)

Diagnostic approach

Therapeutic approach

Disease prevention or health education

System process improvement

No Change

Please check here and explain your choice:____________

3 Please check here and explain your choice:____________

4

Did/Will you use this information for specific patient(s)?

yes

No

5

If Yes, please check all that apply.

As a result of this information, I managed/will manage this patient differently.

I had several options for this patient, and I used/will use this information to justify a choice.

I thought I knew what to do, and I used/will use this information to be more certain about the management of this patient.

I used/will use this information to better understand a particular issue related to this patient.

I used/will use this information to recommend this patient, or other health professionals to make a change for this patient.

Other...

5 Other...

5

If No, please check all that apply.

This information does not apply to my patients.

This infromation is too old.

This information is too new.

This strategy is too expensive.

Patient access barriers.

System based barrier (time, staff,ect).

Other...

5 Other...

6

This patient(s) got/will get the following health benefits as a result of applying this information (Check all that apply)

This information helped/will help to improve this patient's health status, functioning or resilience (i.e., ability to adapt to significant life stressors)

This information helped/will help to prevent a disease or worsening of disease for this patient

This information helped/will help to avoid unnecessary or inappropriate treatment, diagnostic procedures, preventative interventions or a referral, for this patient

Other...

6 Other...

7

Is there anything which the speaker did exceptionally well? (Select all that apply)

Explained content well

Clear and organized slides/materials

Incorporated interactivity

Engaging style of presentation

Highlighted key points

Develop content appropriate for postgraduate peers and care team

Other...

7 Other...

8

What patient/health care problem recently challenged you, and you wish you knew more about?

9

This information was free of commercial bias. If no, please explain.

Yes

No, Why

9 No, Why

10

Comments and Feedback on the learning experience, content, procedure, and instructors, etc. in this session.

11

As a result of my participation in this activity, I am better able to... 4 - Strongly Agree 3- Agree 2 - Somewhat Disagree 1- Strongly disagree

	1	2	3	4
Provide insight on what families really need in terms of bereavement support.	Provide insight on what families really need in terms of bereavement support. - 1	Provide insight on what families really need in terms of bereavement support. - 2	Provide insight on what families really need in terms of bereavement support. - 3	Provide insight on what families really need in terms of bereavement support. - 4
Describe prepare NICU teams for bereavement situations	Describe prepare NICU teams for bereavement situations - 1	Describe prepare NICU teams for bereavement situations - 2	Describe prepare NICU teams for bereavement situations - 3	Describe prepare NICU teams for bereavement situations - 4
Understand to set up hospital units to be a place where appropriate bereavement is set up and can take place appropriately	Understand to set up hospital units to be a place where appropriate bereavement is set up and can take place appropriately - 1	Understand to set up hospital units to be a place where appropriate bereavement is set up and can take place appropriately - 2	Understand to set up hospital units to be a place where appropriate bereavement is set up and can take place appropriately - 3	Understand to set up hospital units to be a place where appropriate bereavement is set up and can take place appropriately - 4

12

The following speaker(s) demonstrated experiential knowledge of the topic 4 - Strongly Agree 3- Agree 2 - Somewhat Disagree 1- Strongly Disagree

	1	2	3	4
Conrad Sigge Pantzerhielm Williams, IV, MD, FAAP	Conrad Sigge Pantzerhielm Williams, IV, MD, FAAP - 1	Conrad Sigge Pantzerhielm Williams, IV, MD, FAAP - 2	Conrad Sigge Pantzerhielm Williams, IV, MD, FAAP - 3	Conrad Sigge Pantzerhielm Williams, IV, MD, FAAP - 4
Nicole MackDiaz	Nicole MackDiaz - 1	Nicole MackDiaz - 2	Nicole MackDiaz - 3	Nicole MackDiaz - 4
Christine Woodburn, D.O.	Christine Woodburn, D.O. - 1	Christine Woodburn, D.O. - 2	Christine Woodburn, D.O. - 3	Christine Woodburn, D.O. - 4

13

Choose the option that best fits your evaluation of this activity: 4 - Strongly Agree 3- Agree 2 - Somewhat Disagree 1- Strongly Disagree

	1	2	3	4
The content provided a fair and balanced coverage of the topic	The content provided a fair and balanced coverage of the topic - 1	The content provided a fair and balanced coverage of the topic - 2	The content provided a fair and balanced coverage of the topic - 3	The content provided a fair and balanced coverage of the topic - 4
The content was free of commercial bias	The content was free of commercial bias - 1	The content was free of commercial bias - 2	The content was free of commercial bias - 3	The content was free of commercial bias - 4

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Together in Care - Bereavement in the NICU