Nursing Responses to Elder Mistreatment:

An Education Course

Participant Evaluation Form

Part I. Training Modules 1 through 12

For Part I, please indicate the extent to which you agree or disagree with the following statements about each module.

1 – I strongly disagree with this statement.4 – I agree with this statement.

2 – I disagree with this statement.5 – I strongly agree with this statement.

3 – I neither agree nor disagree with this statement.NA – Not applicable

MODULE 1: Introduction / Strongly Disagree / Disagree / Neither Agree nor Disagree / Agree / Strongly Agree / Not Applicable
  1. As a result of this module,I can describe the course goal and objectives.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can define elder mistreatment and describe the context in which it will be discussed in this course.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I candescribe nursing roles in responding to elder mistreatment.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can discuss applications of forensic nursing to responses to elder mistreatment.
/ 1 / 2 / 3 / 4 / 5 / NA

MODULE 2: The Demographics of Aging

/ Strongly Disagree / Disagree / Neither Agree nor Disagree / Agree / Strongly Agree / Not Applicable

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Nursing Responses to Elder Mistreatment

Participant Feedback Form

  1. As a result of this module, I can identify societal assumptions about aging and how these assumptions can impact nursing care of older patients.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can discuss basic demographic information about the older population.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can recognize difficulties posed by various age-related impairments.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can discuss data on the health of the older population.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can discuss how generational values can affect an older adult’s understanding and recognition of mistreatment and willingness to seek help.
/ 1 / 2 / 3 / 4 / 5 / NA

MODULE 3: Scope and Nature of Elder Mistreatment

/ Strongly Disagree / Disagree / Neither Agree nor Disagree / Agree / Strongly Agree / Not Applicable

1

  1. As a result of this module, I can discuss the scope and nature of elder mistreatment.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can discuss the incidence and prevalence of domestic and institutional elder mistreatment.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can describe characteristics of victims and perpetrators of elder mistreatment.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can describe signs of different types of possible elder mistreatment.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can describe how common changes in aging, disease, chronic conditions and medications can mask or be misinterpreted as mistreatment.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can discuss family violence in later life, elder sexual abuse and elder mistreatment in institutional settings.
/ 1 / 2 / 3 / 4 / 5 / NA

MODULE 4: Laws and Policies

/ Strongly Disagree / Disagree / Neither Agree nor Disagree / Agree / Strongly Agree / Not Applicable

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  1. As a result of this module, I can identify laws and resources to respond to elder mistreatment.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can discuss mandatory reporting requirements related to mistreatment of vulnerable older adults.
/ 1 / 2 / 3 / 4 / 5 / NA

MODULE 5: Ethical Issues

/ Strongly Disagree / Disagree / Neither Agree nor Disagree / Agree / Strongly Agree / Not Applicable
  1. As a result of this module, I can describe key ethical issues in nursing responses to elder mistreatment cases.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can discuss how to facilitate safety planning with patients.
/ 1 / 2 / 3 / 4 / 5 / NA
MODULE 6: Screening and Assessment / Strongly Disagree / Disagree / Neither Agree nor Disagree / Agree / Strongly Agree / Not Applicable
  1. As a result of this module, I can discuss why, when, where, with whom and how screening and assessing older patients for elder mistreatment should occur.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can describe steps in interviewing older patients to screen and assess for elder mistreatment.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can discuss appropriate questions to ask during the screening and assessment process.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can describe methods and techniques to communicate with patients, as well as their caregivers and family members, when screening and assessing for elder mistreatment.
/ 1 / 2 / 3 / 4 / 5 / NA
MODULE 7: Assessing Patients for Signs of Elder Mistreatment / Strongly Disagree / Disagree / Neither Agree nor Disagree / Agree / Strongly Agree / Not Applicable
  1. As a result of this module, I can discuss steps of assessment for elder mistreatment: identification, evaluation and documentation.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can recognize signs of neglect, physical abuse, emotional/psychological mistreatment, sexual abuse, abandonment, financial exploitation and violation of personal rights.
/ 1 / 2 / 3 / 4 / 5 / NA
MODULE 8: Multi-Disciplinary Team Approaches / Strongly Disagree / Disagree / Neither Agree nor Disagree / Agree / Strongly Agree / Not Applicable
  1. As a result of this module, I can discuss what multidisciplinary team approaches to elder mistreatment are and nursing roles in such efforts.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can describe ways nurses can work with first responders to maximize patient care and safety in elder mistreatment cases.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can identify nursing partners in health care settings and the community, as well as their respective roles, in responses to elder mistreatment.
/ 1 / 2 / 3 / 4 / 5 / NA
MODULE 9: Forensic Evidence / Strongly Disagree / Disagree / Neither Agree nor Disagree / Agree / Strongly Agree / Not Applicable
  1. As a result of this module, I can discuss when evidence should be collected from patients in elder mistreatment cases and nursing roles in collection and preservation.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can describe general strategies for evidence collection and preservation.
/ 1 / 2 / 3 / 4 / 5 / NA
MODULE 10: Photo-Documentation / Strongly Disagree / Disagree / Neither Agree nor Disagree / Agree / Strongly Agree / Not Applicable
  1. As a result of this module, I can discuss purposes of forensic photo-documentation in elder mistreatment cases.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can describe nursing roles in photo-documentation.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can describe how to photograph findings in elder mistreatment cases using basic forensic techniques and document photographic images on body maps.
/ 1 / 2 / 3 / 4 / 5 / NA
MODULE 11: Documentation / Strongly Disagree / Disagree / Neither Agree nor Disagree / Agree / Strongly Agree / Not Applicable
  1. As a result of this module, I can discuss policies related to documentation in elder mistreatment cases.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can discuss the fundamentals of health record documentation—accuracy, timeliness, completeness and appropriateness.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can describe how to communicate findings to appropriate parties in each case, including responses to subpoenas.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can describe what to document in the medical record for elder mistreatment cases.
/ 1 / 2 / 3 / 4 / 5 / NA
MODULE 12: Discharge andCare Transition Planning / Strongly Disagree / Disagree / Neither Agree nor Disagree / Agree / Strongly Agree / Not Applicable
  1. As a result of this module, I can identify the priorities in discharge/care transition planning in elder mistreatment cases on patient safety, health and well being.
/ 1 / 2 / 3 / 4 / 5 / NA
  1. As a result of this module, I can discuss issues to consider and actions to take when planning for discharge/care transition with patients in elder mistreatment cases.
/ 1 / 2 / 3 / 4 / 5 / NA

Part II. Overall

For Part II, please indicate your level of satisfaction or dissatisfaction with each statement.

1 – Very dissatisfied4 – Satisfied

2 – Dissatisfied5 – Very satisfied

3 – Neither satisfied nor dissatisfied

Instructor 1: ______/ Very
Dissatisfied / Dissatisfied / Neither Satisfied nor Dissatisfied / Satisfied / Very
Satisfied
  1. Instructor’s level of preparation and professionalism
/ 1 / 2 / 3 / 4 / 5
  1. Instructor’s knowledge of the subject
/ 1 / 2 / 3 / 4 / 5
  1. How the instructor encouraged discussion
/ 1 / 2 / 3 / 4 / 5
  1. How the instructor responded to questions and comments
/ 1 / 2 / 3 / 4 / 5
  1. Instructor’s level of respect towards participants
/ 1 / 2 / 3 / 4 / 5
Instructor 2: ______/ Very
Dissatisfied / Dissatisfied / Neither Satisfied nor Dissatisfied / Satisfied / Very
Satisfied
  1. Instructor’s level of preparation and professionalism
/ 1 / 2 / 3 / 4 / 5
  1. Instructor’s knowledge of the subject
/ 1 / 2 / 3 / 4 / 5
  1. How the instructor encouraged discussion
/ 1 / 2 / 3 / 4 / 5
  1. How the instructor responded to questions and comments
/ 1 / 2 / 3 / 4 / 5
  1. Instructor’s level of respect towards participants
/ 1 / 2 / 3 / 4 / 5
Instructor 3: ______ / Very
Dissatisfied / Dissatisfied / Neither Satisfied nor Dissatisfied / Satisfied / Very
Satisfied
  1. Instructor’s level of preparation and professionalism
/ 1 / 2 / 3 / 4 / 5
  1. Instructor’s knowledge of the subject
/ 1 / 2 / 3 / 4 / 5
  1. How the instructor encouraged discussion
/ 1 / 2 / 3 / 4 / 5
  1. How the instructor responded to questions and comments
/ 1 / 2 / 3 / 4 / 5
  1. Instructor’s level of respect towards participants
/ 1 / 2 / 3 / 4 / 5
Overall / Very
Dissatisfied / Dissatisfied / Neither Satisfied nor Dissatisfied / Satisfied / Very
Satisfied
  1. Overall quality of the module materials (handouts, audiovisuals)
/ 1 / 2 / 3 / 4 / 5
  1. Comfort of the meeting space
/ 1 / 2 / 3 / 4 / 5
  1. Time allotted for the scope of material presented
/ 1 / 2 / 3 / 4 / 5
  1. Extent to which the modules collectively addressed the critical issues related to elder mistreatment that face today’s nurses
/ 1 / 2 / 3 / 4 / 5
  1. Extent to which the modules contained the right amount of theoretical information
/ 1 / 2 / 3 / 4 / 5
  1. Extent to which the modules contained the right amount of practical information
/ 1 / 2 / 3 / 4 / 5
  1. Appropriateness of materials/information for your level of experience and knowledge
/ 1 / 2 / 3 / 4 / 5
  1. Extent to which the information you learned will help you in your work
/ 1 / 2 / 3 / 4 / 5
  1. What aspect(s) of thiseducation coursewas most helpful and why?
  1. Identify three things you plan to do or change as a result of the education you received through this course. Please be as specific as you can.
  1. ______

______

  1. ______

______

  1. What additional education needs do you foresee having related to the topics covered through this course?
  1. Do you have any additional comments about the education you received through this course?
  1. What part of this course would you suggest changing to make it better for future participants?

Part III. Respondent Information

Please provide us with a little information about yourself.

  1. Which of the following best describes the field in which you work? (Mark only one.)

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Nursing

Nursing student

Medical (other than nursing)

Victim services

Law/justice (prosecution, courts, etc.)

Corrections

Probation and parole

Law enforcement

Health/human services (mental health, substance abuse, etc.)

Education

Vocational services

Faith community

Other (please specify): ______

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  1. How many years of experience do you have in your field of work?

Less than 3 years

3 to 5 years

6 to 10 years

More than 10 years

  1. If you are a nurse, describe the practice setting (e.g., emergency department in a private, nonprofit hospital) in which you work and any areas of specialization you have within the nursing field (geriatrics, wound care, forensics, management, etc.).

Thank you for completing theParticipant Evaluation Form. Your feedback is indispensable in our efforts for continuous course improvement.

Please return your completed form to a staff person before leaving the training.

Note: This form was adapted from an Office for Victims of Crime sponsored training on elder abuse.

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