2004 Virtual Institute of Learning
Complications of Pain Management Evaluation Form

Instructions for Obtaining Continuing Education

To receive CE credit for this virtual session, simply:

  1. Listen to and view the virtual session.
  2. Complete and print the evaluation form.
  3. Fax or mail the completed evaluation to:

Oncology Nursing Society

P.O. Box 3510

Pittsburgh, PA 15230-3510

Fax: 412-859-6160

  1. Verification of your CE credit will be mailed or emailed to you. Certificates will be mailed within six weeks following receipt of your completed and approved evaluation form.

There is a $15 fee for participation in this program.

Complete this evaluation form to receive the CE certificate, assist in evaluating the effectiveness of the educational design, and make recommendations for future continuing education activities.

Name:

Email Address:

RN Non-RNSocial Security #: ––

ONS #:

Address:

City:

State:

Zip Code:

Telephone Number:

Fax Number:

Credit Card Type: MasterCard Visa

Credit Card Number: –––

Expiration Date: –

Name on Card (if different from above):

Commitment to Change:
In light of what you have learned from the CE activity, please tell us in no more than five sentences what change(s) you will make in your practice based on this information.

(Total time for this session is 1 hour, 57 minutes. Contact hours are 2.3)

EVALUATION

KEY:1 = Not At All2 = Low3 = Medium4 = High

To what degree did you achieve the following objectives?1234

1. Explain the relationship between opioid dose intensity and
central nervous system symptoms.

2. Evaluate the effectiveness of balanced analgesia on pain relief
and relief of central nervous system symptoms.

Rate the level of expertise of the following speaker(s)?1234

3. Kyle-Anne Hoyer, RN, BSN, MSN, AOCN®

4. Jeannine Brant, RN, MS, AOCN®

How would you rate the appropriateness of the overall aspects of this program?

5. Presentation Venue

6. Registration Process

7. Teaching Strategies

8. Content

9. Relevance of Content to Practice

10. Organization

11. Opinion of the Program

KEY:1 = Too Basic2 = Appropriate3 = Too Complex

12. Based on previous knowledge and experience, the level of CE activity was

13. Comments/Suggestions:

I verify that I viewed the entire presentation and completed the evaluation form for it, and have earned the contact hours offered for this presentation.

Your CE certificate will be issued after your completed evaluation form is mailed or faxed to ONS and approved.

Oncology Nursing Society

P.O. Box 3510

Pittsburgh, PA 15230-3510 or Fax: 412-859-6160