RN Case ManagerRN Peer Input Tool for Annual Evaluation: Therapeutic Relationships-Engagement

Peer feedback for(RN name):

Directions:

  • Evaluatee to send domainportions to peers who evaluatee would like feedback from
  • Clinical Thinking and Judgment domain is to be completed by another RN
  • Peers should indicate within the last column the level they feel is appropriate for the Evaluatee on each row
  • Peers are encouraged to support their views with concrete examples
  • Peers should complete the peer review within 7 Days and return electronically to the Manager/Designee and Evaluatee

Role Entry / Competent / Expert / Mastery / Peer Should Designate Appropriate Level Below
DOMAIN: Therapeutic Relationships-Engagement: A constellation of nursing activities that are responsive to the uniqueness of the patient and family and that create a compassionate and therapeutic environment with the aim of promoting comfort and preventing suffering
Therapeutic Communication
Individualizes communication based on assessment of patients and families.
Possesses clarity on one’s own values and how they affect interactions, relationships and boundary setting, incorporating that understanding into patient/family interactions / Consistently role models individualized therapeutic communication based on patient and family needs.
Identifies when peers and team members’ values and beliefs affect their clinical judgment and patient/family care. / Intuitively uses therapeutic communication with patient/family.
Challenges and moves to resolves team biases utilizing appropriate resources (I.e. Ethics Committee) as needed.***
Caring Practice and Engagement
Demonstrates empathy in interactions with patients and families. / Plans and provides care management actions that promote intentional caring. / Proactively anticipates patient/family response and provides creative approaches to optimize comfort and support
Empowerment
Invites patients and families to actively participate in plan of care to foster growth, competence, and self-efficacy.*** / Maximizes patient/family participation in decision-making and goal setting along the continuum to ensure and advance the plan of care to support successful transition to the next level of care (I.e. care conferences and other practices).*** / Identifies and actively engages patient/family strengths and expertise and motivates them to implement the plan towards a successful transition.***
Please describe a time when you saw me at my very best. What qualities did I display in this domain?
Please provide your input regarding opportunities for my personal and/or professional growth
I have completed the Peer Feedback Class as required by the UMPNCcontract, paragraph 28E, for participation in the peer review process.
Name: / Date:

Revised 7/2015 Professional Development Framework RSAM Steering Committee/JIT Approved.

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