Program Title:Date of Offering:

Program Sponsor:

Participant Information:

Critical Care Nurse Progressive Care Nurse General Staff Nurse MD Rehab EMS Pharmacist Radiology Tech Interventional Treatment Team Other

Employer:

American Stroke AssociationOverland Park Regional Medical Center St. Mary’s Medical Center American Stroke Foundation Providence Medical Center Shawnee Mission Medical Ct Centerpoint Medical Center Rehab Institute of KC Stormont-Vail HealthCare Lawrence Memorial Hospital Research Medical Center-Belton University of KS Hospital Lee’s Summit Medical Center Research Medical Center Liberty Hospital St. Francis Health Center Other (please list): Menorah Medical Center St. Joseph Medical Center Mid-America Rehab Hospital St. Luke’s Brain & Stroke North Kansas City Hospital St. Luke’s East

Olathe Medical CenterSt. Luke’s South

I am a member of a Rapid/Stroke Response Team? Yes No

Prior to today, were you aware of the monthly programs the Consortium offers? Yes No

Are you attending to obtain required hours for JC stroke certification? Yes No

Objective / Strongly Agree
(4) / Agree
(3) / Disagree
(2) / Strongly Disagree (1) / Comments
1. Registration process was efficient and accurate
2. Presentation format was effective and conducive to learning
3. Audiovisual/Handout materials enhanced learning
4. Program content was relevant and current
5. Material presented is of direct value in clinical practice
6. The program met the objectives as stated: be sure to add your own objectives
(list here)
a.
b.
c.
d.
Speaker: / Strongly Agree
(4) / Agree
(3) / Disagree
(2) / Strongly Disagree (1) / Comments
1. Demonstrated knowledge/expertise of the subject
2. Presentation skills-organized and clear presentation
3. Presentation style engaged audience/maintained interest
4. Teaching methods stimulated critical thinking and/or
discussion
5. Balanced amount of theory and application
6. Demonstrated respect for my learning needs
Comments:
Speaker: / Strongly Agree
(4) / Agree
(3) / Disagree
(2) / Strongly Disagree (1) / Comments
1. Demonstrated knowledge/expertise of the subject
2. Presentation skills-organized and clear presentation
3. Presentation style engaged audience/maintained interest
4. Teaching methods stimulated critical thinking and/or
discussion
5. Balanced amount of theory and application
6. Demonstrated respect for my learning needs
Comments:
Speaker: / Strongly Agree
(4) / Agree
(3) / Disagree
(2) / Strongly Disagree (1) / Comments
1. Demonstrated knowledge/expertise of the subject
2. Presentation skills-organized and clear presentation
3. Presentation style engaged audience/maintained interest
4. Teaching methods stimulated critical thinking and/or
discussion
5. Balanced amount of theory and application
6. Demonstrated respect for my learning needs
Comments:
Speaker: / Strongly Agree
(4) / Agree
(3) / Disagree
(2) / Strongly Disagree (1) / Comments
1. Demonstrated knowledge/expertise of the subject
2. Presentation skills-organized and clear presentation
3. Presentation style engaged audience/maintained interest
4. Teaching methods stimulated critical thinking and/or
discussion
5. Balanced amount of theory and application
6. Demonstrated respect for my learning needs
Comments:
Speaker: / Strongly Agree
(4) / Agree
(3) / Disagree
(2) / Strongly Disagree (1) / Comments
1. Demonstrated knowledge/expertise of the subject
2. Presentation skills-organized and clear presentation
3. Presentation style engaged audience/maintained interest
4. Teaching methods stimulated critical thinking and/or
discussion
5. Balanced amount of theory and application
6. Demonstrated respect for my learning needs
Comment:
Needs Assessment 2015
**If you have already done this in 2015, do not complete again***
Strongly Agree / Agree / Disagree / Strongly
Disagree / N/A / Comments
  1. I have a good understanding of how the NIHSS relates to specific stroke types

  1. I have a good understanding of the indications for administration of tPA

  1. I understand the way tPA works and affects outcomes

  1. I am comfortable in discussing interventional stroke treatment options

  1. I have a good understanding of how to care for the acute ischemic stroke patient

  1. I have a good understanding of how to care for the patient with intracerebral or subarachnoid hemorrhage

  1. I have a good understanding of stroke location and rehabilitation needs

  1. I have a good understanding of treatment approaches/techniques in working with individuals who have survived a stroke

Comments/Future Stroke Topics:

Updated: 6/2015 dn