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Company
LOGO
Improving Patients Safety through Effective
Communication Skills of Health Care Providers
Prepared by:
Claudine Roxas, RN
Cathy Roxas, RN
Efren Juane, RN
Xavier Reyes, RNMichelle Geronimo, RN
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I. Introduction/ Background of the Problem
Ineffective communication is reported as asignificant contributing factor in medical
errors and inadvertent patient harm. In
addition to causing physical and emotionalharm to patients and their families,
adverse events are also financially costly.
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These errors have the potential to causesevere injury or unexpected patient death.
Medical errors, especially those caused by
a failure to communicate, are a pervasiveproblem in todays health care
organizations.
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When health care professionals are notcommunicating effectively, patient safety is
at risk for several reasons: lack of critical
information, misinterpretation ofinformation, unclear orders over the
telephone, and overlooked changes in
status.
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Over the years, there have been repeatedcries and admonitions for improving nurse-
physician communication and questioning
why it is so difficult to achieve. Someresearch has shown that the lack of
interpersonal and communication skills of
physicians and nurses is associated with
errors, inefficiencies in the delivery of care,
and frustration.
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The practice of nursing utilizes constantcommunication between the nurse and the
patient, the patients family, the nurses co-
workers, supervisors, and manyothers. Communication in nursingcan be
a complicated process, and the possibility
of sending or receiving incorrectmessages frequently exists.
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There are numerous intervention studiesindicating that the use of structured
communication tools or other strategies in
health care improves the structure andquality of information exchanged between
healthcare professionals, and/or reduces
patient harm.
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II. THEORETICAL FRAMEWORK
The theory that supports this programproposal is Humanizing Nursing
Communication Theory developed by
Bonnie Weaver Duldt-Battey (1996).
This theory addresses communication and
human relations in nursing.
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It emphasizes the interpersonalrelationships among nurses and others.
These relationships aim to prevent
ineffective communication and
inappropriate outcomes.
The theory aids the nurse in coping with
the negativity experienced in the practice
of nursing.
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Communication is crucial to understandingconcerns people have, especially whendealing with the communication betweenstaff nurses and physicians (Battey, 1996).
In relation to this theory, (Sutcliff et.al.2004) states that in health care
environments characterized by ahierarchical culture, physicians are at thetop of that hierarchy.
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When hierarchy differences exist, people
on the lower end of the hierarchy tend to
be uncomfortable speaking up about
problems or concerns.
Intimidating behavior by individuals at the
top of a hierarchy can hinder
communication and give the impressionthat the individual is unapproachable.
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The Theory of Humanizing NursingCommunication defines the following
concepts: nursing, human beings (the
client, and the nurse, colleagues andpeers), the nursing process, health, the
environment, critical life situations and
communication.
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Nursing
Nursing is the art and science of positive,humanizing intervention in changing healthstates of human beings interacting in theenvironment of critical life situations.
A set of three elements comprises theconcept of nursing, i.e., communicating,
caring, coaching. These are defined asfollows:
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Communicating
Communication, specifically, interpersonalcommunication, is a dynamic process
involving continual adaptation and
adjustments between two or more humanbeings engaged in face-to face
interactions during which each person is
continually aware of the other
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Caring
Caring involves valuing and touching. Thenurse values the client and is concerned
about the individuals well-being.
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Coaching
Coaching refers particularly to theteaching aspect of nursing. The nurse
plans and implements the
teaching/learning process and providessupport and encouragement to clients as
they strive to meet health goals.
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Human Being
The focus of nursing is the human being.Each profession defines the human being
according to those characteristics of
particular relevance to that discipline.
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Communication
Communication is a process characterizedby being existential in nature, involving an
exchange ofmeanings, concerning facts
and feelings, and involving dialogue.
Th t di i f
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There are two dimensions of
communication.
Humanizing communication involves anawareness of the unique characteristics of
being human
Dehumanizing communication ignores
these unique human characteristics.
II E id d b d h
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II. Evidenced based research
study
The study could support our proposal isthe study entitled Improving Patient
Safety through Provider Communication
Strategy Enhancement conducted byCatherine Dingley RN, PhD, FNP; Kay
Daugherty RN, PhD; Mary K. Derieg RN,
DNP; and Rebecca Persing, RN, DNP.
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The purpose of this study was to develop,
implement, and evaluate a comprehensive
provider/team communication strategy,
resulting in a toolkit generalizable to other
settings of care.The specific aims included implementation
of a structured communication tool; a
standardized escalation process; dailymultidisciplinary patient-centered rounds
using a daily goals sheet; and team huddles.
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communication issues with physicians asone of the two most highly contributing
factors, according to the National Council
of State Boards of Nursing reports.
The researchers found that
communication problems were relativelystraightforward and fell into four
categories:
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communications that were too late to beeffective
failure to communicate with all the relevant
individuals on the teamcontent that was not consistently complete
and accurate
communications whose purposes were notachieved
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Throughout the study, a number oflessons learned provided insight that
could be useful for other organizations
considering similar implementation ofteamwork and communication strategies.
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First, it is paramount to secure
administrative and clinical support on allmanagement levels, from the executive to
the unit level support.
It was important for management andleaders to demonstrate that teamwork and
communication were valued as important
factors contributing to patient safety andstaff satisfaction.
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Furthermore it was important that they providedthe means for staff to attend presentations,encouraged further unit level education, andfacilitated integration of the concepts into
practice.
The result of the study could help for caring ourclients because good interpersonal relationship
and open communication of the health careproviders is actually the leading cause ofpatients safety and quality of care.
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IV. Interpretation of Data
All data gathered were tallied and computedinto percentage for better outcome and toeasily interpret by the researchers. Thefollowing are the labels used for the
succeeding results.
n = number of respondents
% = percentageN = total number of respondents
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Communication with MD
10%
67%
23%
The Doctor is not clear in giving orders thrutelephone
average incidence ofmore than once a week
average incidence of atleast once a week
no encounter
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Communication with MD
47%53%
The Doctors handwriting is not clear to read
Average incidence ofmore than once a week
Average incidence of atleast once a week
no encounter
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0%
20%
80%
The Doctor does not accept any recommendations forpatients care
average incidence ofmore than once a week
average incidence of atleast once a week
no encounter
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48%
30%22%
0%
10%
20%
30%
40%
50%
60%
medication errors didn't relay laboratoryresults
forget to carry outorders
What errors did you usually encounter in carrying outdoctors order?
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0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
report to thehead nurse
write anincidence
report
seek help tothe colleagues
no action
43%
17%
34%
6%
How do you take over with these errors?
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0%
10%
20%
30%
40%
50%
60%
70%
act like nothinghappen
say sorry to theclient
monitor thecondition of the
patient
22% 11%
67%
How do you act to your clients when you commit errors?
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32%
32%
32%
4%
0% 5% 10% 15% 20% 25% 30% 35%
didn't verify doctor's order
doctor's order in unreadable
busy/ understaff
novice to work
What are the reasons of committing these errors?
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0%
10%
20%
30%
40%
50%
60%
stress poor interpersonalrelationship
wronginformationprocessing
lack of time
55%
30%
10% 5%
Frequent cause of miscommunication among healthcareworkers
D h it l i ti / i h t
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Does your hospital organize meetings/seminars on how to
improve communications among healthcare workers?
0%
5%
10%15%
20%
25%
30%
35%
40%
45%
50%
often not so often rarely never
13%
34%
50%
3%
Series 1
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93%
7%
Are you willing to attend a seminar regarding thesaid toolkit for effective communication?
yes
no
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V. Program Proposal
The growing body of literature on safety anderror prevention reveals that ineffective or
insufficient communication among team
members is a significant contributing factor to
adverse events.
A 1day seminar will be conducted to improve
patient care through effective communication ofhealth care professionals
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We adapted the toolkit of Dingley et al.which serves as a guide of the nurses and
MDs in providing care to the patients.
The toolkit is composing of situational
briefing guide (SBAR), team huddles and
multidisciplinary rounds using daily goalsheet.
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A standardized communication format, theSBAR, was utilized as a situational briefing
guide for staff and provider communication
regarding changes in patient status orneeds for no emergent events, related
issues, or for events on the unit, in the lab,
or within the health care team.
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SBAR also presents guidelines fororganizing relevant information when
preparing to contact another team
member, as well as the framework forpresenting the information, appropriate
assessments, and recommendations.
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Team huddles it was defined as a quickmeeting of a functional group to set the
day/shift in motion via commentary with
key personnel.
Huddles are Microsystems meetings with
a specific focus, based on the function of aparticular unit and team.
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Multidisciplinary rounds using daily goal sheet,Rounds were focused on open and collaborative
communication, decision-making, information
sharing, care planning, patient safety issues,
cost and quality of care issues, setting dailygoals of care, and communicating with patients
and/or family members as they were able.
VI T t P l ti
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VI. Target Population
The program entitled Improving Patients Safetythrough Effective Communication Skills of Health
Care Providers has a target population of 50
participants working at Nueva Ecija Doctors
Hospital.
The priorities of the said program are the
supervisors, head nurses before the staffnurses. The nurses working outside the
institution are welcome to participate.
VII SMART l / Obj ti
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VII. SMART goals/ Objectives
The seminar highlights the critical importance of,and common barriers to, effective
communication in healthcare organizations and
institutions, and points to some strategies and
tools available to promote effectivecommunication among healthcare professionals.
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SPECIFIC- The objectives of this seminarare to raise awareness and stimulate
discussion and action around what your
healthcare organization, division or unitcan do to improve communication and
teamwork.
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MEASURABLE- participants in thisseminar will learn:
To assess their professional communication
skills To assertively make recommendations to
physicians
To organize and present information to
communicate changes in patients status
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To review pertinent issues of the day and to
go over the days schedule
To identify effective communication strategies
To determine the cause of committing errors
and how to avoid it
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ATTAINABLE- we aim to provide information orskills in a form of a toolkit for the health care
providers to enhance communication strategy
for patients safety in this seminar.
REALISTIC- The seminar includes written
individual and group exercises, group
discussions, group activities and simulationsdesigned to create a highly-effective learning
experience.
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TIME BOUND- this program is a 1 day seminar
approximately 8hours for giving consideration to
the availability of the participants to attend the
provided seminar. We aim to conduct a seminarfor 1day only because of their work schedule.
VIII. Seminar Content and
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VIII. Seminar Content andschedule
Week 1Activity: dissemination of formulated assessment
tool to 30 staff nurses working at Nueva Ecija
Doctors Hospital.
Week 2
Activity: Analysis and Interpretation of the data
collected and formulation of the programproposal.
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Week 3Activity: Implementation of the program
proposal
Day1, September 10, 2012
Time: 8:00am to 8:30am
Registration
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Time: 8:30am to 10:00amTopic: understanding effective communication
among healthcare workers
Importance of Therapeutic Communication
Common Barriers to Effective Communication
and Collaboration
Effects of ineffective communication in patients
safety
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Time: 10:00am to 10:15amSnack/bathroom break
Time: 10:15am to 12:00nnTopic: introduction of toolkit, Situational Briefing
Guide (SBAR)
Definition of the acronym SBAR
Different aspects of situational briefing guide
Group activity/ evaluation
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Time: 12:00nn to 12:30pmLunch break
Time: 12:30pm to 2:45pm
Topic: introduction of toolkit, team huddles
Guidelines in doing huddles
Benefits of team huddles
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Time: 2:45pm to 3:00pmSnack/bathroom break
Time: 3:00pm to 4:00pmTopic: multidisciplinary rounds using daily goal
sheet
Tips to enhance decision making , setting daily
goals of the day and collaborative
communication
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Time: 4:00pm to 4:30pmActivity: giving certificate of attendance to the
participants
Week 4
Activity: Follow up assessment and evaluation of
the program proposal
IX Seminar Budget Plan
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IX. Seminar Budget Plan
a. Program Expenses
Speakers travel expense and food allowances ---------------------5000
Honorarium -------------------------------------------------------------------3000
Speakers gift ----------------------------------------------------------------1000
A/V rental ----------------------------------------------------------------------700
Certificates --------------------------------------------------------------------1500
Function hall rental (9hours) ----------------------------------------------3000
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b. Promotion
Paid advertising (tarpaulin 6x12) -------------------600
Brochure printing (100pcs) ---------------------------200
c. Registration
Printing -----------------------------------------------------20
Name tag -------------------------------------------------100Handouts -------------------------------------------------250
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d. Food and beverages
Am snack (yum burger, fries and regular coke) --------------3000
Lunch (flavor shots with regular coke) --------------------------3000
Pm snack (1 solo c2 and bread with cheese)-------------------700
__________________
TOTAL= P 22,070.00
Sources of Funds/ Resources to be Used in the
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Program
Registration fee 400/head -----------------------------20,000
Donation from NEDH Administrator -------------------2000
Donation from nursing office ----------------------------2000
___________________
TOTAL = P 24,000.00
X. Organizations/Agencies that can support the
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program
Agency of Healthcare Research and Quality, by continuallyconducts research regarding communications among
healthcare workers, and providing different tools on how to
develop excellent interactions in clinical settings.
Communication specialist, such as psychologist,psychiatrists, neuro-linguistic programmers, speaking
coaches, and healthcare workers who has specialization in
communication skills and reporting skills. They can provide
seminars and coaching sessions in improving rapport,
developing trust, understanding and connection among
healthcare professionals.
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Hospital administration of NEDH, by providing venuesand necessary equipments in conducting learning
programs regarding communications among healthcare
workers including dissemination of tools.
Nursing Division Office of NEDH, by proactively
participating in the implementation and continuously
enforcing of the program.
XI Significance and Applicability of the Program
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XI. Significance and Applicability of the Program
The study and its findings will benefit the following:
The Health Clients, for them to received effective,
efficient and quality health care services, thus shortening
their stay in the hospital.
The Nurses, for them to have effective communication
and good collaboration in handling different patient-
centered situations.
The Hospital Institution, for them to have an excellent
health care deliverance and utmost utilization of
manpower services.
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Communication is one of the important keys in renderingeffective health care services. Without it, healthcare
personnel can commit errors that are sometimes fatal to
the patients.
In the means of avoiding it, this program aims to improve
the communications between nurses, doctors, and other
personnel involved in patient care by providing learning
programs which can dramatically increase, hone and
enhance the nurses interpersonal communication skills.
XII Sustainability of the Program
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XII. Sustainability of the Program
Integrating sustainability into a health care improvement isa journey that proceeds incrementally, ideally developing
committed teams, creative solutions, solid strategies,
and measurable goals along the way.
No matter an organization's sustainability driverscost
reduction, regulatory compliance, environmental
stewardship, community pressures, social responsibility,
and so onplanning is essential to achieving
sustainability in a project as well as across theorganization.
Roadmap Approach
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Roadmap Approach
Building Teams. Building an effective team is critical to anysustainability effort. The Roadmap approach to strategic
team-building starts with leadership but includes
representatives from all levels within an organization.
Getting leadership support. Successful sustainability programs
require an institutional commitment, policies to drive change,and dedicated resources to make programs happen. Senior
leadership support and involvement, including good
communication as well as both symbolic and substantive
action, are key to a program's long-term success. The policies
and practices of top management will shape the behavior ofthe entire staff.
http://www.sustainabilityroadmap.org/strategies/greenteam.shtmlhttp://www.sustainabilityroadmap.org/strategies/leadership.shtmlhttp://www.sustainabilityroadmap.org/strategies/leadership.shtmlhttp://www.sustainabilityroadmap.org/strategies/leadership.shtmlhttp://www.sustainabilityroadmap.org/strategies/leadership.shtmlhttp://www.sustainabilityroadmap.org/strategies/leadership.shtmlhttp://www.sustainabilityroadmap.org/strategies/leadership.shtmlhttp://www.sustainabilityroadmap.org/strategies/leadership.shtmlhttp://www.sustainabilityroadmap.org/strategies/greenteam.shtmlhttp://www.sustainabilityroadmap.org/strategies/greenteam.shtmlhttp://www.sustainabilityroadmap.org/strategies/greenteam.shtmlhttp://www.sustainabilityroadmap.org/strategies/greenteam.shtml7/30/2019 Prog Prop Presentation
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Planning the Journey. The plethora of options andopportunities now promoted as ways to integrate sustainability
into a facility's operations can make it difficult to know where
to begin. The Planning a Journey section offers a guide to
getting a sustainable program under way: It begins with
foundational actions such as gathering baseline data againstwhich to measure progress; identifying drivers and barriers to
success; and developing sustainability goals, targets, and
action plans and moves on to broader, more strategic
activities like making the business case for a sustainability
initiative and managing an effort once it is up and running.
http://www.sustainabilityroadmap.org/strategies/start.shtmlhttp://www.sustainabilityroadmap.org/strategies/start.shtmlhttp://www.sustainabilityroadmap.org/strategies/start.shtmlhttp://www.sustainabilityroadmap.org/strategies/start.shtmlhttp://www.sustainabilityroadmap.org/strategies/start.shtmlhttp://www.sustainabilityroadmap.org/strategies/start.shtmlhttp://www.sustainabilityroadmap.org/strategies/start.shtml7/30/2019 Prog Prop Presentation
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Financing. A number of funding options are available forfinancing sustainability initiatives, particularly large
capital projects. This section describes many of the
options and presents a template for evaluating the
business case for a project.
Getting It Done. Go to the Implementation section of the
Roadmap to view an extensive compilation of strategies
for effective communication for improvement of patients
care.
The Plan-Do-Check-Act (PDCA) Model: An Iterative
P I t C l
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Process Improvement Cycle
Educateunderstand
issues/drivers
Defineobjectives
plan
Set targetgoals
Implementaction plan Do
Measure and
report ongoals Check
Build uponSuccess-Do it
again; Act
XIII. Parameters/ Tools for Evaluation
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a a e e s/ oo s o a ua o
Evaluation Form
TOPIC/ TITLE:___________________________________________
Date: __________________________________________________
Part I. Instructions: Please indicate your level of agreement with the
statements listed below. Put a check ( )
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Strongly
Agree
Agree Neutral Disagree Strongly
Disagree
1. The objectives of the
learning program were
clearly defined
2. Participation and
interaction wereencouraged
3. The topics covered
were relevant to me
4. The content was
organized and easy tofollow
5. The learning tools
distributed were helpful
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Strongly
Agree
Agree Neutral Disagree Strongly
Disagree
6. This learning
experience will be useful
in my nursing practice
7. The learning program
conductors were
knowledgeable in the
topics and well prepared
8. The learning program
objectives are met
9. The time allotted for
the learning program
was sufficient
10. The learning program
venue and facilities were
adequate and
comfortable
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Part II. Please indicate your answer in the blanks provided.
1. Overall how would you rate the learning program? 1-5, 5 as the highest and
1 as the lowest. _______________
2. What aspects of the learning program could be improved?
_______________________________________________
3. Do you think you can easily apply what you have learned at your work?
_______________________________________________
4. Would you recommend this learning program to other health care
professionals ( Doctors, Pharmacist, Midwives, Laboratory technician et.) ?
_______________________________________________
5. Other comments and suggestions:
_______________________________________________
THANK YOU FOR THE FEEDBACK!