PNAAF Evaluation Form

PHILIPPINE NURSES ASSOCIATION OF AMERICA FOUNDATION, INC.

EVALUATION FORM

INSTRUCTIONS: To assist us in evaluating the effectiveness of this educational activity, please complete the evaluation form by circling the appropriate rating. Each speaker must be evaluated separately. Please return this form to the Program Coordinator at the end of the program to receive your continuing education credit. Make sure that you sign the attendance sheet.

5 - Strongly Agree, 1 - Strongly Disagree

GENERAL EVALUATION*

	5	4	3	2	1
1. The individual sessions were relevant to the program goals
2. The content addressed important professional issues
3. The speakers were knowledgeable about the topic
4. The facilities were adequate
5. The program was well organized
6. There was an opportunity to network with my colleagues

PRESENTER EVALUATION (SAMPLE ONLY)

Evaluate the presenter and individual session objectives for only those sessions you attended.

5 - Strongly Disagree, 1 - Strongly Disagree

Dexter Louie, MD, JD*

	5	4	3	2	1
1. Apply gained knowledge regarding the health status and disparities of Asian American, Native Hawaiian and Pacific Islander populations.
2. Identify the Affordable Care Act and its complications to our populations and healthcare providers.
3. Recognize action steps to move forward on health reform to achieve optimal health for all.

Lt. Col. Kirk Jensen, MD, USAF, MC*

	5	4	3	2	1
1. Explain the relationship between childhood obesity and chronic illnesses.

Jeffrey Sicat, MD, FACE*

	5	4	3	2	1
1. Describe advances in diabetic management that effectively contain disease progression

M. Catherine Kelly, MSN, MPH, BSN, CRNP*

	5	4	3	2	1
1. Describe the phenomena of homelessness and its causes.
2. Discuss the challenges and needs of homeless patients and families.
3. Apply changes resulting from increased awareness of the difficulties homelessness imposes on the patient’s ability for self care.

Stephen Wohlgemuth, MD, FACS, FASMBS*

	5	4	3	2	1
1. Discuss and learn the disease of Morbid obesity and keys for successful treatment.

Glenda Lewis-Fleming, MSW, ACSW, FAHM*

	5	4	3	2	1
1. Define transition and explore system issues associated with transitioning to adult-oriented system of care.
2. Identify medical, legal, academic, and social implications involving transitioning to adulthood that places this population at risk.
3. Describe and understand the clinician’s role in the transition process.

Carmina Bautista, MSN, RN, FNP-BC, BC-ADM*

	5	4	3	2	1
1. Discuss the application of effective technology to enhance self care empowerment and improve health care outcomes in patients with diabetes.

Lorraine Micheletti, BSN, MA, CCRN*

	5	4	3	2	1
1. Indicate an understanding of what social action is.
2. Recognize the core values of nursing as it relates to the social needs of patients.
3. Identify what activities a nurse can get involved in to make a difference to the patient’s health and well being beyond the scope of hospital care.

List ideas for future topics, locations, and any comments about this activity.*

HOW TO RETRIEVE YOUR CERTIFICATE

You need to fill out your complete name and a valid email address where we can send your certificate. Don't worry, the fields below will not reflect on the evaluation form and your entry will remain anonymous, we just need to collect your name for us to print out your certificate.

Full Name*

First NameMiddle NameLast Name

E-mail*