WOUND MANAGEMENT STAGING PRESSURE AREAS

Transcription

1 WOUND MANAGEMENT STAGING PRESSURE AREAS HCP26 PROGRAM GUIDE FOR PROFESSIONAL NURSES National Educational Video, Inc. TM is an approved provider of continuing education. State Board provider numbers: Florida NCE2896, Alabama 5-97, California CEP8803, Kentucky and West Virginia WV RN. This activity provided by National Educational Video Inc. is approved as a provider of continuing education in nursing by Alabama State Nurses Association, which is accredited as an approver of continuing education in nursing by The American Nurses Credentialing Center's Commission on Accreditation.

2 OUTLINE OF COURSE CONTENT CONTINUING EDUCATION Title of Educational Activity Contact Hours 3 The presenter for our programs are the script writers who write the program guide and the script for the programs. The facilitator/subscriber/purchaser of our program can also be considered the presenter as he/she directs the class and the participants through the guide and the video. The distribution of handouts, glossary of terms, taking of the pretest/post test and discussion of correct answers takes about 30 minutes. Each part of the video has a pretest/posttest to be distributed, completed and discussed. The discussion questions take approximately minutes to discuss adequately. Questions are provided for each part of the video. There is a case study that takes approximately 20 minutes to discuss. 2

3 OUTLINE OF COURSE CONTENT CONTINUING EDUCATION (Continued) Objectives Content (Topics) Time Frame Faculty Teaching Method List objectives in Operational and Behavioral terms List each topic area covered and provide a description or outline of the content to be presented State the time frame for the topic area List the faculty persons or presenter for each topic Describe the teaching method (s) used for teaching Part I Part I Part I Part I Part I 1. Define a pressure area The National Ulcer Advisory Panel definition is used The difference between a pressure area and decubitus is explained The etiology of pressure areas are reviewed 25 minutes for video presentation 10 minutes for review of glossary of terms (Part I) Script writer On site facilitator to review glossary of terms Video presentation 2. List the sites for pressure area development Areas of bony prominence are demonstrated Script writer Video presentation and interview with skin care expert 3. Identify the causes and risks of pressure area development Pressure, friction shear and moisture are discussed as the four most critical factors Other factors reviewed include: Mobility Cognition Sensation Age Body temp Chronic disease Smoking Part of video presentation Script writer On site facilitator Video presentation 4. Describe the four stages of pressure area development Descriptions of : Stage I Stage II Stage III Stage IV pressure areas Part of video presentation 20 minutes for discussion questions (Part I) Script writer On site facilitator Video presentation Visual display of each stage 3

4 OUTLINE OF COURSE CONTENT CONTINUING EDUCATION (Continued) Objectives Content (Topics) Time Frame Faculty Teaching Method List objectives in Operational and Behavioral terms List each topic area covered and provide a description or outline of the content to be presented State the time frame for the topic area List the faculty persons or presenter for each topic Describe the teaching method (s) used for teaching Part II Part II Part II Part II Part II 1. Identify the types of occlusive dressings and indications for each type Types of occlusive dressings are reviewed Hydrogel Hydrocolloid Alginate Film Composites Indications for each type are reviewed 25 minutes for video presentation (Part II) Script Writer On site facilitator Video presentation 2. Discuss the principles of wound care Items to avoid in wound care are reviewed Eight principles of wound care are discussed Nutritional status & lab data are reviewed Other disciplines (other than nursing) that need to be involved in wound care are discussed Part of video presentation Script writer On site facilitator Video presentation Interview with skin care expert 3. Define a vascular ulcer Causes & characteristics of a venous ulcers & arterial ulcers are discussed Review treatment recommendations for both ulcers Part of video presentation Script writer On site facilitator Video presentation Interview with skin care expert 4. Discuss proper documentation of a wound Review ulcer & concise wound care orders Important information needed in order to describe a wound is discussed Part of video presentation Script writer Video presentation 4

5 OUTLINE OF COURSE CONTENT CONTINUING EDUCATION (Continued) Objectives Content (Topics) Time Frame Faculty Teaching Method List objectives in Operational and Behavioral terms List each topic area covered and provide a description or outline of the content to be presented State the time frame for the topic area List the faculty persons or presenter for each topic Describe the teaching method (s) used for teaching Part II Part II Part II Part II Part II 5. Describe the nursing interventions implemented for patients at risk for pressure area development. Interventions include: Management of moisture Management of nutritional deficits Management of mobility & activity deficits Daily skin inspections & general skin care Part of video presentation 20 minutes for discussion questions (Part II) Script writer On site coordinator Video presentation Discussion questions It is recommended that participants read: Pressure Ulcers in Adults Prediction and Prevention quick reference guide for clinicians AHCPR publication No Skin & Aging, June 1988, a review of wound healing & dressing materials, p Home Healthcare Nurse, Vol 17 number 1, January 1999, Wound Dressing: Challenging Decisions, p Case study 5

6 WOUND MANAGEMENT OUTLINE PLEASE COPY AND HANDOUT BEFORE BEGINNING THE PROGRAM I. Definition of pressure area II. Sites for pressure area development III. Causes and risks of pressure area development IV. The four stages of pressure areas V. Types of dressings and when to use Hydrogel Hydrocolloid Alginate Film Composites 6

7 WOUND MANAGEMENT OUTLINE (Continued) PLEASE COPY AND HANDOUT BEFORE BEGINNING THE PROGRAM VI. Principles of wound care Items to avoid Basic principles of care Nutritional status and labs VII. Vascular Ulcers Venous Causes and characteristics and treatment Arterial Causes and characteristics and treatment VIII. Documentation principles IX. Implementing nursing interventions 7

8 PROGRAM DESCRIPTION / GOAL This program will cover the definition of a pressure area, their causes and staging. Also reviewed are the types of occlusive dressings and their appropriate uses. Arterial and venous ulcers and their treatment are discussed. Interventions to prevent pressure area development are also examined. Video running time: 5O minutes (3 contact hours), includes learning guide. OBJECTIVES At the conclusion of this program, the participant will be able to: 1. Define a pressure area. 2. List the most common sites for pressure area development. 3. Identify the causes and risks of pressure area development. 4. Describe the four stages of pressure areas. 5. Discuss the principles of wound care. 6. Identify the types of occlusive dressings and indications for each. 7. Perform a nursing assessment of a wound. 8. Recognize the differences between a venous ulcer and an arterial ulcer. 9. Describe the nursing interventions implemented when a patient is found to be at risk for pressure area development. 8

9 The Nursing Process The nursing process is a systematic method of problem solving. It is based on the scientific method. The nursing process is called "process" because it is ongoing. These are the steps of the nursing process: Assessment: This is the systematic, ongoing collection of information from multiple sources. Assessment is done when a nurse interviews a client and the client s significant others. A physical assessment of the client is also completed observing the following: laboratory data, daily client actions, assessing the client s ability to carry out daily activities, symptoms and the client s response to treatment. In long term care, resident assessment instruments are used to provide a comprehensive multi-disciplinary assessment. Problem Identification or Nursing Diagnosis: Assessment data leads to identifying client strengths and client problems. These may be actual problems the client currently experiences, or potential problems that may occur with that client in the future. Problems are stated and related to a cause or influencing factor. Planning: The systematic steps that the nurse will enact, with others, to assist the client to meet the goals (or outcomes) that are set. For each problem, a measurable, specific goal is identified. The plan includes nursing actions, based on aspects of nursing theory, nursing science, other sciences, and research findings. The beliefs and values of the nursing profession as well as the values of the client are taken into account. Implementation: Carrying out the plan. Evaluation: This is the systematic process of examining each client goal-related outcome to determine if it were met and to revise the plan accordingly. Evaluation may also identify the resources that are needed for the client or the health care provider in their continuing plan of care. Professional Nursing Roles As the nurse carries out the nursing process, the nurse enacts a variety of professional roles. These are: clinician teacher client advocate leader These roles may overlap. In the clinician role, the nurse may provide direct "hands on" care, or may assess a client's needs and direct others to provide services to meet those needs. The nurse may conduct patient and family teaching in a teaching role. The nurse may also teach other health professionals when a multidisciplinary team addresses the client's needs. The nurse is a client advocate when collaborating with the client, finding resources for the client, and acting on behalf of the client. The nurse is a leader when planning and assigning the care of a client to others, maintaining overall responsibility and accountability for that care, assisting other members of the health care team to set and meet goals or when providing resources to other health care providers. 9

10 GLOSSARY OF TERMS Please copy and hand out to each participant at the beginning of the program. Pressure Area: Stage I: Stage II: Stage III: Stage IV: An area of unrelieved pressure over a defined area, usually over a bony prominence, resulting in ischemia, cell death and tissue necrosis. Non-blanchable erythema of intact skin not resolved within 30 minutes of pressure relief. Appears as darkened or red skin. Partial thickness loss of skin involving epidermis, possibly into the dermis. May appear as a blister or a superficial crater or abrasion. Full thickness destruction through dermis into the subcutaneous tissue. May appear as a deep crater with or without undermining of adjacent tissue. Deep tissue destruction through subcutaneous tissue to fascia, muscle, bone or joint. Undermining and sinus tracks may be associated with a stage IV pressure area. It is important to note here, especially for home health, that staging of pressure areas be as accurate as possible. From the PPS perspective and OASIS items MO460, MO476 & MO488, it is critical that your staff have a good grasp of wound management and staging pressure areas. Shearing Force: Friction: Moisture: Eschar: Arterial Ulcer: Venous Ulcer: Occurs when the skin remains stationary and the underlying tissue shifts. Occurs when the skin moves against a support surface. It is the movement of two surfaces moving across each other. This produces skin tears and abrasions. Liquid that causes dampness. It causes maceration or softening of the skin thereby decreasing tensile strength of the skin. Excessive moisture may result from perspiration, wound drainage and fecal or urinary incontinence. A tough, leathery, black appearing slough caused by necrotic tissue. An ischemic ulcer caused by the progressive development of atherosclerosis in the arteries which decreases blood flow. Vascular ulcer caused by deep vein incompetence, superficial vein incompetence, deep vein obstruction, congenital venous malformation, arteriovenous fistula and calf muscle failure. 10

11 GLOSSARY OF TERMS (Continued) Occlusive: Hydrogel Dressing: Hydrocolloid Dressing: Alginate Dressing: Film Dressing: Composite Dressing: Erythema: Debridement: Intertriginous: Friable: Ischemia: Slough: Granulation: State of being closed. A wound dressing with 96% water content. They are soothing and are good desloughing agents. Recommended for burns, skin grafts, donor sites and Stage II-IV pressure ulcers. Not recommended for heavily draining wounds. These dressings consist of a mixture of adhesive, absorbent polymers and a geling agent. They are impermeable to bacteria and other contaminants. They have a wear time of 3-5 days and are comfortable and reduce pain. Recommended for stage I-IV pressure areas, dermal ulcers under compression wraps or stockings and necrotic wounds. These are not recommended for heavily draining wounds, sinus tracts or fragile skin. Non-woven composite of fibers derived from seaweed. They resemble cotton when dry but form a gel as they absorb exudates from the wound. These are recommended for stage III-IV pressure areas, which have moderate to heavy wound drainage, surgical incision/dehisced wounds, sinus tracts, tunnels or cavities and infected wounds. These are transparent and thin and form a bacterial barrier that has a long wear time of 3-5 days. They are non-absorbent and are excellent for superficial wounds and skin tears. These dressings are a combination of two or more physically distinct products manufactured as a single dressing that provides multiple functions. They facilitate autolytic debridement and are comfortable. Redness or inflammation of the skin or mucous membranes, the result of dilatation and congestion of superficial capillaries. Removal of damaged tissue and cellular debris from a pressure area or wound. Erythematous irritation of opposing skin surfaces caused by friction, common sites are the axilla, the folds beneath large breasts and inner aspects of the thighs. Easily shattered, crumbled or pulverized. Decreased supply of oxygenated blood to a body part. To shed dead tissue cells. Healthy tissue that is bright, beefy red with a velvety appearance. 11

12 CHARACTERISTICS OF ARTERIAL LEG ULCERS Please copy and hand out to each participant at the beginning of the program. CHARACTERISTICS VENOUS ULCER ARTERIAL ULCER Pulse Present Absent or decreased Capillary refill < 3 sec > 3 sec Skin temperature Warm Cool ABI <.75 Ulcer location Medial Malleolus Toes, foot or lateral malleolus Ulcer drainage Moderate to large Minimal Ulcer tissue Dark red Black eschar or pale Ulcer margin Irregular Round & smooth Periulcer skin Bronzy-brown thick & hard Pale & thin Friable & shiny Dermatitis Frequent Rare Pruritis Frequent Rare Edema Moderate to severe Minimal Pain Present Intermittent claudication 12

13 PRE TEST PART 1 Circle T if the statements are true. Circle F if the statements are false. T F 1. A pressure area is a clinical problem most likely encountered in an acute care setting, such as a hospital. T F 2. A pressure area can occur only where there is compression over a bony prominence. T F 3. Moisture is an important contributing factor to pressure area. T F 4. Shearing force can be described as movement of two surfaces moving across each other. T F 5. A stage IV pressure area can be described as full thickness destruction through dermis into the SQ tissue and presents as a deep crater. T F 6. One of the most important treatments for wound healing is optimal nutrition. T F 7. Protein and carbohydrate deficiencies have no effect on wound healing. T F 8. Important lab tests that assess the nutritional status of the patient is the CBC. T F 9. The prediction, prevention and early treatment of pressure areas have to be a team effort. T F 10. Two commonly used scales used to assess the risk for pressure area development are the Glasgow Scale and Norton Scale. 13

14 1. Define a pressure area. DISCUSSION QUESTIONS PART 1 2. Where are the most common sites for pressure area development and why? 3. Describe the four most critical factors that contribute to the development of a pressure area? 4. Describe the four stages of pressure area development. 5. What laboratory data is important to adequately assess nutritional status? 6. What other health care disciplines, other than nursing, would be helpful to have on a wound care team. 14

15 Choose the best answer: POST TEST PART 1 1. Common sites for pressure area development are: a. sacrum b. coccyx c. ischium d. calcaneus (heel) e. all of the above 2. Critical factors that contribute to the development of pressure area include: a. pressure b. shear c. friction d. moisture e. all of the above 3. A Stage II pressure area is defined as: a. Non-blanchable erythema of intact skin not resolved within 30 minutes. b. Partial thickness loss of skin involving epidermis, possibly into the dermis. c. Full thickness destruction through dermis into the SQ tissues d. Deep tissue destruction through the SQ tissue to fascia, muscle, bone or joint. 4. Labs to assess nutritional status include: a. sed rate b. BUN c. albumin level d. TSH level 5. Risk assessment scales include factors of: a. immobility b. incontinence c. nutritional status d. sensory perception e. all of the above 15

16 Choose the best answer: POST TEST PART 1 (Continued) 6. Shear can be avoided by: a. use of draw sheets to reposition a patient b. elevate the HOB above 30 degrees c. slide the patient rather than lift to reposition d. apply moisturizing lotions to the skin vigorously 7. Non-blanchable erythema of intact skin is a definition of: a. Stage I pressure area b. Stage II pressure area c. Stage III pressure area d. Stage IV pressure area 8. Simple measures to encourage dietary support would include daily: a. vitamin C b. multi-vitamin with minerals c. protein supplement d. house snack e. all of the above 9. Other disciplines helpful in wound rounds, other than nursing, would include: a. occupational therapy b. physical therapy c. dietary d. pharmacy e. all of the above 10. Which of the following vitamin deficiencies can delay wound healing: a. B 12 b. folate c. vitamin K d. vitamin C 16

17 PRE TEST PART 2 Circle T if the statements are true. Circle F if the statements are false. T F 1. Pressure ulcers require wound coverings that enhance the natural environment and maintain physiologic integrity. T F 2. Hydrogen peroxide is an acceptable solution for wound cleaning. T F 3. A good pressure relieving device in a chair or wheelchair would be a soft foam or rubber ring cushion. T F 4. Occlusive dressings are preferred because they enhance debridement and aid in reepithelialization of the wound. T F 5. Types of occlusive dressings include hydrocolloids, films, foams and hydrogels. T F 6. When obtaining the dimensions of a pressure area, measure side to side and then head to toe using centimeters. T F 7. Pressure ulcers never totally revert to normal tissue and will always be susceptible to re-injury. T F 8. Venous ulcers typically have pale wound beds and are not painful. T F 9. Interventions to prevent pressure areas would include management of incontinence and nutritional deficits. T F 10. Any person to be found at risk for pressure area development should be placed on a pressure reducing surface. 17

18 1. Discuss the principles of wound care. DISCUSSION QUESTIONS PART 2 2. What are the benefits to using occlusive dressings for wound care? 3. Describe the types of occlusive dressings available and indications for each. 4. What items need to be included in a wound care order? 5. Discuss what descriptions need to be in the chart for the documentation of a wound. 6. Describe the differences between a venous ulcer and an arterial ulcer. 7. What are the treatment interventions for pressure ulcer management? 18

19 POST TEST Choose the best answer: PART 2 1. Items to avoid in wound care would include: a. occlusive dressings b. normal saline for wound cleaning c. ring cushion d. position pillows 2. Principles of wound care include: a. eliminate dead space b. use non-toxic wound cleansers c. remove infection, debris and necrotic tissue d. protect surrounding tissue from injury e. all of the above 3. Occlusive dressings are used in wound care because they: a. keep the wound bed dry b. retain wound fluid which aids in healing c. increases the inflammatory response d. decreases debridement in the wound bed 4. Types of occlusive dressings include: a. hydrogels b. hydrocolloids c. films d. composites e. all of the above 5. Film dressings are appropriate for: a. heavily draining wounds b. use in sinus tracts c. Stage IV pressure areas d. superficial Stage I-II pressure areas or skin tears 19

20 POST TEST PART 2 (Continued) Choose the best answer: 6. Foam dressings are indicated for: a. dry eschar b. non-draining wound c. packing wound d. Stage II-IV pressure areas where extra padding is required such as over a bony prominence 7. Wound debridement can be accomplished: a. mechanically b. enzymatically c. by use of sharps d. all of the above 8. Documentation of wounds should include: a. location b. size in centimeters c. presence or absence of exudate d. presence or absence of odor e. all of the above 9. Vascular ulcers are caused by: a. poor circulation b. pressure c. moisture d. friction 10. Intervention to prevent pressure area development would include: a. managing incontinence b. nutritional support c. daily inspection of skin d. reposition immobile patients every two hours e. all of the above 20

21 ANSWER SHEET PRE TEST PART I PART II 1. F 1. T 2. F 2. F 3. T 3. F 4. F 4. T 5. F 5. T 6. T 6. F 7. F 7. T 8. F 8. F 9. T 9. T 10. F 10. T POST TEST PART I PART II 1. e 1. c 2. e 2. e 3. b 3. b 4. c 4. e 5. e 5. d 6. a 6. d 7. a 7. d 8. e 8. e 9. e 9. a 10. d 10. e 21

22 CASE STUDY TO BE USED BY ON SITE PRESENTER FOR DISCUSSION (This must be completed by all RN s attending the program to comply with ANCC guidelines) Mr. Smith is a 76 year-old elderly man who was admitted to a long term care facility for rehab following a two week stay in the hospital for the treatment of a CVA with resulting left hemiparesis. His past medical history includes smoking one pack of cigarettes a day for 40 years, HTN, PVD, mild Parkinson s and early Alzheimer s. Since his CVA, he has had some problems with fecal and urinary incontinence. He is now wheelchair dependent. His daughter tells you that he has had an 8# weight loss in the last two weeks. He has 2+ bilateral pitting pedal edema, pedal pulses are present and he has brawny discoloration and scratch marks of his lower extremities. His skin is warm. His skin assessment reveals: 1. Stage II pressure area to his left ischium measuring 2cm X 3cm. The wound bed is beefy red without eschar or slough. There is a scant amount of serosanguineous exduate without odor. The tissue surrounding the wound is firm. 2. Stage III pressure area to his left trochanter measuring 4cm X 5cm with a depth of 3cm and 2cm tunneling noted at 2 o clock. The wound bed is yellow with moderate amount of serous drainage. 3. An ulcer to medial malleolus measuring 2cm X 2cm. The wound margin is irregular and the wound bed is dark red. It is painful to the touch. There is a large amount of drainage from this wound. No odor present. 4. Fresh skin tear on left forearm measuring 4cm X 1.5cm Discussion Questions 1. What are Mr. Smith s risk factors for pressure area development? 2. What other disciplines would you include in Mr. Smith s care? 3. Which occlusive dressings would you recommend for the skin problems identified? 4. Why would you suspect that the ulcer on Mr. Smith s medial malleolus would be a vascular ulcer? 5. What types of nursing interventions would you recommend for Mr. Smith? 22

23 ANSWER TO CASE STUDY QUESTIONS 1. What are Mr. Smith s risk factors for pressure area development? Age related skin changes Chronic disease Decreased mobility and sensation Malnutrition History of smoking Cognitive impairment Fecal and urinary incontinence Pressure, Friction, Shear 2. What other disciplines would you include in Mr. Smith s care? Physical, speech, occupational therapy Dietary Pharmacy Medical (vascular, plastic, podiatry, psychiatrist) Infection control 3. Which occlusive dressings would you recommend for the skin problems identified? Stage II pressure area to left ischium: Hydrogel or Hydrocolloid Stage III pressure area to left trochanter: Pack tunneling area with an aliginate to eliminate dead space and absorb drainage. Consider a composite to aid in slough removal. Consider a foam dressing to pad bony prominence. Ulcer to medial malleolus: Composite or foam as these can be used under compression and are comfortable. They are also absorbent. Fresh skin tear: Film *Note: There are many appropriate dressings to choose from 23

24 ANSWER TO CASE STUDY QUESTIONS (Continued) 4. Why would you suspect that the ulcer on Mr. Smith s medial malleolus would be a vascular ulcer? This ulcer fits the description of a venous ulcer. Location on the medial malleolus Wound margins are irregular Wound bed is dark red Painful Large amount of drainage Edema present on lower extremities Brawny discoloration Pedal pulses are present Pruritis 5. What types of nursing interventions would you recommend for Mr. Smith? Smoking cessation Dietary supplements Incontinence management Daily skin inspections and skin cleansing after soiling Barrier creams and emollient lotions to skin Reposition every two hours when in bed and encourage Mr. Smith to shift his weight in the wheelchair every 15 minutes Use position pillows, wedges and pressure reducing surfaces Heels elevated off the bed surface Keep elevation of his bed below a 45-degree angle Use lifting devices to raise Mr. Smith in bed (draw sheets) Compression stocking and elevation for lower extremities 24

25 RESOURCE ADVISORS Judith M. Saunders MSN, ARNP graduated from J. Sargent Reynolds Community College, Richmond, VA in 1977, with an Associate Degree as a registered nurse. She completed her undergraduate nursing degree at the University of South Florida in Tampa in 1987 and earned her MSN from USF in Ms Saunders has worked in psychiatry with emphasis on addiction, in home health, and for the past eight years in long term care in Naples Florida as a geriatric nurse practitioner specializing in wound care. NEVCO video educational programs are prepared using specific criteria designed by National Educational Video, Inc. TM All educational programs are coordinated and reviewed under the direction of the NEVCO Director of Education, who is a master s prepared nurse. 25

26 REFERENCES Baranoski, Sharon. MSN, RN, CETN, (January 1999) Wound dressing: challenging decisions, Home Healthcare Nurse 17(1): Choucair, Michelle, MD & Phillips, Tanin, MD, FRCPC, (June 1998) A review of wound healing and dressing materials Skin & Aging Clinical Practice Guidelines Number 3 Pressure Ulcers in Adults: Prediction and Prevention US Department of Health and Human Services AHCPR (Agency for Health Care Policy and Research) No : May Hess, Cathy T. RN, BSN, CWOCN (2000), Clinical Guide to Wound Care 3 rd ed. Springhouse Corp: Harrisburg PA. Scanlon, Valerie C. PhD & Sanders, T. (1999) Essentials of Anatomy and Physiology 3 rd ed. F.A. Davis Company: Philadelphia. Wipke-Tevis, Deidre D. PhD, RNC, CVN, (January 1999) Caring for vascular leg ulcers: essential knowledge for the home health nurse Home Healthcare Nurse 17(1):

27 Participant Evaluation of Objectives Please evaluate this program by circling the number that best represents how well this program met the following objectives: 4=Excellent 3=Good 2=Average 1=Poor 1. Define a pressure area List the most common sites for pressure area development. 3. Identify the causes and risks of pressure area development Describe the four stages of pressure areas Discuss the principles of wound care Identify the types of occlusive dressings and indications for each Perform a nursing assessment of a wound Recognize the differences between a venous ulcer and an arterial ulcer. 9. Describe the nursing interventions implemented when a patient is found to be at risk for pressure area development. 10. Developer of program met intended goal and objectives of this program. 11. All objectives of this program have met the appropriate learning strategies Do you feel you met your personal objectives? COMMENTS: Return this form to the facilitator who distributed the learning materials. Thank you! 27

28 NEVCO Account # REQUEST FOR CERTIFICATES FOR CONTACT HOURS TYPE the NAMES, LICENSE NUMBERS AND JOB TITLES (RN, LPN, MSW, CNA, PT, etc.) of the people who are to be issued a certificate for contact hours for attending the continuing education program: (Facility Name) (Title and Number of Video Program) This request must be submitted along with the completed roster and evaluation sheets for the above named program NAME LICENSE NO. JOB TITLE

29 Must be completed by the facilitator EVALUATION OBJECTIVES: TIB Bank Center th Street N., Suite 207 Naples, Florida (800) Fax (888) FACILITATOR S EVALUATION (NEVCO Video Education Program) (1) To assess extent to which the program was appropriate, adequate and effective. (2) To identify, continue to develop and evaluate effective quality assurance activities. Title of Program Date Place of Employment Job Title Please evaluate the presentation by circling the number that best describes your rating. 4 Excellent 3 Good 2 Average 1 Poor ORGANIZATION OF COURSE Material was organized to facilitate learning The amount of material covered was adequate and accurate There was effective use of time to cover the subject CONTENT OF THE FACILITATOR S GUIDE List total number of objectives in this facilitator s guide List by number the objectives that were met The test material reflected the objectives listed Content can be used to improve nursing practice Content reflected knowledge level and needs of learner The material was current Evaluate Test Questions Pre-Test Discussion Questions Post-Test FACULTY PRESENTING (Video) The presentation was The presenter explained the material The presenter demonstrated knowledge of material OVERALL RATING I felt this teaching method was COMMENTS (Please make suggestions for future topics and additional comments about the presentation or instructor) Thank you for your time in completing this evaluation! We appreciate your comments and suggestions. The NEVCO Educational Staff 1995 Revised 10/2004

30 EVALUATION (NEVCO Video Education Program) TIB Bank Center th Street N., Suite 207 Naples, FL (800) Fax (888) Must be completed by every participant EVALUATION OBJECTIVES: (1) To assess extent to which the program was appropriate, adequate and effective. (2) To identify, continue to develop and evaluate effective quality assurance activities. Title of Program Date Place of Employment Job Title OBJECTIVES Total number of objectives in program Circle the number of objectives that WERE met Circle the number of objectives that were NOT met Please evaluate the presentation by circling the number that best describes your rating. 4 Excellent 3 Good 2 Average 1 Poor ORGANIZATION OF COURSE Material was organized to facilitate learning The amount of material covered was adequate and accurate CONTENT OF THE PRESENTATION The test material reflected the objectives listed Content and/or skills demonstrated can improve my ability to perform my job Content reflected knowledge level and needs of learner The material was current Time for questions was Effective use of time to cover subject was Graphics were beneficial NEVCO FACULTY (who prepared the program and/or appeared in interviews) The presentation was well prepared The presentation explained the material well The presenter demonstrated knowledge of material OVERALL RATING I felt this teaching method was Facilities and classroom were adequate COMMENTS (Please make suggestions for future topics, content of program and instructors) Thank you for your time in completing this evaluation! We appreciate your comments and suggestions. The NEVCO Educational Staff 1995 Revised 10/2004

31 TIB Bank Center th. Street N., Suite 207 Naples, FL (800) Fax: (888) CONTINUING EDUCATION ROSTER This form must be completed and returned to NEVCO. Keep a copy for your facility, but return the original to NEVCO. PRINT OR TYPE Account # Number and title of Video Program Dates Given Contact Hours Name of Facility Address of Facility City/State/Zip RN Facilitator Signature ROSTER OF PARTICIPANTS Participant Name Participant Signature License # Soc. Sec. # National Educational Video, Inc. TM is an approved provider of continuing education. State Board provider numbers: Florida NCE2896, Alabama , California CEP8803 and Kentucky This activity provided by National Educational Video Inc. is approved as a provider of continuing education in nursing by Alabama State Nurses Association, which is accredited as an approver of continuing education in nursing by The American Nurses Credentialing Center's Commission on Accreditation.

32 Participant Name Participant Signature License # Soc. Sec. #

33 599 9 th Street N., Suite Naples, FL Fax: Certificate of Completion This is to certify that Attended and Completed National Educational Video, Inc. TM Program Number and Title For contact hours On Date Facility / Agency Name Facility / Agency Address RN / Facilitator CERTIFICATE FOR ASSISTANTS ONLY National Educational Video, Inc.TM is an approved provider of continuing education. State Board provider numbers: Florida NCE2896, Alabama , California CEP8803 and Kentucky This activity provided by National Educational Video Inc. is approved as a provider of continuing education in nursing by Alabama State Nurses Association, which is accredited as an approver of continuing education in nursing by The American Nurses Credentialing Center's Commission on Accreditation.

34 CERTIFICATE OF COMPLETION For each participant who has successfully completed a continuing education program, please make a copy of the blank NEVCO Certificate (on reverse side) and fill in the following information: 1. Name of the learner 2. Program title and number 3. Number of contact hours 4. Date the program was completed 5. Name and address of your Agency / Facility 6. Signature of the RN / Facilitator responsible for offering the program