ACCREDITATION APPLICATION FOR CNSW CE ACTIVITIES The fllwing prvides a step-by-step verview f hw t submit yur Lcal Chapter's activity fr accreditatin thrugh the NKF Natinal Headquarters ffice fr Scial Wrker activities t be accredited thrugh ASWB, and the dcumentatin that will need t be prepared and submitted. Please fill ut all f the frms belw and submit them when they are cmpleted in their entirety. Submissins that are sent withut all required parts will nt be cnsidered fr accreditatin. Prcess verview: Prir t the activity, the Activity Planning Cmmittee: Creates sign-in sheet fr attendees (this will need t be scanned and submitted after the meeting) Sample is included. Print ut certificates t be distributed Print ut evaluatins t be distributed and cllected On the day f the activity, the Activity Planning Cmmittee: Makes sure sign-in sheet lists all attendees Distributes and cllects sessin evaluatins Distributes certificates t participants After the activity is cmplete, the Activity Planning Cmmittee: Cmpiles evaluatins int a summary and returns participant frms and summary t NKF Scans/returns electrnically the sign-in sheet(s) t NKF Are yu ready t submit yur activity fr Natinal Office apprval? Email this cmpleted packet t Anna.Okniewski@kidney.rg with all yur additinal materials (speakers CVs, marketing materials, etc).
Required dcuments: 1. Planning Frm, which includes: Activity title, frmat, date, lcatin, and amunt f credits yu are applying fr Listing f Activity Planning Cmmittee members 2. Educatinal Activity Overview This frm will include yur bjectives, cntent utline, faculty, time-frame, teaching methds, curse level, and cntent areas. 3. Evaluatin Frm see NKF sample/template attached The certificates fr attendees based n NKF template 4. Sample Certificate see attached template 5. All Speaker CVs/Resumes applicatins will nt be accepted withut inclusin f all CV s. 6. Sample Marketing Brchure/Flyer can be a draft, but must indicate that credits are pending apprval, and include the ASWB accreditatin statement and activity level. Nte: The NKF will nly facilitate the review and apprval f activity and then ntify activity planner nce all dcuments are received. All activities must be submitted 60 days prir t the event.
CNSW CONTINUING EDUCATION ACTIVITY PLANNING FORM* ACTIVITY INFORMATION Title f Activity: CNSW f Anywhere Winter Meeting Prpsed Date(s) f Activity: January 16, 2016 Activity Frmat: Live Webinar Amunt f Credits: 2.0 Lcatin: Venue Name / City, State ACTIVITY CONTACT PERSON Cntact Name: Jane Smith, LMSW Phne: 555-555-5555 E-mail: Jane.smith@email.cm PLANNING COMMITTEE Please list the individuals invlved in the planning f this activity (Please nte fr SW activities: at least ne member shuld be a licensed scial wrker as defined by ASWB) Jane Smith, LMSW Jhn Rberts, MD Jacksn Brwn, LMSW Wuld yu like yur meeting t be advertised n kidney.rg's meeting page? Yes N *Please nte that the Natinal Kidney Fundatin is apprved as a prvider fr scial wrk cntinuing educatin by the Assciatin f Scial Wrk Bards (ASWB) www.aswb.rg, thrugh the Apprved Cntinuing Educatin (ACE) prgram. All activities that are apprved thrugh the NKF fr ASWB accreditatin MUST be affiliated with a NKF affiliate, lcal chapter r divisin.
EDUCATIONAL PLANNING TABLE Activity Title: CNSW f Anywhere Winter Meeting Activity Date: January 16, 2016 I. Educatinal Planning Table Objectives Cntent (Outline f Tpics) Timeframe Faculty Teaching Methds Identify what the learner will knw r be able t d fllwing participatin in the CE activity Prvide an utline f the tpics that will be cvered that crrespnd with each learning bjective. State the timeframe fr each learning bjective List the Faculty fr each learning bjective Describe the teaching methds, strategies, materials & resurces used fr each learning bjective Spirituality and Yu: Addressing the Spiritual and Emtinal Needs f Patients, Families, and Staff Identify three surces f ptential spiritual distress with chrnically ill patients Spiritual distress Define Causes f spiritual Distress Interruptin f religius practices 20 minutes Jhn Rberts, LMSW Lecture Case Studies Discussin Q&A Inner cnflict and guilt Expresses feelings f abandnment by their wn religius grup r Gd Questins mral r ethical implicatins f therapies, especially thse invlving: reprductin, bld transfusin, amputatin r remval f rgans and/r dietary restrictins
List tw surces f spiritual strength that prmte the patient s well-being Spiritual Strengths - what are they? Hpe Meaning Cmfrt 20 minutes Jhn Rberts, LMSW Lecture Case Studies Discussin Q&A Peace Lve and cnsideratin What is the imprtance f rganized religin? Persnal Spirituality and Practices Hw this effects n medical care and end-f-life issues Identify methds f meeting the spiritual and emtinal needs f a patient Interventin Hw can pastral care help? Hw can prayer help? Hw can clinical staff help? 20 minutes Jhn Rberts, LMSW Lecture Case Studies Discussin Q&A Discuss case study Dialysis patient Struggling with end f life/death Anger at Gd/faith fr health status Hw t cpe, what scial wrkers can d t help
Cultural Cnsideratins in Hispanic/Latin Health Cmpare the imprtance f culture and its relatin t health care Definitins What is culture? What is cultural awareness? 30 minutes Jacksn Brwn, LMSW Lecture Case Study Discussin What is cultural sensitivity? Cncepts related t culture in a health care setting Hw des culture affect health care, treatment ptins & medical care? Describe strategies t imprve crss-cultural cmmunicatin, patient engagement, and patient satisfactin Case studies discussins Hispanics and health care situatins and pprtunities Hispanics and health care lack f care 30 minutes Jacksn Brwn, LMSW Lecture Case Study Q&A and missed pprtunities Strategies fr effective interventins with the Hispanic ppulatin Hw can health care prfessinals treat members f the Hispanic ppulatin in a culturally sensitive way? What practices are best accepted by the Hispanic ppulatin in rder t prvide quality medical care? Interventins and care utcmes Evaluate current statistics n the Hispanic ppulatin and healthcare
II. Curse Level Beginner Level: Designed t intrduce the cntent area; utcmes fcus n learning and cmprehensin. Intermediate Level: Designed t present infrmatin that builds n knwledge f practitiners with sme experience; utcmes fcus n using infrmatin in cncrete situatins and understanding the underlying structure f the material. Advanced Level: Designed fr peple wh have been wrking in this area and have a clear understanding f the issues; utcme fcus n synthesizing material t create new patters r structures r evaluating material fr a specific purpse. III. Which f the fllwing scial wrk educatinal areas des this activity fcus n? Scial wrk research, prgrams r practice evaluatins Scial wrk agency management r administratin Develpment, evaluatin and/r implementatin f scial plicy Scial wrk generalist practice Scial wrk clinical practice Diversity and scial justice Scial wrk ethics Other: Click here t enter text.
PARTICIPANT EVALUATION Activity Title: CNSW f Anywhere Winter Meeting Type f Accreditatin: ASWB Date: January 16, 2016 Lcatin: Venue Name / City, State Specialty: Nephrlgy(CKD Stages 3-4) Nephrlgy (HD/PD) Transplantatin Primary Care Internal Medicine Family Medicine Endcrinlgy Cardilgy Infectius Disease Radilgy Diabetlgist Diabetes Educatr Obstetrics/Gyneclgy Other (specify): Number f patients seen per week: 0-50 51-100 101-150 151-200 Mre than 200 Please cmplete upn cnclusin f the activity. Yur respnses help us imprve future activities. Please answer by checking the apprpriate rating: Please cmplete upn cnclusin f the activity. Yur respnses help us imprve future activities. Please answer by checking the apprpriate rating: 5 = Strngly Agree 4 = Agree 3 = Neutral 2 = Disagree 1 = Strngly Disagree I. Extent t which the activity met the stated bjectives Identify three surces f ptential spiritual distress with chrnically ill patients 5 List tw surces f spiritual strength that prmte the patient s well-being 5 Identify methds f meeting the spiritual and emtinal needs f a patient 5 Cmpare the imprtance f culture and its relatin t health care 5 Describe strategies t imprve crss-cultural cmmunicatin, patient engagement, and patient satisfactin 5
II. Effectiveness f the Faculty Name Jhn Rberts, LMSW 5 Jacksn Brwn, LMSW 5 Knwledge f the Subject Matter Presented the Subject Matter Clearly 5 5 Was Respnsive t Participants 5 5 Used Technlgy Effectively 5 5 III. Overall Activity Evaluatin: Curse material was apprpriate t my educatin, experience and/r 5 licensure level Curse material was relevant t my prfessinal needs/scpe f practice 5 Curse material was current 5 The curse materials presented the curse cntent effectively 5 Handuts and teaching aids enhanced the cntent f the curse 5 The lcatin f this activity was suitable 5 The facilities were cnducive t learning 5 The instructins fr requesting accmmdatins fr a disability were 5 clear Prgram administratin questins r cncerns were addressed effectively 5 and in a timely manner I plan t make changes in my practice based n the infrmatin in this activity Yes, planned changes include: (Check all that apply): Mdify my apprach t referral r c-management Mdify my patient educatin infrmatin/materials Mdify elements f staff training r treatment prtcls in my practice Other: N. Please explain What is yur level f cmmitment t making the changes stated abve? Very cmmitted Smewhat cmmittee Nt very cmmitted D nt expect t change I wuld recmmend this activity t my peers 5 Hw did yu learn abut this activity? Brchure E-mail Prfessinal Jurnal NKF Web site
C-Wrker Direct Mail Dn t Recall Other IV. I wuld like the fllwing tpics/issues t be addressed in future activities (select all that apply): CKD Risk Awareness/Risk Reductin Symptm Targeted Interventin (STI) Depressin Patient Educatin Patient Adherence Ethics Living Dnrs Persnality Disrders Pediatrics Sexual Dysfunctin Mtivatinal Interviewing Interdisciplinary Appraches KDQOL scres/utcmes End f Life Transplant Other:
Certificate f Cmpletin This is t certify that: has satisfactrily cmpleted CEUs fr the live curse CNSW f Anywhere Winter Meeting In [city], [state] n January 16, 2016 Scial wrkers participating in this curse will receive 2.0 clinical cntinuing educatin clck hurs. The Natinal Kidney Fundatin Cuncil f Nephrlgy Scial Wrkers, Prvider #1014, is apprved as a prvider fr scial wrk cntinuing educatin by the Assciatin f Scial Wrk Bards (ASWB) www.aswb.rg, thrugh the Apprved Cntinuing Educatin (ACE) prgram. The Natinal Kidney Fundatin Cuncil f Nephrlgy Scial Wrkers maintains respnsibility fr the prgram. Licensed scial wrkers shuld cntact their individual jurisdictin t review current cntinuing educatin requirements fr licensure renewal. Drthy Muench, MSW, LCSW, NSW-C CNSW Prfessinal Educatin Chairpersn
SIGN-IN SHEET Activity: CNSW f Anywhere Winter Meeting NKF Cuncil: CNSW f Anywhere Date: January 16, 2016 Last Name First Name License # Discipline (circle ne) Signature