CAIIN Workshop - Feedback Summary Form.pdf
CAIIN Workshop - Feedback Summary Form.pdf
CAIIN Workshop - Feedback Summary Form.pdf
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CONSULTATION ASSESSMENT AND IMPROVEMENT<br />
INSTRUMENT FOR NURSES - <strong>CAIIN</strong><br />
FEEDBACK SUMMARY FORM<br />
Name of Nurse<br />
Date<br />
Observer<br />
Number of consultations<br />
Signature<br />
PRINCIPAL STRENGTHS<br />
PRIORITY STRATEGIES FOR IMPROVEMENT<br />
ANY OTHER COMMENTS<br />
OVERALL COMPETENCE<br />
1
INTERVIEWING (20%)<br />
Strengths<br />
Mark/<br />
Grade<br />
Suggestions for improvement<br />
EXAMINATION, DIAGNOSTIC TESTING AND PRACTICAL PROCEDURES<br />
(10%)<br />
Strengths<br />
Mark/<br />
Grade<br />
Suggestions for improvement<br />
2
CARE PLANNING/PATIENT MANAGEMENT (20%)<br />
Strengths<br />
Mark/<br />
Grade<br />
Suggestions for improvement<br />
PROBLEM SOLVING (15%)<br />
Strengths<br />
Mark/<br />
Grade<br />
Suggestions for improvement<br />
3
BEHAVIOUR/RELATIONSHIP WITH PATIENT/CLIENT (15%)<br />
Strengths<br />
Mark/<br />
Grade<br />
Suggestions for improvement<br />
HEALTH PROMOTION/DISEASE PREVENTION (10%)<br />
Strengths<br />
Mark/<br />
Grade<br />
Suggestions for improvement<br />
RECORD KEEPING (10%)<br />
Strengths<br />
Mark/<br />
Grade<br />
Suggestions for improvement<br />
h:\projects\caiin\master documents\how to use pack\feedback summary form hand written.doc<br />
4
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