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ESRD NETWORK 18 WebEx Teleconference Participant Evaluation Form Topic End of Life Date of Event December 19 2012 Please complete to receive your 1 hour CEU credit First Name Last Name Professional License State Home Address City Zip Code Please rate the following questions from 1-5 using the scale below that bests reflects your assessment of the conference. Poor Fair Satisfactory Good Outstanding The presentation met the objectives A. Explain how a palliative care approach can improve quality of life for dialysis patients. B. Identify best practices for increasing Advance Care Planning with patients. C. Highlight key resources for dialysis units in the management of dialysis end-oflife care. No Yes I will use the information presented in my practice and make improvements at my facility. Did you learn a specific change idea or tool that you can use to implement change at your facility Please describe below Do you have any questions about the topic featured that were not answered during The speaker presented the information clearly and effectively. Would you recommend this WebEx/Teleconference to your peers The WebEx conference was well organized* This course has been approved by the California Board of Registered Nursing BRN Provider 08511 for one 1 contact hour. Poor Fair Satisfactory Good Outstanding The presentation met the objectives A. Explain how a palliative care approach can improve quality of life for dialysis patients. B. Identify best practices for increasing Advance Care Planning with patients. C. Highlight key resources for dialysis units in the management of dialysis end-oflife care. B. Identify best practices for increasing Advance Care Planning with patients. C. Highlight key resources for dialysis units in the management of dialysis end-oflife care. No Yes I will use the information presented in my practice and make improvements at my facility. Did you learn a specific change idea or tool that you can use to implement change at your facility Please describe below Do you have any questions about the topic featured that were not answered during The speaker presented the information clearly and effectively. No Yes I will use the information presented in my practice and make improvements at my facility. Did you learn a specific change idea or tool that you can use to implement change at your facility Please describe below Do you have any questions about the topic featured that were not answered during The speaker presented the information clearly and effectively. Would you recommend this WebEx/Teleconference to your peers The WebEx conference was well organized* This course has been approved by the California Board of Registered Nursing BRN Provider 08511 for one 1 contact hour. Poor Fair Satisfactory Good Outstanding The presentation met the objectives A. Explain how a palliative care approach can improve quality of life for dialysis patients. B. Identify best practices for increasing Advance Care Planning with patients. C. Highlight key resources for dialysis units in the management of dialysis end-oflife care. No Yes I will use the information presented in my practice and make improvements at my facility. Did you learn a specific change idea or tool that you can use to implement change at your facility Please describe below Do you have any questions about the topic featured that were not answered during The speaker presented the information clearly and effectively.