Synapse Workshop - Evaluation
Step 1 of 2
EVERY NICU IS A NEURO-NICU
Every NICU is a NeuroNICU Evaluation:
Thank you for your time. This survey will only take you a FEW minutes to complete. Please note, that each individual requesting a Continuing Education Certificate must complete a separate evaluation form.
Workshop Date & Location
Choose from the dropdown menu
Sept 19 - San Francisco, CA
Sept 23 - Anaheim, CA
Evaluate the Presentation Style and Content --
Every NICU is a NeuroNICU
Kathi Randall, RN, MSN, CNS, NNP-BC - The instructor’s ability to explain was
Shannon Tinkler, BSN, RNC-NIC - The instructor’s ability to explain was
The pace of the material presented was
The content was clear and easy to follow
The content was presented without commercial bias
Evaluation of Objectives -- Rate how well the presentation met the following learning objectives.
Outline the four pillars of NeuroNICU focused care.
List three bedside neuro-protective practices.
Discuss the options for neuro-monitoring at the bedside and two populations that could benefit.
Create an implementation plan for one care practice that can improve neuro-developmental outcomes for infants or emotional health for parents.
List one new thing you learned during this workshop:
Continuing Education & Certificate Information
Complete the information below to receive a certificate of Participation & Continuing Education. By entering your information below, you certify that you have personally attended the presentation and that you are submitting this form only for yourself.
Please provide your Nursing State License #
This will appear on the certificate
Any additional comments:
Course Code Prefix
These numbers will show BEFORE the course code on the template.
(Don't forget the #)
Number of Units Earned
(Example: 1 hour, 3 hours, 10 magic beans -- be sure to add the measurement)
Email for Questions – firstname.lastname@example.org