Hospice – unizon

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Recruiter Email ID *

First Name *

Last Name *

Phone Number *

Today's Date *

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HOSPICE CARE SETTINGS EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Home care *

Inpatient hospital care *

Extended care facility *

HOSPICE CARE:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Advanced directives *

Restrictive devices / restraints *

Lift / transfer devices *

Specialty beds *

Diabetes mellitus *

Blood Glucose Monitoring (BGM) *

Insulin administration *

Pain assessment & management *

Administration of narcotics / sedatives (fentanyl, Valium, Ativan, roxinal, morphine) *

Use of PCA (IV, intrathecal, epidural) *

Handling of narcotics in the home environment *

Non-pharmacologic strategies *

TENS unit *

Stages of grieving *

Spiritual care *

Death & dying counseling *

Patient & family coping skills *

Patient / family teaching & resources *

Quality of life & ethical decision making *

Death pronouncement *

After treatment (survivorship) *

National Patient Safety Goals *

Awareness of HCAHPS *

Accurate patient identification *

Effective communication *

Interpretation & communication of lab values *

Medication administration *

Medication reconciliation *

Automated Medication Dispensing System, Pyxis, Omnicell, or other *

Bar coding for medications *

Anticoagulation therapy *

Infection control *

Universal precaution *

Isolation *

Minimize risk for falls *

Prevention of pressure ulcers *

Pressure ulcer staging & care *

Wound care *

IV SKILLS:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Venipuncture for blood draw *

Peripheral IV catheter access, maintain & discontinue *

Central Venous Catheter (CVC) maintain & discontinue *

Peripherally Inserted Central Catheters (PICC) *

Groshong / Broviac / Hickman *

Ports *

Epidural catheter maintenance *

Intrathecal catheter maintenance *

Repair of torn / punctured catheters *

Declotting occluded ports or catheters *

IV THERAPY EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Needleless systems *

Administration of blood & blood products *

Administration of chemotherapy *

Monitoring chemotherapy *

Administration of TPN / lipids *

ASSESSMENT EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Cardiovascular assessment *

Respiratory assessment *

Use of Incentive Spirometry (IS) *

Use of oxygen *

Application of nasal cannula *

Application of face mask *

Use of nebulizer *

Placement of oral / NT airway *

Use of ambu bag *

Pulse oximetry *

Oral and nasotracheal suctioning *

Seizure precautions *

Tracheostomy *

Neuro assessment *

Sleep assessment *

CARE OF PATIENT WITH:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Depression *

Anxiety *

Delirium *

Fatigue *

GASTROINTESTINAL:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Gastrointestinal assessment (GI) *

Nutritional assessment *

NG tube insertion, management and discontinue *

Small bore feeding tube insertion, management and discontinue *

Gastrostomy / PEG tube management *

Jejunostomy management *

Ostomy care *

CARE OF THE PATIENT WITH:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Constipation *

Nausea & vomiting *

GENITOURINARY:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Genitourinary Assessment (GU) *

Foley catheter: insert, manage & discontinue *

Nephrostomy tube *

Suprapubic tube *

Shunts & fistulas *

CARE OF PATIENT WITH:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Peritoneal dialysis *

AGE-SPECIFIC COMPETENCIES EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Newborn / neonate (birth-30 days) *

Infant (31 days-1 year) *

Toddler (ages 2-3 years) *

Preschool (ages 4-5 years) *

School age (ages 6-12 years) *

Adolescent (ages 13-21 years) *

Young adult (ages 22-39 years) *

Adult (ages 40-64 years) *

Older adult (ages 65-79 years) *

Elderly (ages 80+ years) *