Inaugural Palliative Care Nursing Awards - Physician and Nursing Awards

1/9 Nominator's Information

Please fill out this form as the nominator suggesting a nominee for the 2023 Nursing Awards.
Name*
First Last
Title
Organization
Address*
Street Address Address Line 2 City State ZIP Code
Phone Number*
Email Address*

2/9 Nominee's Information

Please fill out this form with your nominee's information.
Award Category
- Inpatient and/or Outpatient Nurse
- Hospice and/or Home Care Nurse
Name*
First Last
Title*
Organization
Address*
Street Address Address Line 2 City State ZIP Code
Phone Number*
Email Address*

3/9 Nominee's CV
Please provide a current CV for the nominee at the PDF, JPG, DOC or TXT format
Drop files here or

Accepted file types: pdf, jpg, doc, txt, Max. file size: 50 MB.

4/9 TECHNICAL COMPETENCE
Please provide a description of the nominee's excellence in evidence based practice of palliative nursing care*
The nurse integrates evidence of best practices in palliative care to insure the highest quality of care for patients and families. The nominee applies evidence based practice through their own care and also leads efforts within their organization or community to insure the highest quality of care. Evidence based practice includes all domains of palliative care as established by the NCP Clinical Practice Guidelines for Quality Palliative Care..
(500 words or less)

5/9 PERSONAL INTEGRITY
Please provide a description of the nominee's excellence in personal ethics and integrity*
The nominee exemplifies a model of clinical practice based on the nursing professional code of ethics and acts with integrity. The nurse provides leadership in the many ethical challenges in palliative nursing care including supporting patients and families in health care decisions, honoring values, and respecting diversity.
(500 words or less)

6/9 FAMILY AND FRIENDS
Please provide a description of the nominee's excellence in compassionate relationships with the family*
Recognizing that family, as defined by the patient, is central in the support of seriously ill patients and those facing the end of life, the nominee provides competent and compassionate support of the family. (500 words or less)

7/9 DOCTOR/PATIENT DIALOGUE
Please provide a description of the nominee's excellence in Empathic, human centered communication*
The nurse recognizes that communication is the foundation of nursing practice and relationships with patients, families and colleagues. The nominee exhibits communication that supports patients and families and communication with colleagues to foster cohesive, patient centered care.
(500 words or less)

8/9 TEAM WORK
Please provide a description of the nominee's excellence in Interprofessional team collaboration and leadership*
The nominee demonstrates excellence in interprofessional care and provides leadership to insure that care is coordinated and brings the strengths of all disciplines to support patient and family care. These efforts strengthen quality physical, psychosocial and spiritual care. The nominee also promotes self care for the team .
(500 words or less)

9/9 SUMMARY
Please provide a description of the nominee's excellence in the application of diversity, equity and inclusion*
The nurse demonstrates commitment to diversity, equity and inclusion. Examples may include the nurse’s own practice as well as efforts to insure that these critical elements are integrated in the organization and that care is responsive to the most vulnerable populations.