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APPLICANT NAME: ______

CONTACT NUMBER: ______

CHECKLIST FOR EFFECTIVE PFCC PROGRAM VOLUNTEERS

Ability to see strengths in self and others Does candidate bring a unique perspective to the Council? ___ yes ___ no Is candidate positive and supportive of the hospital mission? ___ yes ___ no Is candidate comfortable in speaking in a group with candor? ___ yes ___ no

Comments:

Ability to provide support to others Is candidate willing to share own experiences constructively? ___ yes ___ no Is candidate nonjudgmental? ___ yes __ no Is candidate coping well with personal emotional issues? ___ yes ___ no Is candidate capable of identifying the needs and feelings of others? ___ yes ___ no

Comments:

Ability to work with other families Is candidate willing to become involved with other families? ___ yes __ no Is candidate able to handle confidential information without discussing it with others? ___ yes ___ no Is candidate a good listener? ____ yes ___ no Is candidate able to work with little praise and recognition? ___ yes ___ no Is candidate able to give to others without expecting something in return? ___ yes ___ no

Comments: Ability to work collaboratively Is candidate able to avoid letting past negative experiences/attitudes get in the way of establishing good working relationships? ___ yes __ no Is candidate able to listen to and reflect upon differing opinions points of view? ___ yes ___ no Is candidate able to work productively and collaboratively with families whose background, experience and style may be different that their own? ___ yes ___ no Is candidate able to work in partnership, even when in disagreement? ___ yes ___ no Is candidate able to maintain realistic expectations for self and the council? ___ yes ___ no Is candidate able to wear two hats, that of consumer and council member? ___ yes ___ no

Comments:

QUESTIONS THAT MAY BE USED TO HELP EXPLORE THESE ISSUES  How did you learn about the PFAC?  What kinds of health care experiences have you and your family had? o Describe some of them.  How have healthcare professionals been most helpful to you and your family? o Describe a situation where they have not been so helpful.  Have you been satisfied with the way in which your health care providers have communicated with you? o Why/why not?  Have you ever been in the position of wanting more information about a health- related situation? o What did you do? o Who helped? o Who should have but did not?  Have you had experience with patient or family support groups? o Describe your experience.  What changes do you think would make health care experiences work better for you and your family?  What skills and qualities do you think are most important for health care professionals and other staff in hospitals and clinics?  How do you think you could help students and trainees to be better doctors, nurses, social workers etc?

** You may need to help guide candidate to traumatic experiences such as moment of diagnosis, return home after extended stay, long wait in the ED, prep for a painful procedure etc.