SELF EVALUATION TEMPLATE
RESPIRATORY THERAPY LEARNING OBJECTIVES FOR
STROKE CARE
NAME: ___________________________
*Opportunities for baseline, mid, and final assessments are provided in the self-rating column as recommendation only.
Users are encouraged to modify the form and its use to serve their purposes.
Self Rating: Using the rating scale provided below, enter a number that most closely reflects your knowledge/skill/
experience with respect to the learning objectives listed for this Learning Area.
NONE or MINIMAL
Knowledge/Skill/Experience
1
2
3
LEARNING AREA
Principles of Stroke Care
There are no respiratory therapy learning objectives
for Principles of Stroke Care.
4
SOME
Knowledge/Skill/Experience
5
Date
6
*SELF-RATING
Base Mid Final
EXTENSIVE
Knowledge/Skill/Experience
7
8
9
Comments
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Anatomy and Physiology
of Stroke
1.
Demonstrates knowledge of the penumbra and
its significance to functional recovery.
2.
Demonstrates knowledge of the rationale for the
diagnostic tests used in the assessment and
management of stroke and incorporates results
as appropriate into the plan of care.
3.
Demonstrates an awareness of:
Acute Medical Management

Thrombolytics

Hypertension (e.g., angiotensin-converting
enzyme inhibitors)

Lipid therapy (e.g., Statins)

Antiplatelet and/or anticoagulants (e.g.,
ASA, Aggrenox, Clopidogrel)
Surgical-interventional Treatment

Carotid endartectomy

Carotid stenting and/or thrombolysis

Carotid angioplasty.
Interprofessional Learning Objectives for Stroke, RT Template
2
LEARNING AREA
4.
Date
*SELF-RATING
Base Mid Final
Comments
Integrates knowledge of the stroke sequelae and
potential stroke complications into the plan of
care to prevent and/or treat complications
including:

Dysphagia and aspiration pneumonia

Respiratory status such as bronchial
hygiene, sleep apnea/disorders, airway
management/ventilation

Tracheostomy

Deep vein thrombosis and pulmonary
embolism.
Interprofessional Learning Objectives for Stroke, RT Template
3
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Cardiovascular and Respiratory Effects
1.
Demonstrates knowledge of the anatomy and
physiology of normal and abnormal
cardiovascular and respiratory systems.
2.
Demonstrates the ability to identify the signs and
symptoms of cardiovascular and respiratory
systems complications and an understanding of
the management of:
3.

Deep vein thrombosis

Pulmonary embolism

Myocardial infarctions
Demonstrates the ability to perform a complete
cardiovascular and respiratory assessment
including:

Inspection

Palpation

Auscultation

Vital signs

Pulse oximetry

Accessory muscle use

Breathing patterns

Peripheral edema

Ability to protect airway

Cough effectiveness

Secretion clearance
Interprofessional Learning Objectives for Stroke, RT Template
4
LEARNING AREA
4.
Date
*SELF-RATING
Base Mid Final
Comments
Demonstrates the ability to recommend, select
and perform different treatments to manage
abnormal breathing mechanisms and patterns
including:

Inhaled respiratory therapies

Oral, nasopharyngeal airways,
tracheostomies

Secretion clearance

Bronchial hygiene.
5.
Demonstrates the ability to assess for the
presence of a gag/cough reflex.
6.
Demonstrates the ability to perform a variety of
respiratory diagnostic procedures including
spirometry, peak cough flow, and maximal
inspiratory/ expiratory pressure maneuvers.
7.
Demonstrates knowledge of and ability to
perform airway management and cardiac support
according to Basic Cardiac Life Support
guidelines.
8.
Demonstrates the ability to assess patterns of
breathing during sleep (e.g., sleep apnea, other
abnormal patterns of breathing), and
communicate for appropriate referral.
9.
Demonstrates the ability to perform methods of
monitoring continuous trending of Sp02/CO2,
pulse (sleep, activity, exercise), and report
findings to a physician for appropriate
intervention.
Interprofessional Learning Objectives for Stroke, RT Template
5
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
10. Demonstrates knowledge of the effect of
medication on the respiratory system, and
performs assessments to determine the impact
of the medication (e.g., pulmonary function tests,
peak flows, etc.).
11. Demonstrates the ability to educate the stroke
survivor and caregivers about cardiovascular
and respiratory status and management.
12. Demonstrates the ability to act as a resource to
the team regarding respiratory status and
respiratory management.
13. Demonstrates the ability to select and maintain
oxygenation status and provide oxygen therapy
to support hypoxemia. For example:

Nasal prongs

Venturi masks

Rebreathing masks

High humidity systems.
14. Demonstrates the ability to assess the need for
manual resuscitation.
15. Demonstrates the ability to ventilate and
oxygenate the stroke survivor using bag-mask
technique.
16. Demonstrates the ability to support mechanical
ventilation therapy and appropriate weaning
from therapy, and to transition the stroke
survivor to spontaneous ventilation.
Interprofessional Learning Objectives for Stroke, RT Template
6
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
17. Demonstrates the ability to obtain and interpret
arterial blood gas.
18. Demonstrates knowledge of the indications for
intubation and the ability to perform
endotracheal intubation including:

Preparation of required equipment

Ability to secure and verify correct
placement using auscultation, capnometry
and chest x-ray
19. Demonstrates knowledge of accessory
equipment available in the event of a difficult
airway (e.g., bronchoscope, cricothyrotomy kit).
Interprofessional Learning Objectives for Stroke, RT Template
7
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Psychosocial Effects
1.
Demonstrates the ability to assess the stroke
survivor’s reaction to the stroke that may affect
coping including:

Level of participation and engagement in
activities

Self destructive behaviours

Quality of stroke survivor and caregiver
support systems

Stability of the stroke survivor’s physical
condition and presence of pain.
2.
Demonstrates awareness of the side effects of
medications that can affect mood and behaviour
and may impair functioning.
3.
Demonstrates knowledge of the treatment
modalities related to altered psychosocial status:

Pharmacological agents (e.g.,
psychotropic medications, and the
potential side effects).

Non-pharmacological treatments.
4.
Demonstrates the ability to assess stroke
survivor’s perception of and need for control and
incorporate this into the plan of care.
5.
Demonstrates knowledge of issues related to
adjusting to illness, grieving and the
psychosocial effects of stroke, and
demonstrates an ability to provide support to
stroke survivors and caregivers related to
communication and dysphagia issues.
Interprofessional Learning Objectives for Stroke, RT Template
8
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Communication
1.
Collaborates with speech-language pathology
and/or designated team members to implement
and provide feedback regarding communication
strategies and/or devices.
2.
In collaboration with other team members,
demonstrates the ability to develop and provide
alternative communication devices such as
speaking valves.
3.
Demonstrates the ability to use alternative
communication strategies and/or devices as
recommended by speech-language pathology.
4.
Demonstrates the ability to refer to Assistive
Devices Program services, and to educate the
stroke survivor and caregiver about the Assistive
Devices Program related to respiratory devices.
Interprofessional Learning Objectives for Stroke, RT Template
9
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Independence in Mobility and Prevention of
Complications of Immobility
There are no respiratory therapy learning objectives
for Independence in Mobility and Prevention of
Complications of Immobility.
Interprofessional Learning Objectives for Stroke, RT Template
10
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Routine Activities of
Daily Living (ADL)
There are no respiratory therapy learning objectives
for Routine Activities of Daily Living.
Interprofessional Learning Objectives for Stroke, RT Template
11
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Instrumental Activities of Daily Living (IADL)
There are no respiratory learning objectives for
Instrumental Activities of Daily Living.
Interprofessional Learning Objectives for Stroke, RT Template
12
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Cognitive, Perceptual and Behavioural
Changes Following Stroke
1.
Demonstrates knowledge of the effect that sleep
disorders may have on cognition, perception and
behaviour.
2.
Demonstrates the ability to assess the effect of
medication on the respiratory system, and
performs assessments to determine the impact
of medication (e.g., nocturnal SpO2 /CO2, pulse,
spirometry).
Interprofessional Learning Objectives for Stroke, RT Template
13
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Sexuality
1.
Demonstrates the ability to assist the stroke
survivor/partner in developing strategies that
address the respiratory impairments that affect
sexual function.
Interprofessional Learning Objectives for Stroke, RT Template
14
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Nutrition
There are no respiratory therapy learning objectives
for Nutrition.
Interprofessional Learning Objectives for Stroke, RT Template
15
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Dysphagia
There are no respiratory therapy learning objectives
for Dysphagia.
Interprofessional Learning Objectives for Stroke, RT Template
16
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Skin Care
There are no respiratory therapy learning objectives
for Skin Care.
Interprofessional Learning Objectives for Stroke, RT Template
17
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Continence Management
There are no respiratory therapy learning objectives
for Continence Management.
Interprofessional Learning Objectives for Stroke, RT Template
18
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Primary and Secondary Stroke Prevention
1.
Demonstrates the ability to assess the risk
factors of sleep apnea/disorders, and implement
the appropriate treatment and education.
2.
Demonstrates the ability to educate the stroke
survivor and caregiver about the rationale
supporting secondary prevention management
related to sleep apnea/disorders.
Interprofessional Learning Objectives for Stroke, RT Template
19
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Transition Management
1.
Demonstrates the ability to use standardized
measures to determine the most appropriate
discharge destination to meet the respiratory
care needs of the stroke survivor.
Interprofessional Learning Objectives for Stroke, RT Template
20