ccp self assess tool misty

8/17/2019 CCP Self Assess Tool Misty

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SELF-ASSESSMETOOL Continuing CompetenPr ogram


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Self-Assessment Tool – CCPCollege of LPNs of Alberta 2nd Edition - Revised October 2008

TABLE OF CONTENTS

SELF-ASSESSMENT TOOL - RATING SCALE ........................................................................ 1

STEP 1: SELF-ASSESSMENT WITHIN STANDARDS OF PRACTICE .................................... 1

A: Nursing Knowledge .............................................................................................................. 1

B: Nursing Process .................................................................................................................... 2

C: Safety.................................................................................................................................... 2

D: Communication and Interpersonal Skills ............................................................................... 2

W: Professionalism .................................................................................................................... 3

X: Nursing Practice and Leadership........................................................................................... 3

Self-Assessment Summary......................................................................................................... 4

STEP 2: SELF-ASSESSMENT OF SPECIFIC COMPETENCIES ............................................. 5

STEP 3: LEARNING PLAN ....................................................................................................... 6

RECORD OF PROFESSIONAL ACTIVITIES ............................................................................. 7


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Self-Assessment Tool – CCPCollege of LPNs of Alberta

Page 12nd Edition - Revised October 2008

SELF-ASSESSMENT TOOL

The Self-Assessment Tool is used to assess your professional practice using the LPN Standards ofPractice and Competency Profile as a guide. Focus your assessment on your practice as a whole andthen those Specific Competencies which are directly related to your role and responsibilities.

RATING SCALE Use the following rating scale to complete your Self-Assessment. 1 2 3 4 5

Excellent Competent Requires Improvement

Developmental Not Applicable

Demonstratesexcellence in theexpectations and /or requirements ofthe competency.

Meets theexpectations and /or requirements ofthe competency.

Has identifiedweakness inareas ofknowledge, skills,attitudes, orclinical judgment.

Requireseducation and/ororientation tomeet theexpectations and /or requirements of

the competency.

Not applicable tocurrent role andresponsibility.

STEP 1: SELF-ASSESSMENT WITHIN STANDARDS OF PRACTICE

Competency Number

Year 2016

Year 20

Year 20

Year 20

Year 20

A: Nursing Knowledge Rating (1-5) Rating

(1-5) Rating

(1-5) Rating

(1-5) Rating

(1-5)

A-1 Applies knowledge of anatomy and physiologyof the human body to the assessment of clientand delivery of nursing care.

2

A-2 Applies knowledge of microbiology throughoutcare, disease prevention, and health promotion.

2

A-3 Applies knowledge of pathophysiology to thenursing care of the client.

3

A-4-4 Uses appropriate medical terminology to reportand document client care.

2

A-5-9 Adjusts nursing practice to the specific growth

and development of the client.

2

A-6 Applies principles of nutrition to the assessmentand care of the client.

2

A-7 Applies knowledge of pharmacology throughoutclient care and teaching.

2


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Competency Number

Year 2016

Year 20

Year 20

Year 20

Year 20

A-8-2 Integrates knowledge and skills from thesciences and humanities into the application ofthe nursing process.

2

B: Nursing Process Rating

(1-5) Rating

(1-5) Rating

(1-5) Rating

(1-5) Rating

(1-5)

B-1 Performs health assessment of client usingassessment techniques and a systematicprocess.

2

B-2-2 Implements the planning process andestablishes client priorities involving client inplanning.

2

B-2-3 Identify and analyze nursing diagnosis. 2

B-3 Implements nursing interventions to carry outnursing care plan.

2

B-3-2 Reassess, review, and modify plan of care tomeet the needs of the client.

2

B-4 Evaluates the clients ’ response to care andtreatment.

2

C: Safety Rating

(1-5) Rating

(1-5) Rating

(1-5) Rating

(1-5) Rating

(1-5)

C-1 to C-4

Applies critical thinking and clinical judgmentwhen responding to emergency situations.

2

C-5-1 Effectively uses protective devices to protectclient, self, and others.

2

C-6-1 Demonstrates the consistent application ofstandard precautions.

1

C-7-1 Applies principles of medical and surgicalasepsis in the delivery of care.

2

C-12 Applies nursing knowledge and clinical judgment to maintain physical safety of client.

2

D: Communication and Interpersonal Skills Rating

(1-5) Rating

(1-5) Rating

(1-5) Rating

(1-5) Rating

(1-5)

D-1 Uses effective verbal and writtencommunication in the practice setting.

2

D-2 Appropriately establishes, maintains, andcloses the nurse-client relationship.

2

D-3 Collaborates with health care team to functionas an effective team member.

4

D-3-7 Adheres to the channels of communicationwithin the employing agency.

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Competency Number

Year 2016

Year 20

Year 20

Year 20

Year 20

D-4 Provides client and family teaching. 2

D-5 Reports and documents following legalprotocols, agency policy and procedure.

4

D-7 Applies clinical judgment in identifying problemsand resolving issues in client care.

2

D-8-1 Effectively manages time and organizes clientcare to meet priority needs.

2

D-8-2 Demonstrates ability to rank the priority of clientneeds.

2

W: Professionalism Rating

(1-5) Rating

(1-5) Rating

(1-5) Rating

(1-5) Rating

(1-5)

W-1-3 Understands the key components of the HealthProfessions Act-LPN Regulation.

2

W-2-3 Understands the Restricted Activityauthorizations in the LPN Regulation .

2

W-3 Understands the CLPNA Standards of Practice. 2

W-4 Adheres to the CLPNA Code of Ethics andStandards of Practice.

2

W-4-5 Acts as an advocate for client and empowersclients and families.

2

W-5-1 Demonstrates accountability for own nursingpractice.

2

W-6 Maintains the confidentiality of clientinformation.

2

W-7 Recognizes professional boundaries within thenurse-client therapeutic relationship.

2

W-9 Accepts responsibility for continuingcompetence and professional development.

2

W-9-4 Participates in continuous quality improvementand evidence based changes to nursingpractice.

2

W-11 Keeps informed of current research affectinghealth care delivery.

2

X: Nursing Practice and Leadership Rating

(1-5) Rating

(1-5) Rating

(1-5) Rating

(1-5) Rating

(1-5)

X-1-5 Recognizes own strengths and limitations as aleader.

2

X-3-5 Uses appropriate channels of communication toreport risks within setting.

2


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Competency Number

Year 2016

Year 20

Year 20

Year 20

Year 20

X-4 Applies critical thinking and clinical judgmentwhen assessing or managing risk.

2

X-7-1 Shares knowledge, skill, and expertise withcolleagues and students.

2

X-7-3 Seeks opportunities to teach and mentor others. 2

X-7-4 Participates in committees, task forces andprofessional activities to offer the LPNperspective.

5

SELF-ASSESSMENT SUMMARY

Year Competency Number

Describe the competency areas you want to improve or develop. List all items rated 2(Competent), 3 (Requires Improvement), 4 (Developmental) in Step 1.

2016 A-1 Applies knowledge of anatomy and physiology of the human body to the assessment ofclient and delivery of nursing care.

2016 A-2 Applies knowledge of microbiology throughout care, disease prevention, and healthpromotion.

2016 A-3 Applies knowledge of pathophysiology to the nursing care of the client.

2016 A-4-4 Uses appropriate medical terminology to report and document client care.

2016 A-5-9 Adjusts nursing practice to the specific growth and development of the client.


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2016 A-6 Applies principles of nutrition to the assessment and care of the client.

2016 A-7 Applies knowledge of pharmacology throughout client care and teaching.

2016 A-8-2 Integrates knowledge and skills from the sciences and humanities into the application ofthe nursing process.

2016 B-1 Performs health assessment of client using assessment techniques and asystematic process.

2016 B-2-2 Implements the planning process and establishes client priorities involving client inplanning.

2016 B-2-3 Identify and analyze nursing diagnosis.

2016 B-3 Implements nursing interventions to carry out nursing care plan.

2016 B-3-2 Reassess, review, and modify plan of care to meet the needs of the client.


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2016 B-4 Evaluates the clients ’ response to care and treatment.

2016 C-1 to C-4 Applies critical thinking and clinical judgment when responding to emergencysituations.

2016 C-5-1 Effectively uses protective devices to protect client, self, and others.

2016 C-7-1 Applies principles of medical and surgical asepsis in the delivery of care.

2016 C-12 Applies nursing knowledge and clinical judgment to maintain physical safety of client.

2016 D-1 Uses effective verbal and written communication in the practice setting.

2016 D-2 Appropriately establishes, maintains, and closes the nurse-client relationship.

2016 D-3 Collaborates with health care team to function as an effective team member.


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2016 D-3-7 Adheres to the channels of communication within the employing agency.

2016 D-4 Provides client and family teaching.

2016 D-5 Reports and documents following legal protocols, agency policy and procedure.

2016 D-7 Applies clinical judgment in identifying problems and resolving issues in client care.

2016 D-8-1 Effectively manages time and organizes client care to meet priority needs.

2016 D-8-2 Demonstrates ability to rank the priority of client needs.

2016 W-1-3 Understands the key components of the HealthProfessions Act-LPN Regulation.

2016 W-2-3 Understands the Restricted Activity authorizations in the LPN Regulation .


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2016 W-3 Understands the CLPNA Standards of Practice.

2016 W-4 Adheres to the CLPNA Code of Ethics and Standards of Practice.

2016 W-4-5 Acts as an advocate for client and empowers clients and families.

2016 W-5-1 Demonstrates accountability for own nursing practice.

2016 W-6 Maintains the confidentiality of client information.

2016 W-7 Recognizes professional boundaries within the nurse-client therapeutic relationship.

2016 W-9 Accepts responsibility for continuing competence and professional development.

2016 W-9-4 Participates in continuous quality improvement and evidence based changes to nursingpractice.


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2016 W-11 Keeps informed of current research affecting health care delivery.

2016 X-1-5 Recognizes own strengths and limitations as a leader.

2016 X-3-5 Uses appropriate channels of communication to report risks within setting.

2016 X-4 Applies critical thinking and clinical judgment when assessing or managing risk.

2016 X-7-1 Shares knowledge, skill, and expertise with colleagues and students.

2016 X-7-3 Seeks opportunities to teach and mentor others.


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STEP 2: SELF-ASSESSMENT OF SPECIFIC COMPETENCIES

In this section, describe, assess, and rate the competencies specific to your area of work, specialty,role and responsibility. Review the competency sections in the Competency Profile to guide yourassessment of the Specific Competencies. Seek feedback from another health professional.

Year Competency

Number Describe & Assess Specific Competencies Rating

(1-5)

2016 A-3 Applies knowledge of pathophysiology of the human body to theassessment of client and delivery of nursing care.

This is something I want to improve on especially consideringcomorbidities in acute medicine.

3

2016 A-7 Applies knowledge of pharmacology throughout client care and teaching.

I do have competent knowledge of this but would again strive to improvemy knowledge of adverse side effects of medication as it relates to clientsin acute medicine who are admitted into the hospital with establishedmedication prescriptions.

2

20 _

20 _

20 _


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STEP 3: LEARNING PLAN This page is intended to document your Learning Plan for one year. Photocopy this BLANK page for each additional year.

Your Learning Plan must consist of at least TWO objectives for each year. You are required to fill outall FOUR columns for each objective. Transfer your Learning Plan onto your Annual CLPNARegistration Renewal Form. Please refer to the Guidelines at www.clpna.com f or more information.

YEAR 20 16

Learning Objectives (What I am going to learn?)

Resources & Strategies(What will I do to meet

objectives?)

Target Date(Realistic time

frame forachievement)

Evaluation (How will I know I learned it?)

I will learn complications ofasthma/copd, hyptertension,and diabetes as they relate toa hospitalized patient in mycare.

Learn side effects to anti-hypertensives, antidiabetic,corticosteroids and

antidepressant medication.

I have a very busy schedule, soI choose to learn when I ’ m onthe go. I bought an app byUnbound Medicine called:Diseases and Disorders whichexplains how the body isfunctions with disease withevidence based rationales.

Pocket Drugs & Classifications(Wiley, 2012)

I used this pocket guide whileon clinical and will continue touse it to commit the objectivesto memory.

July 2016

July 2016

I will be able to state changesin vital signs as indicated bydisease process and be able toprioritize interventionsaccordingly.

I will be able to state howthese classes of medicationsmay manifest altered

symptoms in clients andprioritize care accordingly.

Name: Misty Holm CLPNA Registration #:

http://www.clpna.com/http://www.clpna.com/http://www.clpna.com/http://www.clpna.com/


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RECORD OF PROFESSIONAL ACTIVITIES

Date Professional Activity(include course, seminar,research, hours, details)

Summary of Learning

May 2015 It ’ s Your Move , Alberta HealthServices, 4 hours

Injury prevention program, safe techniques for transferring andambulating clients.

March 2016 Help! Save Stan-InterdisciplinaryHealth Care Workshop, 6 hours

Biopsy Team Communication, Bedside Shift Report, Can You HandleThis (patient ambulating with full lift), Motivational Interviews(Techniques)



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RECORD OF PROFESSIONAL ACTIVITIES

Date Professional Activity(include course, seminar,research, hours, details)

Summary of Learning


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