Carly Legault

September 12, 2013

Self-Assessment Tool – CCP Page 1College of LPNs of Alberta 2nd Edition - Revised October 2008

Self-Assessment Tool – CCP Page 2College of LPNs of Alberta 2nd Edition - Revised October 2008

TABLE OF CONTENTS

SELF-ASSESSMENT TOOL - RATING SCALE..........................................................................4

STEP 1: SELF-ASSESSMENT WITHIN STANDARDS OF PRACTICE.....................................4

A: Nursing Knowledge .................................................................................................................4

B: Nursing Process.......................................................................................................................5

C: Safety.......................................................................................................................................5

D: Communication and Interpersonal Skills..................................................................................5

W: Professionalism.......................................................................................................................6

X: Nursing Practice and Leadership.............................................................................................6

Self-Assessment Summary...........................................................................................................7

STEP 2: SELF-ASSESSMENT OF SPECIFIC COMPETENCIES...............................................8

STEP 3: LEARNING PLAN........................................................................................................10

RECORD OF PROFESSIONAL ACTIVITIES.............................................................................11

Self-Assessment Tool – CCP Page 3College of LPNs of Alberta 2nd Edition - Revised October 2008

SELF-ASSESSMENT TOOL

The Self-Assessment Tool is used to assess your professional practice using the LPN Standards of Practice and Competency Profile as a guide. Focus your assessment on your practice as a whole and then 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

Demonstrates excellence in the expectations and / or requirements of the competency.

Meets the expectations and / or requirements of the competency.

Has identified weakness in areas of knowledge, skills, attitudes, or clinical judgment.

Requires education and/or orientation to meet the expectations and /or requirements of the competency.

Not applicable to current role and responsibility.

STEP 1: SELF-ASSESSMENT WITHIN STANDARDS OF PRACTICE

Competency Number

Year2015

Year20_

Year20_

Year20_

Year20_

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 physiology of the human body to the assessment of client and delivery of nursing care.

2

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

3

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

3

A-4-4 Uses appropriate medical terminology to report and 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 assessment and care of the client.

3

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

3

Self-Assessment Tool – CCP Page 4College of LPNs of Alberta 2nd Edition - Revised October 2008

Competency Number

Year2015

Year20_

Year20_

Year20_

Year20_

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

3

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 using assessment techniques and a systematic process.

2

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

3

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

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

2

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

3

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

3

C: Safety Rating (1-5)

Rating (1-5)

Rating (1-5)

Rating (1-5)

Rating (1-5)

C-1 toC-4

Applies critical thinking and clinical judgment when responding to emergency situations.

4

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

1

C-6-1 Demonstrates the consistent application of standard precautions.

2

C-7-1 Applies principles of medical and surgical asepsis 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 written communication in the practice setting.

2

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

2

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

2

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

4

D-4 Provides client and family teaching. 3

D-5 Reports and documents following legal 2

Self-Assessment Tool – CCP Page 5College of LPNs of Alberta 2nd Edition - Revised October 2008

Competency Number

Year2015

Year20_

Year20_

Year20_

Year20_

protocols, agency policy and procedure.

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

3

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

3

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

3

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 Health Professions Act-LPN Regulation.

3

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

4

W-3 Understands the CLPNA Standards of Practice. 3

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

2

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

3

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

1

W-6 Maintains the confidentiality of client information.

1

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

1

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

1

W-9-4 Participates in continuous quality improvement and evidence based changes to nursing practice.

4

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

3

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 a leader.

2

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

3

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

3

Self-Assessment Tool – CCP Page 6College of LPNs of Alberta 2nd Edition - Revised October 2008

Competency Number

Year2015

Year20_

Year20_

Year20_

Year20_

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

2

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

X-7-4 Participates in committees, task forces and professional activities to offer the LPN perspective.

4

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.

2015 AA-1A-2A-3A-4-4A-5-9A-6A-7A-8-2

Nursing Knowledge

2015

BB-1B-2-2B-2-3B-3B-3-2B-4

Nursing Process

2015

CC-1 toC-4C-6-1C-7-1C-12

Safety

2015

DD-1

Communication and Interpersonal Skills

Self-Assessment Tool – CCP Page 7College of LPNs of Alberta 2nd Edition - Revised October 2008

D-2D-3D-3-7D-4D-5D-7D-8-1D-8-2

2015

WW-1-3W-2-3W-3W-4W-4-5W-9-4W-11

Professionalism

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 your assessment of the Specific Competencies. Seek feedback from another health professional.

Year Competency Number Describe & Assess Specific Competencies Rating

(1-5)

2015

A

A-2

A-2-6

Nursing Knowledge

Microbiology

Explain the concept of asepsis.

3

2015

U

U-1

U-1-4

Medication Administration

Principles of Pharmacology

Demonstrate knowledge of routes for medication administration including: gastrointestinal (oral, orogastric/gastric, nasogastric, rectal) inhalational intra-arterial intracerebral intradermal/epicutaneous

Self-Assessment Tool – CCP Page 8College of LPNs of Alberta 2nd Edition - Revised October 2008

intramuscular intraosseous intrathecal intravenous intravesical mucous membranes (sublingual, buccal, nasal, optic, otic) percutaneous (topical) subcutaneous vaginal

2015

2015

2015

Self-Assessment Tool – CCP Page 9College of LPNs of Alberta 2nd Edition - Revised October 2008

STEP 3: LEARNING PLANThis 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 out all FOUR columns for each objective. Transfer your Learning Plan onto your Annual CLPNA Registration Renewal Form. Please refer to the Guidelines at www.clpna.com for more information.

YEAR 2015 Learning Objectives

(What I am going to learn?)Resources & Strategies

(What will I do to meet objectives?)

Target Date(Realistic time

frame for achievement)

Evaluation(How will I know I learned it?)

I will be able to teach and demonstrate knowledge of routes, sizes and angles for administering medication via subcutaneous and intramuscular to five of my clients during my Preceptorship by the end of April 2016.

I will be able to teach and demonstrate the importance of using asepsis technique during dressing care to avoid contamination by

In order to meet this objective I will read Potter & Perry (2014) on how to properly administer medications. I will thoroughly review the size of syringes to use based on the area of the body to appropriately administer the medication.

I will watch three videos on youtube about:- Subcutaneous

injection- Intramuscular

injection

In order to meet this objective I will read the Canadian Fundamentals of Nursing by Patricia A. Potter & Anne Griffin Perry, Physical

22 April, 2016 In order to evaluate myself I will demonstrate and verbally explain to my preceptor on how and where on the anatomy of the body to properly administer medication via subcutaneous and intramuscular, and have her/him rate me on how well I did.

I will do an exam online on how to administer IM and sub-Q injections with 89% pass.

I will get my five clients to return demonstrate the methods of administering IM and sub-Q and which area of the body to administer.

Self-Assessment Tool – CCP Page 10College of LPNs of Alberta 2nd Edition - Revised October 2008

pathogenic organism to five clients during my Preceptorship by March 2016.

Examination & Health Assessment by Carolyn Jarvis and Brunner & Suddarth’s Textbook of Canadian Medical-Surgical Nursing by Day et al.

I will watch four videos on youtube on how to properly use the asepsis technique during my care.

23 March, 2016 In order to

evaluate myself, I will apply the knowledge I gained through demonstration and explanation to my Preceptor instructor, and have her give me feedback on how I did.

I will do an exam online on asepsis with a 90% as a pass.

I will get two of my clients to return demonstrate the use of asepsis 1-2 hours before discharge.

Name: Sallay Kamara CLPNA Registration #: ____________

Self-Assessment Tool – CCP Page 11College of LPNs of Alberta 2nd Edition - Revised October 2008

RECORD OF PROFESSIONAL ACTIVITIES

Date Professional Activity (include course,

seminar, research, hours, details)

Summary of Learning

7 February, 2015

(WHIMIS) Workplace Hazardous Material Information SystemLength: 4 hoursOnline course

I learned the proper safety procedures to follow when using hazardous products in the workplace. I also learn hazard identification, product classification, product labeling and warning signs.

8 February, 2015

Human Blood-Borne PathogenLength: 5 hoursOnline course

I learned to identify blood borne pathogens and how to protect myself against exposure to pathogens in the healthcare setting. I also learned when and how to properly wear personal protective equipment (PPE) when I’m in an isolated precaution room or in an emergency unit where I may be exposed by bodily fluid.

21 March, 2015

Basic Life Support (BLS) for Health-Care ProvidersLength: 4.5 hoursIn class course

I learned how to perform CPR with and without the use of AED in an emergency situation for adults, toddlers, and infants. I learned how to perform Heimlich maneuver for when someone chokes; wherever I may encounter a choking individual.

1 June, 2015 to 26 June, 2015

Continuing Care Placement @ DickensfieldLength: 4 weeks – 145hoursClinical Experience

I learned how to work as a member of the interdisciplinary team, by providing care for dementia and parkinson’s residents. I was able to assist residents with their activities of daily living and I was also able to gain understanding on how to apply knowledge related to administering medication.

26 October, 2015 to 20 November, 2015

Acute Care/ Medicine Placement @ Royal Alexandra Hospital UNIT 42 (Transition Unit)Length: 4 weeks – 145 hoursClinical Experience

During Medicine placement, I was able to learn the importance of working as a team in the interdisciplinary team. I gained significant amount of knowledge on medication administration, proper documentation methods, and being able to interact and assist clients with dressing change, and learning about how the client is a priority in the healthcare field.

23 November, 2015 to18 December, 2015

Acute Care/ SurgeryPlacement @ Royal Alexandra Hospital – Orthopedic Surgery Centre (OSC) UNIT 410Length: 4 weeks – 145 hoursClinical Experience

In Acute care, I was able to perform many different types of skills that I was not able to perform during Long term. I gained knowledge on the importance of infection and DVT prevention in the OSC unit. I also learned about narcotic medications I’ve never heard of during my first year, and how important to manage and control client pain when needed.

Self-Assessment Tool – CCP Page 12College of LPNs of Alberta 2nd Edition - Revised October 2008

Name: Sallay Kamara CLPNA Registration #:__________

Self-Assessment Tool – CCP Page 13College of LPNs of Alberta 2nd Edition - Revised October 2008