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

Year2014/2015

Year20___

Year20__

Year20__

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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.

3

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.

2

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

3

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

Year2014/2015

Year20___

Year20__

Year20__

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A-8-2Integrates knowledge and skills from the sciences and humanities into the application of the 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 using assessment techniques and a systematic process.

2

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

2

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

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.

2

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

2

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.

3

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

2

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.

3

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.

3

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

3

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

Competency Number

Year2014/2015

Year20___

Year20__

Year20__

Year20__

D-4 Provides client and family teaching. 3

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

3

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

2

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

2

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

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 Health Professions Act-LPN Regulation.

3

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

3

W-3 Understands the CLPNA Standards of Practice. 2

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.

2

W-6 Maintains the confidentiality of client information.

2

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

2

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

2

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

2

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 2

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

Competency Number

Year2014/2015

Year20___

Year20__

Year20__

Year20__

report risks within setting.

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

2

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.

2014/2015

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

2014/2015 A – 4 -4Uses appropriate medical terminology to report and document client care

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20___

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

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)

20__

20___

20___

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Self-Assessment Tool – CCP Page 8College 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 2013 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 want to improve my pharmacology skills and become quicker at recognizing types of medications.

I want to improve my medical terminology because it will be easier for me to understand peoples diagnosis’ and it will be easier for me to chart symptoms in the proper terms.

Keep making cue cards and testing myself. The more medications that I administer through preceptors and working will also help me become more familiar with medications.

I will keep looking up unfamiliar terms and I can also use the learningnurse.org site, as it has multiple terminology quizzes.

June 2016

June 2016

I will be able to evaluate my learning by being able to answer quiz questions from colleagues and having to look up less medications in the drug guide.

I will be able to evaluate my learning by having to look up less terms and by getting more quiz questions right on the learningnurse.org site and having certificates if they are offered.

Name: ___________________________ CLPNA Registration #: ____________

Self-Assessment Tool – CCP Page 9College 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

May 10, 2015

LPN Code of Ethics Learned about the ethics surrounding the LPN career and through doing the quiz, learned the appropriate steps to take in different scenarios and what to do in an ethical dilemma.

November 2014?

Oxygen In-Service at St.Michaels Long Term Care Facility

Learned how to refill oxygen tanks and how to attach tubing to the oxygen tanks available at the facility.

November 2014?

PT In-Service at St.Michaels Long Term Care Facility

Learned how to use the various lifts at the facility including sit to stand lifts, and full lifts. Also discussed slider boards and appropriate usage.

Name: _____________________ CLPNA Registration #:__________

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