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

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.

1

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

1

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.

1

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.

2

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

Competency Number

Year2014

Year20__

Year20__

Year20__

Year20__

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.

3

B-2-3 Identify and analyze nursing diagnosis. 1

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

1

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

1

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

1

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.

5

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

5

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.

1

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.

1

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

1

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

1

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

1

D-4 Provides client and family teaching. 3

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

Competency Number

Year2014

Year20__

Year20__

Year20__

Year20__

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

1

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.

2

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

1

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.

2

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

1

W-3 Understands the CLPNA Standards of Practice. 1

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

1

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

1

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.

2

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

5

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

5

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.

1

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

Competency Number

Year2014

Year20__

Year20__

Year20__

Year20__

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

3

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

5

X-7-3 Seeks opportunities to teach and mentor others. 5

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

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.

2014 A-3A-5-9A-6A-7A-8-2

Applies knowledge of pathophysiology to the nursing care of the client.Adjusts nursing practice to the specific growth and development of the client.Applies principles of nutrition to the assessment and care of the client.Applies knowledge of pharmacology throughout client care and teaching.Integrates knowledge and skills from the sciences and humanities into the application of the nursing process.

2014

B-1

B-2-2

C-6-1C-12

Performs health assessment of client using assessment techniques and a systematic process.Implements the planning process and establishes client priorities involving client in planning.Demonstrates the consistent application of standard precautions.Applies nursing knowledge and clinical judgment to maintain physical safety of client.

2014

D-4D-7D-8-1

Provides client and family teaching.Applies clinical judgment in identifying problems and resolving issues in client care.Effectively manages time and organizes client care to meet priority needs.

2014

W-1-3W-9

Understands the key components of the Health Professions Act-LPN Regulation.Accepts responsibility for continuing competence and professional development.

2014 X-1-5X-4

Recognizes own strengths and limitations as a leader.Applies critical thinking and clinical judgment when assessing or managing risk.

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)

2014D-4-6

Demonstrate ability to evaluate the effectiveness of teaching and learning through appropriate responses, demonstration of skill, or change in behaviour.

Provided patient with DVT exercises via demonstration during my rotation in orthopedic surgery unit

3

2014G-5-4

Demonstrate knowledge and ability to insert, care for, and remove urinary catheters

Performed insertion of catheter on both a male and female patient, successfully removed catheter as per post surgery orders

3

2014

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

2014

2014

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 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?)

1) A-3-4I will increase my knowledge of the pathophysiology related to diabetes, more specifically, the complications related to diabetes

____________________

2) U-7-3I will improve my efficiency in hanging IV medications and using the smart pump.

Reviewing the pathophysiology textbook in regards to diabetes.

Researching medical journals on library database that relates the complications that diabetes presents in patients_____________________

Practicing how to use pumps in open labs at the college

Reviewing videos provided from labs/ lab manual on how to hang IV medication

March 2, 2015(This is the start of the next clinical placement)

_____________

March 2, 2015(By Next clinical start date)

I will be able to describe and inform a patient with the complications that are associated with the disease

_____________________

I will be able to efficiently, in under 10 minutes, hang IV medication and set up the IV smart pump

I will have decreased questions for my buddy nurse about the pump

Name: Alana Chan CLPNA Registration #: ____________

Self-Assessment Tool – CCP Page 10College 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

Sept 1,2014 A-3-4Internet research and use of textbook to review the pathophysiology of Hypertension

1 Hour

I learned how to detect hypertension in patients (what is the systolic/diastolic number that indicates HTN), signs and symptoms of HTN, complications associated to HTN and some common medications to help treat HTN

Oct 1, 2014 G-5-1Attended a buddy shift at the U of A orthopedic surgery unit, observed and assisted buddy nurse in dressing change on post-operative patients

6 Hours

I reviewed how to perform sterile dressing changes on a post-operative wound

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

Name: Alana Chan CLPNA Registration #:__________

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