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SELF-ASSESSMENT TOOL

Continuing Competency Program

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

Self-Assessment Tool CCP


College of LPNs of Alberta

nd

2 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
Excellent

2
Competent

3
Requires
Improvement

4
Developmental

5
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

A: Nursing Knowledge
A-1

Applies knowledge of anatomy and physiology


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

A-2

Applies knowledge of microbiology throughout


care, disease prevention, and health promotion.

A-3

Applies knowledge of pathophysiology to the


nursing care of the client.

A-4-4

Uses appropriate medical terminology to report


and document client care.

A-5-9

Adjusts nursing practice to the specific growth


and development of the client.

A-6

Applies principles of nutrition to the assessment


and care of the client.

A-7

Applies knowledge of pharmacology throughout


client care and teaching.

Self-Assessment Tool CCP


College of LPNs of Alberta

Year
20 15

Year
20

Year
20

Year
20

Year
20

Rating
(1-5)

Rating
(1-5)

Rating
(1-5)

Rating
(1-5)

Rating
(1-5)

3
3
2
3
3

Page 1
nd

2 Edition - Revised October 2008

Year
20 15

Competency
Number

A-8-2

Integrates knowledge and skills from the


sciences and humanities into the application of
the nursing process.

B: Nursing Process
B-1

Performs health assessment of client using


assessment techniques and a systematic
process.

B-2-2

Implements the planning process and


establishes client priorities involving client in
planning.

B-2-3

Identify and analyze nursing diagnosis.

B-3

Implements nursing interventions to carry out


nursing care plan.

B-3-2

Reassess, review, and modify plan of care to


meet the needs of the client.

B-4

Evaluates the clients response to care and


treatment.

C-1 to
C-4

Applies critical thinking and clinical judgment


when responding to emergency situations.

C-5-1

Effectively uses protective devices to protect


client, self, and others.

C-6-1

Demonstrates the consistent application of


standard precautions.

C-7-1

Applies principles of medical and surgical


asepsis in the delivery of care.

C-12

Applies nursing knowledge and clinical


judgment to maintain physical safety of client.

D: Communication and Interpersonal Skills


D-1

Uses effective verbal and written


communication in the practice setting.

D-2

Appropriately establishes, maintains, and


closes the nurse-client relationship.

D-3

Collaborates with health care team to function


as an effective team member.

D-3-7

Adheres to the channels of communication


within the employing agency.

Year
20

Year
20

Year
20

Rating
(1-5)

Rating
(1-5)

Rating
(1-5)

Rating
(1-5)

Rating
(1-5)

Rating
(1-5)

Rating
(1-5)

Rating
(1-5)

Rating
(1-5)

Rating
(1-5)

Rating
(1-5)

Rating
(1-5)

Rating
(1-5)

3
3
3
3
Rating
(1-5)

C: Safety

Year
20

2
2
2
2
2
Rating
(1-5)

2
2
2
2

Year
20 15

Competency
Number

D-4

Provides client and family teaching.

D-5

Reports and documents following legal


protocols, agency policy and procedure.

D-7

Applies clinical judgment in identifying problems


and resolving issues in client care.

D-8-1

Effectively manages time and organizes client


care to meet priority needs.

D-8-2

Demonstrates ability to rank the priority of client


needs.

W: Professionalism
W-1-3

Understands the key components of the Health


Professions Act-LPN Regulation.

W-2-3

Understands the Restricted Activity


authorizations in the LPN Regulation.

W-3

Understands the CLPNA Standards of Practice.

W-4

Adheres to the CLPNA Code of Ethics and


Standards of Practice.

W-4-5

Acts as an advocate for client and empowers


clients and families.

W-5-1

Demonstrates accountability for own nursing


practice.

W-6

Maintains the confidentiality of client


information.

W-7

Recognizes professional boundaries within the


nurse-client therapeutic relationship.

W-9

Accepts responsibility for continuing


competence and professional development.

W-9-4

Participates in continuous quality improvement


and evidence based changes to nursing
practice.

W-11

Keeps informed of current research affecting


health care delivery.

X: Nursing Practice and Leadership


X-1-5

Recognizes own strengths and limitations as a


leader.

X-3-5

Uses appropriate channels of communication to


report risks within setting.

Year
20

Year
20

Year
20

Year
20

Rating
(1-5)

Rating
(1-5)

Rating
(1-5)

Rating
(1-5)

Rating
(1-5)

Rating
(1-5)

Rating
(1-5)

Rating
(1-5)

2
2
2
2
2
Rating
(1-5)

2
2
2
2
2
2
2
2
2
2

2
Rating
(1-5)

2
2

Year
20 15

Competency
Number

X-4

Applies critical thinking and clinical judgment


when assessing or managing risk.

X-7-1

Shares knowledge, skill, and expertise with


colleagues and students.

X-7-3

Seeks opportunities to teach and mentor others.

X-7-4

Participates in committees, task forces and


professional activities to offer the LPN
perspective.

Year
20

Year
20

Year
20

Year
20

4
2
2
4

SELF-ASSESSMENT SUMMARY

Year

Competency
Number

A
20 15 _

I need to improve my nursing knowledge so I rated myself at number 3.


Nursing knowledge involves anatomy physiology, pharmacology,
microbiology, path physiology.

Nursing process is a scientific method of providing care to the patient


which involves nursing assessment, diagnosis, planning, implementation
and evaluation. I rated myself at number 3 because I think I need more
practice in real clinical setting.

Safety involves responding to emergency situation competently, using


standard precaution, and ensuring safe environment to the patient, self
and other. I scored me at 2 because I have done CPR course so I am
confident that I can handle emergency situation. Also I have knowledge of
standard precaution so I can prevent transmission of infection.

20 15_

20 15 _

D
20 15
_

W
20 15 _

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

Effective Communication is very necessary to maintain therapeutic nurse


client relationship, to collaborate with other health care team. I think I
can maintain good therapeutic nurse client relationship and can maintain
good communication with my health care team so I rated me at 2.
This competency describes the roles, responsibility, and code of ethics
for LPN, legal accountability, standard of practice. I rate me at number 2
because I feel competent on my knowledge regarding the roles and
responsibility nurses,

20
15

This competency is about nursing leadership and manager. I have not


practice as nurse leadership so I rate me at number 4.

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

A
20 16 _

B
20 16 _

D
20
16_

Rating
(1-5)

Describe & Assess Specific Competencies

Nursing knowledge involves knowledge regarding human


anatomy, physiology, pathophysiology, pharmacology,
microbiology. I have rated me at number 3 because I think I
have only theory knowledge and I have not integrated this
knowledge into practice. I would review my nursing
knowledge and apply into practice during my clinical
Nursing process is a scientific method of providing care to
the patient which involves nursing assessment, diagnosis,
planning, implementation and evaluation. I rated myself at
number 3 because I think I need more practice in real
clinical setting and I can improve my nursing process skill
during clinical practice.

Effective Communication is very necessary to maintain


therapeutic nurse client relationship, to collaborate with
other health care team. I did not have communicated with
patient so once I practice my clinical, I would have
opportunity to improve my communication skills.

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 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 20 15
Learning Objectives
(What I am going to learn?)

Resources &
Strategies (What will I
do to meet objectives?)

Learning need I am going to


learn anatomy physiology,
pathophysiology, pharmacology,
microbiology, nutrition to improve
my nursing knowledge and will
master at least 80% of course
materials

Target
Date
(Realistic
time
frame for

Evalu
ation
(How will I know I
learned it?)

I will use nursing


Since I am In order to
text books,
planning to evaluate my nursing
medical/surgical
write my
knowledge, I will
nursing, and
CLPNA exam brain storm the
fundamental of
on May 2016 particular topic. I
nursing. I will use
so I want to will ask my friend to
internet resources
be fully
test my nursing
such as watching
prepared by knowledge; If I am
Learning Outcome I would be nursing related videos April 2016. able to answer at
able to describe at least 80% of
that will help me to
least 80% then I
the contents and concepts of
improve my
know I learned it.
anatomy physiology,
knowledge.
pharmacology, microbiology,
nutrition by the end of the April
2016.
I will be able I will be doing my
to prioritize clinical in coming
To practice nursing
at least one January and
Learning need I want to learn
process, I will study
care using February. I will use
the ability to provide nursing care book on nursing
nursing
using nursing process to the
process like nursing
nursing process to
patient.
care plan. I will study process by care the patient.
the case scenarios. I the end of This would give me
Learning outcome I would be will go to clinical in
April 2016. a real opportunity to
able to find one priority care of my January 2016, where I
use nursing process.
patient using nursing process to will have an
I will ask my
provide nursing care by the end of opportunity to provide
preceptor to
January.
patient care using
evaluate me for
nursing process.

nursing process. If I
am able to prioritize
the task then I know
I Learned it.

RECORD OF PROFESSIONAL ACTIVITIES


Date

Professional Activity

Summary of Learning

(include course, seminar,


research, hours, details)

1
WHMIS course
December
2015
1
Human Blood borne
December pathogen exposure.
2015
1
Its you move.
December
2015
12
November
2015

Name:

CPR course

I did this course in order to learn the safe use of


hazardous materials used in Canadians workplaces. I
learned about the six classes of controlled product and
the necessary steps. I should use these products
safely to prevent the injuries, illness, death and fire
caused
by the standard
hazardous
materials. use of personal
I learned
precaution,
protective equipment and when are they used. Overall
I learned the role and responsibilities of the nurses to
protect the transmission of infection from nurse to
patient and vice versa.
Here I learned the importance of appropriate use of
patients equipment during patients transfers and
proper use of body mechanics by nurses in order to
prevent workplace related injuries to patient and
nurses.
Here I learned to provide resuscitation to patient
having cardiac and breathing emergency. I learned
the importance of chest compressions which should
be started quickly to provide oxygen to brain.

CLPNA Registration #:

RECORD OF PROFESSIONAL ACTIVITIES


Date

Professional Activity

Summary of Learning

(include course, seminar,


research, hours, details)

Name: Shobha Pandey

CLPNA Registration #:

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