Escolar Documentos
Profissional Documentos
Cultura Documentos
Page 1
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2nd Edition - Revised October 2008
TABLE OF CONTENTS
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!SELF-ASSESSMENT TOOL - RATING SCALE...........................................................................4
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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
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STEP 3: LEARNING PLAN .......................................................................................................10
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RECORD OF PROFESSIONAL ACTIVITIES .............................................................................11
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Page 2
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2nd Edition - Revised October 2008
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SELF-ASSESSMENT TOOL
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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
Competent
Requires
Improvement
Developmental
Not Applicable
Requires
education and/or
orientation to
meet the
expectations
and /
or requirements
of the
competency.
Not applicable to
current role and
responsibility.
Demonstrates
excellence in the
expectations
and / or
requirements of
the competency.
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Meets the
expectations
and / or
requirements of
the competency.
Has identified
weakness in
areas of
knowledge, skills,
attitudes, or
clinical judgment.
Competenc
y Number
Year
2016
A: Nursing Knowledge
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A-1
A-2
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A-3
A-4-4
Rating
(1-5)
Year
20__
Rating
(1-5)
Year
20__
Rating
(1-5)
Year
20__
Rating
(1-5)
Year
20__
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Rating
(1-5)
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2nd Edition - Revised October 2008
Competenc
y Number
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A-5-9
A-6
A-7
A-8-2
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B-2-2
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B-2-3
B-3
B-3-2
B-4
C: Safety
C-1 to
C-4
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C-5-1
C-6-1
C-7-1
C-12
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B-1
Year
20__
B: Nursing Process
Year
2016
Rating
(1-5)
1
1
Rating
(1-5)
Year
20__
Rating
(1-5)
Year
20__
Rating
(1-5)
Year
20__
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Rating
(1-5)
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1
Rating
(1-5)
1
Rating
(1-5)
Rating
(1-5)
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Rating
(1-5)
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Rating
(1-5)
Rating
(1-5)
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Rating
(1-5)
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(1-5)
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Rating
(1-5)
Rating
(1-5)
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2nd Edition - Revised October 2008
Competenc
y Number
Year
2016
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D-1
D-2
D-3
D-3-7
D-4
D-5
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D-7
D-8-1
D-8-2
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2
4
W-4-5
W-5-1
W-2-3
W-3
W-4
W-6
W-7
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Rating
(1-5)
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Year
20__
Year
20__
Year
20__
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W-1-3
Year
20__
W: Professionalism
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Rating
(1-5)
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Rating
(1-5)
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Rating
(1-5)
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Rating
(1-5)
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2nd Edition - Revised October 2008
Competenc
y Number
Year
2016
W-9
W-9-4
W-11
X-3-5
X-4
X-7-1
X-7-3
X-7-4
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Year
20__
Rating
(1-5)
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Year
20__
Rating
(1-5)
Year
20__
Rating
(1-5)
Year
20__
Rating
(1-5)
Rating
(1-5)
SELF-ASSESSMENT SUMMARY
2016
A-2
A-3
A-6
A-7
Nursing Knowledge
C-1
to C-4
C-5
C-7
Safety
Year
2016
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.
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2nd Edition - Revised October 2008
D-1
D-3
D-3-7
D-4
D-5
D-8-1
W-1-3
W-2-3
W-9-4
W-11
Professionalism
X-3-5
X-7-1
X-7-3
X-7-4
2016
2016
2016
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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.
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Year
2016
Competency
Number
W-2-3
D-3-7
2016
Rating
(1-5)
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Self-Assessment Tool CCP
College of LPNs of Alberta
Page 7
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2nd Edition - Revised October 2008
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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 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.
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Learning Objectives
1. I am going to learn
specifically which skills
and activities are
restricted in the LPN
scope of practice.
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2. I am going to learn
what the proper channels
of communication are in
each health care setting I
am placed, and adhere to
them.
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YEAR 2016
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Target Date
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1. I will
complete this
by July 20th,
2016.
Evaluation
(How will I know I learned it?)
Name: ___________________________
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Self-Assessment Tool CCP
College of LPNs of Alberta
Page 8
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2nd Edition - Revised October 2008
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RECORD OF PROFESSIONAL ACTIVITIES
Date
Professional
Activity (include
course, seminar,
research, hours,
details)
Summary of Learning
April 14,
2016
(3 Hours)
Research and
Presentation in Nursing
Foundations: Maternity
April 16,
2016
(3 Hours)
CPR Renewal
(BLS for HCP: C)
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Name: _____________________
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Page 9
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2nd Edition - Revised October 2008