Self-Assessment Tool - College of Licensed Practical Nurses of ...

SELF-ASSESSMENT TOOLContinuing Competency Program

TABLE OF CONTENTSSELF-ASSESSMENT TOOL - RATING SCALE ........................................................................ 1STEP 1: SELF-ASSESSMENT WITHIN STANDARDS OF PRACTICE .................................... 1A: Nursing Knowledge .............................................................................................................. 1B: Nursing Process .................................................................................................................... 2C: Safety .................................................................................................................................... 2D: Communication and Interpersonal Skills ............................................................................... 2W: Professionalism .................................................................................................................... 3X: Nursing Practice and Leadership ........................................................................................... 3Self-Assessment Summary ......................................................................................................... 4STEP 2: SELF-ASSESSMENT OF SPECIFIC COMPETENCIES ............................................. 5STEP 3: LEARNING PLAN ....................................................................................................... 6RECORD OF PROFESSIONAL ACTIVITIES ............................................................................. 7Self-Assessment Tool – CCPCollege of LPNs of Alberta 2 nd Edition - Revised October 2008

SELF-ASSESSMENT TOOLThe Self-Assessment Tool is used to assess your professional practice using the LPN Standards ofPractice and Competency Profile as a guide. Focus your assessment on your practice as a whole andthen 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 5Excellent Competent Requires Developmental Not ApplicableImprovementDemonstratesexcellence in theexpectations and /or requirements ofthe competency.Meets theexpectations and /or requirements ofthe competency.Has identifiedweakness inareas ofknowledge, skills,attitudes, orclinical judgment.Requireseducation and/ororientation tomeet theexpectations and /or requirements ofthe competency.Not applicable tocurrent role andresponsibility.STEP 1: SELF-ASSESSMENT WITHIN STANDARDS OF PRACTICECompetencyNumberYear20__Year20__Year20__Year20__Year20__A: Nursing KnowledgeRating(1-5)Rating(1-5)Rating(1-5)Rating(1-5)Rating(1-5)A-1 Applies knowledge of anatomy and physiologyof the human body to the assessment of clientand delivery of nursing care.A-2 Applies knowledge of microbiology throughoutcare, disease prevention, and health promotion.A-3 Applies knowledge of pathophysiology to thenursing care of the client.A-4-4A-5-9Uses appropriate medical terminology to reportand document client care.Adjusts nursing practice to the specific growthand development of the client.A-6 Applies principles of nutrition to the assessmentand care of the client.A-7Applies knowledge of pharmacology throughoutclient care and teaching.Self-Assessment Tool – CCP Page 1College of LPNs of Alberta 2 nd Edition - Revised October 2008

CompetencyNumberYear20__Year20__Year20__Year20__Year20__A-8-2Integrates knowledge and skills from thesciences and humanities into the application ofthe nursing process.B: Nursing ProcessRating(1-5)Rating(1-5)Rating(1-5)Rating(1-5)Rating(1-5)B-1 Performs health assessment of client usingassessment techniques and a systematicprocess.B-2-2B-2-3Implements the planning process andestablishes client priorities involving client inplanning.Identify and analyze nursing diagnosis.B-3 Implements nursing interventions to carry outnursing care plan.B-3-2Reassess, review, and modify plan of care tomeet the needs of the client.B-4 Evaluates the clients’ response to care andtreatment.C: SafetyRating(1-5)Rating(1-5)Rating(1-5)Rating(1-5)Rating(1-5)C-1 toC-4C-5-1C-6-1C-7-1Applies critical thinking and clinical judgmentwhen responding to emergency situations.Effectively uses protective devices to protectclient, self, and others.Demonstrates the consistent application ofstandard precautions.Applies principles of medical and surgicalasepsis in the delivery of care.C-12 Applies nursing knowledge and clinicaljudgment to maintain physical safety of client.D: Communication and Interpersonal SkillsRating(1-5)Rating(1-5)Rating(1-5)Rating(1-5)Rating(1-5)D-1 Uses effective verbal and writtencommunication in the practice setting.D-2 Appropriately establishes, maintains, andcloses the nurse-client relationship.D-3 Collaborates with health care team to functionas an effective team member.D-3-7Adheres to the channels of communicationwithin the employing agency.Self-Assessment Tool – CCP Page 2College of LPNs of Alberta 2 nd Edition - Revised October 2008

CompetencyNumberYear20__Year20__Year20__Year20__Year20__D-4 Provides client and family teaching.D-5 Reports and documents following legalprotocols, agency policy and procedure.D-7 Applies clinical judgment in identifying problemsand resolving issues in client care.D-8-1D-8-2Effectively manages time and organizes clientcare to meet priority needs.Demonstrates ability to rank the priority of clientneeds.W: ProfessionalismRating(1-5)Rating(1-5)Rating(1-5)Rating(1-5)Rating(1-5)W-1-3W-2-3Understands the key components of the HealthProfessions Act-LPN Regulation.Understands the Restricted Activityauthorizations in the LPN Regulation.W-3 Understands the CLPNA Standards of Practice.W-4 Adheres to the CLPNA Code of Ethics andStandards of Practice.W-4-5W-5-1Acts as an advocate for client and empowersclients and families.Demonstrates accountability for own nursingpractice.W-6 Maintains the confidentiality of clientinformation.W-7 Recognizes professional boundaries within thenurse-client therapeutic relationship.W-9 Accepts responsibility for continuingcompetence and professional development.W-9-4Participates in continuous quality improvementand evidence based changes to nursingpractice.W-11 Keeps informed of current research affectinghealth care delivery.X: Nursing Practice and LeadershipRating(1-5)Rating(1-5)Rating(1-5)Rating(1-5)Rating(1-5)X-1-5X-3-5Recognizes own strengths and limitations as aleader.Uses appropriate channels of communication toreport risks within setting.Self-Assessment Tool – CCP Page 3College of LPNs of Alberta 2 nd Edition - Revised October 2008

CompetencyNumberYear20__Year20__Year20__Year20__Year20__X-4 Applies critical thinking and clinical judgmentwhen assessing or managing risk.X-7-1X-7-3X-7-4Shares knowledge, skill, and expertise withcolleagues and students.Seeks opportunities to teach and mentor others.Participates in committees, task forces andprofessional activities to offer the LPNperspective.SELF-ASSESSMENT SUMMARYYearCompetencyNumberDescribe the competency areas you want to improve or develop. List all items rated 2(Competent), 3 (Requires Improvement), 4 (Developmental) in Step 1.20___20___20___20___20___Self-Assessment Tool – CCP Page 4College of LPNs of Alberta 2 nd Edition - Revised October 2008

STEP 2: SELF-ASSESSMENT OF SPECIFIC COMPETENCIESIn 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 yourassessment of the Specific Competencies. Seek feedback from another health professional.YearCompetencyNumberDescribe & Assess Specific CompetenciesRating(1-5)20___20___20___20___20___Self-Assessment Tool – CCP Page 5College of LPNs of Alberta 2 nd 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 outall FOUR columns for each objective. Transfer your Learning Plan onto your Annual CLPNARegistration Renewal Form. Please refer to the Guidelines at www.clpna.com for more information.YEAR 20____Learning Objectives(What I am going to learn?)Resources & Strategies(What will I do to meetobjectives?)Target Date(Realistic timeframe forachievement)Evaluation(How will I know I learned it?)Name: ____________________________CLPNA Registration #: ____________Self-Assessment Tool – CCP Page 6College of LPNs of Alberta 2 nd Edition - Revised October 2008

RECORD OF PROFESSIONAL ACTIVITIESDateProfessional Activity(include course, seminar,research, hours, details)Summary of LearningName: ____________________________CLPNA Registration #: ____________Self-Assessment Tool – CCP Page 7College of LPNs of Alberta 2 nd Edition - Revised October 2008