Clpna Self-Assessment Tool Assignment 2

Carly Legault
September 12, 2013
Self-Assessment Tool CCP

College of LPNs of Alberta
Page 1
2nd Edition - Revised October 2008

Page 2
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

Page 3
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
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.
5
Not Applicable
Not applicable to
current role and
responsibility.
STEP 1: SELF-ASSESSMENT WITHIN STANDARDS OF

PRACTICE
Competency
Number
A: Nursing Knowledge
Year
2016_
_
Year
20__
Year
20__
Year
20__
Year
20__
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.
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.

Page 4
Year
2016_
_
Competency
Number
A-8-2
Integrates knowledge and skills from the

sciences and humanities into the application of
the nursing process.
B: Nursing Process
Rating
(1-5)
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.
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)
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.
3
Rating
(1-5)
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__
Rating
(1-5)
D: Communication and Interpersonal Skills
Year
20__
B-1
C: Safety
Year
20__
Page 5
Year
2016_
_
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
Rating
(1-5)
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
Rating
(1-5)
X-1-5
Recognizes own strengths and limitations as a

leader.
X-3-5
Uses appropriate channels of communication to

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)
Page 6
Year
2016_
_
Competency
Number
Year
20__
Year
20__
Year
20__
Year
20__
report risks within setting.

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.
SELF-ASSESSMENT SUMMARY
Year
Competency
Number
2016

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

A-1, A-2, A-3, A-4-4, A-5-9, A-6, A-7, A-8-2
Category B: Nursing Process
B-1, B-2-2, B-2-3, B-3, B-3-2, B-4
Category C: Safety
C-1 to C-4, C-5-1, C-6-1, C7-1, C-12
Category D: Communication and Interpersonal skills
D-1, D-2, D-3, D-3-7, D-4, D-5, D-7, D-8-1, D-8-2
Category W: Professionalism
W-1-3, W-2-3, W-3, W-4, W-4-5, W-5-1, W-7, W-9, W-9-4, W-11
Category X: Nursing Practice and Leadership
X-1-5, X-3-5, X-4, X-7-1, X-7-3, X-7-4
Page 7
20___
20___

Page 8
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
C-12
Rating
(1-5)
Describe & Assess Specific Competencies

Applies nursing knowledge and clinical judgment to maintain physical
safety of client.
2016
I feel that this is an important area to work on as safety is key when
receiving a patient into care. All my instructors stressed safety, and they
have mentioned many times that it should be at the top of our priorities.
This is an area that I would like to improve as though I feel like I am safe
with the client, I want to critically think ahead of possible dangers, and
prevent them. I am currently at a basic level of thinking when it comes to
safety, I lower the bed, put up the side rails, but what I want to improve
is to predict complications based on assessments, and medication
(interactions, or side effects), and to know what to do when an event
occurs.
D-8-1
Effectively manages time and organizes client care to meet priority

needs.
Time management and organization is something that I need to work on

as I have struggled with getting al my documentation, and tasks done
before breaks in clinical. I want to improve this area as it will make my
day easier in the future and it will provide me with the time to give quality
care to my patients. Although I know that some days will be more
challenging and busy, I want to be able to look at the Kardex of clients,
plan my day with thinking of possible complications that can happen
ahead of time.
20___
20___
20___

Page 9
20___

Page 10
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 2016
Learning Objectives
Resources & Strategies
Target Date
Evaluation
(What I am going to learn?)
(What will I do to meet

objectives?)
(Realistic time
frame for
achievement)
(How will I know I learned it?)
I am going to learn to
practice patient safety by
focusing on medication
administration, and
infection control.
I will meet this objective

by reading articles from
Canadian Patient Safety
Institute prevention
strategies with medication
errors, and infection
control.
1 year
February 5,
2017.
I will meet this objective

by reading an article on
time management for
nursing, and using daily
organizational sheet to
manage my time, as well
as reflection after my
shift.
1 year February 5,
2017.
I will learn to manage

my time efficiently to
allow me to meet priority
task of the day.
Name: _____________________g

I will know that I have

met my objective if and
when it reflects on my
work, and care of the
patients. This will include
reflection of any incident
that happens on a daily
shift.
I will know that I have
met my objective if I am
on time for my breaks,
and get off at a reasonable
time after my shift ends.
As I reflect I will be able
to highlight things I can
improve, and things that
went well throughout my
shift.
CLPNA Registration #: ____________
Page 11
RECORD OF PROFESSIONAL ACTIVITIES

Date
1 Feb, 2016
Professional Activity
(include course,
seminar, research,
hours, details)
2 Hours were spent in labs with review of how to properly

Its Your Move Retransfer a patient. This included transfer belts (1-2 p. assist),
certification at NorQuest medi-lift, sit to stand, and the scoop method.
College
November,
2015
In Service at Royal
Alexandra Hospital unit
53: How to Transfer
Stroke Patients
June, 2015
In Service at Norwood,
understanding
Dysphasia
14 March,
2015
Summary of Learning
CPR Certification
Name: _____________________

Half an hour was spent with a RN that explained the

importance of transferring patients, and the proper method
to transfer stroke patients. It also explains the frustration that
patients feel, and gave a better understanding of why they
react certain ways.
An hour was spent in a staff room were the Nutritionist
presented dysphagia and the risk related to. I tried different
consistency of drinks, and food which provided me with a
better understanding of their meals. The safest way to feed
these clients were described: HOB 90 degree (pillow
behind there head), watch for pocketing, do not rush, do not
mix foods.
Completed course BLS-HCP (C). The required CPR
certification for a license practical nurse.
CLPNA Registration #:__________
Page 12

Clpna Self-Assessment Tool Assignment 2

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Carly Legault

September 12, 2013

Self-Assessment Tool CCP

Self-Assessment Tool CCP

SELF-ASSESSMENT TOOL - RATING SCALE..........................................................................4

STEP 3: LEARNING PLAN......................................................................................................10

RECORD OF PROFESSIONAL ACTIVITIES............................................................................11

Self-Assessment Tool CCP

STEP 1: SELF-ASSESSMENT WITHIN STANDARDS OF

Applies knowledge of anatomy and physiology

Applies knowledge of microbiology throughout

Applies knowledge of pathophysiology to the

Uses appropriate medical terminology to report

Adjusts nursing practice to the specific growth

Applies principles of nutrition to the assessment

Applies knowledge of pharmacology throughout

Self-Assessment Tool CCP

Integrates knowledge and skills from the

Performs health assessment of client using

Implements the planning process and

Identify and analyze nursing diagnosis.

Implements nursing interventions to carry out

Reassess, review, and modify plan of care to

Evaluates the clients response to care and

Applies critical thinking and clinical judgment

Effectively uses protective devices to protect

Demonstrates the consistent application of

Applies principles of medical and surgical

Applies nursing knowledge and clinical

Uses effective verbal and written

Appropriately establishes, maintains, and

Collaborates with health care team to function

Adheres to the channels of communication

Self-Assessment Tool CCP

D: Communication and Interpersonal Skills

Provides client and family teaching.

Reports and documents following legal

Applies clinical judgment in identifying problems

Effectively manages time and organizes client

Demonstrates ability to rank the priority of client

Understands the key components of the Health

Understands the Restricted Activity

Understands the CLPNA Standards of Practice.

Adheres to the CLPNA Code of Ethics and

Acts as an advocate for client and empowers

Demonstrates accountability for own nursing

Maintains the confidentiality of client

Recognizes professional boundaries within the

Accepts responsibility for continuing

Participates in continuous quality improvement

Keeps informed of current research affecting

X: Nursing Practice and Leadership

Recognizes own strengths and limitations as a

Uses appropriate channels of communication to

Self-Assessment Tool CCP

report risks within setting.

Applies critical thinking and clinical judgment

Shares knowledge, skill, and expertise with

Seeks opportunities to teach and mentor others.

Participates in committees, task forces and

Self-Assessment Tool CCP

Category A: Nursing Knowledge