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Carly Legault

September 12, 2013

Self-Assessment Tool CCP


College of LPNs of Alberta

Page 1
2nd Edition - Revised October 2008

Self-Assessment Tool CCP


College of LPNs of Alberta

Page 2
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


College of LPNs of Alberta

Page 3
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
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
201__

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.

Self-Assessment Tool CCP


College of LPNs of Alberta

Page 4
2nd Edition - Revised October 2008

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.

1
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.

Self-Assessment Tool CCP


College of LPNs of Alberta

Year
20__

Rating
(1-5)

D: Communication and Interpersonal Skills

Year
20__

B-1

C: Safety

Year
201__

Page 5
2nd Edition - Revised October 2008

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


report risks within setting

Self-Assessment Tool CCP


College of LPNs of Alberta

Year
201__

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
2nd Edition - Revised October 2008

Year
2016

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
201__

Year
20__

Year
20__

Year
20__

SELF-ASSESSMENT SUMMARY
Year
20_16_

Competency
Number

C-1 to
C-4

x-7-4

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

Clinical thinking and judgement

Offering the LPN perspective

20_16_

x-4
20__16_

Critical thinking and critical judgement

20___

20___

Self-Assessment Tool CCP


College of LPNs of Alberta

Page 7
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

20_16_

C-1 to C4

20__16_

X-7-4

20___16

D-8-1

Rating
(1-5)

Describe & Assess Specific Competencies

In nursing, critical thinking and judgement are two key factors in


providing safe and fast care. I have nearly started my career as a
Licensed Practical Nurse, so these areas still require further
development. The best way to obtain this skill set is watching
other nurses in certain situations and seeing how they react to it.

Although soon I will become an LPN, I am still unable to give


the LPN perspective because I have yet to really learn nor
understand what the LPN perspective is. As the years go by I
will be able to identify and explain exactly what an LPNs
perspective is in certain issues that come forth.
My time management skills along with my priority skills are still
very new to me. I can only fix this with practice and with
knowledge from other nurses. It is my responsibility as a nurse
to manage my time wisely to ensure all my patients are taken
care of and everything that needs to be done, gets done in a
timely manner.

20___

20___

Self-Assessment Tool CCP


College of LPNs of Alberta

Page 8
2nd Edition - Revised October 2008

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?)

1) I will review my notes


from my
communication
course about
promoting health and
preventing diseases.
Along with strategies
and areas of nurses
who do so.

1) June 2016
2) August 2016

1) -When my patients
come back from surgery I
will be able to apply the
knowledge I have learnt
throughout my research to
ensure they do not have
any post-operative
complications.
-When our unit gets
audited on handwashing
we will get a top mark
2) I will know Ive learned
more about myself by
constantly reflecting and
by understand where I
have gone wrong and how
I am able to improve these
areas
- I will also confide in
nurses around me and ask
how they find my
progress coming along.

1) knowledge of
microbiology
throughout care,
disease
prevention and
health promotion,
by reading and
reviewing my
pathophysiology
textbook.

2) Recognize personal
strengths and
limitations in myself
by constantly
reflecting.

I will obtain articles from


my work place that
discuss strategies in
preventing spreading of
germs.
I will perform hand
hygiene to ensure I carry
no harmful
microorganisms
2) Keeping a journal
entry on things I have
done right and things
I could improve on.
-Confide in nurses on
the unit to help me
improve my
limitations to better
myself as a nurse.

Name: ___________________________

Self-Assessment Tool CCP


College of LPNs of Alberta

CLPNA Registration #: ____________

Page 9
2nd Edition - Revised October 2008

RECORD OF PROFESSIONAL ACTIVITIES


Date

Professional Activity
(include course,
seminar, research,
hours, details)

Summary of Learning

CPR certification

Basic CPR for health care professionals

160 hours, Long term


care, Devonshire
retirement home

Safe medication delivery, along with providing different


levels of care in the long term care facility

Its your move

How to properly move patients safely and effectively, and


how to protect your back

March
11,2015

2,05,201529,05,2015

February
2015

Name: _____________________

Self-Assessment Tool CCP


College of LPNs of Alberta

CLPNA Registration #:__________

Page 10
2nd Edition - Revised October 2008

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