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 2 3 4 5 Excellent Competent Requires Improvement Developmental 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 Year 2015 Year 20__ Year 20__ Year 20__ Year 20__ A: Nursing Knowledge 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. 2 A-2 Applies knowledge of microbiology throughout care, disease prevention, and health promotion. 2 A-3 Applies knowledge of pathophysiology to the nursing care of the client. 2 A-4-4 Uses appropriate medical terminology to report and document client care. 1 A-5-9 Adjusts nursing practice to the specific growth and development of the client. 2 A-6 Applies principles of nutrition to the assessment and care of the client. 2 A-7 Applies knowledge of pharmacology throughout client care and teaching. 3 A-8-2 Integrates knowledge and skills from the sciences and humanities into the application of the nursing process. 2
B: Nursing Process Rating (1-5) Rating (1-5) Rating (1-5) Rating (1-5) Rating (1-5) B-1 Performs health assessment of client using assessment techniques and a systematic process. 2 B-2-2 Implements the planning process and establishes client priorities involving client in planning. 2 B-2-3 Identify and analyze nursing diagnosis. 2 B-3 Implements nursing interventions to out nursing care plan. 2 B-3-2 Reassess, review, and modify plan of care to meet the needs of the client. 2 B-4 Evaluates the clients’ response to care and treatment. 2 C: Safety 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. 3 C-5-1 Effectively uses protective devices to protect client, self, and others. 2 C-6-1 Demonstrates the consistent application of standard precautions. 3 C-7-1 Applies principles of medical and surgical asepsis in the delivery of care. 2 C-12 Applies nursing knowledge and clinical judgment to maintain physical safety of client. 2 D: Communication and Interpersonal Skills Rating (1-5) Rating (1-5) Rating (1-5) Rating (1-5) Rating (1-5) D-1 Uses effective verbal and written communication in the practice setting. 3 D-2 Appropriately establishes, maintains, and closes the nurse-client relationship. 1 D-3 Collaborates with health care team to function as an effective team member. 2 D-3-7 Adheres to the channels of communication within the employing agency. 2 D-4 Provides client and family teaching. 2 D-5 Reports and documents following legal protocols, agency policy and procedure. 2 D-7 Applies clinical judgment in identifying problems 2
and resolving issues in client care. D-8-1 Effectively manages time and organizes client care to meet priority needs. 3 D-8-2 Demonstrates ability to rank the priority of client needs. 2 W: Professionalism Rating (1-5) Rating (1-5) Rating (1-5) Rating (1-5) Rating (1-5) W-1-3 Understands the key components of the Health Professions Act-LPN Regulation. 2 W-2-3 Understands the Restricted Activity authorizations in the LPN Regulation. 2 W-3 Understands the Standards of Practice. 2 W-4 Adheres to the CLPNA Code of Ethics and Standards of Practice. 2 W-4-5 Acts as an advocate for client and empowers clients and families. 2 W-5-1 Demonstrates accountability for own nursing practice. 2 W-6 Maintains the confidentiality of client information. 2 W-7 Recognizes professional boundaries within the nurse-client therapeutic relationship. 2 W-9 Accepts responsibility for continuing competence and professional development. 1 W-9-4 Participates in continuous quality improvement and evidence based changes to nursing practice. 2 W-11 Keeps informed of current research affecting health care delivery. 2 X: Nursing Practice and Leadership Rating (1-5) Rating (1-5) Rating (1-5) Rating (1-5) Rating (1-5) X-1-5 Recognizes own strengths and limitations as a leader. 1 X-3-5 Uses appropriate channels of communication to report risks within setting. 2 X-4 Applies critical thinking and clinical judgment when assessing or managing risk. 2 X-7-1 Shares knowledge, skill, and expertise with colleagues and students. 1
X-7-3 Seeks opportunities to teach and mentor others. 2 X-7-4 Participates in committees, task forces and professional activities to the LPN perspective. 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 Describe & Assess Specific Competencies Rating (1-5) 2015 A-7 Applies knowledge of pharmacology throughout client care and teaching. 3 2015 C-1-4 Applies critical thinking and clinical judgment when responding to emergency situations. 3 STEP 3: LEARNING PLAN This page is intended to document your Learning Plan for one year. Photocopy this page for each additional year. Your Learning Plan must consist of at 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 (What I am going to learn?) Resources & Strategies (What will I do to meet objectives?) Target Date (Realistic time frame for achievement) Evaluation (How will I know I learned it?)
I will be able to describe the action; routes, adverse reactions and nursing implications of commonly used opioids to become more competent in medication administration. Review opioid medications in Pharmacology for Canadian Health Care 2nd Edition (Lilley, Harrington & Snyder, 2013) Create medication reference cards for common opioids prescribed in practice February 29, 2016 I will know that this learning objective is achieved when I am able to state the action; routes, adverse reactions and nursing implications of commonly used narcotics with 100% accuracy. I will demonstrate knowledge of assessments and interventions pertaining to emergent situations including anaphylaxis, cardiac arrest, CVA, trauma and alterations in hemodynamic stability. Review best practice in Brunner & Suddarth’s textbook of Canadian Nursing 2nd Edition (Day, Paul, Williams, Smeltzer & Bare, 2010) Create a study guide outlining emergent scenarios and corresponding interventions and assessments February 29, 2016 I will know that this learning objective is achieved when I am able to engage in emergency simulations and implement a least 3 appropriate interventions and assessments for each scenario previously stated. RECORD OF PROFESSIONAL ACTIVITIES Date Professional Activity (include course, seminar, research, Summary of Learning
hours, details) Feb. 2nd 2015 CPR (3h) Learned how to proceed with an infant and/or adult that has lost a pulse and/or respirations Learned the procedure for providing life sustaining measures Learned how to use a defibrillator to resuscitate March 14th 2015 Save Stan Workshop (6h) Learned how to communicate with the interdisciplinary team members to provide comprehensive care for an individual requiring care from multiple disciplines Learned how to effectively communicate with a client to meet health outcomes Learned how to respond appropriately to inquiry from clients regarding level of health Developed critical thinking Experienced scenarios involving mental health client, bariatric client, geriatric client, community health nursing and neurological rehabilitation. Developed ability to think on my feet when faced with tough questions from clients Dec. 2nd 2014 Its Your Move (4h) Learned how use proper body mechanics when maneuvering patients Learned how to prevent musculoskeletal injuries Learned how to assess a clients ability to maneuver themselves Learned the different of transferring a client Name: Robyn Begalke CLPNA Registration #:__________