F M Clpna Self Assessment

Fartun Mohammed
February 12, 2016
Self-Assessment Tool CCP

College of LPNs of Alberta
Page 1
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

Page 2
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
2015_
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 3
Year
2015_
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.
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.
2
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.
Adheres to the channels of communication
within the employing agency.

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
D-3-7
Year
20__
Rating
(1-5)
D: Communication and Interpersonal Skills
Year
20__
B-1
C: Safety
Year
20__
3
2
Page 4
Year
2015_
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.

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 5
Year
2015_
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
20__
Year
20__
Year
20__
Year
20__
SELF-ASSESSMENT SUMMARY
Year
Competency
Number
2015
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
2015
Category B: Nursing Process

B-2-2, B-2-3, B-3, B-4
2015
Category C: Safety
C-1 to C-4,C-5-1, C-5-1, C-6-1, C-7-1,C-12
2015
Category D: Communication and Interpersonal Skills

D-1, D-2, D-3, D-3-7, D-4, D-5, D-7, D-8-1
2015
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
2015
Category X: Nursing Practice and Leadership

X-1-5, X-3-5, X-4, X-7-1, X-7-3, X-7-4
2015
STEP 2: SELF-ASSESSMENT OF SPECIFIC COMPETENCIES

In this section, describe, assess, and rate the competencies specific to your area of work, specialty,
Page 6
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
A-3
Rating
(1-5)
Describe & Assess Specific Competencies
Applies knowledge of pathophysiology to the nursing care of the

client.
2015
This is an area I want to improve mostly knowledge of

pathophysiology I specifically choose to work on because it is
important for nurses to understand and be able to assess common
health challenges or diseases.
I will take advantage of various online and computerized

pathophysiology resources to increase my understanding and
cognitive retention of signs and symptoms and etiology.
I will organize and describe pathophysiological processes such
etiology of a disease, signs and symptoms, and course of
treatment and complications and health promotion strategies to
support optimal function of each system. The terminology of
human anatomy and physiology will be stressed
Most importantly I want have confidence in the knowledge and
skills I have gained throughout the program.
D-8-1
2015
Effectively manages time and organizes client care to meet

priority needs.
This is a priority in any area of nursing and it is a skill that I
specifically choose to work on. In order to effectively complete
tasks on time; every nurse needs to have good time management.
Personally, I feel that I am good at managing my time and my
instructor from clinical agrees by stating Excellent time
management and eye for details in assessment and client
teaching- very through. However, I dont feel it is at the level
that I would like to achieve. My aim is to improve and perfect my
skills so that I become great at time management.
I have also been told that I have great organizational skills but I
dont want to settle and become satisfied because doing so will
hinder my goal of always progressing in my career and life in
general.

Page 7
20___
20___
20___

Page 8
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 2015
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
pathophysiology of the
human body the
structure and function of
main organ systems and
health promotion
strategies to support
optimal function of each
system. The
terminology of human
anatomy and physiology
I am going to learn how

to effectively manage
my time and organize
client care to meet the
priority needs.
1. To accomplish this
learning objective I will
use my pathophysiology
textbook.
2. To meet my learning
objective I am going read
textbooks and also
purchase textbooks which
has pictures because I am
a visual learner seeing
pictures and diagrams in
the textbook will help me
learn.
1. To meet my learning
objectives, I will be
asking my preceptor and
other nurses for tips
2. I will make
Organization plans to help
my plan of care and time
management based on
priority needs.
Name: Fartun Mohammed

__________________________
Short goal
April 22,2016
Dec,2016
My target date
is before I
renew my
temporary
license
I will know I have learned

when I be able to identify 4
key signs and symptoms for
6 diseases/illnesses by the
end of my preceptorship
2. I will be able to teach

clients/ families of clients
key signs and symptoms of
the diseases/illnesses
presented.
3. I will know I have
learned pathophysiology
when I can connect disease
and pharmacology
April 22, 2016
1. I will know I have

learned time management
based on my evaluations
from my preceptors and by
having less anxiety and
stress while working. I feel
that when you have good
time management there will
be less stress on an
individual.
CLPNA Registration #: ____________
Page 9

Page 10
RECORD OF PROFESSIONAL ACTIVITIES

Date
Professional
Activity (include
course, seminar,
research, hours,
details)
Summary of Learning
Its Your Move

Sept 24,2015
Its an injury prevention program

(4.5hours )
I have learned how to safely transfer patient from

bed to wheelchair
How to use proper body mechanics
How to use med lift and safely transfer patient from
and to bed chair and toilet
January
27,2015
I completed code
I learned about my responsibility as an LPN to clients,
Ethics ecourse through public, colleagues, and profession.
www.learninglpn.ca
(1 hour)
Glucometers
(2 hours)
Proper techniques for using a glucometer
Diabetes In-Service
Session CBI Home
Health
I learned about the different medication classifications and

actions.
The risk factors and signs and symptoms of
Diabetes.
How to use different insulin pens
Sign and symptoms of hypoglycemia
How to treat hypoglycemia.
How insulin acts on the cells in the body.
Sept 24,2015
July 2015
(3 Hours)

Page 11
Name: _____________________

CLPNA Registration #:__________
Page 12

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Fartun Mohammed

February 12, 2016

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

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

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

Category A: Nursing Knowledge

Category B: Nursing Process

Category D: Communication and Interpersonal Skills

Category X: Nursing Practice and Leadership

STEP 2: SELF-ASSESSMENT OF SPECIFIC COMPETENCIES