Rialyn Palma ID # 1038027

RSeptember 12, 2013

Self-Assessment Tool CCP

College of LPNs of Alberta

Page 1
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2 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

5
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

A: Nursing Knowledge
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

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)

4
3
3
2
2
3

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2 Edition - Revised October 2008

Competency
Number

A-8-2

Integrates knowledge and skills from the

sciences and humanities into the application of
the nursing process.

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.

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

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)

Rating
(1-5)

Rating
(1-5)

Rating
(1-5)

3
3
2
3

4
2
2
2
2

D: Communication and Interpersonal Skills

D-1

Year
20

C: Safety
C-1 to
C-4

Year
20

B: Nursing Process
B-1

Year
2016

3
2
2
2

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.

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.

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

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)

2
3
3
2

3
4
2
2
3
2
2
2
2
3

X: Nursing Practice and Leadership

X-1-5

Year
20

W: Professionalism
W-1-3

Year
2016

4
2

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
20

Year
20

Year
20

Year
20

3
2
3
4

SELF-ASSESSMENT SUMMARY
Year

2016

Competency
Number

A-1 TO
A-8-2

I believe I need to review some of my Nursing Knowledge to improve on this

competency. I need to review more anatomy and physiology and pathophysiology.
I know I have done assessments but I also think there is always room for
improvement especially refreshing my memory on anatomy and physiology. I
challenged pathophysiology course but I think that I should try to recognize and
memorize the common diagnoses and the pathophysiology of the most common
ones I may encounter. I also need to ensure I know the most common medications
to better improve my Pharmacology competency.

B1 to B4

For the Nursing Process competencies rated myself as mostly requires

improvement. I still need more practice with assessment clients since Im only a
student. During my CIA I have done my priorities in order and finished what was
most urgent first (ex. Medications that need to be given on time) but this is still a
learning process that Ill keep improving on especially since as a student I had only
done in the assessment exam.

2016

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.

C1 to C12 Application of nursing knowledge and clinical judgment to maintain safety of

client. This competency is ongoing and updated by going to seminars such as
continuing education. Going to these seminars will ensure that I keep my
competency up-to-date and client safety is maintained.

Self-Assessment Tool CCP

College of LPNs of Alberta

Page 5
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2 Edition - Revised October 2008

D1 to
2016 _ D-8-2

2016

2016

Competency in Communication and Interpersonal Skills. For this area of

competency, I will strive hard during my clinical to ensure that I always meet
priority needs first and then do needs that could wait, afterwards. I do believe that
these can always be improved upon and new situations can always arrive that can
be a learning opportunity to better be able to prioritize time. One of the areas that I
am strong in is being able to communicate with other health care team (as I am a
student I liked to ask questions so in case I ever encounter a certain scenario I can
best understand how to handle it). I do need to improve my communication with
clients. I tend to speak quietly and must learn to speak more confidently especially
when providing teaching to client and/or family.

W-1-3 TO In the competency for Professionalism, some of my strong qualities are accepting
responsibility that I need to continue my competence and that its an ongoing
W-11
development. I always want to make sure that I am doing things according to what
is best practice accorded to evidence based nursing practice. Some things that I
should research more on, are things that are restricted in the LPN regulation so I
completely know my boundaries and limitations.
X-1-5 TO With the competency for Nursing Practice and Leadership, I know need to improve
a lot on. I will be able to select appropriate channels of communication in
X-7-4
reporting risks. I will able to identify and manage risk appropriately through critical
thinking development. I will be able to provide myself with support for developing
course content.

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

Self-Assessment Tool CCP

College of LPNs of Alberta

Rating
(1-5)

Describe & Assess Specific Competencies

Page 6
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2 Edition - Revised October 2008

2016

A-7

U-7-3
2016

Applies knowledge of pharmacology throughout client care

and teaching. Pharmacology was a challenging subject for
me to learn. I believe I need lots of improvement in this
area. I should at least know the most commonly used
medications and know their class, what its used for and the
side-affects. I will remake my med cards (writing helps me
to remember better) and try to read on at least one common
medication use, each day, so that I know the class, use, sideeffects, and nursing implications for each.

I will be able to demonstrate IV initiation and administration

of medications safely and effectively.
4

Self-Assessment Tool CCP

College of LPNs of Alberta

Page 7
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2 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?)

I will join training that

can be organized by
educators to ensure I am
competent in handling
priorities, especially risk
priorities. I will also
review my courses in
Nursing Foundations that
touch on this subject.

September
2016 (When
precepts are
completed) to
November 2016

I will be able to handle

risk and use critical
thinking to a competent
level. The client will note
that I do what is important
first and my colleagues
will see that I am able to
work independently and
also be able to assist them
when needed.

September
2016 to
November 2016

I will be able to handle

the complete amount of
clients and still be able to
prioritize needs and
provide quality care.
Important tasks will be
completed on time. I will
receive good feedback
from my preceptor about
good time management
and good prioritizing.

X-4
Applies critical thinking
and clinical judgment
when assessing or
managing risk.

D-8-1

Self-Assessment Tool CCP

College of LPNs of Alberta

I will observe how my

preceptor effectively
manages their time. I will
take note of how to safely
and effectively save time
and prioritize needs with a
larger client load.

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2 Edition - Revised October 2008

R.Palma
Name: RIALYN PALMA

Self-Assessment Tool CCP

College of LPNs of Alberta

CLPNA Registration #: ____________

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2 Edition - Revised October 2008