1. Assess My Personal Competence and Learning Needs (I Know What I Do Not Know Or Cannot

NURS 437 - LPN Self Assessment

Given your LPN knowledge and your previous coursework in this curriculum, what do you know about the following self-assessment items in relation to family health nursing and the learning outcomes for NURS 437? Take time to reflect on each item and determine your knowledge and competence for each item.

If you answer “yes” to any of the items please provide a brief example, and if you answer “no” to any of the items, please explain your rationale/specific learning need in more detail.

1. Assess my personal competence and learning needs (I know what I do not know or cannot competently perform).

I am confident I can do this consistently (yes or no).
Yes:
Explain: I acknowledge my own unique body of knowledge in terms of skills and scope of practice. Practice limitations will arise in terms of experiential knowledge in conjunction with the LPN body of knowledge related to the particualr agency. Some things I am expected to know and perform, while there are other apsects I may not have encountered before and must ask for clarification, teaching/training, or in some cases be prepared to narrow the focus and set goals specific to the agency setting.
No:
Explain:

I would like to work on this some more (yes or no).
Yes:
Explain: I must be acutely aware of my own boundaries as well as my fitness to practice. This will include any skill I am asked to do in which my previous knowledge and experience is not adequate, or in instance where I am questioned as to the scope of my present practice as an LPN. For example, this may include the administration of vaccinations. I may lack fundamental knowledge or skills in this area and will set priorities and goals for future development.
No:
Explain:

2. Practice nursing in accordance with the CARNA Entry-to-Practice Competencies for the Registered Nurse profession (September 2006)

I am confident I can do this consistently (yes or no).
Yes:
Explain: I realize that as my practice evolves and I gain more experience and knowledge, I will become more specialized in relation to the area of nursing I have chosen. However, it is important to be aware of other cultural and religious practices, for example, recognize resources for dealing with language barriers, and to recognize my own discomfort in dealing with these types of situations where barriers to commuication and qualtiy of care may exist.
No:
Explain:

I would like to work on this some more (yes or no).
Yes:
Explain: Knowledge-based Practice: in working with a specialized body of knowledge, I must be familiar with stages of growth and development for effective health teaching and promotion. For example, a child whose weight versus height showed a high BMI. By asking further questions as to the eating habits and overnight routine (which happened to involve taking formula bottles in addition toa satisfactory amount of calories during the day), my preceptor and I were able to talk with the mother about decreasing formula for the child.

Another mother wondered why we were suggesting the introduction of solid foods at age 6 months instead of 4 months as she had done with "the other children". Knowing "how and where to find evidence to support the provision of competent nursing care" is crucial in this case. We were able to provide information supporting this change in practice, however I would like to pursue this topic further by exploring the research behind it.

Ethical practice: A challenging example was a mother who refused the MMR vaccine for her 18-month old child because of fear based on information provided through the media as well as another child already being diagnosed with autism. We had to accept/respect her refusal of treatment while ensuring that she was making an informed decision. This is definitely an area I would like to learn more about. It also greatly supports evidence-based practice when the health care provider can provide information to the client regarding research beyond media and/or myths that have developed over time causing stigma/fear.
No:
Explain:

3. Use the CARNA Joint Publication on Collaborative Nursing Practice in Alberta as a guide to differentiate between LPN practice and my upcoming RN practice.

I am confident I can do this consistently (yes or no).
Yes:
Explain: I will be moving from a role considered to be "supervised" and caring for "stable" patients to one involving an increased level of critical thinking and implementation of additional resources on many levels. This will be an ongoing, developing skill. The complexity of needs will require a more complex level of care. For example, a child who is behind on their immunizations or whose parents are from an endemic country: as an LPN I would not be in a position to make these decisions, but the RN (based on experience and body of knowledge) is able to make appropriate decisions and provide necessary care. The LPN would be suited to a role of immunizing children in a school where protocol is straight-forward.
No:
Explain:

I would like to work on this some more (yes or no).
Yes:
Explain: Differences between LPN and RN practice within the clinical setting have been evident in terms of the above mentioned and also the role of the LPN in school nursing. This appears to be a somewhat limited role is terms of administering vaccines. LPN's are not involved with the school nurse teaching component. This is an area I would like to explore. Also, discrepancy arises as to whether LPN's should administer vaccines in the clinic - only certain vaccines? Under the direct supervision of an RN? Drawing up the vaccines (reconstituting) or only administering? So many questions and concerns arose in my own mind that I have decided to focus on all other areas of teaching and health promotion, weighing and measuring, safety and nutrition. The knowledge base of immunizations is more important than the skill itself. RN's in the well child clinic take a 6-week orientation course, therefore I have chosen to not put myself in a compromising and perhaps unsure situation at this time.
No:
Explain:

4. Use the 7 values in the Canadian Nurses Association Code of Ethics for Registered Nurses (2008) to guide my RN practice.

I am confident I can do this consistently (yes or no).
Yes:
Explain:I believe this is the foundation of nursing! Valuing each client independent of culture, language, social/income status and providing the same level of quality care to every client. I am realizing my own barriers in terms of appearance (ex. a big, bald man with tattoos and earrings, wearing black Harley Davidson clothing…I soon realized that with conversation and allowing him to open up, he was just as unsure as anyone would be. He was in for immunizations following a stem-call transplant and was struggling with returning back to regular activities and coping with life in general).
No:
Explain:

I would like to work on this some more (yes or no).
Yes:
Explain:Safe, competent, ethical care/Accountability: advocate for additional resources when necessary (inquiring about financial resources Ex. referral to milk fund if necessary).

Quality practice environments: Evaluating the teaching tools available and knowing why we do things the way we do. Sterile technique? Clean environment? Adequate staff?
No:
Explain:

5. Use the Community Health Nurses Association of Canada Standards to guide my RN practice.

I am confident I can do this consistently (yes or no).
Yes:
Explain: I am becoming increasingly more knowledgeable about what health promotion is in terms of incorporating the determinants of health. Each client has a unique set of experiences and challenges. Being aware of available resources is crucial. A mother estranged from her husband, now with a new baby with another man, is struggling to be an influential part of her older children's lives (they live with the 1st husband) while caring for a new baby. She is concerned re: the parenting practices of the older children by the ex-husband (Ex. grounding, taking away belongings for months at a time, children doing the housework/cooking/cleaning, the children stealing, etc.) My preceptor and I provided many resources for help (Ex. East Side Counselling) and encouraged her about communication techniques with the ex-husband.
No:
Explain:

I would like to work on this some more (yes or no).
Yes:
Explain: Promoting Health: to encourage empowerment and using health as a daily resource. Conducting a holistic assessment in a conversational manner requires building repoire and establishing trust. I need to continue to address root causes of illness and disease and be aware of "what is out there" to provide evidence-based care. To look at the whole picture of the client is also to be in collaboration with other members of the health care team such as other nurses and the client's physician(s).

Building Individual/Community Capacity: assisting clients to obtain available resources to support taking action on their individual health issues. I would like to become more aware of resources and to assess readiness for change. In this clinical setting, follow-up may be difficult because unless requested or through the "resource nurse" a different nurse may be following up with each clinic visit.
No:
Explain:

6. Use the CARNA Professional Boundaries document to guide my RN practice.

I am confident I can do this consistently (yes or no).
Yes:
Explain: I will be able to do this consistently with time and guidance. I recognize my own boundaries in terms of physical touch and verbal abuse both on my part and from the client. My struggle lies in wanting to be able to help at times beyond what I am able to provide. I may often be unable to assist and be frustrated by noncompliance, apathy, or negligence/ignorance.
No:
Explain:

I would like to work on this some more (yes or no).
Yes:
Explain: I was challenged by a mother who refused the MMR vaccine for her 18-month old child because of fear related to previous media as well as the fact that an older child in the family has been diagnosed with autism. Instead of insisting on the vaccine based on the long-term benefits, I would like to become more informed on the research to this link as well as understanding autism more thoroughly.
No:
Explain:

7. Access and use relevant nursing research and evidence based information to make practice decisions.

I am confident I can do this consistently (yes or no).
Yes:
Explain: I intend to remain informed of recent research in relation to health promotion and its applications. For example, why do recommendations/guidelines change (babies sleeping on side vs. back, introducing solids @ 6 months vs. 4 months).
No:
Explain:

I would like to work on this some more (yes or no).
Yes:
Explain: Practices in the clinical placement ARE evidence-based, but I would like to go beyond just knowing that to having the specific knowledge base provided by recent research on these topics. For example, being more familiar with autism and the fearful correlation that has been made with the MMR vaccine. Another example is to provide evidence for breastfeeding and healthy growth and development.
No:
Explain:

8. Prioritize my nursing actions based on safety and principles of client protection.

I am confident I can do this consistently (yes or no).
Yes:
Explain: I am aware of the importance of privacy and confidentiality of patient information. Parents must provide consent for treatment of their children and also for additional resources (ex. mild fund) where personal information is required for follow-up care. Client protection and safety must be the primary focus when dealing with estranged or abusive parents specifically. Also, informing clients of potential problems (ex. reaction to immunization) is important.
No:
Explain:

I would like to work on this some more (yes or no).
Yes:
Explain: Challenges lie in cases where cultural factors play a role (Ex. one or both parents from an endemic area, father speaking on behalf of the wife (submissive), or joint custody where care of the child is split between households.
No:
Explain: