Self-Assessment Tool for Level 3 Certification in Pediatric Nursing Name of Candidate: Hospital of current employment: Introduction: A nurse Candidate who seeks to be certified as a specialist in Pediatric Nursing, Level 3, will have to accomplish this self-assessment form and prepare the needed evidence to show proof of competence. Upon accomplishment of the form, the candidate will discuss the data and the evidence with his/her immediate supervisor for validation. It may be necessary to revise responses based on this discussion. The Candidate then submits to the Committee on Assessment and Certification the validated self-assessment tool and supporting evidence for review and assessment by the independent Assessors, who will determine competency or recommend development opportunities. This Self-Assessment Tool is both formative and summative. As such it provides information as to the areas and levels of competency of the Candidate with respect to the standard performance criteria. It also informs on competency gaps and therefore provides the Candidate with leads on which learning and development interventions he/she should undertake. Instructions: The second column in the table lists behavioural indicators that determine successful/outstanding performance in the workplace. In order to provide a calibrated picture of the Candidate s proficiency at demonstrating these behaviors, the tool uses a three-point rating scale that indicates frequency (consistency) of demonstrating a behaviour in a given situation at the workplace. After accomplishing the Self-Assessment Tool, take it for discussion and validation to your Immediate Supervisor, with the accompanying evidence to prove statements of competence. Refer to the Assessment Guide for the list of evidences. Submit the validated tool and evidence to the Committee on Assessment and Certification. Indicate with a tick mark in the corresponding box areas in the hospital where you are currently assigned (most of the time) to provide nursing services: Ward OPD DR OR ER NICU PICU MICU SICU RR CCU CVLab Nursery PDU CAPD Clinic HDU Others Validated by: Signature over Printed Name of Immediate Supervisor Date Signed
Place a tick mark in the corresponding frequency column if you demonstrate the behaviour indicated in the second column as the situation arises at the workplace. Consistency in demonstrating the specified behaviour while meeting the standard required for performance is gauged using the frequency terms: Rarely, Sometimes, Always. 1 2 3 4 5 6 7 8 9 10 11 NCPEDL3A01 Formulate accurate nursing diagnosis based on salient characteristics of critical paediatric condition with corresponding urgency. NCPEDL3A02 Recognize clinical manifestation that warrants emergency management such as respiratory shock, bleeding, or life threatening congenital abnormalities. NCPEDL3A03 Provide a comprehensive correlation of patient s history and physical assessment based on the clinical manifestation with actual diagnosis by physician NCPEDL3A04 Follow through full implementation of relevant diagnostic procedures /correctional intensive care interventions to facilitate prompt interpretation by the physician. NCPEDL3A05 Interpret diagnostic results and initiate emergency management as needed. NCPEDL3A06 Correlate present clinical manifestations and latest diagnostic results in order to modify plan of care. NCPEDL3A07 Integrate innovative nursing intervention in the plan of care. NCPEDL3A08 Prepare a plan of care in collaboration with other health care team members. NCPEDL3A09 Initiate supplementary treatment based on present condition of the patient NCPEDL3A10 Provide feedback on encountered hindrances and implemented solutions in carrying out doctor s orders. NCPEDL3A11 Administer high alert medications (e.g. morphine, chemotherapeutic drugs, antidotes etc.) base on the standards.
12 13 14 15 16 17 18 19 20 21 22 23 24 25 NCPEDL3A12 Analyze adverse drug event with the health care tem NCPEDL3A13 Re-assess the effectiveness of nursing care interventions base on the present clinical manifestation and diagnostic results. NCPEDL3B01 Develop materials and interactive learning activities that will reinforce teaching on health, nutrition, diseases prevention and management relevant to patients condition NCPEDL3C01 Present options to the patient or significant others that will help decision making relative to the treatment or procedure provided to the patient NCPEDL3C02 Sustain support with timely and accurate information about patient s condition NCPEDL3D01 Provide observation, inputs concerning the patient during multi disciplinary rounds or as needed NCPEDL3D02 Provide holistic perspective to health care NCPEDL3D03 Act as liaison / advocate of the patient during decision-making by the health team NCPEDL3E01 Investigates lapses in judgement that resulted to critical incidents NCPEDL3E02 Act on patients bio-ethical issues according to ethico-legal standards, protocols, and polices NCPEDL3E03 Reinforce awareness of patients responsibility for own health through education and communication activities NCPEDL3E04 Guide the patient and significant others in making ethico-legal decisions NCPEDL3F01 Supervise the replenishment of medical supplies and medication NCPEDL3F02 Assist the patients in resolving concern regarding availment of diagnostic and therapeutic procedures
26 27 28 29 30 31 32 33 34 35 36 37 38 39 NCPEDL3F03 Implement patient safety guidelines to eliminate environmental risk and hazard NCPEDL3F04 Implement Infection Control and Patient Safety Principles and policies. NCPEDL3G01 Consider carefully the ethical and legal implication in the documentation of a patient s condition NCPEDL3G02 Adapt to varying documentation processes and formats in different sub-specialty areas NCPEDL3H01 Participate in creation of quality circle/quality improvement team. NCPEDL3H02 Develops a comprehensive quality improvement plan NCPEDL3I01 Perform chest compression and rescue breathing on a neonates utilizing bag valve mask device NCPEDL3J01 Conducts pre test to validate the tools NCPEDL3J03 Oral defence and/or poster presentation NCPEDL3J04 Motivate health members in conceptualizing nursing research. NCPEDL3K01 Maintain an enabling work environment that promote trust, cooperation, and mutual concern NCPEDL3K02 Maintain adequate supply of resources (medical supply, medicine, equipment) to effectively implement policies and SOP s NCPEDL3L01 Actively engages in the pursuit of continuous professional development. NCPEDL3MO1 Behaves such that an image of professionalism is observed and professional values becoming of a role model are demonstrated
Self-Assessment Tool for Level 4 Certification in Pediatric Nursing Name of Candidate: Hospital of current employment: Introduction: A nurse Candidate who seeks to be certified as a specialist in Pediatric Nursing, Level 4, will have to accomplish this self-assessment form and prepare the needed evidence to show proof of competence. Upon accomplishment of the form, the candidate will discuss the data and the evidence with his/her immediate supervisor for validation. It may be necessary to revise responses based on this discussion. The Candidate then submits to the Committee on Assessment and Certification the validated self-assessment tool and supporting evidence for review and assessment by the independent Assessors, who will determine competency or recommend development opportunities. This Self-Assessment Tool is both formative and summative. As such it provides information as to the areas and levels of competency of the Candidate with respect to the standard performance criteria. It also informs on competency gaps and therefore provides the Candidate with leads on which learning and development interventions he/she should undertake. Instructions: The second column in the table lists behavioural indicators that determine successful/outstanding performance in the workplace. In order to provide a calibrated picture of the Candidate s proficiency at demonstrating these behaviors, the tool uses a three-point rating scale that indicates frequency (consistency) of demonstrating a behaviour in a given situation at the workplace. After accomplishing the Self-Assessment Tool, take it for discussion and validation to your Immediate Supervisor, with the accompanying evidence to prove statements of competence. Refer to the Assessment Guide for the list of evidences. Submit the validated tool and evidence to the Committee on Assessment and Certification. Indicate with a tick mark in the corresponding box areas in the hospital where you are currently assigned (most of the time) to provide nursing services: Ward OPD DR OR ER NICU PICU MICU SICU RR CCU CVLab Nursery PDU CAPD Clinic HDU Others Validated by: Signature over Printed Name of Immediate Supervisor Date Signed
Place a tick mark in the corresponding frequency column if you demonstrate the behaviour indicated in the second column as the situation arises at the workplace. Consistency in demonstrating the specified behaviour while meeting the standard required for performance is gauged using the frequency terms: Rarely, Sometimes, Always. Note that where distinct behaviors (criteria) are indicated for each of the three sub-specialties, you may fill out only the criteria corresponding to the sub-specialty of choice. 1 2 3 4 5 6 7 8 9 NCPEDICUL4A01 Coordinate with the members of the health care team regarding the care needed according to recognize clinical manifestation of crititcally ill patient. NCPEDORL4A01 Oversees nursing interventions or activities that provides a standard of excellence in the care of the patient before, during, and after surgery. NCPEDERL4A01 Coordinate with the members of the health care team regarding the care needed according to the recognized clinical manifestation of critically - ill patients. NCPEDICUL4A02 Collaborate with other allied medical teams in the provision of holistic care of critically-ill patient. NCPEDICUL4A03 Performs newborn-screening, Glasgow Coma Scale, APGAR and Ballard scoring as well as assessment of neonates variations of normal, congenital deformities, and malformations accurately. NCPEDERL4A02 Correlate deviated results and initiate appropriate actions promptly. NCPEDORL4A02 Correlate deviated results and initiate appropriate actions promptly during and after surgery. NCPEDERL4A03 Initiates needed emergency procedures such as: Defibrillation Endotracheal Intubation Neonatal/Pediatric Resuscitation Central Venous Access NCPEDORL4AO3 Manage deviated diagnostic result such as: Electrocardiogram Pulse Oximetry Device Arterial Blood Gas Hemoglucose Test
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 NCPEDICUL4A04 Manage deviated diagnostic results and initiate appropriate actions promptly. NCPEDICUL4A05 Evaluates the need to modify mechanical ventilator set up based on disease progression and clinical findings. NCPEDERL4A04 Formulate innovative strategies to zero out barriers in implementing emergency plan of care. NCPEDORL4A04 Formulate innovative strategies to zero out barriers in implementing peri-operative plan of care. NCPEDICUL4A06 Formulate innovative strategies to zero out barriers in implementing plan of care to critically-ill patient. NCPEDERL4A05 Manage resources needed in the implementation of emergency diagnostic and therapeutic procedure. NCPEDORL4A05 Manage resources needed in the implementation of the surgical procedure. NCPEDERL4A06 Explains to the parent/significant others the extent of patient s clinical condition. NCPEDORL4A06 Collaborate implementation of surgical plan with other health team members. NCPEDICUL4A07 Manage resources needed in the implementation of modified plan of care of critically-ill patient. NCPEDICUL4A08 Initiate appropriate interventions during lifethreatening situation. NCPEDICUL4A09 Demonstrates proficiency in supervision of nursing activities in situation that directly affects the patient s health and safety. NCPEDERL4A07 Integrate innovative emergency treatment in the plan of care. NCPEDORL4A07 Integrate identified supplementary treatment in the plan of care. NCPEDERL4A08 Initiate recommendations on quality improvement system based on gather adverse or sentinel events.
25 26 27 28 29 30 31 32 33 34 35 NCPEDORL4A08 Initiate recommendation on quality improvement system based on gathered on adverse and sentinel events during peri-operative care. NCPEDERL4A09 Execute expertise in carrying out emergency nursing care. NCPEDORL4A09 Execute expertise in delivering pre-operative, intraoperative and post-operative nursing care. NCPEDERL4A10 Initiates administration of emergency drugs and IV fluids to reverse patients condition. NCPEDICUL4A10 Integrate identified supplementary treatment in the plan of care NCPEDICUL4A11 Initiate recommendation on quality improvement system based on gathered on adverse and sentinel events. NCPEDERL4A11 Anticipate and eliminate/manage risk during emergency management such as: Medication error Fall IV burn NCPEDORL4A10 Anticipate and eliminate/manage risk associated with surgical procedure such as: Nosocomial infection Medication error Fall Burn Wrong site surgery NCPEDICUL4A13 Anticipate and eliminate/manage risk during critical management such as: Medication error Fall IV burn Nosocomial infection NCPEDL4B01 Revisit and review current policies and procedures in carrying out individualize patient care and make recommendation for improvement NCPEDL4C01 Share with other nursing staff effective strategies and techniques in eliciting patient and significant other cooperation
36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 NCPEDL4C02 Organize learning sessions for nursing staff on current trends and issues on the specialty area NCPEDL4D01 Rationalize observation, patient reactions to diagnostic, treatment NCPEDL4D02 Engage in committee discussion and activities that contribute to the improvement of patient care NCPEDL4E01 Intervene to mitigate effects of negative response of patients or significant others to hospital policies and procedures NCPEDL4E02 Monitor continues cascading to patients and significant others of Patient s Bill of Rights and Obligations NCPEDL4F01 Refer to appropriate department or office equipment that is scheduled for preventive maintenance NCPEDL4F02 Train nurses on the proper use of equipment and gadgets, troubleshooting of minor malfunctions and preventive maintenance NCPEDL4G01 Implement a monitoring system for quality documentation NCPEDL4G02 Recommend improvements to forms, charts, etc. NCPEDL4G03 Identify data that can be used for the improvement of care and/or the system documentation. NCPEDL4H01 Spearhead conduct of quality improvement studies NCPEDERL4I01 Perform chest compression and rescue breathing on pediatric patients and neonates utilizing bag valve mask device. NCPEDORL4I01 Assist surgeon in performing chest compression on pediatric patients and neonates during intra-and post-operative care. NCPEDL4I02 Craft advance training program for clinical enhancement. NCPEDL4I03 Develop and create standard list of equipment for use as checklist to check the instruments as it is set
51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 up for the case. NCPEDL4I04 Monitor procedure of decontaminations and sterilization in accordance to the ORNAP guidelines. NCPEDL4J01 Critique research studies/reports. NCPEDL4J02 Conceptualize protocol/sop in reviewing ethical researches comprehensively. NCPEDL4K01 Mobilizes resources for effective program implementation and service delivery NCPEDL4K02 Influence all nursing personnel to adhere to standards of safely, bioethical principles and evidence-based nursing practice NCPEDL4K03 Perform nursing audit on system and operation NCPEDL4K04 Monitor staff performance NCPEDL4K05 Lead multidisciplinary team as appropriate in the care of pediatric client with different types of diagnosis NCPEDL4K06 Recommend areas for improvement in nursing practice NCPEDERL4L01 Demonstrates enhanced skills in emergency nursing care of pediatric patient. NCPEDORL4L01 Demonstrates enhanced skills in peri-operative nursing care of pediatric patient. NCPEDICUL4L01 Demonstrates enhanced skills in critical nursing care of pediatric patient NCPEDL4L02 Act as mentor to level 1-3 nurses effectively NCPEDL4L03 Identify staff development needs and make necessary recommendation NCPEDL4M01 Seamlessly work with colleagues in tertiary care and other members of the multidisciplinary team NCPEDL4M02 Mindful of emotional impact of interventions and be aware to work with them and other professional confidently
Self-Assessment Tool for Level 5 Certification in Pediatric Nursing Name of Candidate: Hospital of current employment: Introduction: A nurse Candidate who seeks to be certified as a specialist in Pediatric Nursing, Level 5, will have to accomplish this self-assessment form and prepare the needed evidence to show proof of competence. Upon accomplishment of the form, the candidate will discuss the data and the evidence with his/her immediate supervisor for validation. It may be necessary to revise responses based on this discussion. The Candidate then submits to the Committee on Assessment and Certification the validated self-assessment tool and supporting evidence for review and assessment by the independent Assessors, who will determine competency or recommend development opportunities. This Self-Assessment Tool is both formative and summative. As such it provides information as to the areas and levels of competency of the Candidate with respect to the standard performance criteria. It also informs on competency gaps and therefore provides the Candidate with leads on which learning and development interventions he/she should undertake. Instructions: The second column in the table lists behavioural indicators that determine successful/outstanding performance in the workplace. In order to provide a calibrated picture of the Candidate s proficiency at demonstrating these behaviors, the tool uses a three-point rating scale that indicates frequency (consistency) of demonstrating a behaviour in a given situation at the workplace. After accomplishing the Self-Assessment Tool, take it for discussion and validation to your Immediate Supervisor, with the accompanying evidence to prove statements of competence. Refer to the Assessment Guide for the list of evidences. Submit the validated tool and evidence to the Committee on Assessment and Certification. Indicate with a tick mark in the corresponding box areas in the hospital where you are currently assigned (most of the time) to provide nursing services: Ward OPD DR OR ER NICU PICU MICU SICU RR CCU CVLab Nursery PDU CAPD Clinic HDU Others Validated by: Signature over Printed Name of Immediate Supervisor Date Signed
Place a tick mark in the corresponding frequency column if you demonstrate the behaviour indicated in the second column as the situation arises at the workplace. Consistency in demonstrating the specified behaviour while meeting the standard required for performance is gauged using the frequency terms: Rarely, Sometimes, Always. 1 NCPEDL5A01 Acts as trainors on specialized pediatric procedures. 2 NCPEDL5A02 Suggest alternative/ comprehensive diagnostic procedure 3 NCPEDL5A03 Validate effectiveness of Innovative strategies 4 NCPEDL5AO4 Review nursing care plan and provide enhancements 5 NCPEDL5A05 Design alternative protocols in identifying needed supportive treatment 6 NCPEDL5A06 Develop strategies towards culture of safety. 7 NCPEDL5A07 Encourage reporting of adverse drug/sentinel events through analysis of data in a non-punitive manner 8 NCPEDL5A08 Review and enhance/ system relevant to patient care 9 NCPEDAL5A09 Suggest enhancement and innovations on patient care standards in compliance with accrediting bodies. 10 NCPEDL5A010 Provide appropriate guidance and supervision in nursing care. 11 NCPEDL5A11 Review and enhance as appropriate the monitoring system and tools 12 NCPEDL5A12 Cascade monitoring system and tools concerning patient safety standards, quality improvement strategies, etc. 13 NCPEDL5A13 Provide learning/ counselling sessions to nursing staff who s are the subject of negative customer feedback 14 NCPEDL5B01 Supervise the implementation of area-wide health education activities 15 NCPEDL5B02 Develop and implements enhanced policies and procedures on individualized patient care and health education.
16 NCPEDL5B03 Create new policies and procedure in carrying out individualizes patient care. 17 NCPEDL5C01 Act as a resource speaker during learning sessions 18 NCPEDL5C02 Establish policies system and guidelines on therapeutic communication 19 NCPEDDL5D01Monitor the performance of the health care team to ensure proper delivery of patient care. 20 NCPEDDL5D02 Resolve relational and system/process (communication, information dissemination, etc.) concerns within the health care team for enhanced performance 21 NCPEDDL5D03 Utilize results of committee discussion to enhance system and produce relevant to patient care 22 NCPEDL5E01 Review and enhance policies/protocols that will guide nurses on how to assist patients and significant others in proper judgement and decision making when faced with crisis 23 NCPEDL5E02 Analyzes cause of differences in opinions and strategies 24 NCPEDL5E03 Present nursing care options for a patient crisis based on ethico-legal, moral and spiritual reasons and in accordance with hospital policies 25 NCPEDL5F01 Review and enhance policies on calibration of medical equipment 26 NCPEDL5F02 Monitor inventory of medical supply and medicines 27 NCPEDL5F03 Review and enhance policies and guidelines on patient safety, risk management and infection control 28 NCPEDL5G01 Review and enhance the forms, policies, guidelines and monitoring tools tailored fit to the institution s mandate. 29 NCPEDL5H01 Review and enhance policies and procedures on the implementation of quality improvement activities. 30 NCPEDL5H02 Apply the result of successful/approved quality improvement studies in other areas as standard
31 NCPEDL5H03 Act as a effective resource speaker on quality endeavours effectively and the hospital s best practices 32 NCPEDL5I01 Develop activities that will provide enhancement in the delivery of health education to patients. 33 NCPEDL5J01 Integrate research findings in paediatric practice. 34 NCPEDL5J02 Act as adviser in the development of evidence-based research studies 35 NCPEDL5K01 Identify together with staff concerned, performance goals for a given period 36 NCPEDL5K02 Evaluates performances of nursing support staff using standard evaluation tool 37 NCPEDL5K03 Review and enhance management policies and guidelines 38 NCPEDL5K04 Comply with legal and regulatory standards 39 NCPEDL5K05 Disseminates policies, regulations, circulars and programs among nurses and nursing support staff. 40 NCPEDL5K06 Leads improvements efforts and manage resistant to change 41 NCPEDL5K07 Manage resistance to change 42 NCPEDL5L01 Prepare and implement a staff development plan 43 NCPEDL5M01 Monitors personality and professional decorum of the nursing staff while acting as their role model