NURSE CERTIFICATION PROGRAM Self … - Nurse...DOH NCP-CAC Self-Assessment Tool (Form 1) Revision 0 April 2013 ... Gives and receives cues / data on patient status to and from appropriate

Republic of the Philippines

DEPARTMENT OF HEALTH

NURSE CERTIFICATION PROGRAM

DOH NCP-CAC Self-Assessment Tool (Form 1) Revision 0 April 2013

Self-Assessment Tool for Level 3 Certification in Cardiovascular Nursing

Name of Candidate: __________________________________________________________ Hospital of current employment: _______________________________________________ Introduction: A nurse Candidate who seeks to be certified as a specialist in Cardiovascular 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.

No. Performance Criteria Rarely Sometimes Always Comments

1. NCCVNL3A01 Obtains a complete and accurate patient history to identify risks, predisposition to and/or actual cardiovascular problems

2. NCCVNL3A02 Conducts a comprehensive, systematic and organized cardiovascular physical assessment utilizing appropriate tools and methods

3. NCCVNL3A03 Correlates assessment findings with patient’s condition

4. NCCVNL3A04 Conducts risk stratification for cardiovascular diseases utilizing available risk screening tool/s

5. NCCVNL3A05 Receives and provides cardiovascular information (clinical status, diagnostic findings, etc.) significant in the management of the patient

6. NCCVNL3A06 Makes clinical judgments based on immediate grasp of patient’s clinical condition

7. NCCVNL3A07 Coordinates the implementation of the plan of care to appropriate member/s of the health team

8. NCCVNL3A08 Identifies accurately abnormal cardiovascular data from laboratory and diagnostic findings to correlate with the patient’s condition

9. NCCVNL3A09 Interprets basic dysrhythmias correctly

10. NCCVNL3A10 Interprets hemodynamic data correctly

11. NCCVNL3A11 Recognizes early deviations from the expected outcome based on patient’s response (e.g., isolated PVCs)






12. NCCVNL3A12 Implements clinical practice guidelines towards achievement of positive patient outcomes

13. NCCVNL3A13 Implements individualized strategies to overcome barriers in achieving expected outcomes

14. NCCVNL3A14 Modifies interventions to address physical, emotional, and spiritual comfort, pain, and/or suffering

15. NCCVNL3A15 Sets short-term and long-term goals for all nursing problems identified

16. NCCVNL3A16 Modifies plan of care and interventions based on changes in patient’s condition

17. NCCVNL3A17 Provides compassionate and efficient patient care in compliance with clinical safety goals and practices

18. NCCVNL3A18 Prepares patient for cardiovascular interventional procedures

19. NCCVNL3A19 Applies appropriate post-procedural nursing interventions to prevent, detect, monitor and manage early and late potential complications

20. NCCVNL3A20 Responds to cardiac emergencies by initiating or assisting in the provision of standard measures / procedures

21. NCCVNL3A21a CCU/MICU: Provides comprehensive care for patients with the following cardiovascular problems (Ischemic Heart Disease (MI), Valvular Heart Disease, Congenital Heart Disease, Cardiac Dysrhythmias)

22. NCCVNL3A21b ER: Applies standard resuscitative measures such as BLS, ACLS, PALS as the need arises

23. NCCVNL3A21c Telemetry Unit: Provides safe and effective continuous monitoring to cardiovascular patients who do not warrant ICU care






24. NCCVNL3A21d SICU: Provides comprehensive immediate post-operative care to patients who underwent open / closed heart and other types of surgery

25. NCCVNL3A21e PICU: Provides comprehensive care to pediatric patients with cardiovascular problems (Congenital Heart Defects, Rheumatic Heart Disease, etc.)

26. NCCVNL3A21f CV Lab: Provides comprehensive care to patients undergoing invasive diagnostic and interventional procedures

27. NCCVNL3A21g OR: Provides comprehensive perioperative care before, during and after open / closed heart and other types of surgery a. Conducts preoperative orientation to

patients who will undergo surgery b. Performs as scrub/circulating nurse intra-

operatively c. Monitors patient outcomes post-

operatively

28. NCCVNL3A21h Cardio-Renal: Provides comprehensive care for patients with cardio-renal problems undergoing hemodialysis

29. NCCVNL3A22 Modifies plan of care according to patient’s response to nursing and medical management

30. NCCVNL3B01 Provides comprehensive patient-focused cardiovascular health education to patients and family

31. NCCVNL3B02 Acts as resource person for patient and family health education programs

32. NCCVNL3C01 Engages patient and family in a partnered relationship by providing relevant information, resources, access, and support

33. NCCVNL3C02 Gives and receives cues / data on patient status to and from appropriate member/s of the health team utilizing effective standard system






34. NCCVNL3C03 Conducts comprehensive patient care reports clearly (hand-off communication)

35. NCCVNL3D01 Discusses with health care team multi-disciplinary care management

36. NCCVNL3E01 Reinforces information on cardiovascular care and management to enable patient and family to make sound decisions (e.g., request for bioethical consultation, DAMA, DNR, Advance Directives, etc.)

37. NCCVNL3E02 Advocates for patients/families’ needs based on patient/family values, preferences and diversity

38. NCCVNL3F01 Utilizes available resources (manpower, supplies, equipment) necessary in the care of the cardiovascular patient

39. NCCVNL3G01 Makes comprehensive documentation of data obtained from cardiovascular assessment and care using standard methods, forms and protocols (SBAR, FDAR, Flowsheets)

40. NCCVNL3G02 Demonstrates proper safekeeping and handling of records

41. NCCVNL3G03 Maintains confidentiality of patient’s records

42. NCCVNL3H01 Conducts patient care audit in order to identify areas for improvement

43. NCCVNL3I01 Performs patient care consistent with safety goals and practices, policies and national laws on health, the Philippine Nursing Act and hospital policies, rules and regulations

44. NCCVNL3J01 Implements findings of cardiovascular-related researches conducted

45. NCCVNL3J02 Participates in research activities either as Principal or co-investigator, research assistant or as support staff to the research team






46. NCCVNL3K01 Implements effective time management skills in patient care through independent work performance

47. NCCVNL3K02 Mediates conflicts between individuals

48. NCCVNL3L01 Actively engages in the pursuit of continuous professional and personal education, life-long learning and development

49. NCCVNL3M01 Recognizes limits of clinical judgment to seek appropriate help as necessary

50. NCCVNL3M02 Demonstrates core professional values (patient-focused care, respect, integrity, compassion, altruism, human dignity and excellence)

51. NCCVNL3M03 Demonstrates professional decorum at the workplace in a manner consistent with the Nurses’ Code of Ethics, Standards of Nursing Practice, policies and procedures of the hospital/agency









Ward OPD DR OR ER



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. Underpinning NCCVNL3A01 Obtains a complete and accurate patient history to identify risks, predisposition to and/or actual cardiovascular problems

2. NCCVNL4A01 Obtains a complete and accurate patient history to identify impending cardiovascular complications

3. Underpinning NCCVNL3A02 Conducts a comprehensive, systematic and organized cardiovascular physical assessment utilizing appropriate tools and methods

4. Underpinning NCCVNL3A03 Correlates assessment findings with patient’s condition

5. NCCVNL4A02 Identifies risks and danger signs of possible complications that require immediate medical and surgical interventions

6. NCCVNL4A03 Recognizes patterns and trends that predict the direction of cardiovascular problems

7. NCCVNL4A04 Refers promptly to the appropriate member of the health team any condition that requires immediate cardiovascular management

8. NCCVNL4A05 Identifies abnormalities in invasive diagnostic procedures (cardiac catheterization, coronary angiogram) such as single-vessel and multi-vessel disease

9. NCCVNL4A06 Recognizes abnormalities such as cardiac dysrhythmias and hemodynamic instability during diagnostic procedures

10. NCCVNL4A07 Correlates results of diagnostic and laboratory procedures with patient’s clinical condition to initiate prompt intervention and referral






11. NCCVNL4A08 Implements immediate independent nursing measures necessary to manage emergent deviations (variances) from normal

12. Underpinning NCCVNL3A12 Implements clinical practice guidelines towards achievement of positive patient outcomes

13. NCCVNL4A09 Implements individualized strategies to overcome potential barriers that would prevent achievement of expected outcome

14. Underpinning NCCVNL3A14 Modifies interventions to address physical, emotional, and spiritual comfort, pain, and/or suffering

15. NCCVNL4A10 Integrates nursing theories relevant to the preventive, promotive, curative and rehabilitative needs of patients

16. Underpinning NCCVNL3A16 Modifies plan of care and interventions based on changes in patient’s condition

17. Underpinning NCCVNL3A17 Provides compassionate and efficient patient care in compliance with clinical safety goals and practices

18. Underpinning NCCVNL3A19 Applies appropriate post-procedural nursing interventions to prevent, detect, monitor and manage early and late potential complications

19. Underpinning NCCVNL3A20 Responds to cardiac emergencies by initiating or assisting in the provision of standard measures / procedures

20. NCCVNL4A11 Manages potential complications during and after cardiovascular interventional procedures

21. Underpinning NCCVNL3A21a CCU/MICU: Provides comprehensive care for patients with the following cardiovascular problems (Ischemic Heart Disease (MI), Valvular Heart Disease, Congenital Heart Disease, Cardiac Dysrhythmias)

22. Underpinning NCCVNL3A21b ER: Applies standard resuscitative measures such as BLS, ACLS, PALS as the need arises






23. Underpinning NCCVNL3A21c Telemetry Unit: Provides safe and effective continuous monitoring to cardiovascular patients who do not warrant ICU care

24. Underpinning NCCVNL3A21d SICU: Provides comprehensive immediate post-operative care to patients who underwent open / closed heart and other types of surgery

25. Underpinning NCCVNL3A21e PICU: Provides comprehensive care to pediatric patients with cardiovascular problems (Congenital Heart Defects, Rheumatic Heart Disease, etc.)

26. Underpinning NCCVNL3A21f CV Lab: Provides comprehensive care to patients undergoing invasive diagnostic and interventional procedures

27. NCCVNL4A12 CV Lab: Supervises the performance of the scrub and circulating nurses during diagnostic and interventional procedures

28. Underpinning NCCVNL3A21g OR: Provides comprehensive perioperative care before, during and after open / closed heart and other types of surgery a. Conducts preoperative orientation to

patients who will undergo surgery b. Performs as scrub/circulating nurse intra-

operatively c. Monitors patient outcomes post-operatively

29. NCCVNL4A13 OR: Supervises the performance of the scrub and circulating nurses during Closed / Open Heart and other types surgery

30. Underpinning NCCVNL3A21h Cardio-Renal: Provides comprehensive care for patients with cardio-renal problems undergoing hemodialysis

31. NCCVNL4A14 Cardio-Renal: Provides comprehensive care for patients with cardio-renal problems undergoing RRT

32. NCCVNL4A15 Provides the emerging needs of adult and pediatric patients undergoing: a. Invasive diagnostic and interventional

procedures b. Open and closed heart surgery c. Cardiac monitoring






d. Hemodialysis and CRRT

33. NCCVNL4A16 Proposes innovations in nursing care strategies and education programs related to the care and management of cardiovascular patients

34. NCCVNL4A17 Monitors the progress of patients towards achievement of desired outcomes

35. Underpinning NCCVNL3B01 Provides comprehensive patient-focused cardiovascular health education to patients and family

36. NCCVNL4B01 Develops IEC materials for utilization in the prevention and management of cardiovascular problems

37. Underpinning NCCVNL3C02 Gives and receives cues / data on patient status to and from appropriate member/s of the health team utilizing effective standard system

38. NCCVNL4C01 Reinforces disclosure of critical information to patient, family and relatives

39. NCCVNL4D01 Initiates collaboration with medical practitioners and other members of the health team on specific care and management as necessary

40. NCCVNL4E01 Advocates appropriately for patient and family on conflicts and issues that may arise regarding care (e.g., request for bioethical consultation, DAMA, DNR, Advance Directives, etc.)

41. NCCVNL4F01 Maintains availability and functionality of available resources (manpower, supplies, equipment) necessary in the care of the cardiovascular patient

42. Underpinning NCCVNL3G01 Makes comprehensive documentation of data obtained from cardiovascular assessment and care using standard methods, forms and protocols (SBAR, FDAR, Flowsheets)

43. Underpinning NCCVNL3G02 Demonstrates proper safekeeping and handling of records

44. Underpinning NCCVNL3G03 Maintains confidentiality of patient’s records






45. NCCVNL4G01 Monitors completeness and accuracy of documented data on assessment and care rendered

46. NCCVNL4H01 Identifies areas for improvement in cardiovascular nursing practice using appropriate tools/methods

47. NCCVNL4H02 Participates in developing quality plans on patient care processes, procedures, standards and systems in the work area

48. Underpinning NCCVNL3I01 Performs patient care consistent with safety goals and practices, policies and national laws on health, the Philippine Nursing Act and hospital policies, rules and regulations

49. NCCVNL4I01 Addresses legal issues and dilemmas pertaining to care and management (e.g., DNR, DAMA, etc.)

50. NCCVNL4I02 Reports practices that promote potential harm or breaches in policies and procedures

51. Underpinning NCCVNL3J02 Participates in research activities either as Principal or co-investigator, research assistant or as support staff to the research team

52. NCCVNL4J01 Reviews research protocols prior to implementation

53. Underpinning NCCVNL3K01 Implements effective time management skills in patient care through independent work performance

54. NCCVNL4K01 Accepts expanded responsibility and accountability for nursing interventions, treatment outcomes and changes occurring in health care provisions

55. NCCVNL4K02 Coordinates nursing functions based on assessed competencies and abilities of peers while functioning in a leadership role

56. NCCVNL4K03 Acts quickly to resolve conflicts in patient care and within the health care team calmly, objectively and fairly






57. Underpinning NCCVNL3L01 Actively engages in the pursuit of continuous professional and personal education, life-long learning and development

58. NCCVNL4L01 Assumes full accountability for professional behavior during the experience to perform within ethical/legal norms

59. Underpinning NCCVNL3M02 Demonstrates core professional values (patient-focused care, respect, integrity, compassion, altruism, human dignity and excellence)

60. Underpinning NCCVNL3M03 Demonstrates professional decorum at the workplace in a manner consistent with the Nurses’ Code of Ethics, Standards of Nursing Practice, policies and procedures of the hospital/agency

61. NCCVNL4M01 Recognizes limits of clinical judgment to seek multidisciplinary collaboration and consultation as necessary









Ward OPD DR OR ER



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. NCCVNL5A01 Develops nurses’ ability in obtaining complete and accurate cardiovascular patient history

2. NCCVNL5A02 Develops nurses’ ability in conducting a comprehensive, systematic and organized cardiovascular physical assessment

3. NCCVNL5A03 Interprets multiple sources of data to dynamically respond to the situation by seeking multidisciplinary collaboration as necessary

4. NCCVNL5A04 Supervises nurses in making prompt referrals

5. NCCVNL5A05 Evaluates ability of nurses to recognize abnormalities such as cardiac dysrhythmias and hemodynamic instability during diagnostic procedures

6. NCCVNL5A06 Develops the ability of nurses in correlating diagnostic findings and hemodynamic data with patient’s condition

7. NCCVNL5A07 Develops nurses in utilizing clinical practice guidelines towards achievement of positive patient outcomes

8. NCCVNL5A08 Monitors the implementation of Clinical Practice Guidelines / Pathways for Cardiovascular Care and Management

9. NCCVNL5A09 Supervises nurses in preparing nursing care plan; evaluating and modifying care plan as necessary based on the changing needs of patients

10. NCCVNL5A010 Develops the skills of nurses in drug administration, handling patients pre/post non-invasive and invasive cardiac interventions and skills in resuscitation






11. NCCVNL5A11 Initiates care strategies, processes, health education programs, etc. beneficial in the care and management of cardiovascular patients

12. NCCVNL5A12 Supervises nurses in evaluating effectiveness of patient care rendered

13. NCCVNL5B01 Evaluates implementation of health education programs conducted for patients and families

14. NCCVNL5C01 Communicates cardiovascular-related patient care and management issues to appropriate member/s of the health team for appropriate action/s

15. NCCVNL5D01 Participates in the review/ revision / formulation of interdisciplinary policy making for patient care

16. NCCVNL5E01 Supervises the ability of nurses in addressing ethical issues

17. NCCVNL5F01 Allocates resources (manpower, supplies, equipment) necessary in patient care at all times

18. NCCVNL5G01 Evaluates nurses’ ability to document assessment and care

19. NCCVNL5G02 Regulates safekeeping and disposal of records

20. NCCVNL5H01 Evaluates effectiveness of patient care processes, procedures, standards and systems in the work area

21. NCCVNL5H02 Establishes indicators to monitor quality and effectiveness of cardiovascular services rendered

22. Underpinning NCCVNL4I01 Addresses legal issues and dilemmas pertaining to care and management (e.g., DNR, DAMA, etc.)

23. Underpinning NCCVNL4I02 Reports practices that promote potential harm or breaches in policies and procedures

24. NCCVNL5I01 Participates in the formulation of unit and institutional policies and guidelines

25. NCCVNL5J01 Supervises the conduct and implementation of research process and output






26. NCCVNL5J02 Participates in the formulation / implementation / review/revision of cardiovascular policies, procedures and guidelines based on research findings

27. NCCVNL5K01 Supervises the effective delivery of patient care by nurses

28. NCCVNL5K02 Manages situations to avoid conflict

29. Underpinning NCCVNL3L01 Actively engages in the pursuit of continuous professional and personal education, life-long learning and development

30. NCCVNL5L01 Facilitates implementation of a career advancement plan for self and others

31. Underpinning NCCVNL3M02 Demonstrates core professional values (patient-focused care, respect, integrity, compassion, altruism, human dignity and excellence)

32. Underpinning NCCVNL3M03 Demonstrates professional decorum at the workplace in a manner consistent with the Nurses’ Code of Ethics, Standards of Nursing Practice, policies and procedures of the hospital/agency

33. NCCVNL5M01 Monitors clinical decision making, exercise of professional values and decorum of nurses

Documents

NURSE CERTIFICATION PROGRAM Self … - Nurse...DOH NCP-CAC Self-Assessment Tool (Form 1) Revision 0 April 2013 ... Gives and receives cues / data on patient status to and from appropriate