Republic of the Philippines DEPARTMENT OF …ejobs.doh.gov.ph/ncp-update/pdf/GER/Level 4 Self...

Republic of the PhilippinesDEPARTMENT OF HEALTH

NURSE CERTIFICATION PROGRAM

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

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Self-Assessment Tool for Level 4 Certification in Geriatric Nursing

Name of Candidate: __________________________________________________________________

Hospital of current employment: ________________________________________________________

Introduction: A nurse Candidate who seeks to be certified as a specialist in Geriatric Nursing, Level4, will have to accomplish this self-assessment form and prepare the needed evidence to show proof ofcompetence. Upon accomplishment of the form, the candidate will discuss the data and the evidence withhis/her immediate supervisor for validation. It may be necessary to revise responses based on thisdiscussion. The Candidate then submits to the Committee on Assessment and Certification the validatedself-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 theareas and levels of competency of the Candidate with respect to the standard performance criteria. It alsoinforms on competency gaps and therefore provides the Candidate with leads on which learning anddevelopment interventions he/she should undertake.

Instructions: The first column in the table lists behavioural indicators that determinesuccessful/outstanding performance in the workplace. In order to provide a calibrated picture of theCandidate’s proficiency at demonstrating these behaviors, the tool uses a three-point rating scale thatindicates standards of demonstrating a behavior in a given situation at the workplace.

After accomplishing the Self-Assessment Tool, take it for discussion and validation to your ImmediateSupervisor, with the accompanying evidence to prove statements of competence. In your respectivespecialty area. 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 currentlyassigned (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



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Place a tick mark in the corresponding standards column if you fulfill the corresponding evidences to the behaviors listed in the competency criteria.Consistency in demonstrating the specified behaviour while meeting the standard required for performance is gauged using the standards:Satisfactory, Very Satisfactory, Outstanding.

Competency Level 4: Obtain relevant comprehensive and problem-focused health histories for complex acute, critical, and chronically-illpatients using collateral sources as necessary NCGERL4A01Task Description: Evaluates the candidate’s ability to obtain relevant health information and history from patient, family, caregiver, andsignificant other utilizing standardized geriatric assessment tool (CGA) taking into account age, gender and cultural background

Criteria Satisfactory Very Satisfactory OutstandingAssesses relevant comprehensive and problem-focused health histories for complex acute,critical, and chronically-ill patients

As evidenced by:● Accomplished screening tool● Accomplished CGA with other members

of the healthcare team● Documentation in Nurses Notes and/or

prescribed referral form● Completed data which includes the ff:

5 domains documented in:1. Physical and Health Illness Condition2. Functional ability3. Psychological ability4. Cognitive ability5. Social Support System

● Completed valid and reliable geriatricscreening tools

● Documentation of findings both subjectiveand objective information (clinicalevidences) gathered as evidenced by fullyaccomplished CGA form

Able to accomplish 1-2 outof 6 criteria





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Performs holistic assessment including those who arenon-verbal, functionally and/or cognitivelyimpairedAs evidenced by:

● Accomplished reliable and valid age-appropriate assessment instruments to assessacute and chronic health concerns includingbut not limited to mental status, dementia,depression, delirium, pain

● Accomplished standardized assessmentinstruments

● Documented accurate findings gathered afterphysical examination

Recognizes non-verbal, functionally and/or cognitiveimpairment

As evidenced by:● Accomplished reliable and valid age-

appropriate assessment instruments to assessacute and chronic health concerns includingbut not limited to mental status, dementia,depression, delirium, pain

● Accomplished standardized assessmentinstruments

● Documented accurate findings gathered afterphysical examination

Determines health education promotion planningmodels appropriate to OP and expected learningobjectives and outcomes



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As evidenced by:● Copy of suitable health education promotion

model● Documented provision of health education

program in the logbook● Attachment of the patient and family

attendance and evaluation form

Analyses the relationship among development,normal physiology, and specific system alterationsthat can be produced by aging and/or disease process

As evidenced by:● Documentation of recognized specific system

alterations produced by aging and/or diseaseprocess

● Documentation of findings in nurses’ notes● Other forms

Facilitates advance care planning confidently

As evidenced by :● Documentation of interview with the patient

and family and/or SOs as necessary usingopen and ended questions

● Accomplished standardized assessment toolfor Advance Care plan or End-of-Life Careprescribed by the institution

● Documentation information gathered fromthe interview of patient and SOs documentedin Nurses Notes



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Competency Level 4: Perform holistic assessment with non-verbal, functionally and/or cognitively impaired NCGERL4A02Task Description: Evaluates the candidate’s ability to obtain relevant health information and history from patient, family, caregiver, andsignificant other utilizing standardized geriatric assessment tool (CGA) taking into account age, gender and cultural background

Criteria Satisfactory Very Satisfactory OutstandingAssesses non-verbal, functional and/or cognitiveimpairmentAs evidenced by:

● Accomplished reliable and valid age-appropriate assessment instruments thatincludes acute and chronic health concernssuch as:

1. Mental status2. Dementia3. Depression4. Delirium5. Pain6. Others

● Accurate performance of standardizedassessment instrument

● Documented findings gathered after physicalexamination

Determines the health education promotion planningmodels appropriate to OP and expected learningobjectives and outcomesAs evidenced by:

● Accomplished health education promotionmodel

● Documented provision of health educationprogram in the logbook






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● Secure attachment of the patient and familyattendance

● Evaluation form

Evaluates the relationship among development,normal physiology, and specific system alterationsthat can be produced by aging and/or disease process

As evidenced by:● Documentation of specific system alterations

produced by aging and/or disease process● Documentation of findings in nurses’ notes.● Other forms

Performs pharmacologic assessment includingpolypharmacy, drug interactions, complex medicalregimen, OTC, herbal and supplemental product useand the patient’s and caregiver’s ability to safely andcorrectly store and self-administer medications

As evidenced by:● Accomplished interview with the patient and

family and/or SOs regarding properadministration and storage of medications

● Comprehensive documentation ofmedications including:a. polypharmacy

b. drug interactionsc. complex medical regimend. Over-the-counter drugse. herbal and supplemental product use



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3. Correct answer to the assessor’s questions

Analyzes the result of Caregiver Strain Index and/orpatient’s and family’s ability to cope with andmanage developmental (life stage) transitions

As evidenced by:● Documentation of gathered information from

the patient’s caregiver (accomplished CSIform)

● Accomplished checklist of interview with thepatient and family

● Other forms

Assesses the need for transition to a different level ofcare or care setting based on patient’s frailty,stability and resources

As evidenced by:● Documentation of gathered information

gathered from the patient and SOs asnecessary

● Documentation of the following:a. Readiness of the patient and family to

transitionb. Appropriate level and/or care settingc. Coordinating plan and implementation of

transitiond. Complete referral form or transitional

care form



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Competency Level 4: Determine typical and atypical presentations of complex acute and critical illnesses, potential for rapid physiologic andmental health deterioration or life-threatening instability based on clinical evidences NCGERL4A03Task Description: Evaluates the candidate’s ability to facilitate appropriate use of laboratory, diagnostic testing and clinical procedures forscreening and/or disease prevention strategies in collaboration with the attending physician with consideration of the cost, risks, and benefit tothe patient presence of co-morbidities, age-related changes and, its impact on presenting health problems, potential for rapid physiologic andmental health deterioration or life-threatening

Criteria Satisfactory Very Satisfactory OutstandingIdentifies typical and atypical symptomsAs evidenced by:

● Accomplished performance checklist ofCGA

● Documentation of co-morbidities, age-relatedchanges, and its impact on presenting healthproblems in Nurses Notes and CGA findings

● Other formsFacilitates diagnostic strategies to screen for andprevent sequelae of acute and critical illnesses andiatrogenic conditions with consideration of the risks,benefits, and costs to individuals based on goals ofcareAs evidenced by:

● Accomplished summary of CGA results withat least 2 identified geriatric sydromes,changes in levels of care, iatrogenicconditions and other significant healthproblem

● Completed list of geriatric syndromes andother related symptoms in Nurses Notesand/or Care Plan

● Accomplished clinical evidences (attached tochart) that will support the identification ofgeriatric syndromes, changes in levels of


Able to accomplish 3 out of4 criteria




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care, iatrogenic conditions and othersignificant health problem presented by thepatient

Draws differential nursing diagnoses from variety ofclinical sources recognizing disease progression,multisystem health problems, associatedcomplications, and iatrogenic conditionAs evidenced by:

● Documentation of Nursing diagnosis in theNurses Notes

● Documentation of physician’s order forlaboratory/diagnostic test and diagnoses

● Completed laboratory/Diagnostic test resultsthat supports differential diagnosesrecognized

● Charting of differential diagnoses in nursesnotes and/or CGA form

Synthesizes differential diagnoses by priority fornew or recurring complex acute, critical, and chronicphysical, mental health and behavioral disorders andproblems identified from variety of clinical sourcesfor appropriate management, consultation andreferralAs evidenced by:

● Documentation of Nursing diagnosis in theNurses Notes

● Documentation of physician’s order forlaboratory/diagnostic test and diagnoses

● Completed laboratory/Diagnostic test resultsthat supports differential diagnosesrecognized

● Charting of differential diagnoses in nursesnotes and/or CGA form



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Competency Level 4: Develop plan that will support, regain and maintain complex needs consistent with the patient’s goals of careNCGERL4A04Task Description: Evaluates the ability of the candidate to develop short and long term goals for plan of care using SMART method and theirability of the candidate to formulate nursing care plan parallel to and in in collaboration with multidisciplinary team

Criteria Satisfactory Very Satisfactory OutstandingDevelops plan of care with a primary goals ofpreventing acute exacerbation of any underlyingpathological process, prevent unnecessarydeterioration and maintain optimum physical andmental function

As evidenced by:● Documentation of the formulated

comprehensive nursing care plan● Copy of integrated and collaborative plan of

care involving multidisciplinary teammembers

● Complete nursing care plan which includes:a. Health maintenanceb. Disease preventionc. Therapeutic interventions

Develops plan that will support, regain and maintainage-specific physiologic and psychological stabilityspecifically for patients with complex needs(chronically illnesses and dementia consistent withthe patient’s goals of care)

As evidenced by:● Documentation in Nurses Notes






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● Documentation of involvement ofmultidisciplinary team members indeveloping the comprehensive treatmentplan (signed form)

● Other forms

Designs discharge plan that will address thecomplex, acute, critical, and chronic physicalproblems of patient

As evidenced by:● Documentation of comprehensive discharge

plan specific to the problems identified froma complex acute, critical, and chronicphysical problems of patient in collaborationwith multidisciplinary team members

● Accomplished at least 1 Discharge Plan● Other forms

Develops Transitional plan for long-termmanagement of healthcare problems with theindividual, family, and healthcare team

As evidenced by:● Documentation of comprehensive

Transitional Plan● Accomplished the plan with the assessor● Other forms



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Competency Level 4: Support the individual with a rapidly deteriorating physiologic condition NCGERL4A05Task Description: Evaluates ability of the candidate to implement and consequently modify nursing care plan depending on outcomes andresponse of patient to treatment and care

Criteria Satisfactory Very Satisfactory OutstandingIntervenes using basic life support to regainphysiologic stability

As evidenced by:● Documentation of nursing intervention

focusing on each specific problem● Documentation in

1. Nurses Notes2.Teaching plan

Intervenes using advanced life support and otherinvasive interventions or procedures to regainphysiologic stability


focusing on each specific problem in NursingNotes

● Other forms

Reinforces health education promotion process toaccomplish the plan


focusing on each specific problem in NursingNotes

● Other forms






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Competency Level 4: Evaluate effectiveness and adequacy of patient and caregiver’s support systems NCGERL4A06Task Description: Evaluates the candidate’s ability to monitor and assess outcomes of care, and formulate recommendations

Criteria Satisfactory Very Satisfactory OutstandingEvaluates effectiveness and adequacy of patient’ssupport systemsAs evidenced by:

● Documentation of patient, family andcaregiver’s response to nursing interventions

1.1 Progress notes1.2 Nurses notes

● Verbal reports from doctors, supervisors andcolleagues

Evaluates effectiveness and adequacy of caregiver’ssupport systemsAs evidenced by:

● Documentation of patient, family andcaregiver’s response to nursing interventions1.1 Progress notes1.2 Nurses notes


Updates screening to determine whether a re-evaluation is needed

As evidenced by:● Documentation of patient, family and

caregiver’s response to nursing interventions1.1 Progress notes1.2 Nurses notes







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Competency Level 4: Develops strategies to promote effective learning environment specially to patients with multiple comorbidities andcognitive impairment NCGERL4B01Task Description: Evaluates the candidate’s ability to provide patient-specific and additional information relevant to promotion of health,prevention and continuing care

Criteria Satisfactory Very Satisfactory OutstandingAssesses the patient’s learning needs appropriate forOP with complex care needs including multiplecomorbidities, chronic diseases, with sensory and/orcognitive problemsAs evidenced by:

● Documentation of:1. Assessment of the patient2.Documentation of response/s of patient3. Assessment of the family/caregiver

● Records in Nurses Notes and Health Educationlogbook

Assesses patient and family’s level of understandingon patient’s health condition and plan of care

As evidenced by:● Documentation of:

1. Assessment of the patient2.Documentation of response/s of patient3. Assessment of the family/caregiver

● Records in Nurses Notes and HealthEducation logbook

Formulates the appropriate health educationplanning model based on the patient and family levelof understanding

As evidenced by:● Documentation of effective health education

learning






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● Evaluation by the patient and/or familythrough clients’ feedback form

● Documentation in Nurses Notes

Develops strategies to promote effective learningenvironment specially to OP with multiplecomorbidities and cognitive impairmentAs evidenced by:

● Documentation of the provision of healtheducation in an environment conducive forlearning rated by the patient and/or familythrough clients’ feedback form

● Documentation in Nurses Notes● Direct observation in workplace as rated by

immediate supervisor and/or assessor

Designs educational programs that enhances theknowledge of OP, families, caregivers andinterdisciplinary team members regarding normalaging, age-related disorders, health promotion andprevention activities for OP with complex acute,critical, and chronic physical, mental health andbehavioral disorders and cognitive problemsAs evidenced by:

● Comprehensive individualized teaching plan● Documentation in Nurses Notes● Sample teaching plan

Integrates appropriate self-care activities forcomplex acute, critical and chronically ill OP andhow to navigate the healthcare system effectively tothe teaching plan in collaboration with the socialservice worker.



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As evidenced by:● Documentation in Nurses Notes● Health Education logbook● Patient evaluation/feedback form● Performance rating in workplace as rated by

immediate supervisor

Analyzes results of health education promotionprograms and activities as bases for programimprovement

As evidenced by:● Summary Report of evaluation of health

education● Documentation in Nurses Notes● Health Education logbook● Patient/Client’s satisfaction survey● Family/SO’s satisfaction survey

Competency Level 4: Ensure effective and efficient flow of communication among OPs, nursing staff and interdisciplinary team membersNCGERL4C01Task Description: Evaluates the ability of the candidate to provide the patient and his/her family all information relevant to thepatient’s care and elicit collaboration from them to achieve positive outcomes

Criteria Satisfactory Very Satisfactory OutstandingAssesses patients’ ability to communicate especiallythose with impaired sensory and cognition

As evidenced by:






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● Documentation in Nurses Notes● Completed observation checklist in the

workplace rated by immediate supervisor● Accomplished assessor’s evaluation

Determines the barriers to communication especiallythose OPs with impaired sensory and cognition

As evidenced by:● Documentation in Nurses Notes● Completed observation checklist in the

workplace rated by immediate supervisor● Accomplished assessor’s evaluation

Determines factors that interfere withcommunication which may include but not limited tohigh-frequency hearing loss, loss of dentition,reduced vital capacity, and reduced oral motorfunction

As evidenced by:● Documentation in Nurses Notes which

includes:o Age-related sensory changeso Disease and disabilityo Psychological barriero Environmental factors

● Completed observation checklist in theworkplace rated by immediate supervisor

● Other forms

Provides appropriate and effective communication



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that builds therapeutic relationships with diverseindividuals, families and caregivers facing acuteonset, critical, chronic disability, with impairedsensory and cognition or during exacerbations ofcomplex physical and psychological conditions.

As evidenced by:● Documentation in Nurses Notes and● Performance Evaluation by immediate

supervisor● Accomplished assessor’s evaluation

Uses culturally appropriate communication skillsadapted to individual’s cognitive, developmental,physical, mental and behavioral health status

As evidenced by:● Documentation in Nurses Notes and● Performance Evaluation by immediate

supervisor● Accomplished assessor’s evaluation

checklist● Other forms

Analyses information and the use of prescribedforms and reports if there’s a need for revisions

As evidenced by:● Documentation of analysis in Nurses Notes

utilizes FDAR appropriately● Performance Evaluation by immediate

supervisor



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● Accomplished assessor’s evaluationchecklist

● Other forms

Facilitates proper, effective and timely referralsystem to communicate all pertinent informationrelated to patient’ status and problems to theinterdisciplinary team members

As evidenced by:● Documentation in Nurses Notes following

SBAR format● Completely accomplished Referral form● Actual observation rated by immediate

supervisor● Correct answer to assessor’s questions

Acts as care coordinator to ensure proper, effectiveand timely communication among members ofinterdisciplinary team




Converses comprehensive plan of care to receivingclinicians and healthcare team during transition



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Competency Level 4: Coordinate accordingly with other members of the healthcare team regarding client care NCGENL4D01Task Description: Evaluates the ability of the candidate to contribute to the services, decisions and actions of the healthcare team in deliveringcare to the patient

Criteria Satisfactory Very Satisfactory OutstandingGives recommendations for plan of action duringteam meetings/conferencesAs evidenced by:

● KARDEX/Nursing Care Plan● Copy of minutes of the meeting● Other means/forms

Acts as the representative of the nursing serviceduring multidisciplinary discussions and activitiesAs evidenced by:

● Documentation in Nurses’ Note andTreatment Record Sheet● Accomplished Nursing Care Plan● Evaluation in Performance Feedback Form● Copy of Minutes of the Meeting● Other means of documentation

Attends in multidisciplinary meetings concerningpatient’s welfareAs evidenced by:

● Copy of Minutes of the Meeting● Other means

Able to accomplish 1 outof3

criteria





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Competency Level 4: Analyze situations and guide clients and significant others in making decisions in response to ethical issues concerningpatient care (Discharge Against Medical Advice or DAMA, Transfer to Hospital Of Choice or THOC, etc.)NCGENL4E01Task Description: Evaluates the candidate’s knowledge of and ability to abide by ethical rules of conduct in dealing with patient

Criteria Satisfactory Very Satisfactory OutstandingMaintains compliance of client-related actions to thestandard operating procedures and work instructionsof the institution

As evidenced by:● Documentation in Nurses’ Note and

Treatment Record Sheet● No records of non-conformance/Staff 201

file

Conforms duly to hospital protocol when respondingto patient concerns requiring immediate ethicaldecision-makingAs evidenced by:

● Accomplished forms on hospital protocolcompliance

● Documentation of response to patientconcerns

● Properly secured informed consent/waiver which includes:○ Procedure○ Relationship to patient○ Name, Signature of Patient/Guardian

and Witness○ Date/Time Consent has been signed

● Other forms



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Utilizes appropriate institutional documentation of allinterventions and care done involving ethical judgment

As evidenced by:● Documented witnessed consents● Summary of Customer Satisfaction

Survey● Documentation in Nurses’ Note and

Treatment Record Sheet● Case Study/Situational Analysis● Other means of documentation

Competency Level 4: Anticipate needed medical supplies, medical equipment, drugs and medicines NCGENL4F01Task Description: Evaluates the candidate’s ability to use, maintain, organize and properly dispose of resources that contribute to the bestnursing care/ services for the patient

Criteria Satisfactory Very Satisfactory OutstandingAnalyzes critical level of medical supplies, drugsand medicines

As evidenced by:● Analysis report on critical level of

medical supplies, drugs, and medicines● Reports on preventive maintenance of

medical equipment● Accomplished replenishment slips● Other related documentation






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Monitors preventive maintenance of medicalequipment as scheduled

As evidenced by:● Accomplished preventive maintenance

forms● Schedule list of equipment requiring

preventive maintenance● Monitoring logbook for preventive

maintenance or similar● Other related documentation

Accomplishes needed requisition process/es toanticipate needed equipment and/or supplies

As evidenced by:● Accomplished requisition slips for

needed supplies and equipment● Report on needed supplies and/or

equipment for the area● Other related documentation



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Competency Level 4: Formulate measures for continuous quality improvement on current systems and policies pertaining to recordsmanagement NCGENL4G01Task Description: Evaluates the candidate’s ability to document, store, and make available relevant, accurate and complete data concerning thepatient and patient care in a timely manner using appropriate methods and tools

Criteria Satisfactory Very Satisfactory OutstandingPerforms chart and record checking based on thefollowing criteria: completeness, accuracy, properlylabelled, traceability, easily retrievable, availabilityin point of use, legibility and proper correction oferroneous entry

As evidenced by:● Chart Review Logbooks and Monitoring

or similar logbook● Inquiry on knowledge of chart lapse

review protocol based on institutionalpolicies

● Accomplished Performance FeedbackForms

● Other related documentation

Implements corrective actions on proper recordsmanagement

As evidenced by:● Analysis of actual scenario● Chart Review Logbooks and Monitoring

or similar logbook● Accomplished Performance Feedback

Forms






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Recommends revision of forms, procedures andwork instructions on records management

As evidenced by:● Revision recommendation letters on

forms, procedures and/or workinstructions



Competency Level 4: Implement guidelines and activities of the following: NCGENL4H01● ISO 9001:2015 (if applicable)● CQI● Nursing Service Audit

Task Description: Evaluate the candidate’s ability to constantly practice gathering and using of actual data on patient care for improving careprocesses, procedures, standards, and systems

Criteria Satisfactory Very Satisfactory OutstandingFormulates recommendations to address non-conformities or problems related to CQI monitoring

As evidenced by:● CQI monitoring reports/KPI● Non-conformance reports (if applicable)● Recommendation letters for

preventive/corrective actions or CPIAR● Other related documentation

Implements corrective actions for improvement in






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quality patient care based on audit results

As evidenced by:● Recommendation letters for

preventive/corrective actions or CPIAR● Minutes of the Meeting regarding nursing

audit● Non-conformance reports (if applicable)● Other related documentation

Recommends to translate feasible identifiedsolutions into quality procedures or processes

As evidenced by:● Quality Procedure/Process Registration

Forms or similar form/s● Copy of Minutes of the Meeting

involving quality improvement andassurance



Competency Level 4: Recommend Plan of Action on identified nursing issues NCGENL4I01Task Description: Evaluates the candidate’s ability to make judgment, decisions and actions in patient care that complies with national laws onhealth, the Philippine Nursing Act, and with hospital policies, rules, and regulations, even as appropriate care is provided to the patient

Criteria Satisfactory Very Satisfactory OutstandingRecognizes relevant issues concerning patient carethat are not in line with acknowledged institutionalpolicies and local/national guidelines






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As evidenced by:● Actual scenario presentation and inquiry● Nurses’ Reflection Notes/ Nurses’ Diary● Accomplished Performance Feedback

Forms● Other related documentation

Proposes a plan of action to address the relevantissues recognized with the following criteria:reliable, appropriate, clearly stated and applicable

As evidenced by:● Drafted plans and proposals regarding

issues and concerns● Recommendation letters for incident

reviews● Nurses’ Reflection Notes/ Nurses’ Diary● Accomplished Performance Feedback

Forms● Other related documentation

Monitors the implementation of action plansrecommended to resolve patient care issues

As evidenced by:● Monitoring and observation reports● Nurses’ Reflection Notes/ Nurses’ Diary● Accomplished Performance FeedbackForms● Other related documentation



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Competency Level 4: Conduct research study that addresses problems, needs and issues relevant to nursing specialty NCGENL4J01Task Description: Evaluates the candidate’s application of clinical inquiry, critical thinking, and analysis in nursing practice and the use ofclinically obtained data and information to improve practice

Criteria Satisfactory Very Satisfactory OutstandingIdentifies specialty nursing problems or issuesapplicable to current practice

As evidenced by:● Problem List for Nursing Specialty

Research● Research Intention Form or similar● Other related documentation

Prepares a study proposal that addresses a specialtynursing problem, need or issue

As evidenced by:● Actual proposal of a specialty nursing

study● Study proposal documents● Other related documentation

Facilitates in a research study addressing a specialtynursing problem, need or issue

As evidenced by:● Implementation schedule of specialty

study● Actual study documents● Other related documentation






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Competency Level 4: Supervise the delegations of tasks at appropriate level and assignments NCGENL4K01Task Description: Evaluates the candidate’s ability to provide direction and leadership to lower level personnel and facilitate their learning toinclude improvements in care management as well in the management of nursing teams or units

Criteria Satisfactory Very Satisfactory OutstandingSets deadline on assigned tasks

As evidenced by:● Shift Management Reports or similar● Task Progress Monitoring Reports or

similar● Endorsement logbooks● Accomplished Performance Feedback

Forms● Nurses’ Reflection Notes/Nurses’ Diary● Other related documentation and similar

forms used in the institute

Monitors closely progress of assigned tasks per shift

As evidenced by:● Shift Management Reports or similar● Task Progress Monitoring Reports or

similar● Endorsement logbooks/Nurses’ ReportBook● Nurses’ Reflection Notes/Nurses’ Diary● Other related documentation (Key

performance indicators, etc.) and similarforms used in the institute






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Provides right direction and guidelines on patientcare to personnel

As evidenced by:● Accomplished Personnel Evaluation

Reports● Unit Management Reports● Endorsement logbooks● Feedback from peers and personnel● Nurses’ Reflection Notes/Nurses’ Diary● Other related documentation and similar


Evaluates performance of assigned personnel afterthe task has been completed

As evidenced by:● Accomplished Personnel Evaluation

Reports● Consultation logs with personnel or

similar● Endorsement logbooks● Nurses’ Reflection Notes/Nurses’ Diary● Other related documentation and similar




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Competency Level 4: Conduct lectures and act as resource person to different nursing courses as part of professional & personal developmentNCGENL4L01Task Description: Evaluate the candidate’s ability to demonstrate engagement in continuing education and self-development

Criteria Satisfactory Very Satisfactory OutstandingContributes to continuous learning by being aresource speaker or preceptor at least 4 times perannumAs evidenced by:● Certificates of Recognition as Speaker/Lecturer● Certificate of Attendance● Program Activities with assigned topics of lectures● Evaluation Results as Lecturer● Top Evaluation Results● Other related documentation

Participates in the formulation of program careerpathways for nurses at least 3 times per yearAs evidenced by:● Attendance on Career path/Staff development

Meetings● Minutes of the Meeting● Actual career program plans for staff

development● Other related documentation

Attends continuous professional development atleast on the thesis proposal levelAs evidenced by:● School Registration to Postgraduate degree● Thesis Proposal Manuscript● Other related documentation






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Competency Level 4: Monitor professional and personal decorum at all levels of nursing personnel within the standards of nursing practice thatprovides motivation and allows growth & productivity NCGENL4M01Task Description: Evaluate the candidate’s ability to demonstrate critical characteristics and behaviors that a specialist nurse should exhibit as arole model of expertise, excellent performance, and professionalism

Criteria Satisfactory Very Satisfactory OutstandingSupervises peers on proper decorum whenperforming patient careAs evidenced by:

● Accomplished Performance Feedbackforms

● Peer Evaluation Reports● Nurses’ Reflection Notes/Nurses’ Diary● Other related documentation

Advises peers regarding work professionalism andpunctuality throughout their nursing practiceAs evidenced by:

● Accomplished Performance Feedbackforms

● Peer Evaluation Reports● Nurses’ Reflection Notes/Nurses’ Diary● Other related documentation

Obtains recognition and awards based onprofessional duty and practiceAs evidenced by:

● Certificates of Awards/Recognitions● Records of nomination for particular

recognition awards● Other related documentation




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