** Examination: Skill Performance  Rubic BORROWED FROM NACC Personal Support Worker 2005   (for SharingInHealth.Ca) 

Name:				Date: 			

Skill: 									Evaluator(s):				

Total Points Possible = 27

Points Required to Pass = 19 with no "required further practice" ratings

Comments: see below

** At All Times in all Choices with the Client REMEMBER D.I.P.P.S.  ( Dignity , Independence , Privacy , Preferences , Safety is foundational to all the above )  **

Elements	Criteria: Performs competently and confidently (3)	Criteria: Requires minimal supervision (2)	Criteria: Requires further practice (0-1)	Student Score / Rating	
					
Preparation	Predicts potential difficulties or variables & prepares for them	
Prepares Equipment, Environment, Washes hands for routine tasks
	Omits basic preparation tasks		
Safety Measures	
Consistent use throughout

Considers - asepsis

Mechanical, Thermal, Chemical Hazards (WHIMIS and ____ ) and Controls for them
	Applies basic measures	Omits routine safety measures

Unaware of common hazards		
Communication with Client 
( ** Remember up to 90% of People Communicating is non-verbal = ACTIONS SPEAK LOUDER THAN WORDS ** )	
Compassionate, Sensitive, Empathetic Appropriate to Age ( "professional helping relationship" )
	
Explains

Listens

Responds appropriately
	Concentrates on task, Unaware of client's fears and concerns, Does not seek Feedback		
Follows Correct Procedure	
Consistency = Adapts to Client and Situation
	Correct Sequence of Steps Without Prompting	Two or more flaws, Needing prompting		
Physical and Manual Dexterity + Skilled Use of Equipment	Organized

Refined Movements

Can Manage Several Things at Once	
Methodical

Careful

Safe
	
Awkward, Unsure of How Equipment Works or Should Be Used
		
Problem Solving + Adapting to Different Equipment	
Readily Adapts to Age, Culture, and Disease Variables

Demonstrates Active Problem Solving Without Prompting
	Through Questioning Handles Differences in Home and Agency Environments

Adapts to Age Groups	Not able to Vary from a Set of Prescribed Procedure

OR

Recognize Different Requirements		
Speed and Organization	
Efficient in All Stages of Task Demonstration

Thinks in Advance

Predicts and Controls Away From Problems
	Methodical

Reasonable Time as a Beginning Practitioner	Unable to Complete Tasks in Time Limits		
Reporting Observations 
( verbal and charting)	
Emphasizes Important Significant Observations

Gives Detailed Individualized Verbal Report
	Provides a Routine Report of Basic Facts and Observations

Follows Forms	Omits Reporting Basic Observations

Unaware of Significance		
Knows Extent and Limits of One's Role ( see "CCA Scope of Support in Nova Scotia" approved April 2007 ) and scope of employment	
Is Aware of Procedures which are Part of [CCA] role and Those which can be Taught in Individualized Situations

**Asks for Assistance in Complicated Procedures**

Knows Roles of other Health Care Workers with Health Care Team [ i.e.: The Client, Client's Family, RN, LPN, Doctor, Spiritual Advisor, Therapeutic Recreation, Social Worker, Client's Pet, etc. ]
	Follows Care Plan and Seeks Guidance

Reports Appropriately

Carries Out Tasks Appropriate to [CCA] Role	Goes Beyond Limits

OR

Unaware of [CCA] Scope of Support Limitations (i.e.: Failure to FOLLOW CLIENT's CARE PLAN, Poor Communicating with Client )		
			
Total Score		

** At All Times in all Choices with the Client REMEMBER D.I.P.P.S.  ( Dignity , Independence , Privacy , Preferences , Safety is foundational to all the above )  **

Elements	Comments	
		
Preparation	

	
Safety Measures	

	
Communication with Client ( ** Remember up to 90% of People Communicating is non-verbal = ACTIONS SPEAK LOUDER THAN WORDS ** )	

	
Follows Correct Procedure	

	
Physical and Manual Dexterity and Skilled Use of Equipment	

	
Problem Solving - Adapting to Different Equipment	

	
Speed and Organization	

	
Reporting Observations ( verbal and charting )	

	
Knows Extent and Limits of One's Role [ see "CCA Scope of Support in Nova Scotia" approved April 2007 ]	

	
Overall Assessment: