Conduct a personal, professional and self-care assessment of your values, strengths, challenges, readiness for action and goals. Create an action plan for personal, professional and self-care development.

DIRECTIONS

Complete each of the sections using the forms provided. Submit the completed forms.

Part 1: Self-Assessment

Name______________________________________                                       Date ____________

Self-Assessment: Use this part to document a self-assessment of your personal, professional, and wellness values, strengths, areas for improvement, readiness level for change, and identified goals. In each area reflect on what you do to care for yourself, what pressures do you face each day, what are your priorities, and what changes would you like to make that will contribute to your evolving as a person and professional nurse.  The challenge will be to focus on a single goal in each area. Be as specific as possible with you goal statements.

Section A. Personal Assessment

Values (what is important to me as a person? What is my life’s purpose?):

Strengths:

Challenges: (What I want to Change or improve in my personal life):

Readiness Level (on a scale of 1-10, how ready am I to make change and work toward my goal?):

Goal –– (areas in my personal life to continue, enhance or change):

Section B.  Professional Assessment

Values (what is important to me as a professional nurse?):

Strengths:

Challenges: (What I want to change or improve for my professional development):

Readiness Level (on a scale of 1-10, how ready am I to make change and work toward my goal?):

Goal – Your professional goal may relate to specific knowledge, skill, or competency you would like to achieve, such as negotiation, group member skills, evidence based practice, or technology/informatics:

Section C. Wellness/Self-Care Assessment

Review each of the following: 1. Physical Wellbeing (exercise and fitness; health care and self-care; diet and nutrition); 2. Mental Wellbeing (ability to gather, process, recall, exchange information); 3. Emotional Wellbeing (Stress mastery, emotions, attitudes, and self-esteem); 4. Spiritual Wellbeing (meaning and purpose in life, relationship with self, higher consciousness, family and family

Values (what aspects of health are important to me as a person?)

Strengths:

Challenges (What I want to change or improve for my health and well-being) –

Readiness Level (on a scale of 1-10, how ready am I to make change and work toward my goal?):

Wellness Goal (The wellness area I want to continue, enhance or change):

Part 2: Action Plan

Name______________________________________                                       Date ____________

Use this part to document the action plan for each area of your holistic development plan based on your self-assessment.  For each Goal incorporate the following:

1. Criteria of Goal Achievement:  List the new behavior and skill that you will be demonstrating.  How will you know you accomplished your goal? What are the ways you might measure your accomplishment(s)?

2. Actions/Activities:  What steps will you take over the course of the semester as you work toward your goal? The actions are concrete, specific, and measurable.  Consider small steps toward the larger goal.

3. Actions outside your comfort zone: these are actions that may make you uncomfortable, that you believed in the past these actions were beyond your abilities.  These actions enhance your knowledge in an area that has been very challenging to you.  These actions may be considered risk-taking on your part, but you are up to the challenge!

4. Feedback from others:  Change is not a solo journey.  Other people in your life will be impacted and influenced by the changes you make.  You may also find that other people can help you with the changes you are making.  Identify one person for each goal who you would like to receive helpful feedback from along the way. 

Section A. Personal Goal [insert from Assessment]

1.     Criteria of Goal Achievement: 

2.     Actions/Activities: 

3.     Actions outside your comfort zone:

4.     Feedback from others: 

Section B.  Professional Goal [insert from Assessment]

1.     Criteria of Goal Achievement: 

2.     Actions/Activities: 

3.     Actions outside your comfort zone:

4.     Feedback from others: 

Section C. Wellness/Self Care Goal [insert from Assessment]

1.     Criteria of Goal Achievement: 

2.     Actions/Self-Care Activities: 

3.     Actions outside your comfort zone:

4.     Feedback from others: 

Use this link to complete your Holistic Personal, Professional & Wellness Development Plan Download Holistic Personal, Professional &