Health Care Assistant Program Learning Outcomes Verification

This form confirms that the student identified below has completed the required practice education placements and placement hours for the HCA Practice Education program segment and has been deemed by their instructor as having met the required program learning outcomes outlined in the HCA Program Provincial Curriculum Guide 2015, p. 18.

Student Name: (please print)                                              

Multi-level/complex care placement site name(s):                                              

Date(s):                                               Number of hours completed:                                              

Name of instructor(s):                                              

Assisted living/home support/group home placement site name(s):                                               

Date(s):                                               Number of hours completed:                                              

Name of instructor(s):                                              

Directions: Please indicate whether or not the student has met (been able to demonstrate) the following learning outcomes in the clinical setting and sign and date the bottom of the form.

1. Provide person-centred care and assistance that recognizes and respects the uniqueness of each individual client. Met Not Met
Examples and comments:

 

2. Use an informed, problem-solving approach to provide care and assistance that promotes the physical, psychological, social, cognitive, and/or spiritual
well-being of clients and families.
Met Not Met
Examples and comments:

 

3. Provide care and assistance for clients experiencing complex health challenges. Met Not Met
Examples and comments:

 

4. Provide care and assistance for clients experiencing cognitive and/or mental health challenges. Met Not Met
Examples and comments:

 

5. Interact with other members of the health care team in ways that contribute to effective working relationships and the achievement of goals. Met Not Met
Examples and comments:

 

6. Communicates clearly, accurately, and in sensitive ways with clients and families within a variety of contexts. Met Not Met
Examples and comments:

 

7. Provides personal care and assistance in a safe, organized, and competent manner. Met Not Met
Examples and comments:

 

8. Recognizes and responds to own self-development, learning, and health enhancement needs. Met Not Met
Examples and comments:

 

9. Performs the care provider role in a reflective, responsible, accountable, and professional and ethical manner. Met Not Met
Examples and comments:

 

Instructor Name                                  Instructor Signature                                 Date                                

Instructor Name                                  Instructor Signature                                 Date                                

Student Name                                 Student Signature                                 Date                                

Download Health Care Assistant Program Learning Outcomes Verification [PDF].

Note: This sample tool has been included to align with Suggested Course Assessments 3 and 5 included in the Practice Experience in Multi-Level and/or Complex Care course and Suggested Course Assessment 2 included in the Practice Experience in Home Support, Assisted Living, and/or Group Home course. It could be further adapted for use as a self-assessment by the student.