Appendix 1 – Sample template for documenting CPD.

Appendix 1 – Sample template for documenting CPD
Date
Source or
provider
details
Identified
learning needs Action plan Type of activity
Description of topic (s)
covered during activity
and outcome
Reflection on activity
and specification to
practice
No./Title/
Description
of evidence
provided
CPD
hours
16/5/2019 Nursing and
Midwifery
Board of
Australia
(NMBA)
Standards of
Practice
RN Standard of
Practice 1, 4
To provide
optimum nursing
care which is
evidence based,
safe, and
person-centred
along with
conductance of
holistic,
culturally
appropriate
assessments
Engage in
evidence based
practice and
personal
reflection
Unsure of the
histories and
needs of
indigenous
patients
Plan: To improve
skills of cultural
competence
Evidence based and self-
directed learning by drawing
on records of indigenous
patients and reading of
relevant articles.
Review NMBA Code of
Ethics for Nurses, especially
Value Statement 3 on
Diversity
https://
www.nursingmidwifery
board.gov.au/codes-
guidelines-statements/
professional-
standards.aspx.
Evaluated and
understood the relevance
of cultural competence,
the needs of indigenous
Australians and
strategies underlying
deliverance of culturally
appropriate nursing care.
This educational
resource has improved
my understanding on the
needs of indigenous
patients. I will be
successfully able to
provide culturally
competent nursing care
to such patients
Refer to
Position
Statem
ent on
REM
complia
nce
3 hours
24/5/2019 Wound
Manageme
nt (XYZ
provider)
N/A N/A Workshop and Educational
Short course
Wound Management
reaccreditation
This activity educated
me on the importance
and strategies of wound
management in the
patient, prevention of
infection and optimum
tissue healing
Refer to
item 8
Certificate of
Attendance
4 hours
29/5/19 Diabetes
Management
(XYZ
provider)
N/A N/A Workshop and Educational
Short course Diabetes
Management
reaccreditation
This activity educated on
the screening,
assessment, prevention
and management of
patients with diabetes
and provision of
multidisciplinary care
Refer to
item 9
4 hours
Fact sheet: Continuing professional development for nurses and midwives Page 5 of 5