CENTRO ESCOLAR UNIVERSITY

Manila Malolos
School of Nursing

BSN LEVEL III Performance Checklist

NCM 104 (RLE) PSYCHIATRIC NURSING

Name of student Score

Year, Section/Group Number

Rate the student's performance by checking the appropriate box using the following criteria

5 - Excellent (carries out procedure efficiently, systematically and independently)

4 - Very Satisfactory (carries out procedures efficiently and systematically but requires minimal guidance and
supervision)
3 - Satisfactory (carries out procedures efficiently and systematically but requires moderate guidance and
supervision)
2 - Fair (carries out procedures efficiently and systematically but requires close guidance and supervision)
1 - Poor (carries out procedure inefficiently, unsystematically even under guidance and supervision)

* Average mean shall be computed and multiplied by factor 20. The product shall be transmuted using the table for
100 points. Passing cut-off score is 65%

CRITERIA 5 4 3 2 1
I. ASSESSMENT
1.Establish rapport with client and other members of the health team.
1.1. creates trust and confidence of the client
1.2. listens actively to client's concern
2. Obtain and reviews client' medical record
a. Conducts complete psychiatric nursing health history
b.Conduct accurate Physical Assessment (focused assessment)
c. Performs correct and daily Mental Status Assessment (MSA)
3. Analyzes gathered data to determine client's need
4. Identifies, interprets and validates client's verbal and non verbal cues
5. Use effective therapeutic communication techniques (verbal & non verbal)
DIAGNOSIS
1. Formulates appropriate psychiatric nursing diagnosis
2. Determines and prioritized client's needs and problems.
PLANNING
1. Plans the performance of tasks or activities based on priorities
2. Develops comprehensive plan of care in response to the client's need
3. States expected outcomes of selected nursing actions
4. Selects appropriate nursing interventions to address priority care
INTERVENTION
1. Performs specific nursing interventions in response to client's mental need
2. Performs assigned psychotherapy effectively
3. Monitors response of client to psychotherapy
4. Implements nursing actions to clients that is safe and effective
5. Collaborates with the other health team members ( group mates)
in the conduct of various psychotherapy
6. Utilizes therapeutic communication effectively in dealing with the assigned client
7.Performs appropariate safety measures in all aspects of client care
8. Performs specific measures to ensure privacy in all aspect to client care
9. Reports significant changes in client's condition to improve stay in the institution
10. Acts appropriately to improve client's condition or human response
11. Implements nursing care consistent with the client's bill of rights
EVALUATION
1. Evaluates the effectiveness of selected psychiatric nursing interventions
2. Modifies care plan toward expected outcomes
3. Documents outcome of client's care management
II. ATTITUDE
1. Complies with the rules and regulations set by the college
2. Respect proper authorities and other members of health team
3. Projects a positive image of the profession
4. Demonstrates good manners and right conduct at all times
5. Listens to suggestions and recommendations from the team and Faculty
6. Submits a complete case study on time

REMARKS:

Computation:
Raw score divided by total number of items: 30 items x 20 = _______ x Part I to IV (90%) = __________
Raw score divided by total number of items: 6 items x 20 = _______ x Part II (10%) = __________
TOTAL = __________
Equivalent Numeric Grade : _____________________
Interpretation: ________________________________

_______________________________ _____________________________ ________________

Student's Signature Clinical Instructor's Date
Printed Name & Signature