Skills Checklist – Psychiatric Skills Checklist – Psychiatric Name First Last Phone Email CARE OF PATIENTS WITH* Rarely Some Experience Proficient Trainer / Preceptor N/A Affective Disorders Alcohol Dependency Bipolar Disorder Delirium Tremens Detoxification Drug Dependency Dual Diagnosis Eating Disorders Electroconvulsive Therapy Extrapyramial Syndrome Hallucinations Medical-Psychiatric Disorder Necroleptic Malignant Syndrome Obsessive-Compulsive Disorder Organic Disorder Schizoaffective Disorder Schizophrenia Seizure Disorder Suicidal Behavior Tardive Dyskinesia Violent/Assaultive Behavior MEDICATION ADMINISTRATION* Rarely Some Experience Proficient Trainer / Preceptor N/A Antianxiety agents Antidepressants Antipsychotics CNS Stimulants Hypnotics Insulin Mood Stablizers PROCEDURES/SKILLS* Rarely Some Experience Proficient Trainer / Preceptor N/A Assaultive Behavior Management Behavior Modification Techniques Contraband Search Diabetic Patient Care Electroconvulsive Therapy – assist Elopement Precautions PROCEDURES/SKILLS – FOLEY CATHETER INSERTION/CARE* Rarely Some Experience Proficient Trainer / Preceptor N/A Male Female PROCEDURES/SKILLS – INTRAVENOUS THERAPY* Rarely Some Experience Proficient Trainer / Preceptor N/A Angiocath insertion Butterfly insertion IV site maintenance Hyperalimentation infusion Saline/Heparin Lock Blood/Blood Product Infusions Venous Blood Draw Isolation Procedures Locked Unit Routine Lumbar Puncture – assist Milieu Therapy NG Tube Insertion/Care Open Unit Routine PROCEDURES/SKILLS – OXYGEN THERAPY ADMINISTRATION* Rarely Some Experience Proficient Trainer / Preceptor N/A Face mask Nasal Cannula Bag & Mask Portable O2 tank PROCEDURES/SKILLS – PATIENT TEACHING (GROUP)* Rarely Some Experience Proficient Trainer / Preceptor N/A Anger Management Cognitive Behavioral Therapy Depression Education Dialectical Behavioral Therapy Discharge Issues Family Education Medication Education Relapse Prevention Relaxation Techniques PROCEDURES/SKILLS – PSYCHOTHERAPY* Rarely Some Experience Proficient Trainer / Preceptor N/A a. Group b. Individual Rapid Tranquilization PROCEDURES/SKILLS – RESTRAINTS* Rarely Some Experience Proficient Trainer / Preceptor N/A a. Wrist b. Full (4 point) c. Chemical d. Leather Seclusion Procedures PROCEDURES/SKILLS – SUCTIONING* Rarely Some Experience Proficient Trainer / Preceptor N/A a. oropharyngeal b. nasopharyngeal Suicide Prevention Time-Out/Quiet Time Management Tube Feedings ASSESSMENT/OTHER* Rarely Some Experience Proficient Trainer / Preceptor N/A Admission of patients to unit Care Planning Charge Nurse responsibilities Computerized Charting CPR Neurological Assessments Universal Precautions Vital Signs Pediatric Patients Adolescent Patients Adult Patients Geriatric Patients EQUIPMENT* Rarely Some Experience Proficient Trainer / Preceptor N/A Automated Med. Dispensing Systems Automatic BP cuffs Glucometer/Accucheck Pulse Oximetry Computer Charting Systems PAIN MANAGEMENT Pain assessment using pain scales Narcotic Agents Non-narcotic agents Non-pharmacological measures IV Infusion Pumps (Specify Brands) INFUSION PUMP BRAND #1 INFUSION PUMP BRAND #2 EQUIPMENT – INFUSION PUMPS EXPERTISE Rarely Some Experience Proficient Trainer / Preceptor N/A BRAND #1 BRAND #2 Do you speak any languages other than English?* No If yes, enter languages above, separated by commas. Age Group Experience* Rarely Some Experience Proficient Trainer / Preceptor N/A Newborn (birth – 30 days) Infant (30 days – 1 year) Toddler (1 – 3 years) Preschooler (3 – 5 years) School Age (5 – 12 years) Adolescents (12 – 18 years) Young Adults (18 – 39 years) Middle Adults (39-64 years) Older Adults (64+ years) Confirmation* I attest that the information I have given is both true and, to the best of my knowledge, represents an accurate self assessment of my professional skills and/or education. Signature Date Date Format: MM slash DD slash YYYY