Neonatal Intensive Care Unit (NICU) Skills Assessment Today's Date: MM slash DD slash YYYY Name* First Last Email* Phone*Interventions/TherapiesCrisis Intervention 0 1 2 3 Therapeutic Communication 0 1 2 3 Therapeutic Milieu 0 1 2 3 Education or Vocational Training 0 1 2 3 Drug & Alcohol Education 0 1 2 3 ElectroConvulsive Therapy 0 1 2 3 Biofeedback 0 1 2 3 Guided Imagery 0 1 2 3 Expressive Therapy (Art, Movement) 0 1 2 3 Massage Therapy 0 1 2 3 Meditation 0 1 2 3 Recreational Therapy 0 1 2 3 Therapeutic Touch 0 1 2 3 Psychotherapy 0 1 2 3 Individual 0 1 2 3 Group 0 1 2 3 Couple / Family 0 1 2 3 Behavioral 0 1 2 3 General NursingAdmit/Orient Voluntary Clients 0 1 2 3 Admit/Orient Involuntary Clients 0 1 2 3 Initial Comprehensive Assessment 0 1 2 3 Initial Focused Assessment 0 1 2 3 Initial Screening Assessment 0 1 2 3 Initiate Care Plan 0 1 2 3 Reassessment/Update Care Plan 0 1 2 3 Multi-Disciplinary Planning 0 1 2 3 Supervise Unlicensed Personnel 0 1 2 3 Vital Sign Monitoring 0 1 2 3 Full Restraints 0 1 2 3 Wrist Restraints 0 1 2 3 Ambulatory Cuffs 0 1 2 3 Oxygen Administration 0 1 2 3 Admin/Monitor Tube Feedings 0 1 2 3 Insert/Care of Foley Catheter 0 1 2 3 Assist with Lumbar Puncture 0 1 2 3 Isolation Techniques 0 1 2 3 Advance Directives 0 1 2 3 Patient Teaching 0 1 2 3 Case Manager 0 1 2 3 Discharge Planning 0 1 2 3 Discharge Clients 0 1 2 3 Cultural Diversity 0 1 2 3 Ethnic Awareness 0 1 2 3 Forensic Nurse 0 1 2 3 Care of Psychiatric DisordersSchizophrenia 0 1 2 3 Paranoid Psychotic Disorder 0 1 2 3 Catatonic Psychotic Disorder 0 1 2 3 Hallucinations 0 1 2 3 Bipolar Disorder 0 1 2 3 Depression 0 1 2 3 Suicidal Ideation/Attempts 0 1 2 3 Delusional Disorders 0 1 2 3 Anxiety Disorders 0 1 2 3 Panic Attacks 0 1 2 3 Phobias 0 1 2 3 Obsessive/Compulsive Disorder 0 1 2 3 Dissociative Identity Disorder 0 1 2 3 Paranoid/Schizoid 0 1 2 3 Antisocial/Borderline 0 1 2 3 Anxious/Fearful 0 1 2 3 Delirium 0 1 2 3 Dementia 0 1 2 3 Alzheimer's (Dementia) 0 1 2 3 Amnestic Disorders 0 1 2 3 Anorexia Nervosa 0 1 2 3 Bulimia Nervosa 0 1 2 3 Obesity 0 1 2 3 Alcohol -Related Disorders 0 1 2 3 Drug -Related Disorders 0 1 2 3 Sexual Disorders 0 1 2 3 Sexual Abuse/Assault 0 1 2 3 Survivor of Abuse/Violence 0 1 2 3 Post Traumatic Stress Disorder 0 1 2 3 Somatoform Disorders (Pain etc.) 0 1 2 3 Mental Retardation 0 1 2 3 ADHD 0 1 2 3 Developmental/Autistic Disorders 0 1 2 3 Continuum of Care SettingsMed-Psych Unit 0 1 2 3 Transitional Care Hospital 0 1 2 3 Freestanding Psych Hospital 0 1 2 3 Community-Based Hospital 0 1 2 3 Forensic Hospital 0 1 2 3 Subacute Care Units 0 1 2 3 Long-term Care Facilities 0 1 2 3 Emergency Clinic 0 1 2 3 Day-Treatment Programs 0 1 2 3 Residential Programs 0 1 2 3 Home Care 0 1 2 3 Aftercare/Rehabilitation Clinics 0 1 2 3 Meds/IV TherapyAdminister PO Medications 0 1 2 3 Administer NG / GT Meds 0 1 2 3 Administer Rectal Medications 0 1 2 3 Administer IM & SQ Meds 0 1 2 3 Peripheral IV Insertion 0 1 2 3 Administer IV Medications 0 1 2 3 Use of Heparin/Saline Locks 0 1 2 3 Needle-less Systems 0 1 2 3 Care of Central Lines 0 1 2 3 Care of PICC Lines 0 1 2 3 Admin of Hyperalimentation 0 1 2 3 Admin of Blood / Blood Products 0 1 2 3 Infusion Pumps 0 1 2 3 Discontinue Peripheral IVs 0 1 2 3 Venipuncture Blood Draws 0 1 2 3 Pain Assessment/Management 0 1 2 3 Psychotropic AgentsRapid Tranquilization 0 1 2 3 Antipsychotic Agents 0 1 2 3 Hypnotics 0 1 2 3 Antianxiety Agents 0 1 2 3 Antidepressants/Mood Elevators 0 1 2 3 Antimanic Agents 0 1 2 3 Anticonvulsants 0 1 2 3 Anticholinergics/Antiparkinsons 0 1 2 3 Meds side Effects (Recognition/Management)Blurred Vision 0 1 2 3 Constipation 0 1 2 3 Drowsiness 0 1 2 3 Dry Mouth 0 1 2 3 Gastrointestinal Effects 0 1 2 3 Hyp/Hyperglycemia 0 1 2 3 Hypotension/Orthostatic 0 1 2 3 Insomnia 0 1 2 3 Changes in Libido 0 1 2 3 Tachycardia 0 1 2 3 Urinary Retention 0 1 2 3 Weight Gain 0 1 2 3 Parkinsonism Symptoms 0 1 2 3 Akathisia (Motor Restlessness) 0 1 2 3 Acute Dystonic Reactions 0 1 2 3 Tardive Dyskinesia 0 1 2 3 Neuroleptic Malignant Syndrome 0 1 2 3 Age of Patients Cared for:Newborn (birth-30 days) 0 1 2 3 Infant (30 days - 1 year) 0 1 2 3 Toddler (1 - 3 years) 0 1 2 3 Preschooler (3 - 5 years) 0 1 2 3 School Age (5 - 12 years) 0 1 2 3 Adolescents (12 - 18 years) 0 1 2 3 Young Adults (18 - 39 years) 0 1 2 3 Middle Adults (39 - 64 years) 0 1 2 3 Older Adults (64+ years) 0 1 2 3
