M.O.S.

C COLLEGE OF NURSING
MSc NURSING PROGRAMME
PSYCHIATRIC NURSING

CLINICAL DIARY EVALUATION FORM

Name of the student: _____________________________ Roll no: _____________________________

Duration of Posting_______________________________Date________________________________

Sl.No

Criteria

Marks Allotted

Daily Submission

Progress note

Learning experience

Organization

Language

Total

10

Marks scored

Remarks ____________________________________________________________________________

_____________________________________________________________________________________

Name and Signature of the Supervisor

M.O.S.C COLLEGE OF NURSING

MSc NURSING PROGRAMME
PSYCHIATRIC NURSING
EVALUATION FORM- NURSING CARE PLAN

Name of the student: _____________________________ Roll no:_________________________

Duration of Posting_______________________________Date____________________________
Sl.No

9
10
11
12

Criteria

1
2
3
4
5
6
7

Introduction
History collection
Mental status examination
Investigations
Medication
ICD 10 diagnostic criteria
List of nursing diagnosis

Total score Score

awarded
1
2
2
1
1
1
1

Nursing process
Assessment
Nursing diagnosis
Short term goals
Long term goals
Intervention
Evaluation
Progress note
Health education
Discharge counseling
Summary/ Conclusion
Total

1
1
1
1
3
1
2
3
2
1
25

Remarks

Name and Signature of the Supervisor

M.O.S.C COLLEGE OF NURSING

MSc NURSING PROGRAMME
PSYCHIATRIC NURSING
EVALUATION FORM- NURSING CASE STUDY

Name of the student: _____________________________ Roll no:_________________________

Duration of Posting_______________________________Date____________________________
Sl.No

Criteria

1
2
3
4
5
6
7
8
9

Introduction
History collection
Mental status examination
Investigations
Medication
Diagnostic formulation (ICD 10)
Nursing care plan
Admission counseling
Discharge counseling

10

About the illness

11
12

Definition
Psychopathology
Diagnostic criteria
Clinical manifestations
( Comparison of book picture
and patient picture)
Management
Summary & Conclusion
Bibliography
Total

Total score Score

awarded
0.5
2
2
0.5
1
1
5
1
2
1
1
1
1

4
1
1
25

Remarks

Name and Signature of the Supervisor

M.O.S.C COLLEGE OF NURSING

MSc NURSING PROGRAMME
PSYCHIATRIC NURSING

EVALUATION FORM- CLINICAL PRESENTATION/ CASE CONFERENCE

Name of the student: _____________________________ Roll no:_________________________

Duration of Posting_______________________________Date____________________________
Sl.No
1
2

Criteria
Physical arrangement
Lighting
Seating
Teacher
Appearance
Eye to eye contact
Language
Teaching presentation
Introduction
Comparison of patient picture
with book picture.
Group participation
Narration of experience
Adequacy in explanation
Conclusion
A.V Aids
Adequacy
Clarity/Legibility
Display
Use of Pointer
Written material
Adequacy of content
Organization
Neatness
Style of writing
Bibliography
Total

Marks allotted
1
0.5
0.5

Marks attained

1
1
1
1
4
1
3
1
1
1
1
1
1
1
1
1
1
1
25

Remarks

Name and Signature of the Supervisor

Signature of the student

M.O.S.C COLLEGE OF NURSING

MSc NURSING PROGRAMME
PSYCHIATRIC NURSING

EVALUATION FORM- SEMINAR

Name of the student: _____________________________ Roll no:_________________________

Subject:______________________________Topic______________________________________
Duration of Posting_______________________________Date____________________________
Sl.No

Criteria

Physical arrangement
Lighting
Seating
Teacher
Appearance
Punctuality
Eye to eye contact
Voice
Facial expression
Language
Teaching presentation
Introduction
Confidence
Group participation
Narration of example
Adequacy in explanation
Evaluation of students
Conclusion
Time management
A.V Aids
Adequacy
Variety/Novelty
Clarity/Legibility
Display
Use of blackboard
Use of Pointer
Written material
Adequacy of content
Organization
Neatness
Style of writing
Bibliography
Total

Remarks

Marks
allotted
1
0.5
0.5
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
0.5
0.5
1
1
1
1
1
25

Marks attained