Journal Entry Assignment PRAC 6675
Journal Entry Assignment PRAC 6675
Critical reflection on your growth and development during your practicum experience in a clinical setting helps you identify opportunities for improvement in your clinical skills, while also recognizing your strengths and successes.
Use this Journal to reflect on your clinical strengths and opportunities for improvement, the progress you made, and what insights you will carry forward into your next practicum.
Refer to the Population-Focused Nurse Practitioner Competencies in the Learning Resources, and consider the quality measures or indicators advanced practice nurses must possess in your specialty.
Refer to your Clinical Skills Self-Assessment Form you submitted in Week 1 and consider your strengths and opportunities for improvement.
Refer to your Patient Log in Meditrek; consider the patient activities you have experienced in your practicum experience and reflect on your observations and experiences.
In 450-500 words, address the following:
Learning From Experiences
Revisit the goals and objectives from your Practicum Experience Plan. Explain the degree to which you achieved each during the practicum experience.
Reflect on the 3 most challenging patients you encountered during the practicum experience. What was most challenging about each?
What did you learn from this experience?
What resources were available?
What evidence-based practice did you use for the patients?
What would you do differently?
How are you managing patient flow and volume? How can you apply your growing skillset to be a social change agent within your community?
Communicating and Feedback
Reflect on how you might improve your skills and knowledge and how to communicate those efforts to your Preceptor.
Answer these questions: How am I doing? What is missing?
Reflect on the formal and informal feedback you received from your Preceptor.
PRAC 6665/6675 Clinical Skills
|Desired Clinical Skills for Students to Achieve
|Confident (Can complete independently)
|Mostly confident (Can complete with supervision)
|Beginning (Have performed with supervision or needs supervision to feel confident)
|New (Have never performed or does not apply)
|Comprehensive psychiatric evaluation skills in:
|Recognizing clinical signs and symptoms of psychiatric illness across the lifespan
|Differentiating between pathophysiological and psychopathological conditions
|Performing and interpreting a comprehensive and/or interval history and physical examination (including laboratory and diagnostic studies)
|Performing and interpreting a mental status examination
|Performing and interpreting a psychosocial assessment and family psychiatric history
|Performing and interpreting a functional assessment (activities of daily living, occupational, social, leisure, educational).
|Diagnostic reasoning skill in:
|Developing and prioritizing a differential diagnoses list
|Formulating diagnoses according to DSM 5 based on assessment data
|Differentiating between normal/abnormal age-related physiological and psychological symptoms/changes
|Pharmacotherapeutic skills in:
|laboratory and diagnostic studies (e.g., risk/benefit, patient preference, developmental considerations, financial, the process of informed consent, symptom management)
|Evaluating patient response and modify plan as necessary
|Documenting (e.g., adverse reaction, the patient response, changes to the plan of care)
|Psychotherapeutic Treatment Planning:
|Recognizes concepts of therapeutic modalities across the lifespan
|Selecting appropriate evidence based clinical practice guidelines for psychotherapeutic plan (e.g., risk/benefit, patient preference, developmental considerations, financial, the process of informed consent, symptom management, modality appropriate for situation)
|Applies age appropriate psychotherapeutic counseling techniques with individuals and/or any caregivers
|Develop an age appropriate individualized plan of care
|Provide psychoeducation to individuals and/or any caregivers
|Promote health and disease prevention techniques
|Develop SMART goals for practicum experiences
|Evaluating outcomes of practicum goals and modify plan as necessary
|Documenting and reflecting on learning experiences
|Maintains professional boundaries and therapeutic relationship with clients and staff
|Collaborate with multi-disciplinary teams to improve clinical practice in mental health settings
|Identifies ethical and legal dilemmas with possible resolutions
|Demonstrates non-judgmental practice approach and empathy
|Practices within scope of practice
|Selecting and implementing appropriate screening instrument(s), interpreting results, and making recommendations and referrals:
|Demonstrates selecting the correct screening instrument appropriate for the clinical situation
|Implements the screening instrument efficiently and effectively with the clients
|Interprets results for screening instruments accurately
|Develops an appropriate plan of care based upon screening instruments response
|Identifies the need to refer to another specialty provider when applicable
|Accurately documents recommendations for psychiatric consultations when applicable
Summary of strengths:
I believe my strengths lie in my professional skills. I’m able to work with many different personalities and maintain appropriate and respectful boundaries. I’m a team player and understand my duties as a APRN to advocate for my patients with a strong ethical compass. I am able to collaborate with multi-disciplinary teams and stay within my scope of practice. I also believe I am able to be non-judgmental and show empathy toward my patients and their families.
Opportunities for growth:
|Opportunities for growth in my skills that I found are:
· differentiating between pathophysiological and psychopathological conditions.
· selecting appropriate evidence based clinical practice guidelines for symptom management.
· applying age-appropriate psychotherapeutic counseling techniques.
Now, write three to four (3–4) possible goals and objectives for this practicum experience. Ensure that they follow the SMART Strategy, as described in the Learning Resources.
|1. Goal: To improve my skills in efficiently and effectively differentiating between pathophysiological and psychopathological conditions. I will practice these skills and read scholarly articles related to these skills in conjunction with oversight for the remainder of this 12-week course.a. Objective: Efficiently and effectively differentiate between client’s pathophysiological and psychopathological conditions
b. Objective: Practice and execute multiple times under supervision
c. Objective: Complete enough times to become competent in the next 12 weeks.
2. Goal: To improve my skills in selecting appropriate evidence based clinical practice guidelines for psychotherapeutic plan specifically for symptom management.
a. Objective: Become more proficient in selecting appropriate evidence based clinical practice guidelines for symptom management.
b. Objective: Practice how to select appropriate evidence based clinical practice guidelines for symptom management
c. Objective: Look for opportunities to seek guidance and constructive improvements through preceptor oversight and instruction throughout the next 12-week practicum rotation.
3. Goal: To master my skills in applying age-appropriate psychotherapeutic counseling techniques with individuals and/or any caregivers
a. Objective: Continue to master development of my age-appropriate psychotherapeutic counseling techniques with individuals and/or any caregivers.
b. Objective: Implement age-appropriate counseling techniques with individuals and/or any caregivers at every psychotherapeutic session.
c. Objective: Study, read and interpret course material and supplemental resources throughout this practicum 6675 Care across the Lifespan II.
Course/Section: PMHNP Care Across the Lifespan II Practicum
The Degree to Achieve Each Objective during the Practicum Experience Example
The first objective was to effectively differentiate between the client’s pathophysiological and psychopathological conditions. This will help ensure that I have enough information on the pathophysiological condition of the patient and how to treat the symptoms. Secondly, I was to learn how to build a therapeutic relationship with the patients and their families, ensuring effective communication.
Lastly, I was to learn how to remain professional and keep from getting attached to my patients. When patients are going through something difficult, I tend to get too attached to them, impacting my ability to remain objective and make the best decisions for my patients. I have resources that can help with patient interactions and how to make healthy connections as a therapist.
Most Challenging Patient Experiences
The most challenging patient experience I have had during the practicum experience was the case of a 16-year-old boy with ADHD. The case was challenging because the patient was sobbing throughout the interview, making it challenging to communicate. The patient did not want to take any medication for her condition.
Another experience I have had is the case of a Caucasian male patient 16 years old. He had personality changes and psychotic breaks. The case was challenging because the boy insisted he was fine, and his father did not want him to be given any medication. The final challenging patient had low self-esteem and hated himself. It was difficult to get him to speak about positive aspects of his life.
Lessons from the Experience
I learned how to handle and manage the feelings and expectations of family members regarding the mental health condition of their loved ones. It also allowed me to improve my use of patient-centered care since each patient was unique and had unique needs (Cao et al., 2018).
What Resources Were Available?
I had access to the hospital’s experienced psychiatrist, who would share the critical information on the patient’s development and highlight the critical signs to assess the patient. I also had access to previous patient records that I used to find out the patient’s history of mental illness. This information was useful in developing a suitable course of treatment for the patients.
Evidence-Based Practice Used for the Patients
For the three patients, the most effective evidence-based practice was to ensure the utilization of therapeutic communication (Duică, 2019). Therapeutic communication allows the PHMNP to maintain professionalism in dealing with patients and their families and have a human aspect that allows patient-provider trust.
New Skills Learnt
I have learned to be an active listener and understand the patients’ needs. I have also learned the importance of individualized care for patients and how to make the course of action more effective. It has also allowed me to collaborate with other care providers.
What Would Have Been Done Differently?
I would have been more straightforward and firmer with insisting on the importance of medication for my patients. Supporting the families is just as important as supporting and treating the patient (Ozen et al., 2018).
Cao, B., Cho, R. Y., Chen, D., Xiu, M., Wang, L., Soares, J. C., & Zhang, X. Y. (2020). Treatment response prediction and individualized identification of first-episode drug-naive schizophrenia using brain functional connectivity. Molecular Psychiatry, 25(4), 906-913. https://doi.org/10.1038/s41380-018-0106-5
Duică, L. (2019). Doctor-Patient Relationship-Focus In Psychiatry. Acta Medica Marisiensis, 65.
Ozen, M. E., Orum, M. H., & Kalenderoglu, A. (2018). Difficult patient in psychiatry practice: A case-control study. Adıyaman Üniversitesi Sağlık Bilimleri Dergisi, 4(3), 1064-1073. https://doi.org/10.30569/adiyamansaglik.458680