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.

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.

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.

 

            My practicum experience mainly focused on acquiring adequate skills and competencies required for the provision of culturally sensitive care services to patients with mental illness. Through this practicum experience, I have come to appreciate the role of incorporating culture to improve the quality of care for psychiatric patients. As such, this journal provides a critical reflection of my growth and development during this practicum experience including areas of strength and improvement, crucial in promoting future practice.

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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.

            My practicum experience plan focused on three main objectives, which revolve around the provision of quality care to mentally ill patients. The first objective involves the acquisition of appropriate psychotherapeutic skills required in educating patients and their families on the necessary psychotherapeutic services. I am quite confident in achieving this objective given the number of patients and families who reported positive outcomes after deciding on the use of cognitive-behavioral therapy in the management of posttraumatic stress disorder from my teaching. For the second objective, I still need some assistance with the prescription of psychotropic agents for these patients especially those with comorbidities. The last objection was to accurately interpret patients’ lab results and use the results to make a diagnosis, which I am quite conversant with from the experience gained.

Reflect on the 3 most challenging patients you encountered during the practicum experience. What was most challenging about each?

            During this practicum experience, it was quite challenging to provide care for certain patients. For instance, I encountered a young adult African American male patient with symptoms of post-traumatic stress disorder but strongly believed that what was happening to him was normal and he did not need medical attention. The other challenging patient was an Asian descent very reluctant to utilize talk therapy, claiming that talking about painful issues only worsens the pain. The last challenging patient was a middle-aged Asian female with symptoms of major depressive disorder who denied her diagnosis claiming that she comes from a respected family who does not suffer from mental illness.

What did you learn from this experience?

            From this experience, I was able to appreciate the cultural influence on the provision of mental care services. As such, clinicians, especially nurses need to develop culturally sensitive skills and competencies to promote and provide quality care to patients from different cultural beliefs, attitudes, and behaviors (Hansen et al., 2018).

What resources were available?

            Through this practicum experience, I was able to utilize most of the available resources such as the American Psychiatric Association Foundation, the American Psychological Association, and the American Academy of Child and Adolescent Psychiatry to promote the process of diagnosing and managing different mental health problems (Rathod et al., 2018).

What evidence-based practice did you use for the patients?

            During the evaluation of patients, I utilized the diagnostic and statistical manual of mental disorders, fifth edition (DSM-5) to confirm the primary diagnosis of different patients with different mental health problems (Jongen et al., 2018). I then used the American Psychiatric Association (APA) practice guidelines for effective treatment approaches such as the use of CBT for the management of PTSD.

What would you do differently?

            From this practicum experience, I understand the impact of cultural factors in the provision of mental health care services. I such, I would ensure that I take time with each patient, and learn about their cultural values and beliefs before deciding on how to advise them based on my clinical reason and gain their autonomy (Mollah et al., 2018).

How are you managing patient flow and volume?  How can you apply your growing skillset to be a social change agent within your community?

            To ensure a better patient flow, I have always ensured that I promote a culture of accountability in coordinating patient arrival and timely discharge, especially in the morning hours (Jongen et al., 2018). Through this skill set, I tend to promote an improved hospital-wide patient flow to increase the accessibility and affordability of care services to the community members promptly.

Communicating and Feedback

Reflect on how you might improve your skills and knowledge and how to communicate those efforts to your Preceptor.

            To promote my skills and knowledge, especially in the prescription of psychotropic agents in the management of the different mental disorders, I will have to write an email to my preceptor, explaining the areas in which I need additional training and the approximated additional amount of time.

Answer these questions: How am I doing? What is missing?

            I am quite confident in my psychotherapeutic skills, and ability to accurately diagnose different mental illnesses based on the DSM-V diagnostic criteria. However, I am quite reluctant to accurately prescribe psychotropic medications to patients with comorbidities.

 References

Hansen, H., Braslow, J., & Rohrbaugh, R. M. (2018). From cultural to structural competency—training psychiatry residents to act on social determinants of health and institutional racism. JAMA Psychiatry, 75(2), 117-118. doi:10.1001/jamapsychiatry.2017.3894

Jongen, C., McCalman, J., & Bainbridge, R. (2018). Health workforce cultural competency interventions: a systematic scoping review. BMC health services research, 18(1), 1-15. https://doi.org/10.1186/s12913-018-3001-5

Mollah, T. N., Antoniades, J., Lafeer, F. I., & Brijnath, B. (2018). How do mental health practitioners operationalize cultural competency in everyday practice? A qualitative analysis. BMC Health Services Research, 18(1), 1-12. https://doi.org/10.1186/s12913-018-3296-2

Rathod, S., Gega, L., Degnan, A., Pikard, J., Khan, T., Husain, N., … & Naeem, F. (2018). The current status of culturally adapted mental health interventions: a practice-focused review of meta-analyses. Neuropsychiatric disease and treatment, 14, 165. DOI: 10.2147/NDT.S138430

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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.

To Prepare
• 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.

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.

References
https://www.apna.org/files/Councils/Population-Focused-NP-Competencies-2013.pdf