PRAC 6635 Week 11 Psychiatric Clinic Journal Entry Assignment

The goals for the practicum experience included correctly evaluating clinical signs and symptoms of psychiatric illness across the lifespan. I adequately met this goal by preparing individualized treatment plans for clients across the life span developing strategies to assess and treat all patients across the lifespan. The second goal was to utilize and implement an appropriate screening instrument, such as the mini-mental exam status exam, ADHD screening, and anxiety screening for a patient. I adequately met this goal by using screening tools like the PHQ-9, ADHD Questionnaire, GAD-7, Young Mania Rating Scale, Brief Psychiatric Rating Scale, and Positive and Negative Syndrome Scale. The third goal was to select appropriate evidence-based clinical practice guidelines for treatment and prescription writing. I utilized psychiatric guidelines and treatment protocols in developing psychotherapy and pharmacotherapy treatment plans for clients, which helped me achieve this goal.

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The most challenging case was of a 5-year-old boy with Separation Anxiety who had physical symptoms secondary to the disorder. This was a challenging case because the child was not fully mentally developed to engage in psychoeducation interventions, and it was difficult to train the child in anxiety control skills. Another challenging case was of a 45-year-old male with Narcissistic personality disorder who had a great need for admiration, lacked empathy, and had powerful envy. The case was challenging because the patient had a sense of entitlement, was arrogant towards the therapist, and had unrealistic expectations of receiving favorable treatment during therapy. Another case was of a 58-year-old female who was preoccupied with a serious disease that her PCP had not diagnosed. This was a difficult case since we could not persuade the client that she had no major illness despite numerous diagnostic tests.

During the practicum experience, I learned about my professional role as a PMHNP and the scope of practice that I should adhere to in my future practice. I also learned how the PMHNP should demonstrate EBP behaviors and adhere to standards of care when ordering and interpreting diagnostic tests, prescribing treatment, and developing health prevention and maintenance plans. The resources available include clinical practice guidelines, DSM-V, and psychiatric textbooks. We applied various EBP approaches in managing various conditions in patients, including Cognitive behavioral therapy, Psychodynamic psychotherapy, Dialectical behavior therapy, Family therapy, Psychoanalysis, Gestalt therapy, Play therapy, Mindfulness-based stress reduction, and Integrative psychotherapy (Locher et al., 2019).

If I were to redo the practicum, I would strive to provide holistic care by integrating patients’ ethnicity and cultural elements as well as their lifestyles and relationships to understand how these factors work together to affect patients (Hartley et al., 2020). The practicum setting has a high patient volume and flow since other facilities refer patients with mental disorders to this facility. We are managing the high patient flow by adopting technology like dynamic scheduling, which shows patients’ exact location, who has seen them, and who has not yet been with them. I can apply my growing advocacy skills to advocate for improved mental healthcare services in my community, leading to better mental health and overall outcomes. 

References

Hartley, S., Raphael, J., Lovell, K., & Berry, K. (2020). Effective nurse-patient relationships in mental health care: A systematic review of interventions to improve the therapeutic alliance. International Journal of Nursing Studies, 102, 103490. https://doi.org/10.1016/j.ijnurstu.2019.103490

Locher, C., Meier, S., & Gaab, J. (2019). Psychotherapy: A World of Meanings. Frontiers in Psychology, 10, 460. https://doi.org/10.3389/fpsyg.2019.00460

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Week 11  Journal Instructions

Assignment: Journal Entry

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Critical reflection of your growth and development during your practicum experience in a clinical setting has the benefit of helping you to 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” found in the Week 1 Learning Resources, and consider the quality measures or indicators advanced nursing practice nurses must possess in your specialty of interest.
• 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, and consider the patient activities you have experienced in your practicum experience and reflect on your observations and experiences.

Journal Entry (450–500 words)

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 three (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?