Revisit the goals and objectives from your Practicum Experience Plan. Explain the degree to which you achieved each during the practicum experience.

Revisit the goals and objectives from your Practicum Experience Plan. Explain the degree to which you achieved each during the practicum experience.

Revisit the goals and objectives from your Practicum Experience Plan. Explain the degree to which you achieved each during the practicum experience.

The practicum has provided me with a great experience to improve my clinical skills in psychiatry and mental health nursing. I fully achieved the objectives I had set for the practicum, including becoming proficient in the assessment and formulation of psychiatric diagnoses according to DSM 5. I also achieved the objective of performing comprehensive psychiatric assessments of patients, and I gained proficiency in conducting mental status exams. In addition, I fully met the objective of developing a plan for the practicum tasks alongside my preceptor. The plan included selecting screening scales and tools and identifying their use in the clinical areas. I also developed appropriate psychotherapy treatment plans for patients that I performed psychiatric assessments and screened during the practicum.

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I encountered some challenging patient cases which required intervention from my preceptor. One of these cases was of a 23-year-old male with Bipolar disorder (depression) who expressed suicidal ideations, was non-compliant with medications, and was abusing methamphetamine. The case was challenging because the patient later denied having suicidal ideations when he was told he would be admitted and became angry and irritable with the admission decision. The second case was a 19-year-old male who expressed suicidal ideations and had a history of numerous psychiatric admissions. The patient was challenging because he had comorbid disorders including bipolar disorder, ADHD, Cannabis use disorder, Learning disability, and autism. It was thus difficult to develop a treatment plan to address all his disorders. The third case was a 23-year-old male with delusions, aggression, and irritability who reported that his mother had burnt him with water. The case was difficult since we could not establish if the third-degree burns on his back were a result of physical abuse or self-harm.

From the above patient experiences, I learned that every patient is unique and therefore the assessment and treatment plan should be individualized based on the identified healthcare needs (Coffey et al., 2019). I also learned that suicidal ideations should be treated as a psychiatric emergency and patients should be admitted since they are a danger to themselves and could be a danger to others (da Silva, et al., 2020).

Available resources during the practicum included DSM-V diagnostic manual, psychotherapy guidelines, treatment guidelines for psychiatric disorders, and hospital protocols that guided the actions to take for various diagnoses. If I were to repeat the practicum, I would strive to maintain a good interpersonal relationship with patients and their families. I would also take time to educate clients and their families about their conditions and behaviors.

The practicum setting has a high patient flow and volume since most patients from other towns are referred to the facility. We are managing the patient flow and volume through technology measures that automate processes and decrease the need for manual work.  Besides, we ensure patient files, supplies, and equipment are easily accessible to avoid waste wastage.  I can utilize my increasing skill set in psychiatry to be a social change agent by educating my community about mental health, including health prevention measures and treatment options available (Gaffney et al., 2020). I can also encourage people to seek mental health care to promote better mental health outcomes and associated morbidity.

References

Coffey, M., Hannigan, B., Barlow, S., Cartwright, M., Cohen, R., Faulkner, A., … & Simpson, A. (2019). Recovery-focused mental health care planning and co-ordination in acute inpatient mental health settings: a cross national comparative mixed methods study. BMC psychiatry, 19(1), 1-18. https://doi.org/10.1186/s12888-019-2094-7

da Silva, A. G., Baldaçara, L., Cavalcante, D. A., Fasanella, N. A., & Palha, A. P. (2020). The Impact of Mental Illness Stigma on Psychiatric Emergencies. Frontiers in psychiatry, 11, 573. https://doi.org/10.3389/fpsyt.2020.00573

Gaffney, H., Mansell, W., & Tai, S. (2020). Agents of change: Understanding the therapeutic processes associated with the helpfulness of therapy for mental health problems with relational agent MYLO. Digital health, 6, 2055207620911580. https://doi.org/10.1177/2055207620911580

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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?
Communicating and Feedback

Reflect on how you might improve your skills and knowledge, and communicate those efforts to your Preceptor.
Answer the questions: How am I doing? What is missing?
Reflect on the formal and informal feedback you received from your Preceptor.

“I need to kill myself.” HPI: This is the first admission to TSH for this 12-year Caucasian male who is Grand S who was brought in by Mom.pt. apparently tried to kill himself by tying a knot around his neck mom went in and interrupted and brought him in for evaluation and safety. Patient reported to have significant behavioral problem including aggression, aggression toward mom, and aggression at school and cruelty to animals, and killed his a friend guinea pig.

3355. JR. Danger to self, Danger to others, danger of deterioration
C. “Medication adjustment”
HPI: Pt had reportedly been on Concerta 54 mg qAM with IR Ritalin 10 mg at noon from 2007-2020 for treatment of ADHD. Pt and parent report that this had been helpful, no negative s/e. Did not seem to worsen issues with mood lability as pt’s 10+ inpatient hospitalizations seem to have followed onset of COVID in May 2020 and afterwards. She had been an all A student up through. This is the fourth hospitalization to TSH for this 12-year-old Caucasian female who was recently discharged from Terrell State Hospital in Dec. 2021 with a primary diagnosis of intermittent explosive disorder.
O. MEDICATIONS: Current Psychotropic Meds: Clonidine 0.1 mg qHS, Melatonin 10 mg qHS
A. Patient denied ever having suicidal intent or plan at any point. No hx of prior suicide attempts or NSSI. Per admissions staff, prior to my arrival, it was reported that pt was “hysterical.” As pt was a walk-in, prior to my assessment, she was screened by NTBHA MCOT who felt like she met inpatient criteria based on speaking with pt and her mother.
PRESUMPTIVE DIAGNOSES:
MENTAL HEALTH: DMDD, ADHD by history, Unspecified Depression, Unspecified Anxiety, r/o Borderline Personality Traits, Childhood Victim of Sexual Abuse.

Date 03/10/2022 Course #6665C Clinical Faculty: Dr. Rose # 3346 CC: “RL :I want to kill myself; I get ups and downs in my mood” HPI: Patient is a 19-year-old young male with psychiatric history of Learning disability, autism and multiple previous psychiatric hospitalizations currently presents on an ED brought in to TSH accompanied by her father on the basis of likely to cause harm to self &/or likely deterioration to suffer severe and abnormal mental, emotional, or physical distress. Per ED paperwork, “subject stated multiple times that he wanted to die and that he was going to kill himself. Subject got in trouble for having an underage runaway with him”. Father has guardianship of patient. O: – Oxcarbazepine 600 mg po HS and 300 mg po QAM and 450 mg po Qafternoon – Abilify 10 mg po at bedtime – Guanfacine ER 4 mg po QAM – Amantadine 200 mg po QAM to 100 mg po Qafternoon. A; Patient reports that “I want to kill myself”. “Sometimes I think like that”. Patient reports that my mood switches from “happy to sad and mad quickly out of nowhere”. Patient reports that he’s feeling happy currently. Patient reports that he has been hospitalized more than 10-15 times in a psychiatric hospital. He was in green Oaks for about a month. Patient reports that he has been diagnosed with ADHD, Autism, Bipolar disorder P: PRESUMPTIVE DIAGNOSES: MENTAL HEALTH: Other specified bipolar and related disorder; Hx of ADHD SUBSTANCE ABUSE: Cannabis use disorder INTELLECTUAL OR DEVELOPMENTAL DISABILITY: Yes MEDICAL: No acute issues; dental pain No known drug allergies ENVIRONMENTAL: Legal problems Poor compliance Initial Treatment Plan: 1.Admit to the unit L1 on level RED for safety precautions. CME filed to obtain OPC. 2.Routine labs ordered, including, CBC, CMP, TSH, HIV, RPR, Mantoux, UA, antipsychotic protocol, metabolic protocol. 3.Medications: Consents obtained: Lithium, Oxcarbazepine, Amantadine, abilify, Abilify Maintena, Ativan (for agitation)

: Danger to self, Danger to others, Danger of deterioration CC:” “My mother doesn’t like me.” HPI: Mr. B is a 23-year-old, right-handed, single Hispanic male who lives with mother and father, who is currently unemployed. Mr. B was brought here from Gr Hospital on Order of Protective Custody because of delusions, aggression, and irritability. The transferring psychiatrist feeling that he will need more long-term care. The reason for admission to Parkland Psychiatric Emergency Room was due to incidents starting last Wednesday which included “my mother threw hot boiling water on me. O: CURRENT MEDICATIONS: The patient is currently taking Seroquel, Doxepin and Depakote. his vitals were stable at blood pressure 110/71, pulse 80 per minute, respirations 18 per minute, temperature 98.2. His height was 67 inches. He weighed 182.2 pounds. Abdominal girth was 35.5. Oxygen saturation was 99 percent A: His mood was “I feel okay, I don’t feel happy or sad.” He feels that his weight has increased, but due to the medications, sleep at night is decreased to 6 hours. He had a normal range of psychomotor activity and no suicidal thoughts. He enjoys eating at places like Taco Bell, Jack-in-the-Box and playing video games and listening to music which he has been doing throughout these incidents. He feels as though his energy is decreased due to medication usage and that is how he is feeling today. He denies any feelings of worthlessness or guilt. He says his concentration is good. When asked about manic symptoms such as irritable mood, increased pleasurable activities, decrease need for sleep, racing thoughts at one time, he denies this as happening. P: PRESUMPTIVE DIAGNOSIS: Axis I: Schizoaffective disorder, bipolar type Axis II: Deferred Axis III: Second and third degree burn to back and neck Axis IV: Primary support failure Economic

04/21/2022 Course:6665 Clinical instructor: Dr. Onyekwe. Preceptor: Dr.Paul Sobin Objectives 2: I will perform a comprehensive psychiatric assessment and be proficient in the mental status exam by 6 weeks. (3) I will develop a plan nursing practice for practicum work with my preceptor on selecting screening scales/tools their use in the clinical areas an appropriate treatment plan for psychotherapy-based by the end of week 4-Accomplished 2.# MJ 3078. Danger to self and others Danger to others, Danger of deterioration. CC: “I don’t know (why police brought him to TSH)” HPI: Pt is a 23-year-old Hispanic male, single, lives with brother and friend, who was brought in on an Emergency Detention from Van Zandt Jail for an assessment due to “emotional outbursts for no reason- has eaten ink pens in jail . 0: Haldol Deaconate LAI 200 mg monthly for psychosis/mood- last dose on 4/11/22 Zyprexa 20 mg q HS for psychosis/mood, Amantadine 100 mg BID for restlessness PRN Restoril 30 mg q HS for sleep disturbance A. He had very poor eye contact and seemed to be scratching and picking at one of his fingernails. Pt was oriented to person, place, and time and stated that he knows we are TSH and knows its April 20th, 2022. He stated he has “no idea” why police brought him here. I asked him explicitly about statement on emergency. P: At this time, especially without any collateral information, will file OPC on grounds of pt appearing to be at elevated risk of deterioration and will admit him to Unit L1 for further assessment and stabilization. He follows up at Andrews Center for outpatient services reportedly. PRESUMPTIVE DIAGNOSES: MENTAL HEALTH: Unspecified Psychosis, Schizophrenia by history, r/o Neurocognitive disorder secondary to hx of inhalant use SUBSTANCE ABUSE: Inhalant Use Disorder by history, Cannabis Use Disorder by history, Alcohol Use disorder by history INTELLECTUAL/DEVELOPMENTAL DISABILITY: None MEDICAL: No acute issues, NKDA. 1. Admit to TSH Unit L1 under

As I spoke with the patient, he reported his mood as, “I feel like there is no hope.” Initially, he reported that he feels very depressed and has no energy with suicidal ideations. However, denied any plan or intent. Later on, he stated, “Anyways, I don’t want to stay here because MCOT just told me that I can be managed as an outpatient, and I just need some inpatient help with substances, and they said that they could get me to an inpatient rehab facility.” O When I evaluated the patient here in Admissions, his vitals were blood pressure 146/78, pulse 65 per minute, respirations 18 per minute, temperature 98.8 degrees, oxygen saturation 98% on room air. His height was 69.5 inches, weight 178.2 pounds, and an abdominal girth of 37.5 inches A: Patient was noted to be somewhat irritable and pacing, and being argumentative with staff, telling them that he feels like he is being held hostage here and not allowed to leave the hospital. Denied experiencing any racing thoughts. Denied increased goal directed activities. Mentioned that his sleep is not the best and reported that his appetite is fair. When questioned about psychotic symptoms, patient denied experiencing auditory of visual hallucinations. No report of delusions or first rank symptoms. Denies problems with anxiety and denied having access to guns or firearms. P: DIAGNOSTIC FORMULATION: Mr. F is a 52-year-old Caucasian male with history of bipolar disorder, most recent episode depressed, who follows up at The AND center. He has been noncompliant with medications for the last three weeks and has been abusing methamphetamine. He was brought in as a walk-in by his girlfriend to be evaluated for his depressive symptoms. He reports feeling sad, hopeless. Initially voiced suicidal ideations without a plan. Later, said that he is not suicidal and not wanting to get hospitalized at Terrell State Hospital. When we told him that he needs to get admitted, he became angry and irritable, and was unhappy going to the unit. He said that he has a long history of methamphetamine abuse for the last 30 years, and his last use was on Saturday. PRESUMPTIVE DIAGNOSES: MENTAL HEALTH: Bipolar disorder, most recent episode depressed SUBSTANCE ABUSE: Substance use disorders with methamphetamine and alcohol

INTELLECTUAL OR DEVELOPMENTAL DISABILITY: None MEDICAL: Neuropathy GI distress ENVIRONMENTAL: Poor coping skills History of legal problems.
The above are number of interested patients you can use to reflection by their reason for admission and medication use for bipolar and anxiety ,schizophrenia and on of the most interested on is a12old who tried to burn their house nut had no clue about the consequence