Assignment: Journal Entry
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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.
Required Media
In 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 three 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?
PMHNP PRAC 6645 Clinical Skills
Self-Assessment Form
| Desired Clinical Skills for Students to Achieve | Confident (Can complete independently) | Mostly confident (Can complete with supervision) | Beginning (Have performed with supervision or need 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 | X | |||
| Differentiating between pathophysiological and psychopathological conditions | X | |||
| Performing and interpreting a comprehensive and/or interval history and physical examination (including laboratory and diagnostic studies) | X | |||
| Performing and interpreting a mental status examination | X | |||
| Performing and interpreting a psychosocial assessment and family psychiatric history | X | |||
| Performing and interpreting a functional assessment (activities of daily living, occupational, social, leisure, educational). | X | |||
| Diagnostic reasoning skill in: | ||||
| Developing and prioritizing a differential diagnoses list | X | |||
| Formulating diagnoses according to DSM 5 based on assessment data | X | |||
| Differentiating between normal/abnormal age-related physiological and psychological symptoms/changes | X | |||
| Pharmacotherapeutic skills in: | ||||
| Selecting appropriate evidence based clinical practice guidelines for medication plan (e.g., risk/benefit, patient preference, developmental considerations, financial, the process of informed consent, symptom management) | X | |||
| Evaluating patient response and modify plan as necessary | X | |||
| Documenting (e.g., adverse reaction, the patient response, changes to the plan of care) | X | |||
| Psychotherapeutic Treatment Planning: | ||||
| Recognizes concepts of therapeutic modalities across the lifespan | X | |||
| 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) | X | |||
| Applies age appropriate psychotherapeutic counseling techniques with individuals, families, and/or groups | X | |||
| Develop an age appropriate individualized plan of care | X | |||
| Provide psychoeducation to individuals, family, and/or groups | X | |||
| Promote health and disease prevention techniques | X | |||
| Self-Assessment skills: | ||||
| Develop SMART goals for practicum experiences | X | |||
| Evaluating outcomes of practicum goals and modify plan as necessary | X | |||
| Documenting and reflecting on learning experiences | X | |||
| Professional skills: | ||||
| Maintains professional boundaries and therapeutic relationship with clients and staff | X | |||
| Collaborate with multi-disciplinary teams to improve clinical practice in mental health settings | X | |||
| Identifies ethical and legal dilemmas with possible resolutions | X | |||
| Demonstrates non-judgmental practice approach and empathy | X | |||
| Practices within scope of practice | X | |||
| 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 | X | |||
| Implements the screening instrument efficiently and effectively with the clients | X | |||
| Interprets results for screening instruments accurately | X | |||
| Develops an appropriate plan of care based upon screening instruments response | X | |||
| Identifies the need to refer to another specialty provider when applicable | X | |||
| Accurately documents recommendations for psychiatric consultations when applicable | X |
Summary of strengths:
| My greatest strength is listening to my clients because most times healthcare professional do not listen to the patients. Communication is another strong strength of mine understanding that there are different ways of communication which include both verbal and nonverbal. Ability to follow the professional boundaries is very important to me. I am also good at not been judgmental while at work. I also value respecting my clients. Another strength of mine has been my ability to identify my areas of weakness and asking for help for the benefit of my clients. |
Opportunities for growth:
| One of my opportunities I will derive from this course will be to differentiate between pathophysiological and psychopathological conditions. Working with clients from all age group will provide me a good opportunity for growth. Another area of growth will be recognizing concepts of therapeutic modalities across the lifespan. Accurate diagnosis and developing a comprehensive acceptable care plan will be a priority for me too. |
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. |
Pt 1
CC (chief complaint): Arrested by the police.
HPI: AC is a female aged 13 years who are accompanied to the clinic by her grandmother. She has been hospitalized twice in the past because of behavioral issues. After an argument with her sister, she pulled out a knife, resulting in her arrest and hospitalization. She has also been arrested for arguing with the police. AC says she was on her medications when she pulled the knife on her sister. She has also argued with her family upon release from the hospital. In addition, the patient admits to arguing with her teachers at school. She does not report significant improvements with her medication, and she has not been taking them consistently. AC has anger issues, is fearful, depressed, lost interest in activities, and feels it would be better if she were dead. She uses drugs such as nicotine and marijuana.
Pt 2
CC (chief complaint): Going through withdrawal.
HPI: JS is a male, 41 years old, who has presented to the clinic to be evaluated due to withdrawal symptoms. He has been withdrawing from his medication and has not taken them for the past three days. This has led him to experience chills, diarrhea, and agitation. His current medication is Percocet which he used to take 10mg x 6 daily. He was referred to the clinic for a Suboxone prescription. JS is currently on a workers’ compensation scheme; he was shot in 2008, which then affected his twelfth thoracic vertebra. The patient has undergone an amputation in the past and developed sepsis resulting from a hole in the wound he sustained. JS uses a colostomy bag and is also on Melatonin 10 medication to help with his sleeping problems. He has a previous history of substance abuse, taking methamphetamine and cocaine, and he is an occasional smoker. He works out, going to the gym between 5 am and 10 am. He avoids interactions preferring to keep to himself. JS stays with his son-in-law, his granddaughter, and his daughter.
Pt 3.
Pt Name: A.N Age: 32 Years old. Diagnosis: Attention Deficit Disorder / Generalized Anxiety Disorder / Major Depressive Disorder Chief Complain: Seems not to cope with his loss. Pt is a 34-year-old male, who presented to the clinic saying that he lost his grandmother who raised him up and he do not to come in terms that he lost her. It is affecting his life and his relationship with his wife. Though pt is happy that he switched jobs and he is getting a better pay. Pt was suggested therapy to help him cope and heal with his loss. He was prescribed another medication to help him. Pt is Wellbutrin 300 mg once a day, Trileptal 300 mg once daily. He was also offered referral if he needs it. Medication was called in and pt is to follow up in 3 months.
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