Welcome to the last week of your practicum! As you have proceeded through the practicum experience, you have been regularly challenged to reflect on your growth and development as you made progress on your goals. Additionally, you have been evaluated and gained feedback from your Preceptor. As you end this practicum, consider what you have gained from the experiences in your practicum setting. Did you meet your goals and objectives? What were the challenges and how did you manage them? What were the successes and what lessons can you take from those experiences and apply to future experiences? Use your reflections to seek opportunities for growth in the areas you found challenging, while simultaneously celebrating your successes.
This week, your complete a reflective Journal Entry on your practicum experience. Additionally, you must log in to Meditrek and download and print out your Patient Log. This serves as a log to provide to healthcare organizations when requested.
PRAC 6635 WEEK 11 Assignment: Journal Entry
The goals for the Practicum Experience were to: Improve clinical skills and competencies in performing comprehensive psychiatric evaluations, improve my diagnostic reasoning skills, and improve my skills in selecting and implementing psychiatric screening instruments. I achieved the first goal by taking a comprehensive history, physical examination, MSE, and psychosocial assessments for more than ten patients. I improved my diagnostic reasoning skills to a great extent by developing primary and differential psychiatric diagnoses for patients using DSM-V. While assessing patients, I selected, implemented, and interpreted screening instruments, which helped to achieve the third goal.
The most challenging patient case was of a female patient with dissociative identity disorder and had secondary personality disorders sometimes manifested during therapy. This was challenging because each personality state had unique memories, behavior, and social relationships that led to complexities, frustrations, and conflict in the client. The second most challenging case was a male patient with paranoid personality disorder. The patient was reluctant to confide with the therapist due to unjustified fear that the information would be used maliciously against him. In addition, I encountered a challenging case of a patient with Bulimia nervosa because a depressed mood accompanied the condition, and the patient was uncooperative in therapy.
This was an educative practicum experience, and I learned that PMHNPs have the role of protecting patients’ rights to avoid legal issues that are common in psychiatric settings. I also learned of the contemporary PMHNP roles, including promoting and maintaining mental health; diagnosis, treatment, and rehabilitation; patient advocacy; professional collaboration; social and legal accountability; management and referral of co-existing physical health problems (Hartley et al., 2020). The resources available during the practicum included drug handbooks, psychiatric treatment protocols, psychotherapy guidelines, and the DSM 5 handbook. I applied a wide range of EBP interventions in managing patients with various psychiatric conditions, including CBT, Dialectical Behavior Therapy, Mindfulness-Based Cognitive Therapy, and Social Skills Training (Locher et al., 2019). I am learning new skills, including communication with psychiatric patients, analytical skills for different patient situations, and advocacy skills.
In a different practicum experience, I would demonstrate more care and compassion when making decisions as a provider and interacting with patients and their families. I would also have more confidence in my abilities to make decisions, especially in challenging situations, and take charge if the occasion arises (Hartley et al., 2020). The practicum setting has a high patient flow since it is the only facility providing inpatient and outpatient mental health services in the area. We are managing the high patient flow by scheduling appointments for each patient and using group therapy for patients with common conditions since more patients will be attended to.
Communicating and Feedback
I can improve my knowledge and skills by being active in therapy sessions and collaborating with other providers involved in patient care to learn from them. Generally, I am learning a lot from my preceptor and other providers who have been valuable in helping me achieve my objectives. The preceptor has encouraged me to improve my communication skills since communication is not just about talking but also about good listening skills.
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