Clinical Strengths and Opportunities for Improvement
At the beginning of the practicum, I was not confident in assessing a patient using the appropriate screening tools. This included interpreting the results, and I needed a second consult to ensure I got it right. I was also having challenges diagnosing a patient and especially differentiating between pathophysiological and psychopathologic conditions. While I still am not 100% confident, I can say that I am better off than I was as I find I am making fewer consults. With more practice, and especially by completing hypothetical case studies, I will be more confident and well-equipped to administer screening tools, interpret results, and correctly diagnose a patient. In the other goals I had set for myself, I am glad I gained full confidence. Specifically, I can now recognize concepts of therapeutic modalities and select appropriate evidence-based clinical practice guidelines for psychotherapeutic plans. My communication skills with patients have improved as well, though I intend to continue working on bettering myself in this area through online communication skills courses. I also identified one of my senior colleagues at my workplace, and though I have yet to start shadowing him, he has agreed for me to watch and learn as he practices his profession. The colleague, however, noted that this arrangement would only be possible after his patients consented to have me present during their therapy sessions. Nonetheless, I am looking forward to shadowing him.
The first challenging patient I encountered was a nine-year-old female who had ADHD. The most difficult part was to get her to be still enough for her mother to have a conversation with me. The patient seemed to be all over the room, and the mother was always distracted. When the patient began to cry hysterically from bumping her toe, the session was ended. The second patient was a 14-year-old male whose father said he had become rude and troublesome at school. The patient had taken to disappearing from home early in the morning and returning later in the day in his pajamas and looking confused. The teenager would return home, and once inside, he would resume being ‘normal’ according to his father. The challenging part was diagnosing the patient because he seemed alert and oriented to place and time, and I had to rely on his father’s report of the patient’s encounter. I had to refer the patient to a specialist at the healthcare center. Lastly, there was the 78-year-old patient who her niece accompanied. She had gone mum and had refused to talk to anyone for the last five days. The niece was concerned about her aunt’s unending silence. The session was unproductive as the patient vehemently refused to talk, making it impossible to diagnose her.
I learned from the three experiences that communication and first-hand encounters with the patient are very important. A person accompanying the patient will give an account of incidences based on their perception of the patient and the circumstances. The teenager and the elderly patient, for example, did not share their first-hand experiences of what they were going through, and this made diagnosis difficult (Greenhalgh et al., 2018). The available resources were the specialized professionals at the healthcare facility. I, however, would have preferred if the facility had a room where a child, such as the nine-year-old, would interact with play-things such as stuffed toys that would calm her down for a better assessment. As for the teenager, I gave him a small notebook and requested him to journal his thoughts and feelings for a week and then come back the following week, and I would have a one-on-one session with him without his father being present in the sessions (Cook et al., 2018). To get the elderly patient to talk, I requested her to take my tape recorder. I told her that anytime she wanted to say anything, she could record herself, and when she was ready, she could bring it over or request that I visit her at her home and collect it (Trotter, 2015). The one thing I would do differently is to have one of the elderly nurse assistants present when the elderly patient was brought in. I believe the patient would have opened up to someone closer to her age, and this would have helped in determining what her problem was.
Patient flow and volumes have not changed drastically at my workplace. Nonetheless, I am looking forward to having a new software system installed that would automatically book patient appointments and remind them of their work through a phone notification. In addition to this, I am looking to have a mental health educational app developed that will help the community members. The app will be free to install and update community members on upcoming events, such as free checkups and tips on staying mentally healthy, including when and how to access help.
My greatest challenge before the practicum was being completely confident in the abovementioned areas. Following the strategies I will undertake, as noted above, I will keep my Preceptor aware of what I am doing and the scores I get from the hypothetical case studies. At the moment, I believe I still have a short distance to cover in becoming fully confident, but I am working on this. I am in the process of creating flashcards with cues that cover the different areas I am working on, such as diagnosis, screening tools, and communication skills. I have also booked myself for Webinar sessions that focus on mental health and patient diagnosis; I believe I will learn a lot more from other people’s experiences through these sessions.
References
Cook, J. M., Simiola, V., McCarthy, E., Ellis, A., & Stirman, S. W. (2018). Use of reflective journaling to understand decision making regarding two evidence-based psychotherapies for PTSD: Practice implications. Practice Innovations, 3(3), 153.
Greenhalgh, J., Gooding, K., Gibbons, E., Dalkin, S., Wright, J., Valderas, J., & Black, N. (2018). How do patient-reported outcome measures (PROMs) support clinician-patient communication and patient care? A realist synthesis. Journal of patient-reported outcomes, 2(1), 1-28.
Trotter, C. (2015). Working with involuntary clients: A practice guide. Routledge
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Question 
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.
Clinical Strengths and Opportunities for Improvement
Use this Journal to reflect on your clinical strengths and opportunities for improvement, your progress, 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 their 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.
In 450–500 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? 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.