Journal Entry: Practicum Experience Plan
Learning from Experiences
For the duration of my practicum, I labored diligently to achieve the three overall goals stipulated in my Practicum Experience Plan. I enhanced my diagnostic reasoning skills by formulating accurate differential diagnoses for at least five patients weekly and distinguishing pathophysiological from psychopathological conditions according to DSM-5-TR criteria (Chapman et al., 2024). I successfully met my second goal of conducting evidence-based screening measures, including the PHQ-9, GAD-7, and CAGE, independently and implementing them in individualized treatment plans. My third goal of delivering evidence-based psychotherapy was met through the use of CBT and DBT techniques tailored to the patient’s needs and cultural background, with adjustments based on patient response and preceptor input.
The three most challenging patients were a middle-aged male patient with borderline personality disorder and paranoia secondary to stress, an elderly patient with multiple comorbid conditions and complex medication requirements, and an adolescent patient with co-occurring substance use disorder and mood lability. The borderline personality disorder case was challenging in that the patient had unstable trust and intermittent paranoid ideation and required maintenance of rapport in a careful manner. The geriatric case tested my ability to balance polypharmacy risk management with psychiatric stability. The adolescent case was complicated by poor engagement and treatment resistance. The cases taught me the importance of thorough collateral collection, clear therapeutic boundaries, and adaptability in interventions based on readiness to change.
Resources available to me included my preceptor’s expertise, advice from multidisciplinary teams, evidence-based clinical practice guidelines, and patient education brochures. For the borderline client, I relied on DBT as an evidence-based practice, implementing distress tolerance and emotional regulation skills (Vijayapriya & Tamarana, 2023). For the geriatric client, I utilized the foundations of geriatric psychopharmacology to minimize side effects. For the adolescent, I employed motivational interviewing to clear ambivalence. If I could re-examine these cases, I would use earlier formal screening for paranoia, apply family involvement earlier in the adolescent case, and institute pharmacy consultation earlier for geriatric medication review.
Patient flow was managed through strategic scheduling, prioritization based on high-acuity cases, and, where possible, using brief, focused interventions. I learned to prep ahead of time through reading patient histories and planning on likely needs to offer more efficiency without compromising quality. My expanded skill set can be applied as a social change agent by advancing culturally compassionate psychiatric care and expanding mental health education access for underserved groups.
Communicating and Feedback
To further develop my expertise, I intend to continue to refine my ability to select and interpret screening tools for specialty populations, refine my group therapy facilitation skills, and deepen my knowledge of pharmacologic interventions for challenging cases (Burgess et al., 2020). I communicated these areas of growth to my preceptor by bringing them up in weekly supervision, reading new literature, and trying to supervise more challenging cases.
In answering “How am I doing?” I recognize that my diagnostic skills, therapeutic relationship, and application of evidence-based practices are good. “What is missing?” is greater proficiency in brief but comprehensive mental status exams on high-volume clinic days. More formal comments from my preceptor identified my effective patient interaction skills and meticulous documentation, and informal comments led me to trust my clinical judgment and continue to make efficiency improvements. These learnings will shape my future development, whereby I will be more equipped to embark on my subsequent practicum with improved clinical competence and autonomy of practice.
References
Burgess, A., Van Diggele, C., Roberts, C., & Mellis, C. (2020). Feedback in the clinical setting. BMC Medical Education, 20(2), 1–5. https://doi.org/10.1186/s12909-020-02280-5
Chapman, J., Jamil, R. T., Fleisher, C., & Torrico, T. J. (2024, April 20). Borderline personality disorder. PubMed; StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/28613633/
Vijayapriya, C. V., & Tamarana, R. (2023). Effectiveness of dialectical behavior therapy as a transdiagnostic treatment for improving cognitive functions: A systematic review. Research in Psychotherapy: Psychopathology, Process and Outcome, 26(2). https://doi.org/10.4081/ripppo.2023.662
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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.
Journal Entry – Practicum Experience Plan
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.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
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 your 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 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 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.