Journal Entry-Practicum experience

Journal Entry-Practicum experience

My three goals for this practicum were to develop advanced skills to recognize clinical signs and symptoms of psychiatric illness across the life span, develop the knowledge and skills for selecting and implementing appropriate screening instruments and interpreting results, and develop advanced skills for psychotherapeutic treatment planning. I can confidently say that I have achieved the second goal. I can now select and apply an appropriate screening tool to a patient. As for the first and third goals, I am still working to improve my skills in differentiating between pathophysiological and psychopathological conditions. I am also working at improving my skills in applying psychotherapeutic counseling techniques for groups and families; I am well versed with techniques to apply for individuals.

The first patient was a 20-year-old female who wanted to be a cat and believed she was a cat. The patient’s mother said that the girl refused to eat as a normal person would and instead would lick her food and drinks. She refused to bathe and would insist on licking herself. This had gone on for months and seemed to be getting worse. The mother admitted that her daughter had always had pet cats since her childhood. I had to end the session and seek counsel after the girl hid under the office chair and would scratch and make hissing sounds at her mother and me when we asked to come from under the chair. She was wild and had a disturbing look in her eyes. The second patient was a 23-year-old male who appeared to have 3 different personalities. One of the personalities threatened to kill his sister and drink her blood. The personality insisted that the sister was out to kill him, so he would kill her first. Things turned south when the personality said that I was helping the sister to hide, and so he was going to get me as well. I had to press the alarm for the security personnel to come in and protect me. Then there was the third patient whose father insisted he was demon-possessed and did not need a therapist but an exorcist. However, after asking the father to leave the room, I discovered that the 22-year-old patient was depressed. The father refuted my diagnosis and insisted that he would not come back. I later got his mother’s address, and I am hoping she will bring him back.

The main thing I learned from these experiences is to quickly assess a possibly dangerous patient and have security close by. I had never encountered violent patients before, and these awakened me to the danger I exposed myself to without my knowledge. The resources I had were the preceptor I could consult regarding the patients and security personnel that came in handy.

The evidence-based practice that I used for the patients was letting them express themselves and asking appropriate questions to encourage them to talk. However, the 20-year-old and the multi-personality patients both turned wild on me. The more I questioned them to talk, the wilder they got. The next time I get similar patients, I will learn to read the cues, stop with the line of questions, and instead focus on something more pleasant for the patient (Ritter & Platt, 2016).

The patient flow is still low, and therefore, my team and I are able to manage it well. I intend to teach my team members the communication skills I learned to help them communicate better with each other and the patients. When staff members are able to communicate with patients, then patients will be more open to discussing their mental health issues, and hopefully, more people in the community will feel safe enough to come to the healthcare facility and access mental health help (Aggarwal et al., 2016). I believe I am doing well and on the right track to gaining full confidence in the two areas, I discussed earlier. I am still consulting with my preceptor, and I know it is only a matter of time before I will fully manage my own patients without much assistance from my preceptor.

References

Aggarwal, N. K., Pieh, M. C., Dixon, L., Guarnaccia, P., Alegria, M., & Lewis-Fernandez, R. (2016). Clinician descriptions of communication strategies to improve treatment engagement by racial/ethnic minorities in mental health services: a systematic review. Patient education and counseling, 99(2), 198-209.

Ritter, S., & Platt, L. M. (2016). What’s new in treating inpatients with personality disorders?: dialectical behavior therapy and old-fashioned, good communication. Journal of psychosocial nursing and mental health services, 54(1), 38-45.

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Journal Entry-Practicum experience

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.

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: