PRAC 6645 Week 11 Journal Entry
Journal Entry
Learning From Experiences
During this practicum, I sought to accomplish four principal objectives: refining diagnostic thinking, augmenting psychopharmacologic decision-making, advancing competency with screening instruments, and formulating personalized psychotherapy treatment plans. I met each of these objectives to a satisfactory degree. I verified diagnoses with my preceptor, consistently applied DSM-5 criteria to various clinical presentations, and recorded justifications in patient records. Every week, I helped choose and monitor the medications for several patients, recording side effects and suggesting adjustments as needed. Additionally, I frequently employed evidence-based screening tools such as the GAD-7 and PHQ-9, incorporating the findings into my clinical judgment (Kent, 2024). Last but not least, I created psychotherapy programs using methods like cognitive behavioral therapy (CBT) and psychoeducation that were specific to the needs and age of each patient.
This rotation presented three patients who significantly challenged my clinical judgment and emotional resilience. A 19-year-old boy had bipolar I disorder and polysubstance misuse. His mood volatility, impetuous conduct, and erratic participation in treatment necessitate continual reevaluation of his medication and safety requirements. In the second case, a 72-year-old woman was identified with major depression and was thought to have Alzheimer’s disease in its early stages. The coexistence of her depressive and cognitive symptoms complicated the establishment of an accurate diagnosis, while the necessity of including family in decision-making introduced additional complexity. The third patient was a 15-year-old female diagnosed with post-traumatic stress disorder (PTSD) and engaging in self-injurious conduct. Establishing rapport and regaining her trust required several sessions, and ensuring safety while delivering trauma-informed therapy was a considerable learning experience (Vives et al., 2023).
These experiences imparted the significance of personalized, adaptable care planning, particularly for patients with comorbidities. I saw the significance of collaborative care and meticulous communication, particularly when dealing with delicate matters or engaging with vulnerable groups. Available resources included clinical supervision from my preceptor, access to practice guidelines from the American Psychiatric Association, and screening tools built into the electronic health record system (Aggarwal et al., 2022). Depending on the patient’s condition and reaction to treatment, I used methods that have been shown to work, like motivational interviewing, cognitive behavioral therapy (CBT), and psychopharmacology based on guidelines.
If given the chance to handle these cases again, I would advocate for earlier interdisciplinary collaboration, especially with neuropsychologists or trauma specialists. I would enhance the clarity of my paperwork and frequently arrange follow-ups to evaluate treatment adherence and progress more effectively (Kent, 2024). To optimize patient flow and volume, I implemented structured interviewing, prioritized safety issues, and formulated treatment plans in advance, enhancing efficiency while ensuring comprehensive assessments.
Communicating and Feedback
To continue improving my skills, I plan to engage in more frequent case discussions with my preceptor and seek additional literature to support clinical decisions. I would communicate my efforts by presenting recent readings or guidelines during our check-ins and asking for targeted feedback (Wesemann et al., 2022). Currently, I feel like I am making steady progress, but I need to learn how to handle my complicated drug schedules on my own. My preceptor has given me regular informal comments, praising how well I do with patients and how thoroughly I evaluate them. Formal feedback emphasized the need to improve efficiency in documentation and become more assertive in making clinical decisions—areas I will focus on moving forward.
References
Aggarwal, R., Cowley, D. S., Tang, J., Lundquist, R. S., Wolf, K. M., & Walaszek, A. (2022). Understanding the training of psychiatric mental health nurse practitioners. Academic Psychiatry, 47(3), 304–308. https://doi.org/10.1007/s40596-022-01679-0
Kent, K. G. (2024). Psychotherapy skills for Psychiatric Mental Health nurse practitioner Students in the age of Competency-Based Education. Nursing Education Perspectives, 45(5), 316–318. https://doi.org/10.1097/01.nep.0000000000001311
Vives, M., Linkes, C., & Soucy, M. (2023). Teaching psychotherapy to Psychiatric/Mental Health nurse practitioner students in the virtual classroom. Issues in Mental Health Nursing, 44(6), 551–561. https://doi.org/10.1080/01612840.2023.2212769
Wesemann, D., Convoy, S., Goldstein, D., & Melino, K. (2022). How PMHNP Program Directors Facilitate Psychotherapeutic Skill Acquisition. Journal of the American Psychiatric Nurses Association, 30(2), 288–299. https://doi.org/10.1177/10783903221091980
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Journal Entry
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.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
To Prepare
- Refer to the “Population-Focused Nurse Practitioner Competencies” found in the Week 1 Learning Resources and consider the quality measures or indicators advanced nursing practice nurses must possess in your specialty of interest.
- 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 and 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?
Communicating and Feedback
- Reflect on how you might improve your skills and knowledge and how to communicate those efforts to your Preceptor.
- Answer the questions: How am I doing? What is missing?
- Reflect on the formal and informal feedback you received from your Preceptor.
By Day 7
Submit your Journal.
submission information
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.
- To submit your completed assignment, save your Assignment as WK11Assgn+last name+first initial.
- Then, click on Start Assignment near the top of the page.
- Next, click on Upload File and select Submit Assignment for review.
Rubric
PRAC_6645_Week11_Assignment_Rubric
| Criteria | Ratings | Pts |
|---|---|---|
| This criterion is linked to a Learning OutcomeAssimilation and Synthesis: Content Reflection | 50 to >44.0 ptsExcellentReflection demonstrates a high level of critical thinking in applying and integrating key course concepts and theories from readings, lectures, and/or experiences. Insightful and relevant connections are made through contextual explanations and examples.
44 to >39.0 ptsGoodReflection demonstrates moderate level of critical thinking in applying and integrating key course concepts and theories from readings, lectures, and/or experiences. Connections are made through explanations and/or examples. 39 to >34.0 ptsFairReflection demonstrates minimal critical thinking in applying and integrating key course concepts and theories from readings, lectures, and/or experiences. Minimal connections made through explanations and/or examples. 34 to >0 ptsPoorReflection lacks critical thinking. Superficial connections are made with key course concepts and resources, and/or assignments. |
50 pts |
| This criterion is linked to a Learning OutcomeAssimilation and Synthesis: Personal Growth | 30 to >26.0 ptsExcellentExpresses solid evidence of reflection on own work. Demonstrates substantial personal growth and awareness of deeper meaning through inferences, well developed insights, and significant depth in awareness and challenges. Synthesizes current experience into future implications.
26 to >23.0 ptsGoodExpresses moderate evidence of reflection on own work. Demonstrates satisfactory personal growth and awareness through some inferences, insights, and challenges. There is mention of the future implications of student’s current experience. 23 to >20.0 ptsFairExpresses minimal evidence of reflection on own work. Demonstrates less than adequate personal growth and awareness through limited or simplistic inferences made, insights, and/or challenges that are not well developed. Minimal thought of future implications of student’s current experience. 20 to >0 ptsPoorExpresses inadequate evidence of reflection on own work. Personal growth and awareness are not evident and/or demonstrate an impersonal experience. Lacks personal insights, challenges, inferences, and/or future implications are overlooked. |
30 pts |
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting | 15 to >13.0 ptsExcellentWell written and clearly organized using standard English, characterized by elements of a strong writing style and basically free from grammar, punctuation, usage, and spelling errors.
13 to >11.0 ptsGoodAbove average writing style and logically organized using standard English with minor errors in grammar, punctuation, usage, and spelling. 11 to >10.0 ptsFairAverage writing style that is sometimes unclear and/or with some errors in grammar, punctuation, usage, and spelling. 10 to >0 ptsPoorPoor writing style lacking in standard English, clarity, language used, and/or frequent errors in grammar, punctuation, usage, and spelling. Needs work. |
15 pts |
| This criterion is linked to a Learning OutcomeAPA | 5 to >4.0 ptsExcellentContains no APA errors.
4 to >3.5 ptsGoodContains one to two (1–2) APA errors. 3.5 to >2.0 ptsFairContains three to five (3–5) APA errors. 2 to >0 ptsPoorContains more than five (>5) APA errors. |
5 pts |
Total Points: 100