Posted: August 5th, 2022

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Assignment: Journal Entry

Critical reflection of your growth and development during your practicum experience in a clinical setting has the benefit of helping you to 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 “Advanced Nursing Practice Competencies and Guidelines” 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. 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 (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 did you have available?

· What evidence-based practice did you use for the patients?

· What new skills are you learning?

· 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

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Content

Name:

 

PRAC_6635_Week11_Assignment_Rubric

  • Grid View
  • List View
 

Assimilation and Synthesis: Content Reflection

Assimilation and Synthesis: Personal Growth

Written Expression and Formatting

APA

Excellent Good Fair Poor

Points:

Points Range:
50 (50%) – 50 (50%)

Reflection demonstrates a high level of critical thinking in applying and integrating key course concepts and theories from readings, lectures, and/or Discussions. Insightful and relevant connections are made through contextual explanations and examples.

Feedback:

Points:

Points Range:
40 (40%) – 49 (49%)

Reflection demonstrates moderate level of critical thinking in applying and integrating key course concepts and theories from readings, lectures, and/or Discussions. Connections are made through explanations and/or examples.

Feedback:

Points:

Points Range:
31 (31%) – 39 (39%)

Reflection demonstrates minimal critical thinking in applying and integrating key course concepts and theories from readings, lectures, and/or Discussions. Minimal connections made through explanations and/or examples.

Feedback:

Points:

Points Range:
0 (0%) – 30 (30%)

Reflection lacks critical thinking. Superficial connections are made with key course concepts and resources, and/or assignments

Feedback:

Points:

Points Range:
30 (30%) – 30 (30%)

Expresses 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.

Feedback:

Points:

Points Range:
20 (20%) – 29 (29%)

Expresses 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.

Feedback:

Points:

Points Range:
10 (10%) – 19 (19%)

Expresses 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.

Feedback:

Points:

Points Range:
0 (0%) – 9 (9%)

Expresses 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.

Feedback:

Points:

Points Range:
15 (15%) – 15 (15%)

Well 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.

Feedback:

Points:

Points Range:
11 (11%) – 14 (14%)

Above average writing style and logically organized using standard English with minor errors in grammar, punctuation, usage, and spelling.

Feedback:

Points:

Points Range:
6 (6%) – 10 (10%)

Average writing style that is sometimes unclear and/or with some errors in grammar, punctuation, usage, and spelling.

Feedback:

Points:

Points Range:
0 (0%) – 5 (5%)

Poor writing style lacking in standard English, clarity, language used, and/or frequent errors in grammar, punctuation, usage, and spelling. Needs work.

Feedback:

Points:

Points Range:
5 (5%) – 5 (5%)

No APA errors

Feedback:

Points:

Points Range:
4 (4%) – 4 (4%)

Contains one to two (1–2) APA errors

Feedback:

Points:

Points Range:
2 (2%) – 3 (3%)

Contains three to five (3–5) APA errors

Feedback:

Points:

Points Range:
0 (0%) – 1 (1%)

Contains more than five (> 5) APA errors

Feedback:

Show Descriptions

Show Feedback

Assimilation and Synthesis: Content Reflection–

Levels of Achievement:

Excellent
50 (50%) – 50 (50%)

Reflection demonstrates a high level of critical thinking in applying and integrating key course concepts and theories from readings, lectures, and/or Discussions. Insightful and relevant connections are made through contextual explanations and examples.

Good
40 (40%) – 49 (49%)

Reflection demonstrates moderate level of critical thinking in applying and integrating key course concepts and theories from readings, lectures, and/or Discussions. Connections are made through explanations and/or examples.

Fair
31 (31%) – 39 (39%)

Reflection demonstrates minimal critical thinking in applying and integrating key course concepts and theories from readings, lectures, and/or Discussions. Minimal connections made through explanations and/or examples.

Poor
0 (0%) – 30 (30%)

Reflection lacks critical thinking. Superficial connections are made with key course concepts and resources, and/or assignments

Feedback:

Assimilation and Synthesis: Personal Growth–

Levels of Achievement:

Excellent
30 (30%) – 30 (30%)

Expresses 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.

Good
20 (20%) – 29 (29%)

Expresses 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.

Fair
10 (10%) – 19 (19%)

Expresses 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.

Poor
0 (0%) – 9 (9%)

Expresses 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.

Feedback:

Written Expression and Formatting–

Levels of Achievement:

Excellent
15 (15%) – 15 (15%)

Well 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.

Good
11 (11%) – 14 (14%)

Above average writing style and logically organized using standard English with minor errors in grammar, punctuation, usage, and spelling.

Fair
6 (6%) – 10 (10%)

Average writing style that is sometimes unclear and/or with some errors in grammar, punctuation, usage, and spelling.

Poor
0 (0%) – 5 (5%)

Poor writing style lacking in standard English, clarity, language used, and/or frequent errors in grammar, punctuation, usage, and spelling. Needs work.

Feedback:

APA–

Levels of Achievement:

Excellent
5 (5%) – 5 (5%)

No APA errors

Good
4 (4%) – 4 (4%)

Contains one to two (1–2) APA errors

Fair
2 (2%) – 3 (3%)

Contains three to five (3–5) APA errors

Poor
0 (0%) – 1 (1%)

Contains more than five (> 5) APA errors

Feedback:

Total Points: 100

Name: PRAC_6635_Week11_Assignment_Rubric

PRAC 6635 Clinical Skills Self-Assessment Form

Desired Clinical Skills for Students to Achieve

Confident (Can complete independently)

Mostly confident (Can complete with supervision)

Beginning (Have performed with supervision or need supervision to feel confident)

New (Have never performed or does not apply)

Comprehensive psychiatric evaluation skills in: 

Recognizing clinical signs and symptoms of psychiatric illness 

Confident

Differentiating between pathophysiological and psychopathological conditions 

Mostly
confident

Performing and interpreting a comprehensive and/or interval history and physical examination (including laboratory and diagnostic studies) 

Mostly
confident

Performing and interpreting a mental status examination 

Beginning

Performing and interpreting a psychosocial assessment and family psychiatric history 

Mostly
confident

Performing and interpreting a functional assessment (activities of daily living, occupational, social, leisure, educational).

Mostly
confident

Diagnostic reasoning skill in:

Demonstrate knowledge of psychopathology of mental illnesses through discussion for different age groups and mental illnesses

Beginning

Developing and prioritizing a differential diagnoses list

Beginning

Formulating diagnoses according to DSM 5-TR based on assessment data 

Beginning

Differentiating between normal/abnormal age-related physiological and psychological symptoms/changes

Beginning

Psychotherapeutic Treatment Planning:

Provide psychoeducation to individuals and/or any caregivers

Beginning

Promote health and disease prevention techniques

Beginning

Self Assessment skill:

Develop SMART goals for practicum experiences 

Beginning

Evaluating outcomes of practicum goals and modify plan as necessary 

Beginning

Documenting and reflecting on learning experiences

Beginning

Professional skills:

Maintains professional boundaries and therapeutic relationship with clients and staff

Confident

Collaborate with multi-disciplinary teams to improve clinical practice in mental health settings 

Confident

Identifies ethical and legal dilemmas with possible resolutions

Confident

Demonstrates non-judgmental practice approach and empathy

Confident

Practices within scope of practice

Confident

Selecting and implementing appropriate screening instrument(s) and interpreting results:

Demonstrates selecting the correct screening instrument appropriate for the clinical situation 

Mostly
confident

Implements the screening instrument efficiently and effectively with the clients

Mostly
confident

Interprets results for screening instruments accurately

Beginning

Identifies the need to refer to another specialty provider when applicable

Beginning

Accurately documents recommendations for psychiatric consultations when applicable

Beginning

Summary of strengths:

One of my notable strengths is utilizing effective communication techniques and maintaining professionalism. I conduct myself professionally, and I am open to accepting constructive criticism and learning from my mistakes. Recognizing areas of weakness is another strength. Especially when being entrusted with health care decisions for others, it is essential to know when to seek counsel and ask for direction from those with more expertise.

Opportunities for growth:

Most psychopathological disorders are not readily diagnosed using diagnostics tests such as CT scans or even MRI but are instead dependent on the clinician’s assessment; therefore, I would like to extend my knowledge and gain the ability to differentiate between psychopathology and pathophysiological and prioritize psychopathological differential diagnosis. I believe working with individuals and treatment staff will provide me with the most opportunities for advancement in this course.

possible goals and objectives for this practicum experience.

1. Goal: By the end of this clinical rotation, I hope to have examined multiple patients with various mental condition.
a. Objective: Ability to conduct a comprehensive mental examination
b. Objective: Ability to use the Diagnostic Reasoning skills
c. Objective: Develop Professional Skills
2. Goal: I hope to develop the knowledge and skills for selecting appropriate psychiatric screening instruments by the end of practicum
a. Objective: apply advanced techniques and effective communication skills in interviewing patients.
b. Objective: Utilize advanced knowledge in understanding various psychiatric screening instruments
c. Objective: demonstrate advanced techniques in implementing psychiatric screening instruments
3. Goal: Per my practicum acknowledgment, I wish to appropriately connect clinical signs and symptoms to the associated mental disease for each patient I visit this quarter.
a. Objective: competent in comprehensive psychiatric evaluation
b. Objective: Professional skills
c. Objective: Competent in Diagnostic reasoning

RUNNING HEAD: PRACTICUM EXPEIENCE PLAN

2

2

Week 2 Practicum Experience Plan

The purpose of a Practicum Experience Plan (PEP) aims to provide an opportunity to outline that sets forth objectives to frame and guide me through my practicum experience. The practicum’s goal is to provide opportunities to integrate, and apply practical skills, knowledge, and training learned through courses and to further gain professional experience in a professional public health work environment. It is a bridge between classroom and practice, it also creates a learning environment to develop new skills and adjust previously learned practice. Through this practicum, I am expecting to be able to observe and learn from professionals in the field. I will formulate a PEP for this practicum experience and discusss a nursing theory and one counseling theory that I will put into practice to guide my clinical practice and individualized learning objectives. PEP is like a map used when travelling from one city to another, it provides a guide to navigate the field experience from beginning to end.


Part 2: Individualized Practicum Learning Objectives

Objective 1: During my clinical rotation, I will take the initiative to practice selecting screening tools and ask for feedback from my preceptor and implement them as needed.

Planned Activities: Take the initiative and select a screening tool to assess patients across the spectrum, jointly interview my preceptor and allow for constructive criticism by my preceptor and apply and learn.

Mode of Assessment: Direct care and use of DSM V

PRAC Course Outcome(s) Addressed:

· Assess advanced practice psychiatric-mental health nursing skills for strengths and opportunities.

· Develop professional plans in advanced nursing practice for the practicum experience

Objective 2: I will individually conduct a psychiatric evaluation on pediatric/adolescent patients under supervision and practice interpreting results.

Planned Activities: Apply assessment skills learned through prior practicums and course practice to perform an age-appropriate comprehensive assessment.

Mode of Assessment: Direct care and use of DSM V

PRAC Course Outcome(s) Addressed:

· Analyze cases involving advanced care of patients across the lifespan in mental health settings.

· Formulate appropriate treatment plans that include psychopharmacology and psychotherapeutic techniques.

· Use evidence-based practices in improving care.

Objective 3: I will improve my assessment techniques on the mental status of patients.

Planned Activities: To assess not less than

8

0 patients within the practicum period to improve my knowledge of effective assessment techniques for mental health patients.

Mode of Assessment: Direct care and use of DSM V

PRAC Course Outcome(s) Addressed:

· Identify and maintain professional boundaries in the workplace and acknowledge the required therapeutic relationship with patients.

· To interpret the mental status of an individual based on an assessment performed.


Part 3: Projected Timeline/Schedule

My goal is to complete 1

6

0 Practicum hours per the timeline/schedule below. I also understand that I must evaluate at least 80 patients by the end of this practicum experience. I know that I may not complete my practicum hours sooner than eight weeks and may not be in the practicum setting longer than 8 hours per day unless pre-approved by my faculty.

8

12

5

8

12

5

8

12

5

8

12

5

8

12

5

8

12

5

8

12

5

8

12

5

8

8

4

6

Number of Clinical Hours Projected for Week (hours you are in Practicum Setting at your Field Site)

Number of Weekly Hours for Professional Development (these are not practicum hour)

Number of Weekly Hours for Practicum Coursework (these are not practicum hours)

Week 1

8

4

6

Week 2

12

5

Week 3

Week 4

Week 5

Week 6

Week 7

Week 8

Week 9

Week 10

Week 11

Total Hours

160 Hours

© 2020 Walden University 3

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Week 11: Journal Entry

Holly Bowling

Walden University

PRAC 6665: PMHNP Care Across the Lifespan I Practicum

Latanya Battle-Wherry

May 17, 2021

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Week 11: Journal Entry

Learning From Experiences

During my clinical experience, I was able to fully formulate specific diagnoses based on

the assessment data received through individual subjective and objective data, as well as develop

a differential diagnosis for such clients. I was also able to fully perform a comprehensive

psychiatric assessment and was able to utilize different intake forms specific to each client seen

for an initial intake evaluation. For my third goal, I was able to work with the preceptor in

formulating an appropriate treatment plan for clients that incorporated both medications and

psychotherapy that was specific for each client.

One challenging client I encountered was a 56-year-old African American female with

multiple diagnoses, but specifically severe psychosis and paranoia. What made this client so

difficult to treat was the fact that she would not leave her place of living and would not allow

anyone to come to her house to assess her. She was having issues with weakness and falling, and

stated her medications would make her ankles roll. Without actually being able to do a full

physical assessment or being able to do any kind of diagnostics, it became more and more

difficult to treat her and figure out exactly what was going on with her, and put her safety more at

risk. Another client that was difficult to treat was a 5-year-old African American male with

ADHD combined, Conduct disorder, and ODD. It was hard finding a medication that his

insurance would cover, and amphetamines were causing him to lose weight. He was very hyper

and would come into the office and run around, which made it difficult to assess him in any way.

Upon his last visit, he was up to 1 mg of Risperdal and 7.5 mg of Adderall, and the medications

did not touch his symptoms. At this point, it was becoming difficult to find medication

management that would work for him. A third client that was difficult was a 22-year-old African

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American female who presented for an initial visit and was presenting with mania and symptoms

of borderline personality disorder but has never been diagnosed with anything. She was difficult

in the fact that her thoughts were all over the place and it was hard to keep her stories straight,

and also the fact that she didn’t like anyone which made it difficult to build any kind of

therapeutic relationship with.

From this experience, the main thing I learned is that the initial diagnosis may not always

be the correct diagnosis and that oftentimes the diagnosis will change after a while of trial and

error with medications and therapy. Specifically, clients that seem to be presenting with

depression, may be bipolar. Learning to distinguish between different diagnoses was also

something I was able to enhance my knowledge in.

Since this practicum was virtual, I was able to have all of my required resources for this

class available at all times, including the DSM-5, the Prescribers Guide, and the Psychiatric

Interview, which were all valuable resources for this learning experience. Since these resources

are all some of the most up-to-date and widely used, they were the main bases of evidence-based

practice that we utilized throughout this practicum. The DSM-5 was best used for defining the

differential and primary diagnosis, and the Prescribers Guide was best utilized in coming up with

the best treatment options for patients and was used to help in deciphering the best dosage to

start with and titrating specific medications. The Mental Status Exam was also often used for

initial intakes, which helped in building the comprehensive assessment, as well as distinguishing

the most appropriate diagnosis. My preceptor feels that these resources are the best for

diagnosing and treating clients and rarely utilizes additional scales or tools in determining the

most appropriate diagnosis or treatment for her patients.

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If I could do anything differently it would probably be to participate in the practicum on-

site. Sometimes doing virtual health there are issues with the technology and it is not always easy

to interpret everything that is being said by the client. I also feel that a more therapeutic

relationship can be built when the interview is face to face.

We were able to manage patient flow and volume by allotting an hour for each initial visit

and thirty minutes for any follow-up, as to have sufficient time to take and update any notes, as

well as changing or prescribing any medications. This also allows extra time in case of any

emergency cases.

I can apply my growing skillset to social change by educating those in my community

about mental health and the stigma that surrounds it, and teaching them that they are diseases

that can be treated, and referring them to the appropriate professionals for the best possible

outcomes. Also, continuing to always learn and expand my knowledge, to improve on patient

and social conditions.

Communicating and Feedback

I feel that an important way I can improve my skills and knowledge is by taking more of

an initiative to try and diagnose new clients we may see instead of waiting on my preceptor to

tell me what it is, as well as allowing me to come up with the best treatment option for the client,

or at least trying. This way I am more doing than just listening and seeing, which is the best way

for me to personally learn.

Overall, I am exceeding the expectations of my preceptor and I am excelling in

differential diagnosis and treatment options for our clients. Although my preceptor may not feel I

need to improve on much, I always feel that there is room for improvement, and I believe for me,

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it is getting a better understanding of the best and most appropriate treatment options for

adolescents, as they are not always the same for adults.

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