Journal Entry

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.(Comprehensive Reflective Clinical Journal Entry for Nursing Students)
• 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.(Comprehensive Reflective Clinical Journal Entry for Nursing Students)
• 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?(Comprehensive Reflective Clinical Journal Entry for Nursing Students)
• 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?(Comprehensive Reflective Clinical Journal Entry for Nursing Students)
• Reflect on the formal and informal feedback you received from your Preceptor.

By Day 7

Submit your Journal Entry.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK11Assgn+last name+first initial.(extension)” as the name.
• Click the Week 11 Assignment  Rubric to review the Grading Criteria for the Assignment.
• Click the Week 11 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK11Assgn+last name+first initial.(extension)” and click Open.(Comprehensive Reflective Clinical Journal Entry for Nursing Students)
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric:

Week 11 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 11 Assignment draft and review the originality report.

Submit Your Assignment by Day 7

To participate in this Assignment:

Week 11 Assignment

Practicum in Review

Congratulations on completing PRAC 6635: Psychopathology and Diagnostic Reasoning Practicum! Over the course of the practicum, you honed your assessment, communication, documentation, and diagnostic reasoning skills within a clinical setting. You also assessed your clinical strengths and opportunities and worked toward improvement in identified areas. In so doing, you are better prepared for the clinical challenges of advanced practice nursing.(Comprehensive Reflective Clinical Journal Entry for Nursing Students)

Comprehensive Reflective Clinical Journal Entry for Nursing Students-Learning from Experiences

At the beginning of the semester, I could not contemplate achieving as much as I had at this time. Although I anticipated success and failure in equal measure, I was more positive and convicted of improving my clinical competency as a mental health nurse practitioner. In the first week of the semester, I conducted a self-assessment using the clinical skill form from which I created a practicum experience plan constituting the goals and objectives of the practicum. The objectives were developed based on the application-level clinical skills gap I wanted to bridge at the end of the practicum. (Comprehensive Reflective Clinical Journal Entry for Nursing Students)
From my experience, I understood the impact of practicum experience on my nursing career. Clinical practicums are central to nursing education and are crucial in building skills and competence for future practice and shaping their perception of the nursing profession and themselves as future professionals (Kaihlanen et al., 2021). The goals of the practicum were; to be able to identify and implement psychiatric screening instruments and interpret outcomes independently; appraise, document, and reflect on the established learning goals and objectives; recognize the ethical and legal issues in psychiatric care and appropriate interventions. At this point, I can affirm that I have achieved all my practicum learning goals. (Comprehensive Reflective Clinical Journal Entry for Nursing Students)
However, the learning experience was not devoid of challenges of its own. Three challenging patients I encountered included a patient who was non-adherent to treatment, a violent patient, and a teenage patient. The non-adherent patient had a Schizophrenia diagnosis and was receiving outpatient services, and with every visit, her condition worsened as she stopped and refused to take the psychotic medication even with reminders and caregivers. The violent patient had dementia with psychotic features and was not interested in being attended to by a student nurse. Lastly, the teenager had checked in for psychiatric assessment presenting anxiety, sadness, and suicide ideation with a definite plan. The challenging part of the later interaction was that the patient did not want her parents to be informed and involved prompting an ethical dilemma: to determine whether the 14-year-old patient could consent to her treatment. (Comprehensive Reflective Clinical Journal Entry for Nursing Students)
These experiences presented typical challenges in mental health care practice. Issues of treatment non-adherence, informed consent for minors, and violent patients set clinical and ethical challenges that mental health care practitioners should manage to promote high-quality care, patient satisfaction, and well-being. Through collaboration with experienced PMHNPs, we could curtail the clinical situations. Consequently, I can affirm that I have learned how to deal with violent patients, minors, and non-adherent patients in primary care settings. (Comprehensive Reflective Clinical Journal Entry for Nursing Students)
There were various resources available during the practicum. There were clinical guidelines, pharmacology manuals, library resources, and provider support. I appraised evidence-based interventions for challenging situations through these resources, found more information on mental health conditions, and sought guidance whenever necessary. The evidence-based practice I found helpful when conducting clinical assessments with minors, i.e., children and adolescents, are the need to be conscientious and astute when obtaining information from different settings and sources, including caregivers, parents, teachers, and the child. This practice is founded on the fact that minors might not have the appropriate reasoning capacity to contribute to their care. Therefore, information from multiple sources is needed to make a definitive diagnosis and guide consequent clinical interventions. (Comprehensive Reflective Clinical Journal Entry for Nursing Students)
During the practicum, I developed various skills aligned with my learning goals and objectives. I can conduct a psychiatric assessment using an appropriate instrument and interpret results to guide quality and safe mental health care. Moreover, I can conduct a clinical reflection on learning goals to examine the degree of achievement based on the set goals. According to Koshy et al. (2017), reflective practice is crucial in evaluating a practitioner’s experiences and actions against set goals and improving clinical knowledge. I can competently assess and mitigate ethical situations in mental health practice. PMHNPs face ethical dilemmas daily; thus, competency in assessing and addressing ethical issues is vital in promoting fair, quality, and effective clinical mental health care (Haddad & Geiger, 2018). As a practitioner, I can listen to the patient’s concerns, provide information about the conditions, available interventions, risks, and benefits, and uphold sound judgments to promote therapeutic alliance and patient autonomy and prevent non-adherence to treatment. Lastly, I have the skills for collaborative care when working in teams to achieve comprehensive patient-centered care.(Comprehensive Reflective Clinical Journal Entry for Nursing Students)
Given a similar practicum, I would pursue more collaborative practice. Based on the experiences of fellow students, I had preconceptions of experienced nurses who are difficult to work with. I also believe that mental health patients require some unique competency to work with. This practicum, in particular, has challenged these prejudices, and I am more determined to collaborate with experienced nurses and seek mentorship and guidance for improving my clinical competency. Besides, I have realized that although mental health patients present significant issues with cognition, their experiences require routine and specific care to ensure overall well-being. (Comprehensive Reflective Clinical Journal Entry for Nursing Students)
The patient flow and volume were primarily managed through collaboration, improved communication among care teams and departments, and non-clinical services, including patient transport, billings, and administrative tasks. I believe I have much to learn and improve, particularly in communicating my learning to my preceptor. I can improve my skills and knowledge by researching specific areas of interest and consequently discussing with my preceptor on my understanding and seeking feedback. I believe I am on the right path as far as the practicum experience is concerned, and I am actively seeking opportunities to improve clinical knowledge through reflective action and formal and informal feedback on classroom assessments and preceptor feedback. (Comprehensive Reflective Clinical Journal Entry for Nursing Students)

 
References

Haddad, L. M., & Geiger, R. A. (2018). Nursing ethical considerations. Available at: https://www.ncbi.nlm.nih.gov/books/NBK526054/#: (Accessed 5 November 2022)(Comprehensive Reflective Clinical Journal Entry for Nursing Students)
Kaihlanen, A. M., Gluschkoff, K., Koskinen, S., Salminen, L., Strandell‐Laine, C., Fuster Linares, P., … & ProCompNurse Consortium. (2021). Final clinical practicum shapes the transition experience and occupational commitment of newly graduated nurses in Europe—A longitudinal study. Journal of Advanced Nursing, 77(12), 4782-4792. https://doi.org/10.1111/jan.15060 (Comprehensive Reflective Clinical Journal Entry for Nursing Students)
Koshy, K., Limb, C., Gundogan, B., Whitehurst, K., & Jafree, D. J. (2017). Reflective practice in health care and how to reflect effectively. International Journal of Surgery. Oncology, 2(6), e20. https://doi.org/10.1097%2FIJ9.0000000000000020(Comprehensive Reflective Clinical Journal Entry for Nursing Students)

https://www.ncbi.nlm.nih.gov/