PRAC 6675 PMHNP Across the Lifespan II
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.
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?
These are the 3 patients that I have done papers on and still see.
- D.A. is a 73-year-old African American Female who presents today to her SUD, Mental Health Medication Management appointment complaining of worsening depression d/t ongoing issues of bed bug outbreaks in my home and the constant stress made me start using drugs again after 30 years of being clean.
- JC is an 11-year-old heterosexual Caucasian male. The patient is being brought in today by his parents for his increasingly erratic and aggressive behavior’s, he has been showing signs of increasing aggression toward schoolmates and family members with increased defiance, aggression, at school, and school suspensions, which he is doing at school and will have to repeat the 5th grade. The patient states that everyone hates him, and he hates everyone and states that he does not have any friends and does not want or need any. His parents state that he stays in his room mostly and is very moody, any and everything sets him off like a time bomb and he breaks things and does not care who he hurts or what he says and blames everyone else for making him go off like he does. The parents state that it is a struggle to get him to go to bed on time and it usually takes about one to two hours before they can get him to stay in bed for the night. The patient also has been caught stealing from the store and others at home as well as school. JC states that he does ask sometimes for things but sometimes they tell him no and he thinks that that is not fair, he states that he used to ask sometimes, but now he just takes it anyway because he wants it. His parents state that he very rarely does what he is told the first time asked and even then, it is usually not done correctly or finished. They state that he does things at home like break things or steal things, and he tries to blame his older brother, even when he is caught red-handed, and he will hold to the lie no matter what we can prove.
- MF is a 24-year-old Caucasian female who presents today for medication management follow-up for, Attention-Deficit Hyperactivity Disorder, predominantly inattentive type, Generalized Anxiety Disorder, Major Depressive Disorder, recurrent, moderate. MF states issues with Impulsiveness, indecisiveness, sadness, and poor concentration, and exhibits symptoms of inattention. MF states that she makes a lot of careless mistakes which have always been typical for her. She states she frequently forgets appointments or obligations, overlooks details, and has difficulty sustaining her attention. MF reports periods of “zoning out” and her mind wanders or she forgets things quite often. She states that she has been told that she does not seem to listen when spoken to directly often needing directions repeated to her and reports being disorganized. MF states that attentional and hyperactive behaviors have been exhibited at her workplace. The patient was self-employed, working as a driver for delivery services such as DoorDash and Instacart. Her work schedule was irregular, and she usually worked night shifts. She states she prefers the nighttime due to the reduced distractions and lower volume of orders. However, during these shifts, she often becomes preoccupied with her thoughts, which has led to emotional distress while on the job. On one occasion, she consumed an edible in an attempt to manage her emotions, but this only intensified her feelings of sadness and anxiety. MF has been on antidepressants since the age of 10 and states taking ADHD medications for as long as she can remember. Her symptoms include inattentiveness, scatterbrained behavior, and forgetfulness, which affect her at home, work, school, and life in general. exhibits attentional difficulties in school.