Reflection of Clinical Experience for a PMHNP
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 difficult about each?
- Pt is a 17 y/o non-binary gender. They prefer the pronouns Them/They. Andrew was referred by their PCP due to their symptoms. Depression started at age 15 y/o. Trouble controlling their emotions. Feels as if days run together. They also have feelings of numbness. They are dealing with school stressors, maintaining high grades (A student), trouble staying asleep. They will sleep from 4-12 hours. Motivation has decreased. Loves to draw and depression symptoms has decreased these desires. They do still enjoy music. Appetite: will eat lunch. Will sometimes skip breakfast and dinner. According to mother, Andrew is underweight for their age 990lbs and 5'2") Andrew also has anxiety issues around crowds. Will isolate themself and doesn't interact with new people. They are concern about oversharing with friends. When anxious will scratch, heart racing, and minor mistakes with cause a panic and increase breathing. Andrew's family is very supportive. Andrew does not like how their body looks. Will often wish they are invisible. Has thoughts of slipping and falling. Just dying. Will often disassociate. Has a poor coping skills of watching porn. Will often hate themself after watching it. Likes vulgar and suggestive art. Andrew is a virgin and not looking for sex.
- 12 y/o F presents with anger issues. According to mother, Pt had a one of her worst outbursts yesterday. She refused to get out of the car to go into school. While at home, she was walking around with scissors or a knife. She also kicked holes into the wall. Mother was concerned and thought she would have to call the police but was scared too. Patient scared her younger siblings during this incident. Patient also may have locked herself in the car. Mother reports patient is often "triggered" by things. She will hold on to something negative, and then blow up; however, nothing like this for several years. "She has done a great job with self-regulated herself since she was in the 2nd grade." Mother admitted that patient got kicked out of Pre-K due to her behavior/outbursts. In the 1st and 2nd grade, she was considered for an IEP due to her behavior at school and the destruction of other student's property. Mother continues to state that patient has anger issues; however, it is manageable. Patient has of mood swings, emotional detachment. Mother would like patient evaluated.
- 7 y/o male presents with grandmother. Grandmother reports changes within the past yr, involving anger outbursts and mood fluctuations. Reports cursing, property destruction, yelling, slamming and locking doors. Pt refers to the bxs as "push back", admitting he "sometimes" gets his way when he pushes back. Grandmother reports 1 occurrence of forceful pushing during an anger outburst. Pt reports having high levels of energy due to his high intake of sugar; admits to sneaking sugary snacks to his room. Grandmother reports taking items and privileges away when anger outbursts occur. Mood: "Good" Sleep: No concerns w/ sleep; denies interruptions and frequent nightmares Appetite: High sugar intake Concentration: Reports difficulty concentrating at times; observed attentive throughout the session Energy: High; observed able to sit in one seating throughout the session; no interruptions observed SI/HI/SH/AVH: Denies any hx
· 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.
Objective 1: Achieve 85% accuracy in identifying and explaining age-appropriate therapeutic modalities for various developmental stages by the midpoint of the practicum.
Planned Activities:
· Read assigned literature on major developmental stages (infancy, childhood, adolescence).
· Participate in a group discussion to identify key characteristics and challenges of each stage.
· Attend a workshop or seminar on common therapeutic modalities (e.g., play therapy, art therapy, cognitive-behavioral therapy for children).
· Take notes on key principles, techniques, and applications for each modality
Mode of Assessment: (Note: Verification will be documented in Meditrek)
· Notate successful attempts to identify and explain age-appropriate- therapeutic modalities
· PRAC Course Outcome(s) Addressed:
Analyze cases involving advanced care of patients across the lifespan in mental health settings.
Objective 2: Develop a comprehensive list of differential diagnoses for at least five complex cases each month, incorporating patient history and assessment data.
Planned Activities:
· Analyze example case studies with known diagnoses.
· Identify how patient history, symptoms, and test results led to the final diagnosis.
· Read articles and textbooks on the principles of differential diagnosis.
· Take notes on the importance of patient history, physical exams, and diagnostic tests.
Mode of Assessment:
· I will identify patients in Meditrek I have successfully conducted differential diagnoses for.
PRAC Course Outcome(s) Addressed:
· Formulate differential diagnoses for patients across the lifespan.
Objective 3: Maintain accurate and detailed documentation for all client interactions, including adverse reactions, patient responses, and changes to the care plan by the end of this semester.
Planned Activities:
· I will study and understand the clinic's documentation policies and procedures.
· I will familiarize myself with the guidelines set forth by the organization for accurate and secure record-keeping.
· I will delve into patient’s chart and documentation entries for various client interactions.
· This will help me identify the key components that need to be included in my own documentation.
Mode of Assessment: (Note: Verification will be documented in Meditrek)
· My preceptor or clinical supervisor will review my documentation for accuracy. She will provide feedback and guidance in real-time.
PRAC Course Outcome(s) Addressed:
· Assess psychiatric-mental health advanced practice nursing skills for strengths and opportunities.
· Formulate plan of care for patients that incorporate individual, family, or group psychotherapy interventions.