Journal Entry

1. Goal: Enhance Proficiency in Differential Diagnosis Skills

a. Objective: By the end of the first quarter, I will engage in bi-weekly supervision sessions with an experienced clinician to strengthen my ability to differentiate between pathophysiological and psychopathological conditions, achieving a 20% improvement in independent decision-making.

b. Objective: Over the practicum duration, attend relevant workshops and seminars focused on advanced diagnostic reasoning, ensuring a comprehensive understanding of normal/abnormal age-related physiological and psychological symptoms, resulting in a 15% increase in confident decision-making in this domain.

c. Objective: Collaborate with peers and mentors to review and discuss complex cases, seeking diverse perspectives to broaden my knowledge base and contribute to the development of a robust, prioritized differential diagnoses list for each case.

2. Goal: Strengthen Implementation of Screening Instruments

a. Objective: Within the first two months, participate in supervised sessions to enhance my ability to select the most appropriate screening instrument for various clinical situations, achieving a 15% increase in confidence and accuracy.

b. Objective: Implement screening instruments under supervision, aiming for a 20% improvement in efficiency and effectiveness in client interactions by the end of the third quarter.

c. Objective: Independently interpreting and document screening instrument results for at least 15 cases by the end of the practicum, demonstrating a 25% increase in accurate interpretation and actionable recommendations.

3. Goal: Improve Reflective Practice and Documentation Skills

a. Objective: Develop and implement a plan for weekly self-reflection on clinical experiences, documenting insights, challenges, and areas for improvement, with a goal to consistently dedicate at least 30 minutes per week for reflective practice.

b. Objective: Attend a workshop on effective documentation techniques within the first three months, applying the acquired knowledge to improve the clarity, thoroughness, and organization of my clinical documentation, with a target of achieving a 20% enhancement.

c. Objective: Regularly review and discuss my documented goals, outcomes, and modifications with a supervisor, seeking feedback to refine my reflective and documentation practices, aiming for a 15% improvement in the quality of documentation and goal evaluation.

4. Goal: Foster Independence in Diagnostic Reasoning Across Age Groups

a. Objective: Develop a personal study plan to enhance my knowledge of the psychopathology of mental illnesses across different age groups, dedicating a minimum of two hours per week to self-directed learning, resulting in a 25% improvement in understanding.

b. Objective: Independently lead case discussions on diverse age-related mental health issues within a group setting, achieving a 20% increase in confidence and competence in formulating diagnoses based on DSM-5-TR criteria.

c. Objective: Collaborate with experienced clinicians to assess and formulate diagnoses for at least 20 cases across different age groups, aiming for a 15% increase in independence and accuracy in diagnostic reasoning by the end of the practicum.

Assignment to be completed.

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. 

Journal Entry

Learning From Experiences

My goals for this practicum are to: Improve my writing and communication skills and accurately record clients' psychiatric records electronically; perform at least two comprehensive psychiatric examinations to make a diagnosis based on the results; and proficient in creating and classifying lists of differential diagnoses according to DSM-5 criteria. During my practicum, I successfully completed each goal I set for myself. I was responsible for doing some screenings and recording some of them electronically. Screening is done to detect conditions such as tardive dyskinesia, suicide risk, and alcohol and other drug use. Abnormal, involuntary movements are tested to see if the medication is causing any side effects. When performing the first in-depth examinations, I found that in many cases I achieved my goal of arriving at an accurate diagnosis based on the DSM-5-TR, which was very gratifying. My preceptor and I talked about what diagnoses I thought were appropriate for each client to make sure they were correct. I can also carry out some complete and detailed psychiatric examinations. I carried out the first few reviews and was able to independently do many more.

Three most challenging patients I encountered

One of the three most challenging patients I met was a woman who had just had a stroke and has a history of bipolar disorder. She was very nervous because we couldn't restart her Adderall without first consulting with a neurologist to determine if it was safe for her. For my preceptor, non-stimulatory therapy such as Strattera is preferable. The patient was going through a difficult time. At this point in her treatment, she was angry and upset about her medication. Before she could understand why we needed to address this topic with her neurologist and, if possible, move on to Strattera, we had to do a lot of explaining and teaching. After all that, she finally understood why it was necessary.

The second most difficult patient was a 13-year-old girl who stopped taking her medication, suffered from severe depression, and thought she would be better off dead. We learned that she did not want to end her life by committing suicide after talking to her about how she felt. Her mother thought it was appropriate to force her daughter to take medicine if she did not want to. She supported her daughter's decision to stop taking her medication until she experienced signs and symptoms of severe depression and suicidal thoughts. We provided the mother and patient with a lot of information and reassurance about the signs of depression and suicide as well as the dangers of stopping psychiatric medication at the same time. As well as providing resources for suicide hotlines, crisis lines, and other community services they can use if his symptoms get worse We are well aware that there is not much we can do to convince patients to take their medication; All we could do was help and educate them.

The third patient I saw who challenged me was a 46-year-old woman who wanted to take Adderall IR. The patient believes this is the only medication that helps her severe attention deficit hyperactivity disorder (ADHD symptoms). This patient was asked because she was certain about this statement. We told her that we do not distribute this immediate-release form of the drug because it can be abused. But we are willing to provide her with a medication that has a longer lasting effect or another form that does not contain stimulants. Ultimately, we decided it was best for her to try a non-stimulant medication to better control her symptoms. This experience taught me many valuable things, including how to control the conversation while convincing patients. We can confirm that prescriptions are working properly, assess whether dosage adjustments or changes are needed, and maintain timely visits for all of our patients so there are no delays to the schedules. I can find answers to all my questions by consulting the DSM, drug books, physicians, pharmaceutical reps, and other PMHNPs. For medications prescribed to our patients, pharmaceutical representatives can provide up-to-date and data-supported information.

Current Learning and Improvements

Currently, my main goal is to improve my ability to manage medications in a way that is appropriate for the unique signs and symptoms of each patient. Since new drugs will always be produced and old drugs will continually be updated and improved, this is a skill I will always strive to improve throughout my career. Additionally, because there will always be new and improved versions of existing medications, I will always strive to develop new ideas or methods to teach my patients. I do not think I would want to change anything, even if I could back in time to change anything.

Communicating and Feedback

Al through my practicum experience, I believe I understood my preceptor and communicated effectively with him. I also believe he was very open to information, and was helpful in my efforts. I think my preceptor was available to provide me with valuable and detailed information and criticism when necessary. Regarding my performance, I have made a lot of progress and am learning a lot aand gaining more information about the requirements to become a PMHNP. My preceptor provided very helpful feedback and told me that I was an excellent student and would be successful in a PMHNP career. He also believe I am a competent nurse.