Journal Entry

Desired Clinical Skills for Students to Achieve

Confident (Can complete independently)

Mostly confident (Can complete with supervision)

Beginning (Have performed with supervision or needs 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 across the lifespan

x

Differentiating between pathophysiological and psychopathological conditions 

x

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

x

Performing and interpreting a mental status examination 

x

Performing and interpreting a psychosocial assessment and family psychiatric history 

x

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

x

Diagnostic reasoning skill in:

Developing and prioritizing a differential diagnoses list

x

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

x

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

x

Pharmacotherapeutic skills in:

Selecting appropriate evidence based clinical practice guidelines for medication plan (e.g., risk/benefit, patient preference, developmental considerations, financial, the process of informed consent, symptom management) 

x

Evaluating patient response and modify plan as necessary 

x

Documenting (e.g., adverse reaction, the patient response, changes to the plan of care)

x

Psychotherapeutic Treatment Planning:

Recognizes concepts of therapeutic modalities across the lifespan

x

Selecting appropriate evidence based clinical practice guidelines for psychotherapeutic plan (e.g., risk/benefit, patient preference, developmental considerations, financial, the process of informed consent, symptom management, modality appropriate for situation) 

x

Applies age appropriate psychotherapeutic counseling techniques with individuals and/or any caregivers

x

Develop an age appropriate individualized plan of care

x

Provide psychoeducation to individuals and/or any caregivers

x

Promote health and disease prevention techniques

x

Self-assessment skill:

Develop SMART goals for practicum experiences 

x

Evaluating outcomes of practicum goals and modify plan as necessary 

x

Documenting and reflecting on learning experiences

x

Professional skills:

Maintains professional boundaries and therapeutic relationship with clients and staff

x

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

x

Identifies ethical and legal dilemmas with possible resolutions

x

Demonstrates non-judgmental practice approach and empathy

x

Practices within scope of practice

x

Selecting and implementing appropriate screening instrument(s), interpreting results, and making recommendations and referrals:

Demonstrates selecting the correct screening instrument appropriate for the clinical situation 

x

Implements the screening instrument efficiently and effectively with the clients

x

Interprets results for screening instruments accurately

x

Develops an appropriate plan of care based upon screening instruments response

x

Identifies the need to refer to another specialty provider when applicable

x

Accurately documents recommendations for psychiatric consultations when applicable

x

I have a comprehensive range of skills in the psychiatric field, as evidenced by my ability to complete skills such as identifying clinical signs and symptoms of mental conditions across diverse age groups clinical skills independently. I also demonstrate exceptional competence in the ability to differentiate pathophysiological and psychopathological conditions, interpret mental health status conditions and psychosocial assessments, as well as patient family histories. Additionally, I am also competent in selecting empirically supported medication and psychotherapeutic treatment plans, appraising patient responses, and adapting treatment accordingly. I also exuded professionalism by collaborating effectively with a multidisciplinary team, maintaining therapeutic relationships with patients and practicing within my scope. From the self-assessment form, it is also evident that I possess the exceptional capability to select and implement suitable screening instruments for my clients, and I can provide a correct interpretation of results and develop personalized care plans based on clients’ responses. Other skills that I consider contributing to my areas of strength include providing psychoeducation without supervision, promoting health and disease prevention techniques independently and documenting information pertinent to a client’s case. While I exhibit exceptional strength in the psychiatric field, there are other areas in which I am mostly confident, but I need supervision to complete them accurately. These skills include performing functional assessments, taking a comprehensive history and differential diagnoses and identifying ethical and legal dilemmas. Generally, identifying ethical and legal dilemmas is challenging for nursing students because we have limited exposure to real-world situations, making it difficult to identify such dilemmas accurately (Rubio et al., 2020). Also, apprentices may struggle to navigate the nuances involved in identifying this dilemma. Overall, I believe that I have a strong foundation of clinical skills in psychiatry, and there are immense opportunities for growth and development.

Although I have a strong foundation in clinical skills for psychiatry, there are still areas in practice where I can leverage my potential to grow professionally and career-wise. These areas include performing and interpreting comprehensive history and physical examination, particularly with regard to lab and diagnostic procedures. With the right supervision and guidance, I can enhance my functional assessment skills. With proper and adequate exposure to various situations, I can also improve my ability to identify ethical and legal dilemmas. By focusing on these areas, I will improve my clinical competence and confidence to practice them independently, which will, in turn, build a well-rounded and proficient practitioner in psychiatry.