case study 4

Desired Clinical Skills for Students to Achieve

Confident (Can complete independently)

Mostly confident (Can complete with supervision)

Beginning (Have performed with supervision or need 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

Mostly confident 

Differentiating between pathophysiological and psychopathological conditions 

Mostly confident 

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

Mostly confident 

Performing and interpreting a mental status examination 

Performing and interpreting a psychosocial assessment and family psychiatric history 

Mostly confident 

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

Mostly confident 

Diagnostic reasoning skill in:

Developing and prioritizing a differential diagnoses list

Beginning

Formulating diagnoses according to DSM 5 based on assessment data 

Mostly confident 

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

Beginning

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) 

Beginning

Evaluating patient response and modify plan as necessary 

Mostly confident 

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

Mostly confident 

Psychotherapeutic Treatment Planning:

Recognizes concepts of therapeutic modalities across the lifespan

Beginning

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) 

Beginning

Applies age appropriate psychotherapeutic counseling techniques with individuals, families, and/or groups

Mostly confident 

Develop an age appropriate individualized plan of care

Mostly confident 

Provide psychoeducation to individuals, family, and/or groups

Mostly confident 

Promote health and disease prevention techniques

Mostly confident 

Self-Assessment skills:

Develop SMART goals for practicum experiences 

Confident 

Evaluating outcomes of practicum goals and modify plan as necessary 

Mostly confident 

Documenting and reflecting on learning experiences

Mostly confident 

Professional skills:

Maintains professional boundaries and therapeutic relationship with clients and staff

Confident

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

Mostly confident 

Beginning

Identifies ethical and legal dilemmas with possible resolutions

Confident

Demonstrates non-judgmental practice approach and empathy

Confident

Practices within scope of practice

Confident

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 

Mostly confident 

B

Implements the screening instrument efficiently and effectively with the clients

Beginning

Interprets results for screening instruments accurately

Beginning

Develops an appropriate plan of care based upon screening instruments response

Beginning

Identifies the need to refer to another specialty provider when applicable

Beginning

The test for mental disorders and behavioral disorders is difficult to administer. The PMHNP must be competent to use psychosocial assessment, mental status evaluation, diagnostic tests, and physical examination to determine the differential diagnosis and rule out the psychopathology diagnosis (Chambers & Ryder, 2018). However, there are some areas where I need to improve, such as distinguishing between pathophysiological and psychopathology variables when attempting to prioritize psychopathological diagnosis. As a registered nurse, I have experience caring for patients suffering from behavioral and mental illnesses. I've realized that diagnosing and managing psychopathological conditions necessitates broad knowledge and assessment skills. This is due to the fact that the ability and competency of the clinician in assessment is required for the diagnosis and treatment of psychopathological disorders (Price & Reichert, 2017).

To improve on the aforementioned weaknesses, I must constantly broaden my psychiatric knowledge and assessment skills and apply everything I learn during clinical shifts. Interpreting a patient's mental status reports has also proven to be a weakness of mine. However, I must take advantage of every opportunity to improve on this weakness during clinical rotations. Furthermore, by enrolling in the facility's training program, I will continue to broaden my knowledge, particularly in research and clinical site assessment skills. Overall, I plan to participate in activities that will help me improve my personal and professional skills, as well as my PMHNP skills and knowledge, in order to promote evidence-based quality and safe care (Krautter et al., 2017).

1. Goal: At the end my practicum project, I need to have developed vast advanced mental status assessment skills.

a. Objective: identify potential mental and behavioral disorders using mental status exam

b. Objective: perform mental status exam on all patient encounters

c. Objective: interpret results of mental status examination

2. Goal: Develop autonomous skills and knowledge of assessing psychiatric problems towards the end of this project.

a. Objective: apply advanced assessment skills in making and prioritizing psychiatric differential diagnosis.

b. Objective: Develop psychiatric differential diagnosis for patient encounters using patient’s concerns, physical assessment and laboratory results.

c. Objective: make necessary diagnosis by demonstrating advanced techniques in performing focused assessment.

3. Goal: By the end of the practicum, to have developed appropriate psychiatric screening knowledge and skills and the use of instruments.

a. Objective: demonstrate advanced techniques in implementing psychiatric screening instruments.

b. Objective: Understand various psychiatric screening methods by applying advanced knowledge of practice.

c. Objective: interview my patients using effective communication skills and advanced interviewing technique