Week 11_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

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 

Mostly

Confident

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

Mostly

confident

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

Mostly

confident

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

Mostly

confident

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) 

Mostly

confident

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

Confident

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) 

Confident

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

Mostly

confident

Develop an age-appropriate individualized plan of care

Mostly

confident

Provide psychoeducation to individuals and/or any caregivers

Mostly confident

Promote health and disease prevention techniques

Mostly confident

Self-assessment skill:

Develop SMART goals for practicum experiences 

Mostly 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 

Confident

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

Implements the screening instrument efficiently and effectively with the clients

Mostly

confident

Interprets results for screening instruments accurately

Mostly

confident

Develops an appropriate plan of care based upon screening instruments response

Mostly

confident

Identifies the need to refer to another specialty provider when applicable

Mostly confident

Accurately documents recommendations for psychiatric consultations when applicable

Mostly confident

My greatest strength in my everyday interactions with patients is providing patient-centered care. I can gather pertinent historical data and conduct a thorough physical and mental state exam because of my patient-centered approach. I know patients' empathic interviewing approaches because of my culturally competent communication skills. In order to treat patients with respect and dignity, a nurse practitioner must practice patient-centered care (Park et al., 2018). Another asset is my ability to provide my customers with individualized and supportive care. I learned over time how to communicate with patients while keeping a cheerful attitude to prevent upsetting them. I can do a thorough evaluation of patients using empathic interviewing techniques to determine the condition they are experiencing. I use them daily in hospital wards and community health clinics to maintain these abilities. The patient's presentation can vary depending on the patient's age and cultural background. I find that identifying and suggesting the potential use of psychotropic medicines is another crucial ability to have. I typically adopt a friendly approach when speaking with my patients because it is crucial to get historical data from many sources. I can discuss typical anomalies and their causes since I fully comprehend each part of the mental status examination (Norris et al., 2016). The communication concept has helped me behave professionally, become more sympathetic while receiving criticism, and learn from my mistakes. Another noteworthy strength is my ability to document clinical facts, diagnoses, and clinical reasoning. It's possible that laboratory results won't always be available, so I utilize my communication skills to get information from the patient and other professionals. In particular, the early detection of psychopathology symptoms has benefited greatly from my multifaceted skill sets.

I need to improve my interviewing skills for difficult scenarios like dealing with aggressive, perhaps violent, and mentally deficient patients. The diagnosis of mental and behavioral diseases is fraught with difficulties. I need to develop a deeper understanding and more vital evaluation abilities because most psychological and pathophysiological diseases are difficult to identify because they necessitate significant knowledge. Since it has taken precedence, I must concentrate on the differential diagnosis of psychopathology. Separating pathophysiology from psychopathology, two broad domains that call for deeper comprehension is another area that may be better. The mental diagnosis procedure is drawn out since it starts with a physical examination of the patient.

After that, a psychological evaluation is conducted to exclude differential diagnoses and reach a precise psychosocial diagnosis. I have provided care for patients with behavioral problems for many years, and I have seen that diagnosing and treating psychopathology requires in-depth understanding and evaluation abilities. Since psychopathological illnesses are difficult to diagnose, most diagnostic tests are ineffective. To strengthen these areas, I need to increase my understanding of psychopathological disorders (Blomberg et al., 2016). During the clinical rotations, I must use each chance to put the new information into practice. Performing and interpreting mental status exams is another area where I may be held accountable. I need to start engaging in rigorous clinical training sessions to increase my proficiency in interpreting mental status exams. I can also increase my expertise in clinical sites through ongoing practice and professional growth. As a PMHNP, the newly gained abilities will promote the delivery of patient-centered, evidence-based care.

1. Goal: Include understanding of differential diagnosis and clinical reasoning.

a. Objective: Identify the warning signs and symptoms of any psychopathological condition.

b. Objective: comprehend fundamental test results and other professional reports

c. Objective: Create a differential diagnosis for some patients with mental problems.

2. Goal: Improve my ability to assess mental state by the end of the session

a. Objective: Observe patients and do comprehensive cognitive evaluations

b. Objective: Recognize and distinguish clinical signs to formulate precise recommendations

c. Objective: Conduct mental health examinations and correctly evaluate the results

3. Goal: Be able to develop a mental health diagnosis on my own at the end of the practicum

a. Objective: Show how to use cutting-edge methods realistically when conducting assessments.

b. Objective: Utilize the patient's concerns and the physical examination results to determine the various psychiatric diagnoses .

c. Objective: Use medical testing from laboratories and other sources to evaluate patients