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End of Program Reflective Paper
Student Name
Institution
Course Code and Title
Instructor
Date
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ANA Standards of Practice
Now that I stand in the position of a graduate student in the Family Psychiatric Mental
Health Nurse Practitioner (FPMHNP) program, the need to uphold all the ANA Standards of
Practice could not be overemphasized. They act as a framework that guides APRNs in rendering
safe, effective, patient-centered care to their clients. Among these standards, three are
particularly critical for my future role as an APRN. Competencies that have been addressed
include Standard 5B (Health et al.), Standard 5D (Prescriptive et al.), and Standard 6
(Evaluation).
Specific to Standard 5B is recognizing the essential and primary foundation of health
promotion and education in psychiatric-mental health nursing. Given the role of FPMHNP as a
practitioner, it remains crucial to offer adequate information, resources, and support to patients
and their families to enhance their understanding of mental health and manage the problem
adequately. Especially during my clinical shifts, I ensured that the patient understood the
diagnosis, treatment, and care plan, depending on their learning ability. This way, patients get a
sufficient understanding of the various resources and therapies that exist in their care footprint
and take an active part in it. According to the American Nurses Association, American Psychiatric
Nurses Association, and International Society of Psychiatric-Mental Health Nurses (2022), this standard
is another one of the key ways to reducing mental health literacy and supporting patients to
enhance their health, which is both essential for the improvement of the mental health status of
the patient.
Standard 5D deals with medication and prescriptions, as well as prescriptive competence,
which is a crucial competency of psychiatric mental health nursing. This standard appears
particularly important as it describes the ethical standards and scopes of practice for APRNs with
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prescription privileges. Compliance with this standard also eliminates hazards that may be
inherent in the administration of drugs or the use of medicines and boosts therapeutic outcomes.
In all my clinical rotations, I learned the need to conduct medication evaluations and ensure that
we complied with the laws regarding the prescription of controlled substances. King and Shapiro
(2022) also stress the importance of this standard, which outlines that individualized medication
administration is a critical factor in attaining the best possible outcomes for patients and
mitigating the risks associated with the treatment of mental disorders.
Evaluation is a crucial function defined by Standard 6 as necessary for determining
whether ongoing interventions have the desired impact on patient outcomes. It enables the
manufacturers to evaluate patient responses to interventions, track their progress, and
methodically modify the therapeutic plans. Since Standard 6 applies to APRNs, they can assess
the necessary improvements, evaluate the interventions, and monitor patient outcomes. LaManna
et al. (2019) have also demonstrated how this competency promotes the formation of essential
habits of mind, such as critical thinking and diagnostic reasoning in advanced practice nurses,
leading to good evidence-based practice.
Factors that facilitated or presented a barrier to my role as a FPMHNP
This is an exciting learning experience for me as a student pursuing the FPMHNP, and
my three clinical rotations, which lasted 495 hours, have greatly enriched my clinical knowledge
and skills. Stemming from my current work environment, where I currently work in corrections
in the psych and detox units, and prior inpatient psychiatric RN experience before joining
Kettering benefited my learning during these rotations. This diverse background has given me
the knowledge base that I need when dealing with complicated psych cases and how the various
patients I will encounter will face life.
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One of the most significant enablers during my internships was the positive professional-
clinician rapport I enjoyed with all my preceptors. In my first semester at CPEP, I was fortunate
enough to be tutored by a very experienced psychiatrist who gave me the view of comprehensive
acute psychiatric care that I wanted to gain from my experience. During the second and third
semesters, I was privileged to care for a knowledgeable and meticulous female psychiatric NP in
a blended telehealth and in-person capacity at an outpatient addiction facility, where I was
primarily conducting the evaluations. These diverse experiences allowed me to work with
various patient populations and use cross-sectional approaches, and they strengthened my
clinical competencies.
However, I also witnessed some challenges during my rotations. One tricky aspect of the
workflow in the CPEP that I had yet to encounter in my previous assignments in other health
facilities was the fast pace. We were still learning to adjust to the rapid pace of decision-making
and crisis management tendencies inherent in this environment. Moreover, the extensive census
of patients that passed through the CPEP underserved established care and long-term evaluation
of the effectiveness of treatments. Such a scenario made it challenging to evaluate the
effectiveness of interventions usually prescribed in psychiatry to patients over time; this was
important in offering timely therapies. In their recent publication, Beauchemin et al. (2019)
elaborate on the difficulties of applying clinical practice guidelines in complex care contexts,
focusing on the authors' idea that it is possible to incorporate the principles of clinical practice
guidelines when working in fast-paced environments.
However, these exercises amalgamated various clinical experiences that were also
important when developing myself as a future FPMHNP. LaManna et al. (2019) highlight that
clinical variations can improve advanced practice nurses' clinical reasoning abilities. My clinical
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practice encompassed numerous settings – from the Emergency Psychiatric Service to outpatient
Substance Abuse Treatment – which helped me to understand the Continuum of Mental Health
Care and the variety of tasks that I would be performing shortly.
Challenging feelings are addressed through self-awareness.
The most challenging thing I saw during the clinical practice was high anxiety and
depression rates in patients of young age and pregnant/ postpartum women. Possessing exquisite
experience in working with geriatric patients in the past, this change in the demographic pattern
was quite stressful and demanded intense emotional transitions. This specific scenario
emphasizes the necessity of self-reflectiveness and emotional stability in psychiatric nursing
practice.
One such case was during my experience in the CPEP administrative work. I saw a
female patient aged 34 years who had been readmitted two weeks after giving birth. She said that
she had heard the voices urging her to harm her baby. In this case, I had to address the patient's
mental state and the physical needs of the baby while maintaining the medical professional-
client-sequel detachment. The magnitude of emotionality, in this case, was high since it altered
my perception of maternal mental health and the extent of the mentioned PPMDs.
This ensured that I had to develop an understanding of my emotional state about certain
clinical situations and how to handle them. It took efforts to describe the first shift as rather
uncomfortable while still being able to show consideration for patients' well-being. Sukhera and
Watling (2018) Illustrated the role of understanding and eradicating biases in service delivery,
especially concerning the diversity of the patient population. Through consistent practice of
reflecting on my reactions and feelings toward the situation and the patients, I was more
concerned and helpful to patients with psychiatric problems.
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Furthermore, this case helped me understand the need to reach out for help and get advice
from co-workers and superiors in emotionally tricky cases. The debriefing and reflective practice
allowed me to work through such scenarios and identify ways to protect myself from too close of
interaction while being compassionate and supportive to patients.
Self-evaluation of strengths
I highlighted several assets when participating in specified professional practice and
skills performance in clinical affiliations. Hear and See (H&S), also known as active listening
and empathy, understanding clients, and communication skills, all arose as tangible strengths that
positively impacted patients. The patients look at me in a way that they feel free, like being with
a friend or even close relatives; some even call me by my first name, while others appear to be
very comfortable discussing issues that may be bothering them in confidence. This skill of
making an early and warm assessment of the potential patient is highly beneficial to psychiatric
nursing, given that the creation of rapport is central to facilitating recovery.
Clinical confidence also improved as I progressed through my initial and subsequent
clinical experiences. The skills I acquired during the CPEP in the first semester allowed me to
perform assessments efficiently and help with admissions that were vital in my site, the
outpatient addiction treatment center, during subsequent rotations. In showing this development,
the following transitions exemplify my learning, effective clinical practice, and flexibility to
work in different clinical environments.
Moreover, the experiences I have been through in correctional facilities, as well as
inpatient mental health establishments, gave me an edge when it comes to handling crises and the
use of different tactics to defuse a situation. These skills were of much importance in the CPEP
setting since most of the patients that I worked with were in states of severe agitation and
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anxiety. The helpful English cognitive skill was stress management, which enabled me to deal
with situations that called for one to remain as calm as possible when caring for patients and
their families.
Areas needing improvement
Now that I am within a year of graduating, I find several areas pertinent to my education
and skills that deserve enhancement. First of all, there are knowledge gaps related to
psychotropic medications, such as when to change medications or when it is necessary to start
the reduction of dosages. This is a challenging area, given the nature of psychiatric drugs and the
difficult task of making decisions regarding interactive efficacy and side effects. King and
Shapiro (2022) explain the necessity of developing an increasingly holistic experience in the
understanding of psychopharmacology, stating that formal education is essential, but so is a
clinical practice to reach the mastery of what they call "the art of psychopharmacological
prescription."
I must also try to gain more knowledge in the prescription process for specific groups,
including patients' age and gender. These groups possibilities very significant problems in terms
of tolerance to medication therapy, possible interactivity, and long-term outcomes. The emphasis
on the growth of age-oriented pharmacological strategies is also essential for a client-centered
approach throughout the life cycle.
A second domain advocated for improvement is the differentiation between true
psychiatric emergencies and petty fabrication or Munchausen syndromes. For instance, during
my first day in the CPEP, I came across a 27-year-old man with a complaint of psychosis.
Through this assessment, we learned that he had a future court date and was possibly using the
psychiatric emergency room to avoid court. This emphasized the importance of the clinical
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evaluation and differential diagnosis skills that require improvement and the need to acquire
these amid acute care settings where time is limited.
Strategies for improvement
In response to these areas of concern, I will embark on a professional learning approach
that entails continuous professional development. To start with, I will attend and present papers
and posters at local, regional, and international conferences on the topic of psychopharmacology
and pharmacotherapy. These events will open the possibility of getting ideas from other
professionals in psychiatric medicine and managing medications.
Also, I plan to continue conducting literature reviews and reviewing clinical practice
guidelines to enhance my knowledge and practice of current and most effective strategies for
handling patients with psychiatric complications. Beauchemin et al. (2019) also stress that it is
vital to maintain the relevance of knowledge as they are updated to achieve optimal, evidence-
based practice. If I devote a certain amount of time to literature updates, they can help me
understand what I am doing and ensure my practice aligns with present knowledge and
suggestions.
In addition, I will apply for practical experience and support by closely working with
experienced colleagues and engaging in case analyses and debriefs of interdisciplinary groups.
These strategies will assist me in understanding how to individualize patient care, intervene in
personal patient needs, and identify complex patient needs. In a more recent study, LaManna et
al. (2019) demonstrate the qualities and benefits of delivering traditional collaborative learning
and peer assessment to help learners build progressive clinical reasoning abilities.
To improve my competencies of interrelating with people of different backgrounds, I
would like to engage in further education in geriatric and pediatric psychiatry. This specialized
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knowledge, particularly in emergent and adult care, will be necessary in offering the patient total
health. Furthermore, I hope to attain higher education in forensic psychiatry to enhance
understanding and caring for correctional facility patients and distinguish between factitious
pathology and exaggeration.
I will keep a reflective practice diary including complex cases, experiences, successful
outcomes of interventions in my practice, and weak areas. It also signifies the self-reflective
method through which I will monitor my professional development and examine daily learning
requirements. Fadus et al. (2020) stress the need for ongoing self-care and cultural awareness
education to create an inclusive environment as well as to serve marginalized and at-risk groups,
including sexual and gender minorities, who face prejudice when in the wrong hands within
psychiatric facilities.
Plans
In the future, I want to remain a part of corrections but rather work as a Psychiatric
Nurse Practitioner after quitting my current RN position. This setting will enable me to use my
specialized knowledge and hone specific skills I have acquired in the correctional healthcare
setting. Correctional settings bring added complexities and possibilities within the treatment of
patients' psychology disorders, such as addressing medical conditions with dual diagnoses and
treating and dealing with substance use disorders and mental health illnesses in offenders.
Ideally, being in this position means that I shall endeavor to ensure that adequate and
tested interventions are adopted and that the mental health of the prisoners is enhanced. Its
treatment will, therefore, entail formulating complete treatment care plans that seek to respond to
mental health emergencies and also long-term illnesses with particular regard to re-occupation
integration.
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Also, I plan on being a strong voice for better mental health in the criminal justice system
since there has been research that shows that inmates require quality psychiatric services. This
may entail working in concert with, for example, a psychologist, a social worker, and correction
officers to address mental health issues more comprehensively within inmates.
In this respect, I look forward to further personal growth and constant learning as my next
professional growth step. The area of specialization in psychiatric mental health nursing requires
development, and I understand the need to update my knowledge base with the current research,
interventions, and evidence-based practice. Thus, with the help of continuing education, I want
to improve the lives of my patients as well as to bring a positive change to the field of providing
mental health services in correctional facilities.
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References
American Nurses Association, American Psychiatric Nurses Association, International Society of
Psychiatric-Mental Health Nurses. (2022). Psychiatric-Mental Health Nursing: Scope and
Standards of Practice (3rd Ed.) Silver Spring, MD. ANA (pgs. 59-92)
Beauchemin, M., Cohn, E., & Shelton, R. C. (2019). Implementation of clinical practice guidelines in the
Health Care Setting.DAdvances in Nursing Science,D42(4), 307–324.
https://doi.org/10.1097/ans.0000000000000263
Fadus, M., Hung, K., & Casoy, F. (2020). Care considerations for LGBTQ patients in acute psychiatric
settings.DFOCUS,D18(3), 285–288. https://doi.org/10.1176/appi.focus.20200002D
King, I., & Shapiro, Y. (2022). Learning the "Science of the art of prescribing": From evidence-based
algorithms to individualized medicine in Psychiatric Care.DJournal of Psychiatric Practice,D28(5),
409–420. https://doi.org/10.1097/pra.0000000000000651
LaManna, J. B., Guido-Sanz, F., Anderson, M., Chase, S. K., Weiss, J. A., & Blackwell, C. W. (2019).
Teaching diagnostic reasoning to advanced practice nurses: Positives and negatives.DClinical
Simulation in Nursing, pp. 26, 24–31. https://doi.org/10.1016/j.ecns.2018.10.006
Sukhera, J., & Watling, C. (2018). A framework for integrating implicit bias recognition into health
professions education.DAcademic Medicine,D93(1), 35–40.
https://doi.org/10.1097/acm.0000000000001819
