Week 15: Clinical Journal

Running head: JOURNAL

Journal

Author's Name

Institutional Affiliation

JOURNAL

Reflect on your clinical experience by writing(four to five sentences)responses to each of the

following questions. Include references from the learning activities or from journal articles and

resources located in the Regis Library Database:

1. What were thehighlights of this week'sclinical? Describe a particular patient, patient

interaction, or disease process that stood out to you.Autism spectrum disorders

2. Reflect on a situation or a patient presentation that youwere unfamiliar withduring

clinical this week (i.e., the disorder and/or symptoms the patient was exhibiting). Describe

how you handled this unfamiliar situation/case.Obsessive-compulsive disorder

3. Describe a situation or encounter from this week that led you to anew understanding of

a specific mental health condition.

4. Discuss any interactions with patients that you observed, either in a therapy or a

medication management session, that weremissing some of the conceptsyou have

been learning about regarding therapeutic relationships and communication.

5. How did youapply the content learnedin your online courses to your clinical setting this

week?

6. Which chief complaints did you see most often this week? Providedetails about how you

feltabout developing your own preliminary differential diagnoses lists for these patients

based on the complaints/symptoms they expressed.

7. Given the most frequent psychiatric disorders you encountered in your clinical rotation this

week, what is themost useful set of guidelines(i.e., depression guidelines, Beer’s

criteria, etc.) to refer to for additional information for prescribing and/or psychotherapy?

8. Thinking about the common mental health conditions you saw in your clinical this week

(see question #7), did you feel that you hadadequate knowledgeto discuss these

diagnoses with your preceptor? If not, what preparation work do you have planned to help

you feel more confident for the upcoming clinical week?

JOURNAL

9. List abrief plan of carefor one of the patients you saw this week. Include your

preceptor’s plan, too. Discuss, briefly, whether or not you agree with your preceptor’s plan

of care. If not, describe what you would have done differently and why.

10. What situation or patient presentation did you see in your clinical setting this week that

hasnot yet been coveredin your online psychiatric courses?(hypochondriasis)

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What were the highlights of this week's clinical? Describe a particular patient, patient

interaction, or disease process that stood out to you

The major highlight of this week was the successful reduction of autism spectrum disorder

symptoms in a 10-year-old patient. While there are no one-size-fits all treatment for autism

patients, we combined home-based and school-based behavior and communication therapy and

educational therapy. Applied Behavior Analysis (ABA) effectively helped to teach positive

patient behaviors while also reducing the negative ones. A visual after school schedule was

developed and involved teaching the student time management, and reading.

Reflect on a situation or a patient presentation that you were unfamiliar with during

clinical this week (i.e., the disorder and symptoms the patient was exhibiting). Describe

how you handled this unfamiliar situation/case.

During the week, I came across a patient with obsessive-compulsive disorder. The patient was

brought to the facility with somewhat unfamiliar symptoms. For instance, the middle-aged

female patient exhibited excessive fear of being contaminated by germs, impulsivity, social

isolation, and hypervigilance. These were unfamiliar symptoms since it was the first time I had

attended to a patient with a type of disorder. Being an unfamiliar situation, I had to consult our

preceptor, who immediately diagnosed the patient's problem as an obsessive-compulsive

disorder.

Describe a situation or encounter from this week that led you to a new understanding of a

specific mental health condition.

Attending the above-mentioned patient led to me to a deeper understanding of the obsessive-

compulsive disorder. Firstly, the obsessive-compulsive disorder can cause significant anxiety due

JOURNAL

to obsessive thoughts. This was proved by the patient's excessive obsession with germs

contamination, which caused her to check on her hands repeatedly, clothes, and everything

around her. According to OCD.org, "people with OCD who are obsessed with germs can't stop

thinking about being contaminated and may even avoid going into public places. These cause

anxiety or discomfort that significantly interferes with normal life."

Discuss any interactions with patients that you observed, either in therapy or a medication

management session that were missing some of the concepts you have been learning about

regarding therapeutic relationships and communication.

Interacting with the patient with OCD was somewhat challenging since it lacked some of the

concepts we have learned about therapeutic relations and communication. This patient's high

levels of anxiety levels and impulsivity made it difficult to effectively communicate and interact

with her. Her inability to hold successful conservation made it challenging to obtain information

needed to address mental possess which activate her OCD symptoms effectively. As a result, it

was not easy to build a successful therapeutic relationship with this particular patient.

How did you apply the content learned in your online courses to your clinical setting this

week?

The online content was very instrumental in this week's clinical setting. Noteworthy, the online

content was an important source of additional information and insights into various health

conditions. For instance, when faced with unfamiliar or complex situations, I relied on this

content for guidance. In so doing, I can say this content helped me to improve the quality of my

service significantly. Consulting the online content helped to reduce costly errors that could

otherwise compromise the quality and safety of care.

JOURNAL

Which chief complaints did you see most often this week? Provide details about how you

felt about developing your own preliminary differential diagnoses lists for these patients

based on the complaints/symptoms they expressed

Majority of the patients who came to the facility this week mainly complained about depression

and related symptoms. Developing preliminary differential diagnoses for the different depression

patients was both challenging and informative. By developing differential diagnoses for

depression patients with different symptoms and from diverse backgrounds enabled me to gain a

more in-depth understanding of how to how the mental disorder manifests and, more

importantly, ways to treat it for patients from various backgrounds.

Given the most frequent psychiatric disorders you encountered in your clinical rotation

this week, what is the most useful set of guidelines (i.e., depression guidelines, Beer's

criteria, etc.) to refer to for additional information for prescribing and psychotherapy?

This week I found Beer's criteria a more effective set of guidelines. One hand, the Beer's criteria

are easier to understand, and it helps healthcare providers to differentiate between potentially

appropriate and inappropriate medications for individuals with depression. In the words of Lund

et al. (2011), Beer's criteria provide physicians with a rating of severity for adverse outcomes. In

addition, it provides a description of the concerns associated with various medications.

Thinking about the common mental health conditions you saw in your clinical this week

(see question #7), did you feel that you had adequate knowledge to discuss these diagnoses

with your preceptor? If not, what preparation work do you have planned to help you feel

more confident for the upcoming clinical week?

JOURNAL

In my opinion, I believe I now possess the necessary knowledge and experience to discuss the

diagnoses of the different mental health conditions with my preceptor. Everything learned and

done in this week, I still need several additional preparations to improve my confidence and

overall preparedness. For example, I will need to consult our online content and other reading

materials further.

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List a brief plan of care for one of the patients you saw this week. Include your preceptor's

plan, too. Discuss, briefly, whether or not you agree with your preceptor's plan of care. If

not, describe what you would have done differently and why

Care plan for depression

Assessment Data Expected Outcomes Nursing

Interventions

Rationale

Self-loathing, apathy,

feelings of emptiness,

insomnia, loss of

appetite, lack of

interest and pleasure

in normal activities,

mood swings, and

constant sadness.

Improve patient’s sleeping

patterns

Eradicate feelings of loss

of agitation, helplessness,

and loss of interest.

Return the patient to the

previous level of

functioning.

Cognitive

restructuring

Activity

scheduling

Prescribe

necessary

medications.

CBT.

The patient’s

understanding

of his

depression

systems will

be improved.

CBT,

Cognitive

restructuring

will help to

help identify

the patient’s

cognitive

distortions.

I agree with this particular care plan particularly because it involves a combination of both

medications and psychotherapy. This makes it more effective. In the words of Cuijpers et al.

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(2015) “combined treatment of depression may be the best treatment available for adult

depression, and that it is significantly more effective than placebo, pharmacotherapy alone,

psychotherapy alone and the combination of psychotherapy and placebo.”

What situation or patient presentation did you see in your clinical setting this week that has

not yet been covered in your online psychiatric courses?

During the week I encountered a patient with hypochondriasis, which has not yet been covered in

our online course.

JOURNAL

References

Lund, B. C., Steinman, M. A., Chrischilles, E. A., & Kaboli, P. J. (2011). Beers criteria as a proxy for

inappropriate prescribing of other medications among older adults. Annals of Pharmacotherapy,

45(11), 1363-1370

Cuijpers, P., de Wit, L. M., Weitz, E. S., Andersson, G., & Huibers, M. J. (2015). The combination of

psychotherapy and pharmacotherapy in the treatment of adult depression: a comprehensive meta-

analysis.

OCD.org (2019). “Facts about Obsessive Compulsive Disorder.” Retrieved from

http://beyondocd.org/ocd-facts

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