Journal Entry

Journal Entry

Critical reflection of your growth and development during your practicum experience in a clinical setting has the benefit of helping you to identify opportunities for improvement in your clinical skills, while also recognizing your strengths and successes.

Use this Journal to reflect on your clinical strengths and opportunities for improvement, the progress you made, and what insights you will carry forward into your next practicum.

Critical reflection of your growth and development during your practicum experience in a clinical setting has the benefit of helping you to identify opportunities for improvement in your clinical skills, while also recognizing your strengths and successes.

Use this Journal to reflect on your clinical strengths and opportunities for improvement, the progress you made, and what insights you will carry forward into your next practicum.

To Prepare

· Refer to the “Population-Focused Nurse Practitioner Competencies” found in the Week 1 Learning Resources, and consider the quality measures or indicators advanced nursing practice nurses must possess in your specialty of interest.

· Refer to your Clinical Skills Self-Assessment Form you submitted in Week 1, and consider your strengths and opportunities for improvement.

· Refer to your Patient Log in Meditrek, and consider the patient activities you have experienced in your practicum experience and reflect on your observations and experiences.

Journal Entry (450–500 words)

Learning From Experiences

· Revisit the goals and objectives from your Practicum Experience Plan. Explain the degree to which you achieved each during the practicum experience.

· Reflect on the three (3) most challenging patients you encountered during the practicum experience. What was most challenging about each?

· What did you learn from this experience?

· What resources were available?

· What evidence-based practice did you use for the patients?

· What would you do differently?

· How are you managing patient flow and volume?

· How can you apply your growing skillset to be a social change agent within your community?

Communicating and Feedback

· Reflect on how you might improve your skills and knowledge, and communicate those efforts to your Preceptor.

· Answer the questions: How am I doing? What is missing?

· Reflect on the formal and informal feedback you received from your Preceptor.

Self-Assessment Form

In the nursing profession, clinical assessment is critical and significant in the identification of areas for professional development. Understanding these elements will enable a professional to find effective ways to improve patient care (Ahn & Choi, 2019). By conducting a self-assessment, a healthcare professional will be able to assess their goals, objectives, and competences and determine whether they have been achieved or not.

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
Differentiating between pathophysiological and psychopathological conditions
Performing and interpreting a comprehensive and/or interval history and physical examination (including laboratory and diagnostic studies)
Performing and interpreting a mental status examination
Performing and interpreting a psychosocial assessment and family psychiatric history
Performing and interpreting a functional assessment (activities of daily living, occupational, social, leisure, educational).
Diagnostic reasoning skill in:
Developing and prioritizing a differential diagnoses list
Formulating diagnoses according to DSM 5 based on assessment data
Differentiating between normal/abnormal age-related physiological and psychological symptoms/changes
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)
Evaluating patient response and modify plan as necessary
Documenting (e.g., adverse reaction, the patient response, changes to the plan of care)
Psychotherapeutic Treatment Planning:
Recognizes concepts of therapeutic modalities across the lifespan
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)
Applies age appropriate psychotherapeutic counseling techniques with individuals and/or any caregivers
Develop an age appropriate individualized plan of care
Provide psychoeducation to individuals and/or any caregivers
Promote health and disease prevention techniques
Self-assessment skill:
Develop SMART goals for practicum experiences
Evaluating outcomes of practicum goals and modify plan as necessary
Documenting and reflecting on learning experiences
Professional skills:
Maintains professional boundaries and therapeutic relationship with clients and staff
Collaborate with multi-disciplinary teams to improve clinical practice in mental health settings
Identifies ethical and legal dilemmas with possible resolutions
Demonstrates non-judgmental practice approach and empathy
Practices within scope of practice
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
Implements the screening instrument efficiently and effectively with the clients
Interprets results for screening instruments accurately
Develops an appropriate plan of care based upon screening instruments response
Identifies the need to refer to another specialty provider when applicable
Accurately documents recommendations for psychiatric consultations when applicable

Summary of strengths:

Problem Solving One of my strengths is the ability to identify problems, analyze them, develop alternative approaches, and select the best course of action to solve them. This is a critical strength because nurses always have to identify troubles and how to solve them on a daily basis. I believe that during my practicum experience, I will face different hurdles that will require me to think critically and creatively to resolve them. Therefore, I will use my problem-solving strength to recognize problems and develop solutions to ensure that I am successful during the practicum. Endurance I have great physical and mental endurance skills as part of my core strengths. Mental endurance will help me remain focused and dedicated to caring for the patients and families depending on me. Regarding physical endurance, this will help me keep myself energized to keep going and effectively handle the activities that will be taking place in the practical setting. Santillan-Garcia et al. (2020) explain that for healthcare professionals, endurance can significantly reinforce their performance. Communication I have great verbal and written communication skills that will act as a core element of my success in the goals and objectives I plan to achieve. Using this strength, I will be able to communicate efficiently with interprofessional teams in the practical setting. As Anselmo-Witzel et al. (2017) explain, communication skills are significant in a health care environment because they ensure that there is effective and accurate sharing of information that can be used to make effective decisions and establish collaboration. Patience This strength is about my ability to set goals and work towards achieving them while adopting a “one day at a time” mentality. Nursing is about setting goals and striving to achieve them. However, achieving some of these goals may sometimes be difficult as a result of the nature of the nursing profession (Hwang et al., 2018). Practical health care settings have numerous activities going on, and it is easy to lose patience. Therefore, I will leverage this strength to remain rational and calm even in challenging situations. Maintaining a rational and calm status will help put me in the best position to make effective decisions as required.

Opportunities for growth:

Opportunities for Growth Advancing Education There is an opportunity for me to use education to advance my skills and knowledge. These opportunities may present themselves in different ways. For example, I look forward to enhancing my existing knowledge and discovering new concepts during the course. Networking By interacting with interprofessional teams in similar and different environments, I have an opportunity to establish a strong support system within the medical community. Through networking, I will receive guidance and support that will be beneficial to me as I pursue my goals and objectives. Research There is also an opportunity for me to carry out research and utilize an evidence-based approach in my practice. Through research, I can identify better ways to improve my clinical skills and enhance my professional goals (Kaihlanen et al., 2018). Furthermore, it will provide a more comprehensive understanding of concepts and topics that will significantly and positively impact my professional and clinical development.

Now, write three to four (3–4) possible goals and objectives for this practicum experience. Ensure that they follow the SMART Strategy, as described in the Learning Resources.

1. Goal: To enhance my skills for psychotherapeutic treatment planning. a. Objective: To effectively provide psychoeducation to individuals, families, and groups. b. Objective: To effectively recognize elements of therapeutic modalities across the lifespan. c. Objective: To effectively chose the best clinical practice guidelines for psychotherapeutic plans. 2. Goal: To enhance my skills for choosing screening instruments and making recommendations. a. Objective: To successfully recognize and select proper screening instruments for clinical events. b. Objective: To successfully utilize screening instruments with clients. c. Objective: To effectively interpret results for the screening instruments. 3. Goal: To enhance my skills of diagnostic reasoning. a. Objective: To effectively differentiate between abnormal and normal age psychological and physiological symptoms. b. Objective: To effectively develop a prioritized differential diagnosis list for patients. c. Objective: To effectively develop diagnoses based on DSM 5 criteria and evaluation data.

Conclusion

All the aforementioned elements are critical and will offer guidance to achieve my goals for this practical. I have utilized the clinical self-assessment form to identify my clinical areas that require improvement. By working towards the goals and objectives listed above, I will be developing my clinical and professional skills. I will maximize my strengths and opportunities to make sure that I succeed at achieving these goals and objectives by the end of the practicum.

Signature:

Date:

Course/Section:

References

Ahn, Y. H., & Choi, J. (2019). Incivility experiences in clinical practicum education among nursing students. Nurse education today, 73, 48-53.

Anselmo-Witzel, S., Orshan, S. A., Heitner, K. L., & Bachand, J. (2017). Are generation Y nurses satisfied on the job? Understanding their lived experiences. JONA: The Journal of Nursing Administration, 47(4), 232-237.

Hwang, B., Choi, H., Kim, S., Kim, S., Ko, H., & Kim, J. (2018). Facilitating student learning with critical reflective journaling in psychiatric mental health nursing clinical education: A qualitative study. Nurse education today, 69, 159-164.

Kaihlanen, A. M., Haavisto, E., Strandell‐Laine, C., & Salminen, L. (2018). Facilitating the transition from a nursing student to a Registered Nurse in the final clinical practicum: A scoping literature review. Scandinavian Journal of Caring Sciences, 32(2), 466-477.

Santillan-Garcia, A., Zaforteza-Lallemand, C., & Castro-Sanchez, E. (2020). Nurses as political knowledge brokers, opportunities for growth in the Spanish context. International Journal of Nursing Studies, 110, 103690.

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