NU673-7 Unit Clinical: Journal Reflection

NU673-7 Unit Clinical: Journal Reflection – You will create 5 entries for your Reflective Journal about a patient encounter. In the 5th entry, you will review the previous 4 entries…

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NU673-7 Unit Clinical: Journal Reflection

Reflective Journal Instructions

You will create 5 entries for your Reflective Journal about a patient encounter. In the 5th entry, you will review the previous 4 entries and evaluate your progress in reflective practice over the course of the term.  Each journal should be a minimum of 250 words.

The purpose of this reflective journal is self-reflection regarding the role in the process of self-reflection as a PMHNP provider. Through reflective practice, the student will evaluate their own emotional health and recognize one’s own feelings as well as one’s ability to monitor and manage those feelings.

The point of the exercise is to learn yourself, your triggers, the types of cases you end up getting overly involved with, and those you’d rather refer to someone else. The idea is to be able to personally reflect on your behaviors/thoughts/decisions and how those impact you in the role of PMHNP.

Journal 1

Introduction address the following items: 

• Describe your past experience in mental health or with someone with mental illness.
• What are the reasons you have chosen to work with this population? 
• Discuss any concerns you have regarding this specific clinical course and population Adult/Geriatric.
• Identify personal and academic/professional goals for the clinical course and population Adult/Geriatric. 

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Journal 2

• Discuss a patient interaction in which there was transference, countertransference, prejudice/biases, or judgments that you may be making about the patients or that they are verbalizing about you. Have you encountered this before? From where does this originate? Would it appropriate for you to continue to provide care to the patient and if so, how will you prevent these issues from affecting the care you are able to provide the patient? 

Journal 3

• Describe a significant event/patient interaction you have experienced anytime in your nursing career up to this week. Discuss the impact this had on you in terms of increasing your understanding of the PMHNP role, psychopathology, and/or the provider-patient relationship.
• Explore your personal strengths and limitations and their effect on the provider/patient relationship. Include reflection on your therapeutic use of self. Your discussion should reflect your specific learning/insight. Identify something specific that you learned from reflecting on this event/interaction and how will you apply that learning in your future practice? 

Journal 4

• Describe a new experience, significant event/patient interaction, never seen before diagnosis, etc… you have experienced in clinical this week. You can choose the same case you used for your SOAP Note this week if that case had an effect on you.  Discuss the impact this had on you in terms of increasing your understanding of the PMHNP role, psychopathology, and/or the provider-patient relationship.
• Explore your personal strengths and limitations and their effect on the provider/patient relationship. Include reflection on your therapeutic use of self. Your discussion should reflect your specific learning/insight. Identify something specific that you learned from reflecting on this event/interaction and how will you apply that learning in your future practice? 

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Journal 5

The ability to analyze one’s self and be aware of how one’s emotions and responses affect others is a crucial component to developing a therapeutic relationship with patients.

During this clinical/course and particularly through this exercise it is expected that the student develops recognition of their own feelings, prejudices, biases, triggers, anxieties, limitations, and of course strengths while developing the ability to appropriately manage these issues as they arise and how to best align your strengths to overcome your limitations. In this final journal entry, review your previous journal entries and reflect upon your success in achieving this as well as the goals you stated in your first video journal.

Questions to address in your final reflective video include: 

• What goals did you set for yourself at the beginning of the semester? Did you meet these? 
• What feelings, prejudices, and biases did you experience during your clinical experience and how did you manage them? 
• How did you manage your anxiety, self-doubt, and/or uncertainty? 
• What understanding or insights did you develop during your clinical experience? 
• Has reflective practice impacted you as a person, student, and/or provider? If so, how? 
• Will you continue to use reflection in your future practice? If so why and how? 

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Solution

Unit 3 Assignment – Clinical: Journal Reflection

According to the National Alliance on Mental Illness, 1 in 5 American adults experiences mental illness each year (NAMI, n.d). Severe mental conditions may lead to suicide which is considered the second leading cause of death among people aged 10-34 years. I have had a previous encounter with a person who has a mental illness. He was a 32-year-old man who had partial depression, followed by periods where he could live everyday life. While he could secure a job, most of his colleagues avoided interacting with him, following the topic’s stigmatization.

Nonetheless, his relationship with his wife was strained, leading to a divorce, where he was denied custody of his children due to his mental condition. The turn of events worsened his situation, resulting in him seeking mental health services to help him cope with the issue. His mental disorder led to him taking on unhealthy eating patterns, which resulted in him being overweight.

He attempted to commit suicide on several occasions, but every time he was distracted. I decided to work with this population because people suffering from mental health are prone to committing suicide. Listening and providing care to them makes them feel supported and loved, which helps improve their mental and emotional health.

One of my concerns regarding this clinical course is prioritizing assessing and managing risks ranging from suicidal attempts, self-harm, neglect, aggression, and violence among patients with mental health issues. Psychiatric mental health nurse practitioners (PMHNP) should have the fundamentals of identifying risks in patients with mental health issues and manage them effectively to avoid adverse effects on the patient and improve their quality of life (Mangano et al., 2020).

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Moreover, the adult population is prone to suffering from behavior disorders, anxiety, and moodiness, resulting in severe mental health disorders when left unattended (Bergmans et al., 2019). Lastly, I aim to learn the fundamentals of mental health nursing and deliver quality care to the adult population, reducing stigmatization associated with mental health and providing emotional support to these victims.

References

• Bergmans, R. S., Zivin, K., & Mezuk, B. (2019). Perceived sleep quality, coping behavior, and associations with major depression among older adults. Journal of Health Psychology, 26(11), 1913-1925. https://doi.org/10.1177/1359105319891650
• Mangano, E., Gonzalez, Y., & Kverno, K. S. (2020). Challenges faced by new psychiatric–mental health nurse practitioner prescribers. Journal of Psychosocial Nursing and Mental Health Services, 58(10), 7-11. https://doi.org/10.3928/02793695-20200915-01
• NAMI. (n.d.). Mental health by the numbers. NAMI: National Alliance on Mental Illness. https://www.nami.org/mhstats

Unit 5 Assignment – Clinical: Journal Reflection

Nurse-patient interactions are core in determining the effectiveness of healthcare delivery. However, bias, judgment, prejudice, transference, and countertransference factors may negatively affect this relationship, leading to ineffective healthcare delivery. I have encountered a patient who refuted me from delivering healthcare because I was a nursing practitioner. She doubted my qualifications and instead asked for a psychiatrist to serve her. She believed a practitioner is not experienced enough to offer treatment.

According to Keen et al. (2019), treatment refusal is common in nursing practice and is often due to different reasons. While these reasons may be rational, health providers need to consider these reasons for the patient’s satisfaction. The patient had bipolar disorder, which made her have extreme opposite reactions to the matter. Initially, she was very cooperative in the treatment procedures, and we had a healthy relationship with her. However, she posed an opposite reaction when she learned that I was a psychiatric mental health nurse practitioner (PMHNP).

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Upon rejection, I doubted my expertise and questioned my professionalism. At that time, I could not understand why she decided I should not attend to her. I was triggered emotionally and left the room to report to the psychiatrist on the matter. She calmed me down and urged me not to take her comments to heart. With time, I understood her, but I found it best not to attend to her. In this regard, it would be best to receive care from someone she trusted to enhance her cooperation in the treatment plan.

Autonomy is essential in healthcare delivery as everyone, including patients, has a right to make informed decisions about their healthcare and how it should be delivered (Oshodi et al., 2019). For this reason, nurses need to respect the patient’s right to refusal of care from a given health provider to help deliver quality care.

References

• Keen, A., Thoele, K., Fite, L., & Lancaster, S. (2019). Competent patient refusal of nursing care. Journal of Wound, Ostomy & Continence Nursing, 46(5), 390-395. https://doi.org/10.1097/won.0000000000000569
• Oshodi, T. O., Bruneau, B., Crockett, R., Kinchington, F., Nayar, S., & West, E. (2019). Registered nurses’ perceptions and experiences of autonomy: A descriptive phenomenological study. BMC Nursing, 18(1). https://doi.org/10.1186/s12912-019-0378-3

Unit 9 Assignment – Clinical Journal Reflection

Neff et al. (2018) found evidence that patients had positive experiences with nursing practitioners based on effective communication, good therapeutic relationships, clinical skills, and effective collaboration. Given that nursing practitioners spend most of their time providing indirect care and other activities related to patient care services, there is a need to optimize creating healthy relationships with patients.

I recently encountered a patient suffering from depression, and her attempt to commit suicide failed, and her family members rushed her to hospital. Her family members claimed that she only wanted to take her life through poisoning but did not understand the reasons behind her actions.

Once the patient was conscious, she explained her experience with depression and the stigmatization she experienced from her family members. She claimed that she wanted to remain in the facility as she did not feel valued at home. She said that her parents constantly criticize her for her actions, and even after telling them of her depression, they shut her, claiming that it is not an illness rather its pretense.

I did not incorporate the cultural beliefs in healthcare delivery, which led to disputes with the family members. However, I acted autonomously according to the patient’s will and increased the awareness of depression among the family members present. As a result, they were better placed to understand the patient’s condition and promised to care for her at home.

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From this encounter, I learned about the influence of social and cultural beliefs on mental health. Mental health issues such as depression, anxiety, and bipolar disorders are not prioritized in some cultures, leading to high levels of stigmatization. This experience makes it difficult for patients suffering from mental health to open up on their condition or ask for help.

Additionally, some cultures perceive mental health as a weakness, resulting in most victims committing suicide (Al-Krenawi, 2019). This cultural perception of mental health may limit community support, where the victims do not receive the care they deserve. In some instances, the victim’s families tend to hide the issue to avoid stigmatization related to the topic. Therefore, PMHNP should understand the impact of culture on the wellness of a victim. Following this interaction, I have gained insights into the matter and will apply this to increase mental awareness in different communities, to improve patient care.

References

• Al-Krenawi, A. (2019). The impact of cultural beliefs on mental health diagnosis and treatment. Culture, Diversity and Mental Health – Enhancing Clinical Practice, 149-165. https://doi.org/10.1007/978-3-030-26437-6_9
• Neff, D. F., Yoon, S. H., Steiner, R. L., Bejleri, I., Bumbach, M. D., Everhart, D., & Harman, J. S. (2018). The impact of nurse practitioner regulations on population access to care. Nursing Outlook, 66(4), 379-385. https://doi.org/10.1016/j.outlook.2018.03.001

Unit 11 Assignment – Clinical Journal Reflection

Research shows that mental illnesses including bipolar, Schizophrenia, and depressive disorders contribute to the global health burden. Depressive disorders account for 4.7% of the worldwide disease burden, while bipolar disorder has a prevalence of 1%. Nonetheless, Schizophrenia is the most common disorder affecting 0.4% of the overall population (Ayano et al., 2021).

While the symptoms of these illnesses are almost similar, there are increased chances of misdiagnosis. Misdiagnosis leads to inaccurate treatment, which negatively affects the quality of life among patients. It can also lead to dangerous psychological conditions that may affect the victims’ emotional, mental, and behavioral functions.

Recently, I attended to a patient who had been previously misdiagnosed with bipolar disorder in a different facility and provided with inappropriate treatment. After months of taking the medication, she did not feel any improvements, and instead, her condition worsened.

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As a result, she decided to seek professional help from another facility. I decided to assess and diagnose the patient before providing treatment. I assessed the subjective and objective data using SOAP notes and diagnosed the patient with Schizophrenia. It was my first encounter with a misdiagnosis that had affected the patient for approximately three months.

Wrong medication had worsened the patient’s condition requiring close monitoring. I communicated to the patient effectively on the problem and the reason behind her worsening conditions. However, the patient was shocked and denied the results as she did not believe she could have Schizophrenia. To some point, she did not cooperate in the treatment, which affected the program’s effectiveness.

Nonetheless, I created a healthy relationship with her and showed her compassion for her situation, which increased her trust in her healthcare providers and treatment plans. She began asking questions she did not understand and agreed to follow the treatment plan provided.

I learned that misdiagnosis worsens the patient’s condition resulting in low quality of life. Nonetheless, it has a mental and emotional toll on the patient who is shocked to know she has been taking the wrong medication and may imagine the worst situations about their health. Following this experience, I will always ensure I use all available diagnostic tools to avoid misdiagnosis cases.

Reference

• Ayano, G., Demelash, S., Yohannes, Z., Haile, K., Tulu, M., Assefa, D., Tesfaye, A., Haile, K., Solomon, M., Chaka, A., & Tsegay, L. (2021). Misdiagnosis, detection rate, and associated factors of severe psychiatric disorders in specialized psychiatry centers in Ethiopia. Annals of General Psychiatry, 20(1). https://doi.org/10.1186/s12991-021-00333-7

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Unit 13 Assignment – Clinical Journal Reflection

The effectiveness of therapeutic relationships with patients depends on a nurse practitioner’s awareness of their emotions and the impact on other people (Wain, 2017). The reflective journals have effectively identified my strengths, weaknesses, and emotional triggers and the impact I have on patients and healthcare delivery.

At the beginning of the semester, I set a goal to increase mental health awareness among communities to reduce stigmatization and provide a safer space for people with mental illness to improve their condition. I have engaged in mental awareness programs both online and physically in several instances, which has helped me achieve the set objectives.

Nonetheless, I have experienced bias after a patient judged my ability to deliver patient care because I am a practitioner. While it negatively triggered my emotions and made me question my professionalism, I managed to address the situation effectively with the help of the psychiatrist in charge.

The patient had bipolar disorder and had different reactions to the care provided. However, it was difficult to convince the patient of my expertise and skillset, making it best to respect her decision without taking her comments to heart. The bias also led to increased self-doubt, thinking I was not delivering healthcare effectively. However, I understood her condition and learned that it was not about me but the patient and her understanding of how healthcare should be provided. This perception helped me to believe in myself and deliver quality care to other patients.

Additionally, I gained several insights on the need to establish healthy relationships with patients. Patient-nurse relationships determine the effectiveness of healthcare delivery. In this regard, healthy relationships help gain the patient’s trust, resulting in higher cooperation levels in the treatment plan. I also learned that misdiagnosis has adverse effects on the patient’s well-being.

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There is a need to incorporate all diagnosis tools available to ensure the patient receives the right treatment plans to achieve positive health outcomes. This reflection has been effective in improving my practice. Therefore, I will continue using reflection to understand my actions better which will enhance my healthcare delivery.

Reference

• Wain, A. (2017). Learning through reflection. British Journal of Midwifery, 25(10), 662-666. https://doi.org/10.12968/bjom.2017.25.10.662

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