PRACTICUM JOURNAL ASSIGNMENTS 1
PRACTICUM JOURNAL ASSIGNMENTS 2
The purpose of the week one journal entry is to review both a nursing theory and a counseling theory that will guide my practice as a student PMHNP. Also, this journal will cover three goals and objectives that I have for this practicum experience as well as a timeline for my practicum activities.
Nursing Theory
The nursing theory that I have chosen to guide my practice is the Theory of Interpersonal Relations by Hildegard Peplau. In psychotherapy, the relationship developed between the PMHNP and the patients is the base of treatment. The PMHNP must earn the clients trust for therapy to be effective. Peplau’s theory contains four phases of the professional and client relationship- orientation, identification, exploitation, and resolution (Fatemeh et al., 2017). During the orientation phase, the client defines their problem, and the mental health professional will complete their initial assessment. Gaining a patients trust is important because they need to be comfortable enough to be completely truthful so they can be treated properly. For example if a client has a history of sexual abuse in childhood and does not disclose it with the PMHNP then the form of treatment they need they may not receive. I have worked with several patients that have had difficulty disclosing childhood trauma until they felt comfortable enough with me.
Second is the identification phase where a plan of care will be created, during this time the patient will feel as if they belong and that they have real potential to fix the problem. The third is the exploitation phase where the nursing plan will be implemented; actions will be taken in meeting the goals (Bittencourt et al., 2018). The last stage in Peplau’s theory is the resolution phase where the termination of the professional relationship is completed because the client’s needs have been met though their collaboration. I believe that it is critical to develop a strong bond with each client I work with; this theory can be used with every client.
Behavioral Theory
The behavioral theory assumes that behavior is learned from the environment and individuals around us (McLeod, 2010). Thus, being said if a behavior is learned by a person it can be unlearned. I like the behavioral theory to use with individuals because it gives the opportunity to focus on current problematic behaviors that the client may be facing (McLeod, 2010). This theory only looks at observable behaviors, unlike the psychoanalytic theory that focuses on emotions. The reason I chose this theory is that my goal is to work with children that have mental health conditions that result in behavioral issues such as a child with autism or ADHD. Today behavior analysis is often used as a therapeutic technique to help children with autism, and developmental delays acquire new skills (Siti Ithriyah, 2018). ABA is used to help children diagnosed with ASD to decrease negative behaviors that can affect learning and to increase the positive and helpful behaviors.
Goals for Psychotherapy with Groups & Families
The first goal that I have for this course is to fully understand the laws and state regulations regarding group and family therapy in the state of Florida. There are many legal and ethical considerations when conducting group or family therapy, and it is crucial for the PMHNP to be aware of these regulations, so I will be able to protect myself as well as the clients I work with.
The second goal I have in this course is to have the ability to document on an individual patient treatment plan properly. Though I am a psychiatric nurse supervisor, I have never documented on individual patient so learning the documentation process and notes is very important for me to learn while in this course.
Lastly, the third goal I have in this course is to build confidence in providing individualized treatment plan for a client.
Objectives for Psychotherapy with Groups & Families
My first learning objective for this course is to have the capability to provide accurate psychiatric diagnoses for the clients I assess during practicum upon completion of the course. Second objective is to have the ability to recall important legal and ethical implications specific to the District of Columbia when providing psychotherapy to clients and families. The last learning objective is to complete at least 5 full initial assessments with new clients during my practicum experience and to develop a plan of care with those clients.
My Course Timeline
I will be completing a total of 5 weeks of clinicals with a total of at least 160 clinical hours. Each week I will be working with my preceptor for a minimum of 4 days per week at least 8 hours day. The first two weeks I plan to get acquainted with my preceptor Dr. Jaji and the practicum site/ Telehelth. During my first two weeks I plan to shadow Dr. Jaji and get set up with the computer system that he she uses. By week 2, I want to be comfortable with the computer system and could chart properly on client’s treatment plan.
By weeks 2-3, I want to be more comfortable with the documentation process and complete notes on my own. Also, during weeks 3-4 I want to be treating patients by joint care with my preceptor until I become comfortable to become mostly independent. In weeks 4-5 I plan to be practicing mostly independently, after each session I will receive feedback from my preceptor, so I will be aware of specific areas that I can improve on. I would like the opportunity to complete assessments on new patients to have the opportunity to formulate a proper psychiatric diagnosis and plan of care. By the last week of clinical I want to feel confident it my ability to provide psychotherapy to groups and families.
Assessing Clients
Description of the Client
The patient was a 35-year-old man who, on several occasions, attempted to commit suicide. In this case, the patient climbed up in the tree and jumped off the tree. Seemingly, the patient is in a delusional, suicidal state. The truth behind his suicidal attempt was that he lacks material things to enable him to live a comfortable life. Here are the historical medical examinations conducted, audio and visual hallucination, and the delusional disorder. However, he deliberately denied undergoing surgery and the prescribed medications. Besides, he denied his involvement in the family mental issue. Later, he accepted a risperidon and Seroquel medications.
The Justification of the Diagnosis for this Client
Seemingly, the patient has a psychotic mental disorder. According to the American Psychiatric Association (2013), this disorder can be characterized by delusions, which are unattainable beliefs enshrined in the patient’s mind. In addition, his condition indicates hallucinations, a thought that drives someone to overthinking, which later leads to mental disorder. Under hallucinations, there is no apparent cause of the mental disorder. Concerning the facts about the patient in question, a mere shortage of material things to support life is insufficient and cannot stimulate a mental disorder.
Ethical Implications Related to Counseling of this Client
Clinicians indeed need to adhere to their medical code of conduct while performing their duties. It is ethical for a clinician to counsel a person with a mental disorder while embracing kind words so that they feel some care and friendliness. Concerning the above, a patient needs to be isolated from the general community so that they are unable to meet stressful moments among people (Thomas, Owino, Ansari, Adams, Gaynes, & Glickman, 2018). In this case, a counselor may force the patient to persistently stay indoors for some specific periods so that he can experience peaceful mental seasons. However, this was contrary to the needs of the patient since he preferred free movements to staying indoors. Truly, the counselor always needs to be available to monitor the conduct of the patient in confinement. As such, patients will be free from extreme seclusion as he enjoys the company of the counselor.
Week 4 assignment.
Introduction
As a healthcare provider, one has an obligation of ensuring that patients have an effective assessment to allow for reliable diagnosis that in turn will ensure that the patient receives care that is in line with their condition. Reference points out that the process of treatment of issues of psychotherapy requires critical analysis of the patient before the patient is prescribed with a medication or a treatment plan. The purpose of this journal entry is to help in the provision of an evaluation of a client as well as for the development of a therapeutic plan for the treatment or care of the identified client. The provision of an explanation using DSM-5 and treatment plan are provided as well as the ethical implications for the process of provision of the counseling process.
Description of the client (without violating HIPAA regulations) and identify any pertinent history or medical information, including prescribed medications
The client is taken into account in this journal entry is a female African American working as a nurse in the local health facility and her name is MK. MK is 35 years old and has been married for the past 10 years and has three children one aged 7, the other aged 3 years, and 1 year. The client speaks with clarity and she is seen to be intelligent and is a Christian. She points out that she has shared her condition with the church group and she has been receiving emotional support from the group.
The patient has been presented to the healthcare facility as a result of an increase in symptoms of depression. MK claims that “I have not has time to be with my husband and my children due to the extensive amount of work I am being assigned to and it seems I cannot be able to convince the leader in reducing the burden” she continues to indicate that “every day I come home tired and always go directly go to bed before waking up in the morning for work.”
In relation to the history of the illness, the client has been having mood swings as well as a rise in the cases of anxiety for the last 3 months. She indicates that although the onset of the issue is blamed on the amount of work she does, she as well feels worse when she comes home to find her husband and children are already asleep. MK claims that she does not have any factors that she could consider to be a remedy to help in relieving her condition. The main symptom that is seen in the patient is the challenge of anxiety and a reduction in motivation.
In addition, MK has not shown signs of being suicidal for the last three months since the onset of her depressive symptoms. However, her level of productivity has reduced with an increase in complaints at work being seen as a result of being slow and the lack of commitment. The patient has had an appointment with a therapist for the past one and half months but she has not been coming for the therapy all the time citing the lack of time and the commitment to come. As she gets the therapy she has been using Selective serotonin reuptake inhibitor class called citalopram 20 mg PO qDay.
In relation to the past history of psychiatry, the initial time that MK had an encounter with the therapist was when there was an accident in the health facility that she was assigned to work and two of her colleagues ended up dying. This was a year ago and during the time, the patient was diagnosed with persistent depressive disorder and anxiety disorder. This was the first time that she made use of citalopram 20 mg PO qDay. The use of the medication has been instrumental in the control of her condition.
The patient shows the psychiatrist for a period of three months before she absconded her appointments. The episode of depressive disorder has risen aging for the past three months although they are not seen to be related to the initial cause of concern for the patient. The patients has pointed out that there has not been any reports of terminal illnesses in her family but her father has depression and her mother has anxiety disorder that has disturbed her for the past 20 years. The family has not reported any issues of having diabetes or cancer. The patient does not present any issues of being violated or molested in the past.
In relation to medication, MK has never been admitted in the health facility due to any condition that was considered dangerous and the only times that she was admitted to sleep in the hospital was the time that she was giving birth to her three children. The patients have not presented any medical allergies and she has had her immunization made up to date. The client has not had any issue of surgery and the patients have not had any other health issue of concern in the past that required a blood transfusion. MK has indicated that she does not make use of alcohol and has never used tobacco.
The differential diagnosis for the patient is Persistent depressive disorder. Otte et al. (2016) depict that this is a health condition that is also referred to as the dysthymia and may be less severe but there is a challenge that the condition may be a chronic form of depression. The condition does not lead to the cases of a patient being disabled but can result in poor performance of an individual (Gibson-Smith et al., 2016). As a result of the health condition, one may end up not having a full living.
DSM-5 Diagnosis
Dysthymia F34.1 – ICD10 is a condition that may last for a few years and may require that one has an effective process for the management of the issue. The client will be diagnosed with the condition when they have symptoms that are in line with the healthcare condition and hence one has depressive moods as well as the loss of enjoyment of life and hence one does not have any pleasure as affirmed by Zvolensky et al. (2015). The other symptoms that help in the diagnosis of the patient with the condition include the cases of fatigue and this is seen in the case of MK who has had complained of being unproductive at work. The diagnosis of the patient as well as associated with the onset and the activities that recurred over the same time.
Individualized Plan
As a result of the fact that MK has been making use of citalopram 20 mg PO qDay, she needs to be convinced of the importance of the continuous use of the medication. In addition, I propose that MK should have an effective education plan on the importance of compliance and the importance of having psychiatric visits. This will be instrumental in the management of her condition and allow for close monitoring of changes in her health.
Legal and Ethical Implications of Counseling
During the process of having psychiatric sessions, it will be of importance that a strategy is put in place to help in the support of the legal and ethical challenges. Meynen (2016) present that there is a need for the healthcare provider to make use of the code of conduct with the provision of healthcare services to the patient. One of the ethical and legal requirement is to ensure that the services that will be provided for the patient will not have harm to patient health. The patient should as well sign an informed consent before the start of the sessions to allow for the protection of the services being offered.
The post The purpose of the week one journal entry is to review both a nursing theory and a counseling theory that will guide my practice as a student PMHNP. Also, this journal will cover three goals and objectives that I have for this practicum experience as well as a timeline for my practicum activities. appeared first on Versed Writers.