Practicum Journal Assignments 2 The purpose of the week one ✓ Solved

Practicum Journal Assignments 2 The purpose of the week one

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. 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 client's 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 completes their initial assessment. Gaining a patient's 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 to the PMHNP, they may not receive the form of treatment they need. I have worked with several patients who have had difficulty disclosing childhood trauma until they felt comfortable enough with me.

The second phase is identification, where a plan of care is created, and the patient feels a sense of belonging and potential to solve their problems. The third phase, exploitation, involves implementing the nursing plan to meet the goals (Bittencourt et al., 2018). The last stage, resolution, marks the termination of the professional relationship when the client’s needs have been met through collaboration. I believe that developing a strong bond with each client I work with is critical; this theory can be applied to every client.

Behavioral Theory

The behavioral theory assumes that behavior is learned from the environment and individuals around us (McLeod, 2010). Since behaviors are learned, they can also be unlearned. I prefer using the behavioral theory with individuals because it focuses on current problematic behaviors that the client may be facing (McLeod, 2010). Unlike psychoanalytic theory that emphasizes emotions, behavioral theory concentrates on observable behaviors. My goal is to work with children experiencing mental health conditions resulting in behavioral issues, such as autism or ADHD. Currently, behavior analysis is often used therapeutically to assist children with autism and developmental delays in acquiring new skills (Siti Ithriyah, 2018).

Applied Behavior Analysis (ABA) is employed to help children diagnosed with Autism Spectrum Disorder (ASD) reduce negative behaviors affecting learning and increase positive, constructive 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 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 to protect myself and the clients I work with. The second goal is to properly document an individual patient treatment plan. Though I am a psychiatric nurse supervisor, I have never documented an individual's patient treatment plan, so mastering the documentation process is vital for me. Lastly, my third goal is to build confidence in providing an individualized treatment plan for clients.

Objectives for Psychotherapy with Groups & Families

My first learning objective is to provide accurate psychiatric diagnoses for the clients I assess during practicum upon course completion. The second objective is to recall important legal and ethical implications specific to the District of Columbia when providing psychotherapy to clients and families. The final objective is to complete at least five full initial assessments with new clients during my practicum experience and develop a plan of care with those clients.

My Course Timeline

I will complete a total of five weeks of clinical training with at least 160 clinical hours. Each week, I will work with my preceptor for a minimum of four days per week, spending at least eight hours each day. In the first two weeks, I plan to get acquainted with my preceptor, Dr. Jaji, and the practicum site/Telehealth. I will shadow Dr. Jaji and familiarize myself with the computer system he/she uses.

By week two, I want to be comfortable with the computer system and be able to chart properly on clients' treatment plans. During weeks two to three, I aim to become more adept at the documentation process and complete notes independently. Also, during weeks three to four, I will begin treating patients in joint care with my preceptor until I become increasingly confident in working mostly independently. In weeks four to five, I plan to practice predominantly independently, receiving feedback from my preceptor after each session to identify areas for improvement. By the last week of clinical, I want to feel confident in my abilities to provide psychotherapy to groups and families.

Assessing Clients

Description of the Client

The patient is a 35-year-old man who has attempted suicide several times. He appears to be in a delusional, suicidal state, and the underlying issue seems to be his lack of material resources to live comfortably. Historical medical examinations indicate issues such as audio and visual hallucinations and a delusional disorder. He initially denied undergoing surgery and taking prescribed medications, but later accepted risperidone and Seroquel.

Justification of the Diagnosis

The patient appears to have a psychotic mental disorder, characterized by delusions (American Psychiatric Association, 2013). His condition indicates hallucinations, leading to excessive overthinking and subsequent mental health issues. A mere lack of material things cannot solely account for his mental disorder.

Ethical Implications of Counseling

It is ethical for clinicians to counsel individuals with mental disorders while ensuring they feel cared for and understood. Sometimes, a patient may need to be isolated to avoid stress from the outside world (Thomas et al., 2018). However, it’s crucial to balance isolation with the patient's need for freedom. Counselors must monitor patients consistently to avoid unnecessarily extreme confinement.

Conclusion

This journal entry reflects the vital integration of nursing and behavioral theories to inform my practice as a student PMHNP. By establishing my goals and understanding the importance of these theories, I am better equipped to provide effective psychotherapy for future clients.

References

  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

  • Bittencourt, G., Andrade, R. G., & Maia, T. R. (2018). Peplau's theory in psychiatric nursing. Journal of Nursing Theory, 27(2), 95-100.

  • Fatemeh, S., Haghani, H., & Zare, F. (2017). Peplau's Interpersonal Relations Theory: A Review of the Literature. Journal of Nursing and Care, 5(4), 132-138.

  • Gibson-Smith, D., et al. (2016). The influence of depression on work functioning: A population-based study. Work & Stress, 30(3), 282-293.

  • McLeod, J. (2010). Counseling Skills: A Practical Guide for Counsellors and Helping Professionals. Open University Press.

  • Meynen, G. (2016). Ethical considerations in psychiatric care. Journal of Medical Ethics, 42(4), 241-245.

  • Otte, C., et al. (2016). The efficacy of psychotherapy for posttraumatic stress disorder: A meta-analysis. Psychological Medicine, 46(14), 801-811.

  • Siti Ithriyah, A. (2018). The role of Applied Behavior Analysis therapy for children with Autism Spectrum Disorder. International Journal of Community Medicine and Public Health, 5(5), 2093-2097.

  • Thomas, C. R., Owino, R. E., Ansari, A. R., Adams, A. R., Gaynes, B. N., & Glickman, L. (2018). Ethical challenges in the treatment of suicidal patients. Crisis, 39(6), 398-401.

  • Zvolensky, M. J., et al. (2015). The role of anxiety sensitivity in the emotional regulation of chronically stressed patients. Journal of Affective Disorders, 189, 159-166.