**Reflective Journal Entry 5: Progress and Insights as a PMHNP Provider**
### Introduction
Reflective practice is an essential component of professional growth for a Psychiatric Mental Health Nurse Practitioner (PMHNP). It enables practitioners to evaluate their experiences, understand their emotional responses, and improve their therapeutic relationships. This final journal entry reflects on my progress over the semester by reviewing my previous journal entries, assessing the goals I set, and examining the insights gained throughout my clinical experiences.
### Initial Goals and Their Achievement
**Goal Setting:**
At the beginning of the semester, I set several goals for myself:
1. Develop a deeper understanding of mental health disorders, particularly substance use and depressive disorders.
2. Improve my ability to manage transference and countertransference in clinical settings.
3. Enhance my skills in creating a therapeutic alliance with patients.
4. Reduce the stigma associated with mental illness within the community.
**Achievement of Goals:**
Reflecting on my experiences, I can confidently say that I have made significant progress toward achieving these goals.
1. **Understanding Mental Health Disorders:**
My encounters with patients suffering from depression, substance use disorder, schizophrenia, and generalized anxiety disorder have deepened my understanding of these conditions. Through active involvement in their treatment plans and continuous learning, I have enhanced my diagnostic and therapeutic skills.
2. **Managing Transference and Countertransference:**
Through my clinical experiences, particularly with patients exhibiting transference and countertransference, I have become more adept at recognizing these dynamics. By engaging in self-reflection and supervision, I have learned to maintain professional boundaries and manage my emotional responses effectively.
3. **Creating a Therapeutic Alliance:**
Establishing a therapeutic alliance has been a priority in all patient interactions. My approach of showing empathy, actively listening, and creating a safe environment for patients to express themselves has been instrumental in building trust and rapport.
4. **Reducing Stigma:**
Educating patients and their families about mental health has been a crucial part of my practice. By promoting understanding and acceptance, I have contributed to reducing the stigma associated with mental illness.
### Emotional Responses, Prejudices, and Biases
During my clinical experience, I encountered various emotional responses, prejudices, and biases. For instance, working with a patient suffering from substance use disorder triggered feelings of empathy but also frustration due to their repeated relapses. Through supervision and self-reflection, I managed these emotions by focusing on the patient’s progress and maintaining a non-judgmental attitude.
In another instance, I recognized a bias towards patients with schizophrenia. Initially, I had preconceived notions about their ability to improve. However, witnessing their progress and recovery challenged these biases and reinforced the importance of individualized care and hope in the therapeutic process.
### Managing Anxiety and Uncertainty
Anxiety and self-doubt are common in clinical practice, especially when dealing with complex cases. To manage these feelings, I employed several strategies:
1. **Supervision and Consultation:**
Regular supervision sessions provided a platform to discuss challenging cases and receive guidance from experienced practitioners. This support helped alleviate my anxiety and reinforced my clinical decisions.
2. **Mindfulness and Self-Care:**
Practicing mindfulness techniques and engaging in self-care activities helped me manage stress and maintain emotional balance.
3. **Continuous Learning:**
Staying updated with the latest research and clinical guidelines through academic resources such as the DSM-5, psychiatric nursing standards, and relevant textbooks boosted my confidence and reduced uncertainty in clinical decision-making.
### Insights and Understanding
Throughout my clinical experience, several insights have emerged:
1. **Importance of Self-Awareness:**
Self-awareness is crucial in recognizing and managing personal biases, emotional responses, and transference-countertransference dynamics. It ensures that patient care remains objective and compassionate.
2. **Therapeutic Relationship:**
Building a strong therapeutic relationship is foundational to effective mental health care. Trust, empathy, and active listening are essential components that facilitate patient engagement and positive outcomes.
3. **Holistic Approach:**
A holistic approach that considers the patient’s physical, emotional, and social well-being is vital. Integrating family therapy, cognitive therapy, and other interventions ensures comprehensive care.
### Impact of Reflective Practice
Reflective practice has profoundly impacted me as a person, student, and provider. It has enhanced my self-awareness, emotional intelligence, and clinical competence. Reflecting on patient encounters and my responses has helped me identify areas for improvement and celebrate successes, fostering continuous professional growth.
As a student, reflective practice has deepened my understanding of psychiatric nursing and reinforced the importance of lifelong learning. As a provider, it has improved my ability to deliver patient-centered care, build therapeutic relationships, and manage complex clinical scenarios effectively.
### Future Use of Reflection
I will undoubtedly continue to use reflection in my future practice. Reflection is a powerful tool for personal and professional development. It allows for continuous learning, self-improvement, and adaptation to the evolving demands of mental health care. By regularly reflecting on my experiences, I can ensure that I remain empathetic, competent, and effective in my role as a PMHNP.
**Why and How:**
1. **Continuous Improvement:**
Reflection will help identify areas for growth and enable me to address any challenges or biases that arise in my practice.
2. **Enhancing Patient Care:**
By reflecting on patient interactions, I can improve my therapeutic techniques, better understand patient needs, and enhance the quality of care provided.
3. **Professional Development:**
Engaging in reflective practice will support my ongoing professional development, keeping me aligned with best practices and emerging trends in mental health care.
To integrate reflection into my future practice, I will maintain a reflective journal, participate in supervision and peer consultation, and engage in professional development activities. This structured approach will ensure that reflection remains a central component of my practice, contributing to my growth as a compassionate and competent PMHNP.
### Conclusion
Reflecting on my journey this semester has been enlightening. I have made significant progress in achieving my goals, managing emotional responses, and understanding the complexities of mental health care. Reflective practice has become an invaluable tool for my personal and professional development, and I am committed to continuing this practice in my future career. By doing so, I will ensure that I remain an effective, empathetic, and continuously evolving PMHNP provider.
### References
American Nurses Association & American Psychiatric Nurse Association. (2015). Psychiatric–mental health nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: American Nurses Credentialing.
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Text Revision DSM-5-TR (5th ed.). Washington DC: APA Press.
Carlat, D. J. (2023). The psychiatric interview (4th ed.). Philadelphia, PA: Wolters Kluwer.
Johnson, K., & Vanderhoef, D. (2016). Psychiatric mental health nurse practitioner review manual (4th ed.). Silver Spring, MD: American Nurses Association.
Unit 13-Assignment final Journal Reflection. 900w. due 8-1-24. 4 references. NU673 Psychiatric Mental Healthcare.
Instructions
You have created 4 entries for your previous Reflective Journal about a patient encounter this semester. Each reflective journal is shown below.
Create a 5th journal. For this 5th entry, you will review the previous 4 entries below and evaluate your progress in reflective practice over the course of the term.
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.
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 journal.
Questions to address in your final reflective essay include:
1. What goals did you set for yourself at the beginning of the semester?
2. Did you meet these?
3. What feelings, prejudices, and biases did you experience during your clinical experience and how did you manage them?
4. How did you manage your anxiety, self-doubt, and/or uncertainty?
5. What understanding or insights did you develop during your clinical experience?
6. Has reflective practice impacted you as a person, student, and/or provider?
7. If so, how?
8. Will you continue to use reflection in your future practice?
9. If so why and how?
Resource to use
Course Description
This course prepares students to assess, diagnose, and manage mental health care needs across the lifespan. Emphasis will be placed on underlying acute and chronic psychiatric/mental health diagnoses. Clinical opportunities will be utilized for all PMHNP to apply concepts in primary and acute care settings with adults and families.
Program: Graduate Nursing
Resources
Carlat, D. J. (2023). The psychiatric interview (4th ed.). Philadelphia, PA: Wolters Kluwer. ISBN: 9781975212971
American Nurses Association & American Psychiatric Nurse Association. (2015). Psychiatric–mental health nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: American Nurses Credentialing. ISBN-13: 978-1558105553 ISBN-10: 1558105557
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Text Revision Dsm-5-tr (5th ed.) (DSM-5). Washington DC: APA Press. ISBN: 978-0890425763
Johnson, K., & Vanderhoef, D. (2016). Psychiatric mental health nurse practitioner review manual (4th ed.). Silver Spring, MD: American Nurses Association. ISBN: 978-1-935213-79-6
Robert Joseph Boland, Verduin, M. L., Ruiz, P., Arya Shah, & Sadock, B. J. (2021). Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (12th ed.). Philadelphia, PA: Lippincott Williams, and Wilkins. 9781975145569
Recommended
Bickley, L. (2016). Bates’ Guide to Physical Examination and History-Taking [VitalSouce bookshelf version]. https://batesvisualguide.com/. Eleventh, North American Edition; Lippincott Williams & Wilkins: ISBN 1609137620
Corey, G. (2016). Theory and practice of counseling and psychotherapy (10th ed.). Boston, MA:Cengage. ISBN: 9781305263727
Heldt, J. P., MD. (2017). Memorable psychopharmacology. Create Space Independent Publishing Platform. ISBN-13: 978-1-535-28034-1
Shea, S. C. (2017). Psychiatric interviewing: The art of understanding (3rd ed.) Elsevier.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge University Press. ISBN 978-1-107-68646-5
Stahl, S. M. (2020). Prescriber’s guide: Stahl’s essential psychopharmacology (7th ed.). Cambridge University Press. ISBN 978-1108926010
Journal 1
Describe your past experience in mental health or with someone with mental health.
My experience was in a clinic with a patient who had substance use and depressive mood disorder. The patient had been brought to the clinic after she had tried to commit suicide. The patient could not eat or sleep well at home, isolated herself from others, and had selective mutism, and with the few words she spoke, she could express suicidal ideation (Park, S. C., & Kim, D. 2020). The psychiatrist and Nurse Practitioner started a treatment plan that included antidepressants. The patient was encouraged to attend three group therapy per day. A therapist would hold therapy sessions on alternate days. I encouraged her to express her emotions by providing her the opportunity to express her frustrations, educated her family on how to assess for suicidal tendencies and employ safety measures at home, and promote sleep and food intake by encouraging her to eat and avoid sleeping during the day to promote rest at night. The patient improved as days passed; she was happier, could interact with everyone, express her feelings, and had positive thoughts about herself and the world. The sleeping patterns improved, and food intake increased.
What are the reasons you have chosen to work with this population?
I have a lot of empathy for people suffering from depression and substance addiction. Family neglects them, and some end up in the street, and some even die. I want to reduce the stigma associated with mental illness (Peter, L. J et al., 2021). By helping people understand that it is a disease like any other; they need care and acceptance to have a better life. It is fulfilling when a patient with depressive disorder and mental illness gets better and goes back to everyday life (Avena, N. M et al., 2021). Create awareness about mental health to increase acceptance of such patients.
Discuss any concerns you have regarding this specific clinical course and population.
A concern of this clinical course is that a lot of emphasis and resources should be put on mental conditions in schools because one in every eight people in the world has a mental condition (Melamed, O. C et al., 2020). Students should be well equipped before graduation to be able to detect and handle mental illness. Another concern is stigma and discrimination against the mentally sick, and awareness should be created about mental illness and there is the lack of resources in the community to handle this population.
Identify personal academic/professional goals for the clinical course and population.
My goal is to work with underserved populations suffering from mental illness to increase access to these population groups; I would also like to reduce the negative stigma associated with mental illness.
Acquire more knowledge and skills on substance use disorder and mental health illness to be able to recognize and handle mental and substance use disorders comfortably.
References
Avena, N. M., Simkus, J., Lewandowski, A., Gold, M. S., & Potenza, M. N. (2021). Substance use disorders and behavioral addictions during the COVID-19 pandemic and COVID-19-related restrictions. Frontiers in Psychiatry, 12, 653674.
Melamed, O. C., Hauck, T. S., Buckley, L., Selby, P., & Mulsant, B. H. (2020). Article commentary: Covid-19 and persons with substance use disorders: Inequities and mitigation strategies. Substance abuse, 41(3), 286-291.
Park, S. C., & Kim, D. (2020). The centrality of depression and anxiety symptoms in major depressive disorder determined using a network analysis. Journal of affective disorders, 271, 19-26.
Peter, L. J., Schindler, S., Sander, C., Schmidt, S., Muehlan, H., McLaren, T., … & Schomerus, G. (2021). Continuum beliefs and mental illness stigma: a systematic review and meta-analysis of correlation and intervention studies. Psychological Medicine, 51(5), 716-726.
Journal 2
transference, countertransference, prejudice/biases, & judgments
Transference is a situation where a client in therapy projects feelings that were meant for someone else in a past relationship, such as feelings towards a parent, onto their therapist, and it usually happens unconsciously. Countertransference is a phenomenon where the therapist unconsciously redirects their own emotions onto a client from unresolved past emotions. Prejudice or biases are opinions and generalized beliefs about someone that are not true and are not from experience. They can be positive or negative, conscious or unconscious, and affect decisions and perceptions. Judgment is the ability to objectively assess, manage, and evaluate a client’s situation and treatment plans without personal influences or prejudice, thus making a sound judgment (de León de Bernardi, B. 2023).
A patient interaction that had transference, countertransference, prejudice/biases, or judgment occurred when I encountered a patient who was suffering from depression from abandonment by his parents at a young age. He expressed feelings of loneliness, being unwanted and unworthy in life, stating that he fears engaging in relationships as he feels he will still be unwanted. I had empathy for him, was compassionate towards him, and was so protective of his feelings that he became very attached and developed strong affection towards me, seeing me as a supportive figure indicating transference. I developed countertransference in this situation by being overly protective and compassionate because as the patient expressed his feelings, my unresolved conflicts with my mother were triggered. Prejudice occurred in that I took my patient’s side, became sympathetic, and validated their feelings, forming an opinion that the parents abandoned him, without understanding the complexity of their relationship. I became judgmental towards my patient’s parents, labeling them unloving, uncaring, and neglectful, being biased toward my client’s feelings.
I have experienced prejudice/biases, judgments, and countertransference in my prior patient encounters. These occurrences are frequent in clinical practice and can take on different shapes that affect treatment outcomes and the therapeutic relationship. I have experienced transference and countertransference, especially with those with comparable experiences or histories. It has also happened when patients’ resistance or lack of development incited skepticism or dissatisfaction in me. One continuous component of my self-reflective practice as a psychiatric mental health nurse practitioner provider has been recognizing these dynamics (Mann, D. 2021). Reflecting on these encounters, I see how crucial it is to acknowledge and deal with transference and countertransference dynamics to preserve therapeutic rapport and prevent detrimental effects on patient care.
The situation arises from the patient or therapist projecting their own emotions from the past onto other people. Various factors, such as individual experiences, cultural background, societal influences, and professional training, combine to produce these phenomena. In contexts involving patient care, discrimination, transference, countertransference, and judgments can all be influenced by our unresolved issues, biases, and stereotypes. Furthermore, how patients and clinicians view each other may be influenced by society’s ideas around stigmatization and mental health. These dynamics are rooted in the intricate interactions between responsibilities in the workplace, emotional weaknesses, and personal experiences (Velarde, C et al., 2024). Unresolved issues or past traumas may influence my perception and response to patients and patients may feel transference when similar memories are evoked in a therapy situation.
It would be inappropriate for me to continue caring for that patient as I may not provide objective judgment in that particular case and the patient will not get adequate treatment. I will prevent these issues from affecting patient care by becoming better at controlling my emotional responses and keeping a more detached perspective when providing patient care through self-reflection and supervision and attending ongoing education to address any prejudices or stereotypes that might affect my practice—practicing mindfulness techniques to improve self-awareness, and getting supervision or consultation to examine my emotional reactions enabling me to get important insights and support in handling complex therapeutic issues. To minimize the impact of transference and countertransference and to preserve professionalism, I will always set clear boundaries within the therapeutic alliance. This entails abstaining from behaving based on preconceived notions or biases, keeping the proper emotional and physical distance, and abiding by ethical standards. Collaborating with the patient in developing treatment goals and interventions fosters empowerment and mutual respect in the therapeutic relationship. By actively involving the patient in decision-making processes, we can address any concerns or misunderstandings that may arise due to transference or countertransference. I will keep developing my self-awareness and improving my ability to handle the challenges of the therapeutic alliance going forward. From my previous entries, I see the importance of maintaining constant self-awareness and watchfulness when controlling prejudice, biases, transference, and judgments in patient care (Jenks, D. B., & Oka, M. 2021). Even though it can be challenging to eliminate these problems, it is essential to recognize that they exist and take proactive steps to lessen their influence on the therapeutic relationship.
References
de León de Bernardi, B. (2023). Field theory: The transference-countertransference relationship and second look. The International Journal of Psychoanalysis, 104(4), 737-754.
Jenks, D. B., & Oka, M. (2021). Breaking hearts: Ethically handling transference and countertransference in therapy. The American Journal of Family Therapy, 49(5), 443-460.
Mann, D. (2021). Psychotherapy: An erotic relationship: Transference and countertransference passions. Routledge.
Velarde, C., Johnson, M. C., Hayes, J. A., & Villarán, V. (2024). Identifying the origins of countertransference using the Core Conflictual Relationship Theme method: A multiple case study approach. Psychotherapy Research, 34(3), 366-378.
Journal 3
Schizophrenia
Reflective Journal Entry 5: Progress and Insights as a PMHNP Provider appeared first on Destiny Papers.
