10
Self-assessment of Clinical Skills
Ariel Cordova Lopez
Walden University
PRAC 6635: Psychopathogy and Diagnostic Reasoning Practicum
Dr. Brandy Benson
March 05, 2022
Introduction
According to the American Association of Nurse Practitioners, NPs are licensed clinicians with a doctorate or master’s education who provide advanced health care to clients in collaboration with other health care professionals. Clinical training is an educational module that provides psychiatric mental health nurse practitioners an opportunity to assess, diagnose, and treat patients with mental and behavioral disorders. Clinical training offers PMHNP with essential skills to undertake their job functions. The clinical assessment form identifies and discusses my strengths and weaknesses concerning clinical skills. During the practicum experience, goals and objectives are necessary to maintain focus throughout the experience (Kleinpell et al., 2018).
Desired Clinical Skills for
Students to Achieve
Confident (Can
complete
independently)
Mostly
confident (Can
complete with
supervision)
Beginning (Have
performed with
supervision or
need
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
Confident
Differentiating between
pathophysiological and
psychopathological
conditions
Mostly confident
Performing and interpreting a comprehensive and/or interval history and physical examination (including laboratory and diagnostic studies)
Mostly confident
Performing and interpreting a
mental status examination
Beginning
Performing and interpreting a
psychosocial assessment and
family psychiatric history
Mostly confident
Performing and interpreting a
functional assessment
(activities of daily living,
occupational, social, leisure,
educational).
Mostly confident
Diagnostic reasoning skill in:
Demonstrate knowledge of
psychopathology of mental
illnesses through discussion
for different age groups and
mental illnesses
Beginning
Developing and prioritizing a
differential diagnoses list
Beginning
Formulating diagnoses
according to DSM 5 based on
assessment data
Beginning
Differentiating between
normal/abnormal age-related
physiological and
psychological
symptoms/changes
Beginning
Psychotherapeutic
Treatment Planning
Provide psychoeducation to
individuals and/or any
caregivers
Beginning
Promote health and disease
prevention techniques
Mostly confident
Self-Assessment skill:
Develop SMART goals for
practicum experiences
Mostly confident
Evaluating outcomes of
practicum goals and modify
plan as necessary
Mostly confident
Documenting and reflecting
on learning experiences
Mostly confident
Professional skills:
Maintains professional
boundaries and therapeutic
relationship with clients and
staff
Confident
Collaborate with multidisciplinary teams to improve
clinical practice in mental health settings
Confident
Identifies ethical and legal
dilemmas with possible
resolutions
Confident
Demonstrates nonjudgmental practice
approach and empathy
Confident
Practices within scope of
practice
Confident
Selecting and implementing
appropriate screening
instrument(s) and
interpreting results:
Demonstrates selecting the
correct screening instrument
appropriate for the clinical
situation
Beginning
Implements the screening
instrument efficiently and
effectively with the clients
Beginning
Interprets results for
screening instruments
accurately
Beginning
Identifies the need to refer to
another specialty provider
when applicable
Beginning
Accurately documents
recommendations for
psychiatric consultations
when applicable
Mostly confident
Summary of strengths
Patient-centered care is my greatest strength during my daily routines with my patients. my patient-centered approach enables me to obtain relevant historical information and perform a complete physical and mental status exam. My culturally competent communication methods make me aware of patients’ empathic interview techniques. Patient-centered care enables a nurse practitioner to treat clients with respect and dignity. Another strength is delivering personalized and supportive care to my clients (Chambers & Ryder 2018). Over the years, I gained experience maintaining a positive attitude while communicating with patients to avoid annoying them. Empathic interview techniques allow me to perform a comprehensive examination of patients to develop an accurate diagnosis of their condition. To maintain these skills, I practice them daily in community health clinics and medical wards. I can describe the variations in the patient presentation according to age and cultural background.
Another essential skill that is quite beneficial to me is recognizing and making recommendations on the possible use of psychotropic drugs. I usually embrace a warm demeanor during my interactions with my patients, which is essential in obtaining historical data from multiple sources. I have a complete understanding of each component of the mental status exam which enables me to describe common abnormalities and their causes. The principle of communication has allowed me to conduct myself professionally and be more empathetic to accept criticism and learn from my mistakes. Documentation is another notable strength that I utilize to note down clinical findings, diagnoses, and clinical reasoning. At times, laboratory findings may be unavailable; hence, I use my communication skills to obtain information with the patient and other professionals. My multifaceted skill sets have been an immense help, especially in the early identification of psychopathology symptoms.
Opportunities for growth
I need to develop more interview techniques for challenging situations, such as dealing with hostile, potentially assaultive, and cognitively impaired patients. There are many complications when it comes to diagnosing mental and behavioral disorders. Most psychological and pathophysiological disorders are challenging to diagnose because they require extensive knowledge; hence I need to gain a more comprehensive understanding and better my assessment skills. I need to focus on psychopathological differential diagnosis in that it becomes my priority. Another area of improvement is distinguishing between psychopathology and pathophysiology since they are two broad fields that require more profound understanding. The mental diagnosis process is lengthy in that it begins with the conduction of a physical examination of the patient (Phillips, 2020).
A mental status examination is then done, followed by a psychological assessment to do away with differential diagnosis to arrive at an accurate psychosocial diagnosis. Over the years that I have been caring for patients with behavioral disorders, it goes unnoticed that psychopathological diagnosis and treatment require in-depth knowledge and assessment skills. As a result, most diagnostic tests are unreliable during diagnosing psychopathological diseases. I need to widen my knowledge of psychopathological conditions to improve these weaknesses. I have to take advantage of every opportunity during the clinical rotations to apply the acquired knowledge. I also have a liability in the performance and interpretation of mental status examinations. I have to embark on vigorous clinical practice sessions to boost my experience in the interpretation of mental status examinations. Another way to improve my knowledge at the clinical sites is by continuous practice and personal and professional development. The newly acquired skills will encourage the provision of evidence-based and patient-based care as PMHNP (Price & Reichert, 2017).
Possible Goals and objectives
1. Goal: Incorporate knowledge on clinical reasoning and differential diagnosis
a) Objective: Identify signs and symptoms predisposing to any psychopathological disorder
b) Objective: understand basic test outcomes and other professional reports
c) Objective: Develop differential diagnosis of some clients with psychiatric disorders.
2. Goal: Independently develop psychiatric diagnosis at the end of the practicum
a) Objective: demonstrate the practical application of advanced techniques in the assessment process
b) Objective: Identify differential psychiatric diagnosis by utilizing patient’s concerns and physical assessment
c) Objective: Apply laboratory and other medical tests to evaluate clients
3. Goal: Expand mental status examination skills by the end of the period
a) Objective: monitor patients and perform cognitive assessments
b) Objective: recognize and differentiate clinical features to make accurate recommendations
c) Objective: perform mental status exams and interpret its results accurately
References
Chambers, C., & Ryder, E. (2018). Compassion and caring in nursing. Routledge.
Kleinpell, R., Cook, M. L., & Padden, D. L. (2018). American Association of Nurse Practitioners National Nurse Practitioner sample survey: Update on acute care nurse practitioner practice. Journal of the American Association of Nurse Practitioners, 30(3), 140-149.
Phillips, K. (2020). Mental illness is not anyone’s fault: a review of NAMI, the National Alliance on Mental Illness. Journal of Consumer Health on the Internet, 24(1), 75-81.
Price, S., & Reichert, C. (2017). The importance of continuing professional development to career satisfaction and patient care: meeting the needs of novice to mid-to late-career nurses throughout their career span. Administrative Sciences, 7(2), 17.