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Creating of 3 SMART Goals related to this course. SMART goal statements are complete and reflect each SMART criterion.
1. I will be able to competently conduct a thorough MSE and complete an accurate risk assessment for patients manifesting psychotic disorders with a clear understanding of the common symptomology observed in acute psychiatric care setting including suicidal ideations—harm to self and others, bipolar disorders, schizophrenia, and anxiety and obsessive-compulsive related disorders. In order to attain this goal, I will utilize the recommended textbooks for this semester and actively participate in the weekly forums, critically assess case scenarios as well as supplement my learning plan with Kaplan & Saddock’s synopsis of psychiatry to reinforce proper nursing assessment, evaluation, and documentation (Saddock & Saddock, 2007).
I will achieve this particular goal by the end of this term as slated on March 2020.
Reflection: The past 12 weeks has been very productive for me, the course is intense and that I have to dedicate a solid hours of reading time, more or less 2-3 hours of quality reading has helped me retain the salient information and had significantly sustained me to integrate the theoretical aspect into clinical practice as I successfully completed 96 hours of total clinical placement education at Surrey Memorial Hospital in an acute psychiatric care setting.
The value of conducting MSE as a here and now manifestations of patient’s clinical features is important as well as freeing my mind with biases as essentially mental status assessment should be non-judgmental and objective (Austin et al.
, 2019). Furthermore, during 1-1 assessment time management is necessary in order to obtain as much information as possible and observational skills is a huge part to accurately capture the presenting symptoms of the patient. For example, the most important aspect in nursing care is safety especially if the patient is at risk for harming self and others this includes assessing suicidal ideation, plan and intent. By means of conducting risk assessment it is imperative that I reassure my patient that he or she is safe and it is critical to stay with the patient or increase the level of observation by every 15 minutes (Stuart, 2013). I have also witnessed this in the clinical placement education as patient’s behavior can be volatile; the importance to noting tell-tale signs of aggression such as pacing, glaring and aggressive manifestations has to be addressed immediately in order to maintain safety of the patient as well as the whole unit. Overall, I can confidently say that I have met this goal and will continuously practice my clinical skills in order to further develop the accuracy of my assessments and integrate a holistic care plan at all times.
2. I will demonstrate a clear understanding of setting appropriate professional boundaries when establishing rapport to my patients. In order to carry out this goal, I will refer to BCCNP’s RPN entry-level competencies and demarcate its pertinent roles and responsibilities when maintaining a safe nurse-patient relationship (BCCNP, 2018). I will achieve this goal by the end of this course as slated on March 2020.
Reflection: The importance of professional boundaries entails an appropriate nurse-patient relationship that is within the bounds of establishing a trusting environment as well as being able to keep my assessments objective (BCCNP, 2018). As a future psychiatric nurse, the value of setting the right expectations as well as the roles and responsibilities has to be delineated at the onset of care so as not to confuse or send a different signal on the part of the client (Stuart, 2013). By being self-aware I maintained to be mindful of how I carry out my 1-1 interview with my clients in a way that will make them comfortable to open up but at the same time reinforcing scheduled activities as per the unit’s protocol. For example, I have a patient who happened to be dismissive and would demand to have her medication given early on; by means of calmly explaining to her the importance of scheduled medication and as a student I cannot override the 10am medications to 8am, gave her a better understanding of how the schedule of medication works. As Austin et al (2019) says, therapeutic relationship requires nurses to be able to determine orderliness and maintaining respect at the same time provide patients education of the rationale of scheduled medications and unit’s processes. Likewise, for assessment I have learned from the clinical placement rotation the examples shown in the textbook as well as in the online discussion and forum that during an initial assessment it is important to collaboratively work with other members of the care team, also avoid reading through the chart as it will create a preconceived notion which can cloud clinical judgment (Austin et al., 2019). However, the importance of going through the Kardex and listening thoroughly on the shift handover is crucial as that will serve as a baseline during initial assessment. All in all, I can say that I have accomplished this goal both in learning the theoretical aspect as well as carrying it out during the clinical placement education.
3. I will identify the common classifications of psychotropic agents including its indications as part of the nursing process and management in the acute psychiatric care setting (Ralph, 2019). In order to bring about this goal, I will make use of weekly discussions and learning activities such as creating a comprehensive nursing care plan with all-inclusive nursing priorities that mainly focuses on schizophrenia spectrum and other psychotic disorders, mood disorders and anxiety and obsessive-compulsive related disorders (Ralph, 2019). I will achieve this goal, just in time with the completion of my acute psychiatric nursing clinical placement education as scheduled on February 2020.
Reflection: Pharmacology and Acute Psychiatric Nursing Theory and Clinical Practice are my favorite subjects so far this semester. I must say that the discipline of establishing a good study habits and staying focused and organized helps a lot. The importance of safe medication administration is an expected basic nursing skill, understanding the common complications and side effects of antipsychotic medications is important as it can be observed and detected through critical thinking with the use of evidenced based data. For example, agranulocytosis has monitored through regular blood laboratory test as this is a common side of effect of the medication (Austin et al., 2019). The following has to be taken into account to ensure that the patient is not at risk of decreased WBC/neutropenia which can lead to serious and life-threatening complications. Frequency of Monitoring based on Stage of Therapy or Results from WBC Count and ANC Monitoring Tests:
Additionally, antidepressants such as TCAs are commonly known to have caused orthostatic hypotension as such it is critical as a future psychiatric nurse to obtain sitting and standing vital signs upon initial assessment. Also, patient education is key component to ensure that they slowly get up in bed especially for elderly as this can be part of the universal fall precautions (Austin et al., 2019). Aside from psychotropic medications managing patient’s symptoms such as hyperglycemia and checking of blood glucose level is part of my nursing responsibility, I have appreciated my experience in the clinical placement education to integrate the fundamental principles of nursing assessment such as head to toe assessment, understanding the hypoglycemic protocol which was part of the general nursing practice (Austin et al., 2019). Critical thinking is ensuring that patient is safe and that their immediate needs were assess which includes pain and providing comfort measures to relieve discomfort. This skill is a continuous learning process that I will keep to develop in order to obtain a comprehensive nursing assessment, be able to tailor fit and provide the accurate nursing diagnosis and most importantly carry out the nursing intervention and evaluation with a balance of therapeutic relationship and setting the right professional boundaries.
My overall experience for this subject in both theory and practical skills has been productive. I acknowledge the help of my instructor, Karim thank you for actively engaging in the forum discussion that helped me to dig deeper and explore the weekly reading in a more in-depth manner of studying which truly helped me in clinical rotation and exams. I enjoyed being in your class.
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