How to write a self-reflection journal as a PMHNP provider

How to write a self-reflection journal as a PMHNP provider

Patient interaction event

After receiving night report from night shift staff, I started routine procedures in taking care of mentally ill patients. The first patient to interact with was suffering from paranoid schizophrenia, and we had already discussed his condition before. He seemed to be in a better mental state than how he was during admission day, and he requested privacy talk to raise some issues that were bothering him and his stay at the facility. During the talk, he reported some people known by him were plotting to kill him, but we did not respond accordingly; he suddenly slapped me on the face.

Impact of the event

As a PMHNP, this significant event has contributed to my clinical practice immensely. Having understood that schizophrenia patients have poorer control of their aggressive condition and significantly impaired thought process, I had to change how I review my patients’ care plan and progress. I limited my questioning of the patients’ delusions in my reviews since aggressiveness in patients with paranoid schizophrenia is often triggered by questioning their delusions (Pompili & Fiorillo, 2015). Additionally, instead of reviewing the patients at their bedside, I realized a safer environment for both the provider and the patient, such as a reviewing room, would be safer and more efficient in managing cases of aggressiveness. Regarding psychopathology, schizophrenia patients sometimes have acute episodes, and one cannot predict them through observation. As such, it is critical to evaluate a patient’s agitation using tools such as Buss-Durkee Hostility Inventory to assess aggression among patients (Lee & Bourdage, 2020). After this event, every patient who exhibited any aggressive behavior was monitored closely before, during, and after hospitalization. Studies indicate that this strengthens the therapeutic relationship between the provider and the patient (Bickman, Lyon & Wolpert, 2016). I was able to follow up on my patient’s progress closely, which gave me more insight into their treatment approaches.

Strengths and limitations

I am a good team member in providing care to patients, which is significant as it ensures continuity of care and harmony in the working environment. I was able to collaborate inter-professionally while making diagnoses and prescribing the correct treatment to mentally ill patients, reducing medical errors that have been often experienced in this field.

Through this event, my limitation is the inability to anticipate that patient can be aggressive again even after recovery from previous episodes of aggressiveness. I will work on it because it is essential for me as a health care provider and the patients am taking care of.

Self-reflection

Generally, patients who have paranoid schizophrenia are portrayed as having unpredictable violent and impulsive behavior. Consequently, they are overly stigmatized and the treatment administered bears poor outcomes. However, in a therapeutic environment, where both the provider and the patient are safe, it is feasible to achieve a better health outcome for patient review and a multidisciplinary team approach in their treatment.  The event taught me the importance of using an evaluation tool before conducting routine patient reviews. Additionally, it taught me not to underrate any symptoms in a potentially aggressive patient, regardless of their mental health state. Using this experience, I have been able to advocate setting aside a room specifically for individual review of patients. Also, I have been careful with the number and kind of questions I ask patients, particularly those with paranoia and mistrust.

 

 

References

Bickman, L., Lyon, A. R., & Wolpert, M. (2016). Achieving precision mental health through effective assessment, monitoring, and feedback processes.

Lee, C. S., & Bourdage, J. S. (2020). Hostility, Personality Correlates of. The Wiley Encyclopedia of Personality and Individual Differences: Personality Processes and Individual Differences, 237-241.

Pompili, M., & Fiorillo, A. (2015). Aggression and impulsivity in schizophrenia. Psychiatric Times, 32(7), 12-12.

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