Learning Plan Acute Psych Clinical Rotation

GUEVARA, FREDESMINDA
0513 PSYN 121-6
Learning Objectives
Standard 2:
Application and
Integration of TheoryBased Knowledge
Clinical Competency
3.42 Administers oral,
rectal, vaginal, topical,
intramuscular,
intravenous, and
subcutaneous
medications
My short-term goal is to
learn the basics of IM,
IV, and SQ
administrations, as well
as effectively administer
oral meds to patients. In
particular, I am aiming
to be well-versed in
preparations and safety
precautions in giving IM
injections, and to have
an opportunity to
administer this
medication to an actual
patient by the end of this
semester.
Resources and Strategies

Consult appropriate text:
Chapter 22: Parenteral Medications pp. 574-603
(Perry, A.G. & Potter, P.A. (Eds.) (2010). Clinical nursing skills
and techniques (7th ed.). Toronto, ON: Elsevier Canada)
Consult appropriate videos/websites/other resources:
http://www.youtube.com/user/hawknurse?blend=6&ob=5
http://www.youtube.com/watch?v=ZIJG4i6pUKo
IM Injection sites:
http://www.youtube.com/watch?v=HUFwaLwhCOU
How to give an Intramuscular Injection:
http://www.youtube.com/watch?v=Spoz3T5D_SU
Intramuscular Injections: Z-Track:
http://www.youtube.com/user/sterilefield#p/u/6/IPp28ZGgobw
Intramuscular Injection Technique:
http://stenbergcollege.mrooms3.net/pluginfile.php/60568/mod_reso
urce/content/0/IM_injections.pdf
Giving a Subcutaneous Injection:
urce/content/0/SC_injections.pdf
Strategies:
I will continue practicing on oranges to master that quick and
darting motion, practice preparing injections particularly removing
bubbles, and watch videos repeatedly to reinforce learning and
guide practice sessions.
Types of Evidence of achievement

Successful oral administration of
meds to an older adult patient as
evidenced by a journal entry in
Week 3, February 11-12, 2014.
Performed a comprehensive IM
administration practice session with
instructor from preparation of
syringe to mock injection and
needle safety precautions as
evidenced by journal entries on
Week 3, February 11-12, and Week
2 January 28-29, 2014
Administration of meds to an adult
patient as recorded in journal at
Week 2, February 4-5, 2014.
With my instructors supervision I
pulled 4 ml of ondasteron, an
antiemetic, to administer to a patient
who was complaining of pain and
nausea, used Z-tracking to landmark
in her hip (VG), and followed
procedure for injection: 10s/ml fluid,
extra 10s after full injection, and
putting on the safety clip over the
needle when done (3.42, 3.49)
(March 25-26, 2014 journal entry)
Criteria to validate
objectives achieved
Self-Evaluation:
I rate myself as 5/5
with respect to
administration of oral
meds, and 5/5 for IM
since I have
successfully performed
the procedure on a
patient needing a PRN.
Follow-up:
I still need to practice
on oranges and work
on becoming more
familiar with landmarking at the
different sites through
practicing on my
family members and
watching videos.
0513 PSYN 121-6
Standard 2:
Application and
Integration of Theorybased Knowledge
Clinical Competency
1.04 Assesses mental
and physical status
For this competency, my
goal is to perform a
Mental Status Exam
(MSE) on patients at
least once every week.

Chapter 6: Psychological Context of Psychiatric Nursing Care
(pp. 88-97):
(Stuart, G. (2013). Principles and Practice of Psychiatric
Nursing (10th ed.). St. Louis, MO: Mosby Elsevier)
Performing a mental status exam:
http://www.youtube.com/watch?
v=3cFHSxLPf9w&feature=related
http://www.youtube.com/watch?
v=LscpVQaWdE0&feature=related
http://www.youtube.com/watch?v=dO7QxvHLy9c
http://www.youtube.com/watch?v=BwQOPXHx048
Stenberg Resources
http://stenbergcollege.mrooms3.net/mod/resource/view.php?
id=46557&redirect=1 (Components of MSE)
id=46559&redirect=1 (Mood List)
id=46558&redirect=1 (Mood and Affect)
Strategies:
I will get to know my materials fairly well and practice with people
I know so I would be comfortable conducting an actual MSE with
patients at clinical
Performed mental status exams on

several patients in both main ward
and Special Care Unit as evidenced
by journal entries on the following
dates:
February 18-19, 2014 (Wk 4)

February 11-12, 2014 (Wk 3)
February 4 - 5, 2014 (Wk 2)
January 28-29, 2014 (Wk1)
All I had to do was ask her about

herself and she immediately talked
about her abuse from her husband,
her happy childhood upbringing,
her loving parents and
grandparents, and her lovely
daughters. She displayed a full
range of emotions, from sad to
pleasant, but sometimes there was
incongruence with her verbal
statements of well-being and her
facial expressions (teary). (March
18, 2014, journal entry)
But although she reported feeling
in pain, she would be momentarily
distracted and smile at my
redirecting efforts, but would
return to shaking and being
restless soon after. (March 25-26,
2014 journal entry)
Self-Evaluation:
My rating for this
competency is 5/5
because I have been
able to conduct
assessments for each
patient at least twice a
day. I have also learned
to use more
appropriate and more
concise terms for
assessing. Also I have
learned to observe
patients for congruence
of mood and affect,
and general
presentation as well.
Follow-up:
To polish my MSE
assessment skills, I
will read nurses
reports and pay
attention to how they
conduct theirs. I will
review my resources at
least once a week for
familiarization.
0513 PSYN 121-6
Standard 1:
Therapeutic
Relationships
Clinical Competency
6.07 During goaloriented interactions,
demonstrates empathy,
warmth and respect
My long-term goal is to
sharpen and improve my
therapeutic relationshipbuilding skills and I will
start by establishing o
rapport with patients as
well as show warmth,
respect and empathy in
my verbal and
nonverbal interactions
with them in One South.
I hope to be able to
connect with and
interact successfully
with patients especially
with those who are
difficult to get along
with.

Chapter 3: Communication pp. 27-43
(Perry, A.G. & Potter, P.A. (Eds.) (2010). Clinical nursing skills
and techniques (7th ed.). Toronto, ON: Elsevier Canada)
Chapter 2: Therapeutic Nurse-Patient Relationship
Box 2-2 & Clinical Example p.18
Facilitative Communication pp. 21-24
Therapeutic communication techniques pp. 25-34
I have learned how to make patient

at ease and invite them to open up
and share confidences with me
willingly. I have also practiced
redirecting conversations so that the
focus is on the patient. Empathy,
respect and trust are values that I
strive to establish with patients, as
evidenced by several references in
weekly journal entries on the
following dates:
February 18-19, 2014 (Wk 4)

February 11-12, 2014 (Wk 3)
Consult appropriate websites/videos/other resources:
February 4 - 5, 2014 (Wk 2
Empathy: http://www.youtube.com/watch?v=ySotkACJkCo Focus January 28-29, 2014 (Wk1)
Charting: http://www.youtube.com/watch?v=7aWYp4cXBV0
When she started to cry, I patted
her arm and hand to show that I
Stenberg Resources:
cared and I empathized, and
encouraged her to think of her
urce/content/0/Empathy_Article.pdf (Empathy)
reasons for living, which she
mentioned to be her mom. (March
id=46581&redirect=1 (Empathy and Genuineness)
18, 2014 journal entry)
id=46588&redirect=1 (TR Prompts and Probes)
Strategies:
I will review materials consistently, apply principles during
interactions with patients, and ensure that my non-verbal cues
match my verbal communication.
Self-Evaluation
Objectively, I have to
rate myself as 5/5
because I have come a
long way from being
an uninvolved
spectator to a
concerned, respectful
and empathic talker
and listener. Saying
hello and encouraging
smiling responses from
patients are becoming
second nature to me.
Follow-up:
I will continue to
practice empathic
listening and
communicating with
warmth and respect. I
will attempt to speak
and greet patients even
if I am just passing by.
0513 PSYN 121-6
Standard 4: Professional
Ethics
Clinical Competency
7.08 Document observations
and psychiatric nursing actions
on appropriate records
I am aiming this semester to
be more familiar and more
confident with charting and
documenting of nursing
activities.

Chapter 4: Reporting and Recording pp.46-48; 51-53
Table 4-1- Legal Guidelines for Recording
Table 4-2 Examples of Criteria for Reporting

and Recording
Box 4.2 Formats for recording progress notes

(Perry, A.G. & Potter, P.A. (Eds.) (2010). Clinical nursing
skills and techniques (7th ed.). Toronto, ON: Elsevier
Canada)
Consult appropriate videos/websites/other resources
CRPNBC Nursing Documentation:
https://www.crnbc.ca/standards/lists/standardresources/151nu
rsingdocumentation.pdf
Stenberg Resources:
id=46529&redirect=1 (Nursing Documentation Guide)
http://www.youtube.com/watch?v=ZNTTYegcxhc (Nursing
Documentation)
Strategies:
I will make an effort to be familiar with nursing
documentation through frequent reviews of reading material,
viewing video resources and observing procedures at my
clinical facility.
I have successfully charted

Mental Status Exam
assessments on patient
progress notes in the main
ward and SCU, as well as
vital sign values at Peds.
Evidence of these activities
are recorded in journal
entries on the following
dates:
February 18-19, 2014

(Wk4)
(Wk3)
February 4 - 5, 2014
(Wk2)
Self-Evaluation:
For this competency, I give
myself 4/5 because I have
done charting fairly well but I
feel that I can still improve
more. Also, there are new
additions that required
documentation which I have
not yet performed because of
my stints outside the main
Acute unit (e.g. shift report,
flow map).
Follow-up:
I will continue learning about
the different documentation
and other administrative
work that I can have access
to, and practice observing
what nurses and other staff
are busy with in the nursing
station.
0513 PSYN 121-6
Standard 2: Application and

Integration of Theory-based
Knowledge
Clinical Competency
2.03 Observes the planning,
implementing and evaluation
of the program
I would like to observe
possible procedures, programs
and nursing activities available
to me as a student in One
South and to develop
appreciation of how nursing
teamwork keeps the facility
running efficiently.

Barker, P., & Walker, L. (2000). Nurses' perceptions of
multidisciplinary teamwork in acute psychiatric
settings. Journal of Psychiatric & Mental Health
Nursing, 7(6), 539-546. doi:10.1046/j.13652850.2000.00357.x
Consult appropriate videos/websites/other resources
http://www.youtube.com/watch?v=luLpITUkgO8
http://www.youtube.com/watch?v=3fplsSQUB-k
http://www.youtube.com/watch?v=EB5WRu0d8Uo
http://www.youtube.com/watch?v=7ZgJS-MN7RM
Strategies:
I would observe how nurses work together with patients, with
peers and with doctors and administrators, and how
collaboration and teamwork works in this facility.
Self-evaluation:
I have had opportunities to
observe the different aspects
of psychiatric nursing care
in One South main, SCU
units, 5South (Peds), as well
as shadowed the Charge
Nurse in her morning rounds.
Evidence of these
observations are in journal
entries on the following
dates:
February 4 - 5, 2014
January 28-29, 2014
In the afternoon, however,
her demands had grown quite
insistent and while her nurse
and I went through her
medication record to look for
alternative PRNsshe
suddenly raised her voice and
started shouting profanities
directed towards her doctor,
her nurse, and me. Her nurse
informed her in a calm, slow
but firm voice that it was her
(the nurses) duty to verify
with the doctor, not mine. She
told the patient to give her a
few minutes to call the doctor
and the patient immediately
calmed down. (April 1-2,
2014 journal entry)
I rate myself as 4/5 as there

were still programs and
procedures that I had not
participated in such as sitting
down with admission or
discharge processing
Follow-up:
I will continue observing how
the nursing process is being
implemented in the facility,
and request my instructor to
include me in the lineup for
these programs to enhance
my learning experience.
0513 PSYN 121-6

Knowledge
Clinical Competency 1.06
Prepares a nursing care plan

with measurable, realistic
behavior goals based on
identified actual and
potential client problems
To be familiar with a patients
problem list, prioritize his/her
nursing diagnoses, and create
simplified but feasible goals
and interventions.

Chapter 11: Implementing the nursing process pp. 149-164
Chapter 18: Emotional responses and mood disorders pp.289322
Chapter 19: Self-protective responses and suicidal behaviors
pp.323-343
Appendix A: NANDA-I Nursing Diagnoses 2012-2014
http://www.careplans.com/pages/about.aspx
How to write a nursing diagnosis - part 1:
http://www.youtube.com/user/hawknurse#p/u/28/JyAaQ5hIL
Ss
How to write a nursing diagnosis - part 2:
http://www.youtube.com/user/hawknurse#p/u/27/onnoPvwJ8
SM
Strategies:
I will prioritize the enhancement of my assessment and
critical thinking skills to identify my clients issues and be
able to contribute to the implementation and evaluation of her
care plan. I can do this by frequently consulting my resources
above, peers, instructor and nurses on the ward.
I did assess her food

consumption as part of her
care plan to address her
weight loss, and I reported
that on two occasions I had
seen her snacking and
included her self-report that
she ate a big bacon and egg
sandwich while on pass.
(April 1-2, 2014 journal
entry)
My report included her
problem list, and we agreed
on a NANDA diagnosis for
her and formulated goals
and nursing interventions
appropriate to her identified
diagnosis. (March 25-26,
2014 journal entry)
I informed her nurse who
told me to continue
redirecting and observing
her. (April 1-2, 2014
journal entry)
Self-evaluation:
I rate myself with 4/5, as I
was not able to identify one
of my patients main problem
because her verbal
communication was
impaired. I took her
subjective report of pain but
she was displaying more
symptoms of anxiety and was
not able to give her the prn
medication for anxiety.
However, it was quite an
excellent learning situation
for me and I will now be
more careful in assessing
symptoms as well as be
aware that patients may not
correctly give personal
reports.
Follow-up:
I will refer often to (or
review) to the patients
history and care plan to make
sure that I do not overlook
prominent issues.
0513 PSYN 121-6

Knowledge
Utilizes, as appropriate,
problem-solving techniques
during interactions
I will assist my patients even
in small ways to find solutions
for their issues
She also verbalized that she

didnt really needed one
right away, so I offered to
help her redirect (from her
drug-seeking behavior)
through playing Ping-Pong,
taking short walks and even
doing short jogs up the hill.
entry)
Self-evaluation:
Follow-up:
Consult appropriate videos/websites and other resources
To alleviate her anxiety, I

assured her that based on
research evidence, ECT has
very minimal negative effects
but has documented positive
benefits
entry)
http://www.crpnbc.ca/
https://www.criticalthinking.org/pages/critical-thinking-andnursing/834
http://pakazoid.blogspot.ca/2011/12/education-innursing_19.html
http://www.americansentinel.edu/blog/2011/07/27/nursingstrategies-common-tactics-for-managing-conflict/
My goal was to engage her

until lunchtime (which was
about half an hour away)
when she could have her
scheduled pain reliever.
(March 18, 2014 journal
entry)
Taylor, C. (2000). Clinical problem-solving in nursing:

insights from the literature. Journal Of Advanced
Nursing, 31(4), 842-849. doi:10.1046/j.13652648.2000.01342.x
Roberts, J., While, A., & Fitzpatrick, J. (1993). Problem
solving in nursing practice: application, process, skill
acquisition and measurement. Journal Of Advanced
Nursing, 18(6), 886-891. doi:10.1046/j.13652648.1993.18060886.x
Bach, S. & Grant, A. (2009). Communication and
interpersonal skills for nurses. Retrieved from
http://sgh.org.sa/Portals/0/Articles/Communication%20and
%20Interpersonal%20Skills%20for%20Nurses.pdf
Strategies:
I will use therapeutic tools and communication strategies to
build rapport with patients to facilitate problem-solving.
I believe that I deserve a 4/5

for this competency, as I feel
that I have not gathered
enough skill and knowledge
to adequately help patients
with their issues, and there
have also been few
opportunities to help with.
I will continue to practice

problem-solving with patients
and I have to make sure that I
am well-armed with
information, advice from
experienced personnel and
insightful observations which
I can acquire by researching,
asking, and paying attention.
0513 PSYN 121-6

Knowledge
Identifies social and ethical
issues relating to psychiatric
nursing practice
I will observe and be on the
lookout for ethical issues and
dilemmas that may occur in
the acute psych ward and form
my own opinions based on my
own judgment and critical
thinking
Butts, J., & Rich, K. (2005). Nursing Ethics: Across the

Curriculum and into Practice. Sudbury, MA: Jones and
Bartlett Publishers
Lakeman, R. (2009). Ethics and nursing. In Barker, P. (Ed.).
Psychiatric and Mental Health Nursing: The Craft of Caring,
p.607-617. London, UK: Hodder Arnold.
MacDonald, H. (2007). Relational ethics and advocacy in
nursing: literature review. Journal of Advanced
Nursing, 57(2), 119-126. doi:10.1111/j.13652648.2006.04063.x
http://www.youtube.com/watch?v=D2NbNGIhvqw
http://www.cna-aiic.ca/en/on-the-issues/best-nursing/nursingethics/ethics-reading-resources
http://allnurses.com/hipaa-nursing-challenges/ethicalpersonal-dilemma-780467.html
http://nursingethicsblog.com/
http://www.vanderbilt.edu/CenterforEthics/resources.html#nu
rsing
Strategies:
I will refer frequently to my resources above to enhance my
understanding of ethical and moral issues in psychiatric
practice. If in doubt about anything, I will consult my
instructor for verification and guidance, as well ask nurses in
charge.
I felt that putting a

transponder outside
psychiatric reasons was not
mandated by the Mental
Health Act and therefore not
ethicalI personally decided
that I would, as those were
technically his possession and
it was up to RCMP to prove
otherwise, as ethically, it was
not part of the scope of the
acute psych ward. (April 12, 2014 journal entry)
if she didnt give up her

pins, I feel torn about the
ethical thing to do if I were the
nurse in charge. I am not yet
sure if a strip search is
permissible in 5 South, or if
seclusion is done at PEDS
pscyh, but I know that these
methods can be traumatic
especially for children.
However, the patient would
likely harm herself again if
those pins remained in her
possession and might subject
herself to infections. I am still
baffled by this ethical issue
(February 18-19, 2014
journal entry)
Self-evaluation
I give myself a 4/5 for
identifying nursing issues
with social and ethical
aspects as I was able to
observe and be aware of
certain situations in the main
ward and PEDS ward.
However, these are not the
only examples that can occur
during the rotation, and I still
need to be open to exploring
possibilities to advocate for
patients when possible, and
to seek clarification and
guidance when confronted
with an ethical, social, or
moral issue.
Follow-up:
I will need to be more aware
of how ordinary or unusual
nursing practices can present
with ethical , social or moral
issues and I can do this by
educating myself through
research, asking and
observing others with more
experience and by putting
myself in the patients shoes.
0513 PSYN 121-6
0513 PSYN 121-6

Knowledge
Keeps current with the
classification system of
psychopathology contained
within the Diagnostic and
Statistical Manual (DSM IV,
1994)
I will be more familiar with
psychiatric diagnoses of
patients in relation to DSM
criteria to acquire a more
concrete understanding of their
illnesses/disorders

Barker, P. (2009). Psychiatric Diagnosis. In Barker, P. (Ed.).
Psychiatric and Mental Health Nursing: The Craft of Caring,
p.123-140. London, UK: Hodder Arnold.
Stuart, G. (2013). Principles and Practice of Psychiatric
Nursing (10th ed.). St. Louis, MO: Mosby Elsevier
Malaspina, D. et al (2013). Schizoaffective disorder in the
DSM-5. Retrieved from
http://ccpweb.wustl.edu/pdfs/2013dsm_sr.pdf
http://www.dsm5.org
Anxiety and Mood Disorders in DSM-5
http://www.youtube.com/watch?v=RV4T8IUJ4BE
DSM 5 changes 1: http://www.youtube.com/watch?
v=_xkhQbzhAjY
DSM-5: http://www.youtube.com/watch?
v=Oa2Ee5pFuhA&feature=youtu.be
http://www.psychiatry.org/practice/dsm/dsm5
Strategies:
I will research the psychiatric diagnoses of my patients using
online links and resources listed above.
Self-evaluation:
I discussed her reason for
admission (major depressive
disorder with prominent
anxiety), and elaborated on
the DSM IV and DSM 5
criteria for the disease,
focusing on the qualifiers
and definitions. (March 2526, 2014 journal entry)
a Schizoaffective disorder
meant a life course of illness
where psychotic symptoms can
be present without prominent
mood symptoms or if full
mood disorder episodes
presented since onset of
psychosis up until the present
diagnosisher current
psychosis likely did not meet
the DSM 5 criteria for a full
schizophrenic episodeher
borderline personality traits
which again did not qualify
enough for the full disorder as
outlined in the DSM which
required at least five
symptoms that composed a
pattern of behavior. (April 12, 2014 journal entry)
I give myself a 4/5 for this

because my knowledge is still
very limited although I have
been doing a lot of
researching to get more
familiar with how psychiatric
illnesses/disorders are being
diagnosed.
Follow-up:
I intend to read up more on
DSM 5 and perhaps get a
copy for my own education.
0513 PSYN 121-6

Knowledge
Recognizes and interprets the
manifestations of emotional
and physical states
I will apply my theoretical
knowledge on the spectrum of
mental illness and disorder to
practice by observing
prominent behaviors and
symptomology and relate these
to their etiologies in order to
understand why patients
behave in certain ways.

Chapter 15: Anxiety Responses and Anxiety Disorders
Chapter 18: Emotional Responses and Mood Disorders
Chapter 19: Self-protective Responses and Suicidal
Behavior
Chapter 20: Neurobiological Responses and Schizophreia
and Psychotic Disorders
Chapter 21: Social Responses and Personality Disorders
Stuart, G. (2013). Principles and Practice of Psychiatric
http://www.camh.ca/
http://mayoclinic.org/
http://www.psychiatry.org/mental-health
http://www.nimh.nih.gov/
https://www.nami.org/
http://www.mind.org.uk/
Strategies:
I will familiarize myself (through referring to resources
and listening to observations during debrief) with the
different ways that mental illness/disorder present in
emotional and physical states so that I can recognize these
on my patients
As I assessed her from time

to time, I concurred with the
nurse observation as I also
saw that her anxiety was
increasing with time - she
would stop shaking when she
was distracted but would start
up again when she re-focused,
and also start getting restless,
nauseous, and complain of a
fuzzy head as well.
(March 25-26, 2014 journal
entry)
Self-evaluation:
She could go off-tangent to

any topic and keep on going
until redirected, and she had
an unwanted tendency to
include herself in private
conversations such as one
between me and a patient, and
also one between my
classmate and her patient
which she also monopolized
She could go off-tangent to
any topic and keep on going
until redirected, and she had
an unwanted tendency to
include herself in private
conversations such as one
between me and a patient, and
also one between my
classmate and her patient
which she also monopolized.
(April 1-2, 2014 journal entry)
Follow-up:
I rate myself as 5/5 because I

believe that I have gained
enough insight to
differentiate and identify
physical and emotional
manifestations of mental
illness/disorder in a general
sense which is appropriate to
my exposure so far.
I will continue to enhance my

learning through additional
resources, by paying attention
to discussions about patients
especially by nurses
(morning report, care plan
discussions) and during
classroom meets.

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GUEVARA, FREDESMINDA

0513 PSYN 121-6

Resources and Strategies

Types of Evidence of achievement

Consult appropriate text:

Performed mental status exams on

February 18-19, 2014 (Wk 4)

All I had to do was ask her about

Consult appropriate text:

I have learned how to make patient

February 18-19, 2014 (Wk 4)

Consult appropriate text:

Table 4-1- Legal Guidelines for Recording

Table 4-2 Examples of Criteria for Reporting

Box 4.2 Formats for recording progress notes

I have successfully charted

February 18-19, 2014

Standard 2: Application and

Consult appropriate text:

I rate myself as 4/5 as there

Standard 2: Application and

Prepares a nursing care plan

Consult appropriate text:

I did assess her food

Standard 2: Application and

Consult appropriate text:

She also verbalized that she

Consult appropriate videos/websites and other resources

To alleviate her anxiety, I

My goal was to engage her

Taylor, C. (2000). Clinical problem-solving in nursing:

I believe that I deserve a 4/5

I will continue to practice

Standard 2: Application and

Consult appropriate text:

Butts, J., & Rich, K. (2005). Nursing Ethics: Across the

I felt that putting a

if she didnt give up her

Standard 2: Application and

Consult appropriate text:

I give myself a 4/5 for this

Standard 2: Application and

Consult appropriate text:

As I assessed her from time

She could go off-tangent to

I rate myself as 5/5 because I

I will continue to enhance my

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