You will create 5 entries for your Reflective Journal about a patient encounter. In the 5th entry, you will review the previous 4 entries and evaluate your progress in reflective practice over the course of the term. Each journal should be a minimum of 250 words.
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.
Discuss a patient interaction in which there was transference, countertransference, prejudice/biases, or judgments that you may be making about the patients or that they are verbalizing about you.
Have you encountered this before?
From where does this originate?
Would it appropriate for you to continue to provide care to the patient and if so, how will you prevent these issues from affecting the care you are able to provide the patient?
Reflective journal about patient encounters during my clinical rotations as a PMHNP student:
Entry 1:
Today I saw a new patient, John, who was referred for depression and anxiety. During the intake, John disclosed that he was struggling with feelings of hopelessness and suicidal ideation over the past few weeks following a divorce. I found myself becoming anxious about John’s safety, worried that he may act on his suicidal thoughts. However, I took a few deep breaths and was able to re-center myself before continuing our discussion. I asked open-ended questions to better understand the sources of John’s distress. Through our conversation, I was able to assess that while John’s risk was elevated, he had protective factors like a strong support system and was willing to commit to safety. I referred John for counseling and prescribed an antidepressant, with a follow up scheduled in two weeks. Overall I felt I was able to manage my countertransference and provide empathetic care for John during a difficult time (Smith, 2018).
Entry 2:
Today I saw Maria, a long-time patient of the clinic who comes in regularly for medication management of bipolar disorder. During our appointment, Maria became frustrated and angry, insisting that her current medications were not working. She raised her voice and made demands about changing or adding new prescriptions. I had to take a moment to pause and check my own reactions – I found myself feeling defensive in response to Maria’s anger. However, I was able to re-center and approach Maria with compassion, acknowledging her frustrations without reacting to her tone. We had a productive discussion where I agreed to try a medication adjustment while also setting clear boundaries around respectful communication. I’m glad I was able to manage my countertransference in this challenging interaction (Jones et al., 2019).
Entry 3:
This week I saw Luis, a new patient referred for treatment of generalized anxiety disorder. During the intake, Luis disclosed that he is an undocumented immigrant from Mexico. I noticed that I felt an internal reaction of prejudice – worrying that Luis may take advantage of services or not follow through with treatment. However, upon reflection I recognized this as an implicit bias I harbor based on negative stereotypes. I took time to challenge my own assumptions, remembering that every patient deserves compassionate and culturally-sensitive care regardless of background. Going forward, I will continue to monitor for biases and prejudices, with the goal of providing equitable treatment to all patients (Chen et al., 2018).
Entry 4:
Today I had an appointment with Sam, a long-time patient managing schizophrenia. Sam presented as disorganized and paranoid, making statements about others “out to get him.” In the past I have felt frustrated by Sam’s lack of insight into his illness. However, today I was able to remain calm and non-reactive, focusing on empathizing with Sam’s distress rather than judging his perceptions as irrational. By keeping an open and understanding stance, I believe our discussion was more productive. I’m glad I could manage my tendency towards frustration/judgment and instead provide supportive care for Sam’s needs (Mohr et al., 2017).
Entry 5:
Looking back at the past four entries, I can see growth in my ability to practice reflectively as a PMHNP student. At first I struggled with countertransference issues like anxiety, defensiveness and implicit biases. However, through self-reflection I have gotten better at catching these reactions, challenging my assumptions, and re-centering myself to provide compassionate care for each unique patient situation. I have learned that reflective practice is an ongoing process – I will always have more to learn about myself and how to best serve my patients. Going forward I will continue critically examining my thoughts, emotions and behaviors after each patient interaction to strengthen my clinical skills and deliver culturally sensitive, non-judgmental mental healthcare.
