Before embarking on any professional or academic activity, it is important to understand the background, knowledge, and experience you bring to it. You might ask yourself, “What do I already know? What do I need to know? And what do I want to know?” This critical self-reflection is especially important for developing clinical skills such as those for advanced practice nursing.  

The Psychiatric-Mental Health Nurse Practitioner (PMHNP) Clinical Skills List and Clinical Skills Self-Assessment Form provided in the Learning Resources can be used to celebrate your progress throughout your practicum and identify skills gaps. The list covers all the necessary skills you should demonstrate during your practicum experiences.

Just as you did in PRAC 6635, for this Assignment, you assess where you are now in your clinical skill development and make plans for this practicum. Specifically, you will identify strengths and opportunities for improvement regarding the required practicum skills. In this practicum experience, when developing your goals and objectives, be sure to keep assessment and diagnostic reasoning in mind.

To Prepare

• Review the resources and clinical skills in the PMHNP Clinical Skills List document. It is recommended that you print out this document to serve as a guide throughout your practicum.  
• Review the “Developing SMART Goals” resource on how to develop goals and objectives that follow the SMART framework. 
• Review the resources on nursing competencies and nursing theory and consider how these inform your practice. 
• Download the Clinical Skills Self-Assessment Form to complete this Assignment. 

Assignment

Use the PMHNP Clinical Skills Self-Assessment Form to complete the following:   

• Rate yourself according to your confidence level performing the procedures identified on the Clinical Skills Self-Assessment Form.  
• Based on your ratings, summarize your strengths and opportunities for improvement.   
• Based on your self-assessment and theory of nursing practice, develop 3–4 measurable goals and objectives for this practicum experience. Include them on the designated area of the form.  

 Topic 1 DQ 1

Compliance of a patient is one key to successful medication by therapists. Therefore, in a case like that of Alma, a healthcare professional has first to find a way to overcome the non-compliant nature of Alma so that the pelvic procedure will be carried out successfully. In helping to provide a solution to the non-compliant nature of Alma, the health care professional has first to focus on finding out the root cause of the behavior. In this case, the cause of the non-compliance might be illiteracy, or maybe economic hardships, or an array of other issues which are personal to the patient. Therefore, after getting causes of the root cause of the non-compliance, the real solution will be looking at patterns of care and utilization. By taking a care route, the health care professional will be able to solve the non-compliance problem of Alma. Some of the strategies to adopt for the health care professional for successful solvation of non-compliance will be maintaining their rationality, placing responsibility where it belongs, setting reasonable limits in addressing the problem, and not focusing more on the negative aspects.

In the case of Alma, patient education will have to come in. Patient education encompasses three aspects, which determine the approach one can take: the educator, the non-compliant patient, and the healthcare setting. For the educator, a high degree of familiarity with the case of the patient is needed. Familiarity, in this case, means that whatever might be meaningful to the patient regarding the diagnosis should be made known to them through appropriate methodologies. For the patient, for complete compliance, they should be convinced enough that the procedure of treatment that is set to them will help avoid the adverse condition they are facing. Regarding the healthcare setting, the educator should look for an appropriate environment that will enhance communication between the healthcare professional and the non-compliance professional.

Alma Faulkenberger is an 85-year-old female outpatient sitting in the waiting room awaiting an invasive pelvic procedure. The health care professional who will assist in her procedure enters the room and calls “Alma.” There is no reply so the professional retreats to the work area. Fifteen minutes later the professional returns and calls “Alma Frankenberg.” Still no reply, so he leaves again. Another 15 minutes pass and the professional approaches Alma and shouts in her ear, “Are you Alma Frankenberg?” She replies, “No I am not, and I am not deaf either, and when you get my name correct I will answer you.”

Using the topic 1 materials, develop a plan to help Alma be compliant with the procedure and post-treatment medication. Also, describe the approach you would take to patient education in this case.

Using 200-300 words APA format with at least two references. Sources must be published within the last 5 years

Allied health professionals are confronted with different death and dying practices. An effective allied health professional recognizes the importance of understanding different cultural practices, and learns how to evaluate the death, dying, and spiritual beliefs and practices across the cultures.

Read the two specified case histories and choose one for this assignment.

Chapter 4, “Stories of Abby: An Ojibwa Journey” and Chapter 14, “Stories of Shanti: Culture and Karma,” by Gelfland, Raspa, and Sherylyn, from End-of-Life Stories: Crossing Disciplinary Boundaries (2005), from the GCU Library. 

http://ebookcentral.proquest.com.lopes.idm.oclc.org/lib/gcu/detail.action?docID=423235

Identify your role as a health care professional in supporting Abby’s or Shanti’s dying rituals, and in creating strategies for displaying respect while still providing quality care. Identify communication strategies necessary in caring for your select person. Integrate your strategies as you develop a care plan describing how you would approach the situation and care for the patient. Review the “Care Plan” template prior to beginning.

Include the following in your care plan:

1-Communication: family and patient

2-Treatment options that align with the specific culture

3-Education: family and patient

4-Family roles in the process

5-Spiritual beliefs

6-Barriers

7-Cultural responses

8-Any additional components that you feel would need to be addressed (from your perspective as a health care professional)

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

Discussion Prompt

Post your answers to the 6 questions corresponding to this week’s content on primary care medication management. Provide your responses and rationales. Support your rationales with high-level evidence. (See Post Expectations)

A 70-year-old woman is in your office complaining of recently having trouble maintaining her balance after taking diazepam (valium). She occasionally takes diazepam when she feels anxious and has trouble sleeping. She has a 15-year history of taking diazepam.

Q1. Explain the cause of this patient’s difficulty in maintaining her balance?

Q2. Diazepam experiences a significant first-pass effect. What is the first-pass effect, and how can first-pass metabolism be circumvented?

A 75-year-old woman develops symptoms of a cold and buys an over-the-counter cold medication at the grocery store. The medication contains diphenhydramine, acetaminophen, and phenylephrine. She takes the recommended adult dose but soon after taking the medication she becomes very confused and disoriented.

Q3. What is likely causing the signs of confusion?

A 26-year-old woman who has never been pregnant is seeking preconception care as she is planning to pursue pregnancy in a couple of months. Currently, she has no symptoms to report and on review of body systems, there were no concerns. Her past medical history is significant for a history of rheumatic fever as a child. She subsequently underwent valve replacement with a mechanical heart valve. She is followed by a cardiologist who has already evaluated her cardiac function and she has received clearance from her cardiologist to pursue pregnancy. Records from her cardiologist include a recent cardiac echocardiography report that reveals a normal ejection fraction indicating normal cardiac function.

She has no alterations in her daily activities related to her heart. She has no other significant medical or surgical history. She is a non-smoker, drinks occasionally but has stopped as she is attempting to conceive, and does not use any non-prescription drugs.

Current Medications: Her current medications include only prenatal vitamins, which she has begun in anticipation of pregnancy, and warfarin. She has no known drug allergies.

Vital Signs: On examination, her pulse is 80 beats per minute, blood pressure is 115/70 mm Hg, respiratory rate is 18 breaths per minute, and she is afebrile.

Measurements: Weight = 152 pounds, Height = 5′5 ″, BMI= 25.29

Q4. How is warfarin metabolized? Does warfarin cross the placental barrier?

Q5. Explain the hepatic drug metabolism of children 1 year and older. How do they compare with the hepatic drug metabolism of infants and adults?

Q6. Explain protein binding in the neonate.

PLEASE PROVIDE A HIGH LEVEL OF EXPLANATION FOR EACH QUESTION