NRNP 6665 Week 3 Personal Reflection and Study Plan
Personal reflection and study plan
Nursing education is meant to prepare healthcare professionals for excellent clinical practice. Psychiatric Mental Health Nurse Practitioners (PMHNPs) are among the health care professionals that must go through education to acquire the advanced necessary skills required to handle patients with mental health issues. Such advanced nursing education ensures that PMHNPs have future professional effectiveness.
At the end of this master’s degree level education program, PMHNPs must learn how to diagnose and treat psychiatric conditions. Tests are one of the ways to ensure that PMHNPs possess these competencies. Tests assess both practical and cognitive skills which are acquired through education. Tests are offered by the American Nurses Credentialing Centre (ANCC). Continuous learning is one of the ways one can ensure they pass the certification exam. Continuous learning ensures that one is constantly improving on their weaknesses.
It also gives one the chance to evaluate their weaknesses and find ways to improve on them. A personal development plan can ensure one improves on their knowledge deficiencies. It can do this by ensuring that one gets out of their comfort zone. The purpose of this reflection paper is to look at some of my strengths and weaknesses as I prepare for the certification exam and also to provide a development plan which includes a study plan and some of the goals I intend to achieve before the certification exam.
Strengths and weaknesses.
The test revealed that there are areas that I need to work on and areas which I have mastered. One of my strengths is my ability to comprehensively take a psychiatric history and evaluate patients. This has been made possible by my understanding of the various psychopathologic processes of different psychiatric conditions. This allows me to ask the right questions that might lead me towards an accurate diagnosis and to create a proper plan of management. I did fairly well in questions relating to psychotherapy because of the vast amount of knowledge I acquired from the psychotherapy class. I also did a number of practice questions on psychotherapy.
However, my weaknesses include psychopharmacology which entails having to memorize how psychoactive drugs exert their effects on behavior by altering neuronal communication in the brain, the use of specific classes of medications in treating mental disorders, as well as therapeutic use of psychotropic medication.
Going into the test I had some fears that I was weak in psychopharmacology and the test proved me right. This is mostly due to the fact that psychopharmacology has a lot of content and my opinion is that most of the content requires cramming in addition to basic understanding of pharmacokinetics and pharmacodynamics. I have difficulties with cramming. It is this weakness that will help me come up with my SMART goals.
SMART goals.
Goal 1: Increase my Knowledge base in psychopharmacology
Task: to ensure that I increase my knowledge in psychopharmacology, I will study for at least two hours daily, six days of the week until I sit for my certification exam. This will ensure that my learning is always continuous. I can use a psychopharmacology review book to help me accomplish this goal. I will make notes to enhance my understanding when reading. I will also join a study group that will help me go over the various concepts in psychopharmacology. Study groups are useful for information sharing (Rahman et al., 2019). A study group might help me to simplify some of the concepts and to consolidate information into memory much easily.
Goal 2: Familiarize myself with test questions.
Task: to help my self to be more familiar to exam questions related to psychopharmacology, I will use a series of practice exam questions. This will help me to identify my weaknesses in psychopharmacology and to help me improve on them. The practice exams will also help me to keep track of how prepared I am for the final certification exam. I will ensure that I do at least 20 questions on a daily basis from Monday to Friday. I will also subscribe to various psychopharmacology review websites to ensure that I do not run out of questions to practice with Testing is superior to re-studying concepts when trying to promote long-term retention of information (Yang et al., 2019).
Goal 3: improve my memory of psychopharmacotherapy concepts.
Task: to ensure this, I will make a list of psychiatric conditions and the most commonly prescribed major classes of psychotropic medications. I will also use flashcards that summarize the most important information in psychopharmacology. Flashcards optimize the learning of factual knowledge and improves memory performance (Sharmin & Chow, 2020). I will make sure that I go through these flashcards every day before I go to sleep. I will also do practice questions on the various psychopharmacology concepts to help me ensure that I consolidate information into my long-term memory.
Resources and study plan.
To ensure that I accomplish the highlighted goals, several resources will be needed. Some of these resources include psychopharmacology review textbooks, online study resources, psychopharmacology review questions, flashcards, stationery including pens, notebooks, coloured markers, and well written lecture notes. Learning aids like Quizlet can also be a useful resource. Group-based discussions help with interactive learning (Gouvea, 2019). All senses should be involved when learning to help with better retention of information. Additionally, I need to work on my test taking strategies. I the order to be smart about my pacing I will better distribute my test practice time, since it has been repeatedly proven to be more effective than cramming, so I won’t run out of time on my certification exam.
| DAY 1 | DAY 2 | DAY 3 | DAY 4 | DAY 5 | DAY 6 |
| Study : 3 hrs.Spaced repetition: 1 hr. | Study: 2 hrs.Study Group: 1hr Practice Questions: 1 hr. | Study: 2 hrs.Study Group: 1hr Practice Questions: 1 | Study: 2 hrs.Study Group: 1hr Practice Questions: 1 | Study: 2 hrs.Study Group: 1hr Practice Questions: 1 | Study: 2 hrs.Study Group: 1hr Practice Questions: 1 hr. |
| TOTAL : 4 HRS | TOTAL : 4 HRS | TOTAL : 4 HRS | TOTAL : 4 HRS | TOTAL : 4 HRS | TOTAL : 4 HRS |
NRNP 6665 Week 3 Personal Reflection and Study Plan References
Gouvea J. S. (2019). Learning in a Group, as a Group, and between Groups. CBE life sciences education, 18(2), fe4. https://doi.org/10.1187/cbe.19-03-0067
Rahman, K., Wahid, A., Afandi, I., Bali, M. M. E. I., & Hakim, L. (2019). Effectiveness of Teams Teaching-Hybrid Learning (TTHL) in Higher Education. In WESTECH 2018: Proceedings of 1st Workshop on Environmental Science, Society, and Technology, WESTECH 2018, December 8th, 2018, Medan, Indonesia (p. 263). European Alliance for Innovation. http://dx.doi.org/10.4108/eai.8-12-2018.2284036
Sharmin, N., & Chow, A. K. (2020). Augmented Reality Application to Develop a Learning Tool for Students: Transforming Cellphones into Flashcards. Healthcare informatics research, 26(3), 238–242. https://doi.org/10.4258/hir.2020.26.3.238
Yang, B. W., Razo, J., & Persky, A. M. (2019). Using Testing as a Learning Tool. American journal of pharmaceutical education, 83(9), 7324. https://doi.org/10.5688/ajpe7324
NRNP 6665 Week 3: Special Considerations Related to Prescribing for Children and Adolescents
There is probably no greater responsibility that the psychiatric-mental health nurse practitioner assumes than the responsibility of prescribing medications. While patients can be harmed by psychotherapy, the level and intensity of the harm generally does not approach the same level of harm that can occur from improper prescribing. PMHNPs must understand their responsibility, both at the state and federal levels, when it comes to prescribing medications.
This week, you will explore the particular clinical considerations associated with prescribing for children and adolescents.
Learning Objectives
Students will:
- Recommend psychopharmacological interventions for children and adolescents
- Recommend nonpharmacological interventions for children and adolescents in mental health settings
- Analyze clinical decision making related to treatment of children and adolescents in mental health settings
- Evaluate mastery of nurse practitioner knowledge in preparation for the nurse practitioner national certification examination
- Create a study plan for the nurse practitioner national certification examination
Assignment 1: Prescribing for Children and Adolescents
Off-label prescribing is when a physician gives you a drug that the U.S. Food and Drug Administration (FDA) has approved to treat a condition different than your condition. This practice is legal and common. In fact, one in five prescriptions written today are for off-label use.
—Agency for Healthcare Research and Quality
Photo Credit: Getty Images/Ingram Publishing
Psychotropic drugs are commonly used for children and adolescents to treat mental health disorders, yet many of these drugs are not FDA approved for use in these populations. Thus, their use is considered “off-label,” and it is often up to the best judgment of the prescribing clinician. As a PMHNP, you will need to apply the best available information and research on pharmacological treatments for children in order to safely and effectively treat child and adolescent patients. Sometimes this will come in the form of formal studies and approvals for drugs in children. Other times you may need to extrapolate from research or treatment guidelines on drugs in adults. Each individual patient case will need to be considered independently and each treatment considered from a risk assessment standpoint. What psychotherapeutic approach might be indicated as an initial treatment? What are the potential side effects of a particular drug?
For this Assignment, you consider these questions and others as you explore FDA-approved (“on label”) pharmacological treatments, non-FDA-approved (“off-label”) pharmacological treatments, and nonpharmacological treatments for disorders in children and adolescents.
Reference:
Agency for Healthcare Research and Quality. (2015). Off-label drugs: What you need to know. https://www.ahrq.gov/patients-consumers/patient-involvement/off-label-drug-usage.html
To Prepare
- Your Instructor will assign a specific disorder for you to research for this Assignment.
- Use the Walden library to research evidence-based treatments for your assigned disorder in children and adolescents. You will need to recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating this disorder in children and adolescents.
The Assignment (1–2 pages)
- Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents.
- Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
- Explain whether clinical practice guidelines exist for this disorder and, if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.
- Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Attach the PDFs of your sources.
Prescribing for Children and Adolescents Example
Separation anxiety Disorder (SAD) is a developmental phenomenon; nonetheless, it manifests with excessive severity at a disproportionate age or inappropriate manner. SAD is characterized by great concern, worry, and even dread of separation from a close individual, whether actual or predicted (Feriante & Bernstein, 2020). Separation anxiety appears naturally between the ages of 6 and 12 months, persisting until around three and then lessening under normal conditions. The US Food and Drug Administration has not yet approved any drugs to treat Separation Anxiety Disorder.
Fluoxetine can be used as an off-label drug. Although some evidence supports using fluoxetine to treat separation Anxiety disorder, healthcare professionals should assess the medication’s potential advantages against its side effects (McNeil et al., 2022). This is based on the recommendations from consensus guidelines based on randomized controlled trials. Cognitive behavioral therapy is a non-drug treatment that I would suggest. It may help children learn how to deal with their anxiety better. The objective is also to assist a child in dealing with things that might make them anxious.
Numerous validated screening methods for childhood anxiety disorders are widely available. The Screen for Child Anxiety-Related Emotional Disorders (SCARED) is what I would employ. The five subscale scores for the five most prevalent children’s anxiety disorders, SAD among them, make up the overall score. The SCARED evaluation instrument is considered a consistent, trustworthy, accurate, and sensitive indicator of anxiety. The SCARED screening tool has demonstrated strict invariance of measurements and test-retest solid reliability.
The use of fluoxetine has risks and benefits accompanying the off-label drug. Concerns about safety due to side effects (like an increased risk of suicidal thoughts or plans or lowered inhibitions that lead to aggression) prevent their use in pediatric populations right now unless the individual’s reaction is closely monitored or if the patient has responded well to SSRIs or SNRIs in the past (Bernstein, 2020). Except for fluoxetine, which seems to have an excellent risk-benefit ratio, the risks of giving SSRIs to children outweigh the benefits. Fluoxetine may hurt the gastrointestinal system more than other SSRIs. It should not be given to kids who are physically aggressive, whose families have a past of suicidal or parasuicidal thoughts or actions, or who are more likely to hurt themselves.
Current professional guidelines for treating SAD depend. If the symptoms are minimal, encouragement, support, and awareness may be enough to assist the patient in getting back to their regular routines. Maintaining consistent routines for eating, sleeping, and exercising while removing irregular ones should be encouraged. Validated screening techniques should be used to examine anxiety symptoms periodically to check for changes. Cognitive behavioral therapy is advised as the first-line therapy when treatment is necessary (Feriante & Bernstein, 2020; Silk et al., 2020).
There are no drugs with an FDA-labeled prescription for SAD, but selective serotonin reuptake inhibitors (SSRIs) are frequently prescribed and proven effective at managing anxiety disorders (Ramsey et al., 2019). According to the American Academy of Child and Adolescent Psychiatry (AACAP), patients with separation anxiety aged 6 to 18 years old may benefit more from receiving combination treatment (CBT and an SSRI) than either CBT alone or an SSRI alone (Walter et al., 2020). Serotonin-norepinephrine reuptake inhibitors (SNRIs) may also be prescribed to patients with separation anxiety who are between the ages of 6 and 18.
References
Bernstein, B. E. (2020). Separation anxiety and school refusal medication: Tricyclic antidepressants, selective serotonin reuptake inhibitors, anxiolytic agents, antihistamines, beta-adrenergic blocking agents, anticonvulsants, alpha-adrenergic agents. Emedicine.medscape.com. https://emedicine.medscape.com/article/916737-medication#3
Feriante, J., & Bernstein, B. (2020). Separation anxiety. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560793/
McNeil, D. W., Preston, D. L., Blackwood, M., & Porter, H. (2022). Fluoxetine use for the treatment of anxiety-induced vomiting in 3-year-old children with complex trauma and developmental concerns: A case report. https://doi.org/10.21203/rs.3.rs-2049898/v1
Ramsey, L. B., Bishop, J. R., & Strawn, J. R. (2019). Pharmacogenetics of treating pediatric anxiety and depression. Pharmacogenomics, 20(12), 867–870. https://doi.org/10.2217/pgs-2019-0088
Silk, J. S., Pramana, G., Sequeira, S. L., Lindhiem, O., Kendall, P. C., Rosen, D., & Parmanto, B. (2020). Using a smartphone app and clinician portal to enhance brief cognitive behavioral therapy for childhood anxiety disorders. Behavior Therapy, 51(1), 69–84. https://doi.org/10.1016/j.beth.2019.05.002
Walter, H. J., Bukstein, O. G., Abright, A. R., Keable, H., Ramtekkar, U., Ripperger-Suhler, J., & Rockhill, C. (2020). Clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 59(10), 1107–1124. https://doi.org/10.1016/j.jaac.2020.05.00
Assignment 2: Study Plan
Based on your practice exam question results from Week 2, identify strengths and areas of opportunity and create a tailored study plan to use throughout this course to help you prepare for the national certification exam. This will serve as an action plan to help you track your goals, tasks, and progress. You will revisit and update your study plan in NRNP 6675, and you may continue to refine and use it until you take the exam.
Photo Credit: [Jacob Ammentorp Lund]/[iStock / Getty Images Plus]/Getty Images
To Prepare
- Reflect on your practice exam question results from Week 2. Identify content-area strengths and opportunities for improvement.
- Also reflect on your overall test taking. Was the length of time allotted comfortable, or did you run out of time? Did a particular question format prove difficult?
The Assignment
- Based on your practice test question results, and considering the national certification exam, summarize your strengths and opportunities for improvement. Note: Your grade for this Assignment will not be derived from your test results but from your self-reflection and study plan.
- Create a study plan for this quarter to prepare for the certification exam, including three or four SMART goals and the tasks you need to complete to accomplish each goal. Include a timetable for accomplishing them and a description of how you will measure your progress.
- Describe resources you would use to accomplish your goals and tasks, such as ways to participate in a study group or review course, mnemonics and other mental strategies, and print or online resources you could use to study.
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