Psychiatry Management
Introduction
In this reflective journal, I will describe the situation and discuss how I managed my anxieties, feelings, prejudices, and biases. Moreover, I will elaborate on the awareness developed during the clinical experience, the changes I will implement because of it, and how this clinical situation could impact my role as an advanced practice nurse.
Clinical Situation
The clinical situation happened during my rotation in an inpatient psychiatric unit. One of my clients, C.L., a 29-year-old female, had a history of depression and anxiety. C.L. had been admitted to the unit for suicidal ideation and was prescribed antidepressant medication. During the session, C.L. disclosed that she was still experiencing suicidal ideation despite being on medication. She expressed feelings of hopelessness and helplessness and believed there was no point in continuing treatment. Hearing C.L. talk about her feelings of worthlessness and despair triggered my emotional response.
I felt various emotions, including sadness, worry, and frustration. I felt sad for C.L. and could empathize with her hopelessness and helplessness. I also worried about her safety and well-being, especially given her history of suicidal ideation. At the same time, I felt frustrated that despite being on medication, C.L. was still experiencing symptoms of depression and suicidal ideation. I questioned whether I was providing adequate care and whether other treatment options could better address C.L.’s symptoms.

Anxiety Management
Initially, I felt anxious and overwhelmed by the situation. I recognized that I had personal biases that made me uncomfortable, such as the fear of making a mistake, the fear of being unable to help C.L., and the fear of being judged by my preceptor. However, I quickly identified these biases and used cognitive-behavioral techniques to manage my anxiety. I reframed my negative thoughts, practiced deep breathing, and used positive self-talk to help me stay focused and present at the moment (Firth, Ward, & Stubbs, 2019).
I utilized mindfulness techniques, such as deep breathing and self-reflection, to manage my anxieties and feelings. I reminded myself of the importance of remaining present and focused on C.L.’s needs while recognizing my emotional reactions. I reminded myself to approach the situation with an open mind and a non-judgmental attitude to manage potential prejudices or biases. I avoided making assumptions or jumping to conclusions and to remain curious and empathetic toward C.L.’s situation.
Awareness Developed
This clinical situation heightened my awareness of the impact of mental health conditions on individuals and their families. It also helped me recognize that, as a PMHNP, I need to be aware of my biases and prejudices and how they may affect my clinical practice. Furthermore, I realized that active listening, empathy, and validation are vital in building a therapeutic relationship with clients.
Changes Implemented
The clinical experience with C.L. allowed me to reflect on my practice and identify areas for improvement. One significant change I will implement is increasing my knowledge and skills related to suicide risk assessment and management. I realized that despite having some knowledge about suicide risk assessment and management, I needed to improve my confidence and competence in this area. I plan to seek additional training and education opportunities to improve my skills and knowledge of suicide prevention and intervention. Another change I will implement is to ensure that I utilize evidence-based practices and interventions in my clinical practice (Nyman, Hofvander, Nilsson, & Wijk, 2019). I recognized that becoming complacent and relying on familiar practices is easy without considering the most up-to-date research and recommendations.
Impact on Advanced Practice Nursing Role
The clinical situation with C.L. significantly impacted my role as an advanced practice nurse. It reinforced the importance of ongoing education and training to improve my knowledge and skills related to suicide risk assessment and management. It also highlighted the critical role that advanced practice nurses play in assessing and managing clients with mental health concerns (Nyman, Hofvander, Nilsson, & Wijk, 2019). As an advanced practice nurse, I am responsible for providing evidence-based, culturally competent, and compassionate care to my clients.
Furthermore, the clinical situation with J.A. reinforced the importance of building a therapeutic alliance with clients and developing practical communication skills. These skills are crucial for establishing trust and rapport with clients, which can facilitate practical assessment, intervention, and treatment.

References
Firth, J., Ward, P. B., & Stubbs, B. (2019). Editorial: Lifestyle Psychiatry. Frontiers in Psychiatry, 10. https://doi.org/10.3389/fpsyt.2019.00597
Nyman, M., Hofvander, B., Nilsson, T., & Wijk, H. (2019). Mental Health Nurses’ Experiences of Risk Assessments for Care Planning in Forensic Psychiatry. International Journal of Forensic Mental Health, 19(2), 103–113. https://doi.org/10.1080/14999013.2019.1646356