NR 548 Week 8 Assessment Reflection Example

Assessment Reflection: Three Things I Now Notice, Ask or Write Down That I Did Not in Week 1, Each Traced to the Encounter That Changed It, and One Thing That Is Still Hard

Student Name

College of Nursing, Chamberlain University

NR 548: Psychiatric Assessment for Psychiatric-Mental Health Nurse Practitioner

Instructor Name

Month Day, Year

Assessment Reflection: Three Things I Now Notice, Ask or Write Down That I Did Not in Week 1, Each Traced to the Encounter That Changed It, and One Thing That Is Still Hard

What This Reflection Is About

This course was about interviewing and recording, not treatment. The changes I can report honestly are therefore small changes in what I notice, what I ask and what I write, not a general gain in confidence, which nobody could check. For each change below, I name the encounter or feedback that produced it and compare an early piece of my own work with a later one. Most of the encounters involve the same patient, a 52-year-old with depression, heavy drinking and suicidal thoughts whom I saw across the term in a community mental health clinic.

Change 1: I Ask About Suicide in Words That Allow a Yes

Before. In my Week 1 discussion post I quoted the question I had actually asked this patient at the first visit: a negatively framed question asking whether the patient was not having thoughts of self-harm, which trailed off into a vague catch-all The answer was no. My preceptor asked again, directly, ten minutes later and learned that the patient had thought about a handgun on most nights.

What changed it. That single contrast did more than the reading. Hearing two questions produce opposite answers from the same person within one interview made it impossible to believe my softened version was protecting anyone.

After. In my risk note in Week 4, the questions are recorded verbatim, and every one is phrased so that yes is as easy to say as no, including a plain question about thoughts of killing oneself. I now use the same wording with every patient who reports low mood, and I ask about method, intent, plan and preparation in that order. I also know that asking directly does not increase suicidal ideation (DeCou & Schumann, 2018), which removes the fear I used to hide behind.

Change 2: I Write Down What I Saw, Not What I Concluded

Before. My first draft of the mental status examination described the patient as "disheveled," with "speech normal" and insight and judgment "fair."

What changed it. My preceptor returned the draft with one question beside each adjective: "What did you see?" I could not answer for "fair," which meant I had written a verdict without evidence.

After. The revised write-up records a stained T-shirt, several days without shaving, several seconds of silence before each answer about mood, and insight that was present for depression and absent for drinking. The revision was longer but more useful, and the Week 6 evaluation note drew directly on it. I now draft the mental status examination in observations first and add characterizations only at the end, if at all. Shea (2017) warns that mental status records drift easily into labels, and I can now see that drift in my own drafts.

Change 3: I Say Why Before I Ask Something Frightening

Before. At the first visit, I asked the patient, "Where is the gun kept?" having read about hunting in the referral note. The patient folded both arms and asked, "Who said I have a gun?"

What changed it. My preceptor's recovery was to explain that the clinic asks everyone with such thoughts about firearms, because firearms are what the team most wants to make safer. The patient answered within a minute.

After. I now explain the purpose of a sensitive question before asking it, and I say at the start of an interview what I already know from the record. At the follow-up visit in Week 7, where I failed in a different way, I at least did not make this mistake again.

Something Still Difficult

The twelve-minute follow-up visit showed me something I have not resolved: I still follow my own agenda more closely than the person in front of me when time is short. I had a list from the first visit, with alcohol at the top, and I followed it into a room where the patient's daughter was sitting. I have written down the corrections, asking privately who should be present and opening with what has happened since the last visit. But under time pressure the list still pulls at me. I expect this to be the hardest habit to change, because it feels like thoroughness. For the next rotation I have asked my preceptor to flag it whenever it happens.

Part of the difficulty is that the agenda is often right. Alcohol was the most important follow-up item for this patient. What went wrong was not the choice of topic but the order and the setting in which I raised it. Learning to hold an agenda loosely, to know what must be covered but let the patient decide when, is a skill I can describe but have not yet shown under pressure.

Comparing My Own Work

Setting my Week 1 post beside my Week 6 evaluation note, the difference is not length or vocabulary. It is that the early piece describes what I intended to do, while the later one records what the patient said and did in words someone else could check. The risk note in Week 4 contains the exact questions and answers; my first-week post contains a question I would no longer ask. The structured tools I learned, including the Columbia Suicide Severity Rating Scale (Posner et al., 2011), helped, but mainly by giving me wording to hold to when the conversation became uncomfortable.

The patient's course also shaped the reflection. At the last visit I attended, the patient was drinking less, still had suicidal thoughts but less often, and the handgun remained with the brother. I cannot claim credit for that. I can say that the assessments recorded the facts accurately enough for my preceptor and the team to act on them, which is what this course was meant to teach.

If I compare the risk note with the mental status write-up, I can also see that the two improved for the same reason. Both became better when I stopped trying to sound finished and started recording what was actually there. That lesson may be the most transferable one from this course, since it applies to every note I will write.

References

DeCou, C. R., & Schumann, M. E. (2018). On the iatrogenic risk of assessing suicidality: A meta-analysis. Suicide and Life-Threatening Behavior, 48(5), 531-543. https://doi.org/10.1111/sltb.12368

Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., Currier, G. W., Melvin, G. A., Greenhill, L., Shen, S., & Mann, J. J. (2011). The Columbia-Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168(12), 1266-1277. https://doi.org/10.1176/appi.ajp.2011.10111704

Shea, S. C. (2017). Psychiatric interviewing: The art of understanding (3rd ed.). Elsevier.