Reflective Journal

Kelsy Dannenberg
Kapiolani Community College

Clinical: Week 1
Personal objectives:
1.
2.
3.
4.
5.

Establishes rapport with the mentally ill patient.

Appropriately seek assistance when needed.
Identify mental health alterations after assessing the patients mental status
Provide safety for patients
Conduct a mental status assessment with the mentally ill patients and compares and contrasts
findings with prior assessments made by members of the multi-disciplinary team
Friday, August 26 was the first day of clinicals at Kahi Mohala. Students were given a tour of

the facility and oriented to each unit. Although there was minimal interaction with the patients,
this was an eye opening experience. The negative stigma of psychiatric hospitals and wards
stands true to myself, and seeing Kahi for the first time, with my own eyes changed that stigma.
It is not scary as I had imagined and patients are dressed in regular clothes and look like
regular people. With some, there is no significant observation that alerts others that they have a
mental illness or disorder.
One incident that went well was being able to watch my clinical instructor interview an
adolescent patient. This was beneficial because I got to see firsthand how the conversation was
conducted, as well as how to use therapeutic techniques without sounding like a job interview.
One incident that did not go as well was when we each went to our own unit. I was in the
residential adolescent unit. Most patients were watching a movie which didnt leave much room
for interaction. I ended up using my time looking through charts and documentations about the
patients. Although this is not what I had planned, it was beneficial because I got to read how
different people involved in the patients life document (psychiatrist, social worker, nursing staff,
etc.) Reading the charts ended up being a little more demanding than I had expected. It was
overwhelming at first because there are a lot of papers to read. Especially if they had been

admitted for a while, they had documents that dated a while back. It was time consuming to read
on their progress. It was also challenging because this was right after lunch and I was feeling
very, very tired.
Being oriented to the place was an incident that was pretty ordinary. It went as I expected,
with me feeling lost in relation to my physical and spatial awareness. I was always confused on
which building I was in and which pathway lead to which building.
I believe we made an impact on the adolescent we interviewed. Since our clinical group
watched the CI talk with the patient, there were a lot of eyes on her. She had to courage and
ability to successfully continue the conversation without feeling like she needed to leave or take
a break. It was a lot of pressure on her and I think we will be a significant memory to her because
of the high pressured situation. As much of an impact we made on her, she also made on us, or at
least me. She is the first person Ive ever heard to be so open about her suicidal thoughts. Im
assuming shes familiar with being open about it due to previous discussions between her and
whoever shes talked to, but for me, this was significant. Ive seen movies about it, and read
stories about people and their suicidal ideations, but to experience and hear it for myself was
something new.
I honestly had an ah-ha reaction when I understood how to buy lunch. There wasnt really
any other ah-ha moments around the units. There were not any incidents that made me think,
this is why I became a nurse or about the essence of nursing.

Clinical: Week 2
New Personal Objectives:
1. Develop professional relationships and good rapport with faculty, clinical staff, patients,
families, and other students.
2. Contracts with patient effectively.
3. Communicate recognition of ones own strength and limitations.
4. Co-facilitate patient groups and applies knowledge of group process.
5. Utilizes appropriate leadership skills while co-facilitating patient groups
Previous Personal Objectives:
1.
2.
3.
4.
5.

Establishes rapport with the mentally ill patient.

Appropriately seek assistance when needed.
Identify mental health alterations after assessing the patients mental status
Provide safety for patients
Conduct a mental status assessment with the mentally ill patients and compares and
contrasts findings with prior assessments made by members of the multi-disciplinary
team
This week was our first real week in clinicals because we spent our day on the unit and

interacting with the patients. It was honestly intimidating at first but the staff was very
friendly and made me feel more comfortable. The day started off by getting report. Since
report is given from a recorded device, the clarity of the words was not the best. It was hard
to understand what was being said and also difficult to write everything down so quickly. But
I tried my best and the staff was very accommodating of me, asking if I needed to see or hear
anything again. They also asked me what my goals were for the day so they could help me
accomplish them. I thought this was really nice of them, and I was shocked because I havent
come across a lot of nice nurses in my clinical experience.
After report, we met up with the CI for pre-conference. Then we went back to the unit. I
was introduced to the girls and it was surprised to be so welcomed by them. I was on the
residential adolescent unit, so they had school shortly after I was introduced. During school, I

was able to observe each patient. I picked up on a lot of nonverbal ques which led me to a
few ideas of who I wanted to attempt a therapeutic conversation with.
The patients have a 30-minute break from school which they take back on the unit.
During this time, I sought advice from the charge nurse on who he thought would be an
easier patient to talk with. We decided on a particular patient and I was able to approach her,
sit down, and have a conversation. This event was something that went well, but also not
ideal at the same time. I feel it went well because it was a successful approach, and I did not
get rejected. Im proud of myself for having the courage to approach someone knowing that
they might not have wanted to talk. On the other hand, this didnt go as expected because I
was not able to get all the information I needed. I got stuck a few times and had a difficult
time guiding the conversation. It was so much to focus on. I was trying to remember certain
communication techniques, while also actively listening to the patients story of why she was
admitted, while trying to think of her diagnosis and what the symptoms were, while also
trying to redirect the conversation and focus on today and peel the onion. It was a very
hard task to do, but it was a great experience. Im sure itll get easier with time and I just need
to keep practicing.
After their break was done, they went back to school but I stayed behind to look over
some charts. My CI arrived and this is where I gave him report, or at least tried to. I
definitely need to work on my MSE reporting skills and also which words to use other than
normal. After my unsuccessful attempt at a report, I was able to look through more charts and
compare my findings on the patient I interviewed with what her charts said. The findings
were congruent with the charts having more background history, which helped me piece
everything together. It clarified a lot of questions I had.

After we ate lunch, we went back to the unit. This is when I unexpectedly had the most
fun. They had a CT group going on when I entered, so I decided to look at more charts while
they did their activity. However, it was somewhat distracting because they were singing
karaoke and I couldnt help but watch. They were having so much fun and it was honestly
enjoyable to watch. After karaoke was done, my goal was to talk with the same patient from
before and try to peel more layers off. It wasnt successful because as soon as I got her
alone, the other girls came over and sat by us. Although I wasnt able to have 1 on 1 time
with her, I enjoyed talking with all the girls. It was interesting to hear what their thoughts
were on Kahi and the topics they brought up. I had forgotten I was a nursing student at
clincals for a minute, and I just felt like we were talking story.
After the CI came to grab me, I started to wonder if these girls just wanted someone to
talk to. Not a doctor or a therapist or anyone with a title, just some ordinary person to talk to.
I honestly enjoyed myself this week (which I dont know if Ive ever enjoyed clinicals), and I
could see myself working at some place like Kahi in the future.

Clinical: Week 3

New Personal Objectives:

1. Identify situations that affect the patients and or the familys ability to accept the mental
illness.
2. Assess patients to determine health care needs.
3. Maintain honesty in all communication.
4. Identify the influence of social and personal responsibility, religious and cultural values,
and assess the patients perception of these as well as the patients perception of wellness.
Previous Personal Objectives:
1. Develop professional relationships and good rapport with faculty, clinical staff, patients,
families, and other students.
2. Contracts with patient effectively.
3. Communicate recognition of ones own strength and limitations.
4. Co-facilitate patient groups and applies knowledge of group process.
5. Utilizes appropriate leadership skills while co-facilitating patient groups

This week was a very draining for me. I had my psychoeducation teaching activity, had to
get enough information for my capstone, and also preform the closest to perfect therapeutic
conversation for my process recording. Overall, I feel like it went pretty well. The morning
started off it report as usual. This week was not successful in getting a good report. I am still
not used to getting report from a recorded. The voice was so muffled and report was also not
given in the same order as the Kardex. Also, the charge was holding the Kardex files towards
him so I couldnt see the names or pictures, and the staff was casually talking during report.
So I ended up leaving report with no information.
After preconference, we entered the unit. I was partnered with another student for the
day. We had our psychoeducational teaching planned and so we ran our activity by the staff
first to make sure there were no red flags. The activity went pretty well and it seemed like the

patients and staff had fun. The only thing I wish was different was the amount of people that
participated. I feel like it wouldve been more fun if we had more people.
After the activity, it was snack time. I sort of just hung around the same area to see if I
could get enough information for a DAR and MSE. I had talked to a few patients, but not
enough to gather and subjective information. I did, however, experience my first grandiose,
delusional patient. I honestly believed everything he was saying at first, and then his stories
got more and more exaggerated. This is when I got suspicious. Now that I think about it, its
funny because I was the gullible one and he got me to believe his stories.
I looked through some charts after to gather information for capstone, and my CI came at
this time. I reported off the best MSE I could with the minimal communication I had with the
patients. Reporting an MSE is slowly getting easier. Its still difficult but Im a little more
comfortable with the terminology. I think the hardest part is knowing which words to say in
place of normal.
After that was lunch, my favorite. And it was during this time that I realized I still had a
lot of things to accomplish after we went back to the unit. I had to make sure I had all my
information for capstone and I also had to do my process recording. The pressure was on and
it was motivating. I had set those 2 goals for after lunch and I was determined to accomplish
them.
We went back to the unit after and the patients were playing a card game. I asked the staff
when the best time would be to have a one on one conversation with my selected patient. I
had targeted the patient Im doing my capstone on because it would be the most efficient. I
would get my process recording done while gathering the information I need for capstone. I
was able to talk with her after they were done playing cards. This was probably the hardest

thing I did all day. Having a therapeutic conversation, trying to remember everything that
was said, trying to connect the dots, and trying to dig deeper so I could get my capstone
information. My brain felt like a 5 car accident on the HI going west at 5:00pm on a Friday.
It was so demanding and it definitely did not go as planned. I got stuck a lot! And I feel like it
couldve been so much better. This is definitely one of my weaknesses; communicating
therapeutically and trying to get to the point without any fluff. Regardless of the struggle, I
tried my best and Im relieved that its done.
I have been with the adolescents for the past 2 weeks. Next week I am on the adult unit. I
am a little nervous because they are older and Im afraid they wont talk to me as much as the
adolescents. But Im excited to see the different diagnoses and how they manifest.

Clinical: Week 4
New Personal Objectives:
1. Demonstrate utilization of therapeutic communications evidenced in process recordings,
clinical reflective journals, and clinical conferences.
2. Communicate patients status accurately to faculty and staff each clinical day.
3. Collaborate with the various members of the mental health team regarding the patients
care.
4. Demonstrate understanding of the patients psychopathology, pathophysiology,
pharmacology, and diet therapy as they relate to the patients behavior or treatment.
5. Demonstrate critical thinking behavior on process recordings
Previous Personal Objectives:
1. Identify situations that affect the patients and or the familys ability to accept the mental
illness.
2. Assess patients to determine health care needs.
3. Maintain honesty in all communication.
4. Identify the influence of social and personal responsibility, religious and cultural values,
and assess the patients perception of these as well as the patients perception of wellness.
This week in clinicals wasunknowingly needed. It reminded me that I need to make time to
decompress. Balance is so crucial and I tend to forget this from time to time. Sometimes I feel as
if I dont have the time to relax. But its very, very necessary and I needed this week to remind
myself to make time for fun.
This week was my first experience on the adult unit so I got to see a lot of manifestations that
are not present in adolescents. There were a lot more patients diagnosed with schizophrenic
subtypes, so it was a learning experience to see how their hallucinations impact them. There were
also a lot more substance use disorders so I got to see the long term effects of those substances.
The morning started off slow. When we got to unit after pre-conference, the adults were at
breakfast. There were only 2 patients on the unit and the other student I was with had already
started talking to one patient. So I approached the other patient, but unfortunately she didnt feel
like talking. So I just stood around, looked at charts, and twiddled my thumbs. I shouldve

looked at the MAR but I felt like we were bothering the staff and I didnt want to be any more of
an inconvenience.
Eventually the patients came back and I was able to talk to a couple of them. I think this was
the most patients Ive talked to since starting clinicals. Either Im getting more comfortable or
they made themselves more available. Whatever the reason, Im happy for it. I was able to
interact with very different types of diagnoses. Some were mild and it was a pretty typical
conversation, and some were fairly severe with auditory hallucinations. Im surprised that I was
able to handle the auditory hallucinations conversations. It was very challenging because the
patient was hard to understand and would keep rambling on about a lot of things. So I had to
really use my brain to bring it all back in and summarize what he was saying. I was also trying to
think of everything I read about how to interact with someone who has active hallucinations. I
just tried to be as real as possible and not confirm or deny the voices he was hearing. I was also
able to assess if there was a safety issue. I asked the patient if the voices told him to harm
himself or others, and if he was able to tell the difference between the voices and reality. He said
they dont tell him to harm anyone, but he couldnt tell the difference between them and reality.
After a little more conversation, I was able to confirm that he wasnt any harm to anyone and he
knew when to tell the staff if the voices got unbearable.
Other things that happened during the clinical day was midterm evaluations. I think those
went pretty well. Its comforting to know how were doing, especially for people who worry
consistently like me. Knowing that there arent any immediate concerns about my clinical
performance is reassuring and puts my mind at ease. Another thing that happened was Pictionary.
We played Pictionary as our psychosocial activity. It wasnt as lively as I was hoping for, but I
understand that some of the medications make the patients very sleepy. However, we still had a

decent sized group and a few patients who were actively participating. The others needed a little
bit of encouragement, but they were very receptive to it. I was surprised at how artistic a lot of
them are. I havent played Pictionary in a few years, but I dont think I could draw as nicely and
detail oriented as them. It was exciting and I kind of want to play with my friends!
Overall, this week was a good week. Im slowly getting used to how overwhelming school is,
and aside from getting up early, clinicals arent that bad, I look forward to the next half of mental
health.

Clinical: Week 5
New Personal Objectives:
1. Consult with faculty and/or staff before implementing patient care.
2. Utilize DAR charting process to document the assessment, plan, interventions and
outcomes of the students nursing care.
3. Accepts feedback in a positive manner.
4. Demonstrate ethical behavior at all times, including but not limited to, following the code
of ethics for nursing and ANA standards for nursing practice.
Previous Personal Objectives:
1. Demonstrate utilization of therapeutic communications evidenced in process recordings,
clinical reflective journals, and clinical conferences.
2. Communicate patients status accurately to faculty and staff each clinical day.
3. Collaborate with the various members of the mental health team regarding the patients
care.
4. Demonstrate understanding of the patients psychopathology, pathophysiology,
pharmacology, and diet therapy as they relate to the patients behavior or treatment.
5. Demonstrate critical thinking behavior on process recordings
This week, we submitted our process recordings. We didnt get our scores back yet, but I
am hopeful that I passed. I feel I have demonstrated my abilities to communicate
therapeutically in the process recording, as well as use my critical thinking skills by
connecting the patients thoughts to their feelings to their behavior.
The clinical day started off by a slight change to the schedule. I switched units with a few
others students, and so I was on the unit I was on last week. We had a little bit of a late start
so I missed the first half of report. The night shift nurse was there so he gave report verbally.
It was so easy to hear his report versus hearing it from a recorder. After report was given, the
day nurse assigned tasks and breaks to the MHSs. This was an awkward moment for me
because of the one MHSs had shared that she could not wait to leave this job. It was
awkward for me because I didnt know what to say and I was also very sleepy since it was
still early in the morning. Im not sure if this is something thats said often by this MHS, but
the other staff didnt seem phased by it.

After report and pre-conference, I asked to go to a different unit. I wanted to switch units
because I had already been on that unit and I enjoy the adolescent units more. I, luckily, got
to go to the residential adolescent unit. Myself and another SN went with the patients to
school. I forgot how little time you have to talk with them. They just watched a movie in
school and it was honestly boring. They had their break after and I decided to stay on the unit
for the second half of school. I was able to get an MSE done as I talked with a transgender
patient. It was my first experience talking to an openly transgender patient and I feel it went
fairly well. She was able to open up to me about her trauma, which I later learned was a
recent thing. The staff informed me that she does not open up to them and they recently
found out about the trauma she had discussed with me. Because she opened up to me, I was
able to report to staff on her current status. I was also able to ask staff about an ethical side to
this patients situation. How did they decide which gender this patient is to room with? The
patient was born female, but identifies as a male. So does he room with the girls or the boys?
What about showering? The staff helped me to understand that each case is different. They
choose which gender the patient rooms with depending on the comfort of the patient, the
comfort of the other patients, and if there would be any complications such as 2 roommates
not getting along. The patients all shower individually so this was not a concern of the staff.
I also got to talk with staff about possible employment opportunities at Kahi. It was
informative and sounds like a potential pathway for me. Im still unsure of what field I want
to go into, but Im not opposed to mental health. Overall, it was another good and successful
clinical day.

Clinical: Week 6
New Personal Objectives:
1.
Previous Personal Objectives:
1. Consult with faculty and/or staff before implementing patient care.
2. Utilize DAR charting process to document the assessment, plan, interventions and
outcomes of the students nursing care.
3. Accepts feedback in a positive manner.
4. Demonstrate ethical behavior at all times, including but not limited to, following the code
of ethics for nursing and ANA standards for nursing practice.