NURS6640 Walden Week 4 Substance Abuse Cognitive Behavioral Therapy Journal Entry Assignment 2

NURS6640 Walden Week 4 Substance Abuse Cognitive Behavioral Therapy Journal Entry Assignment 2: Practicum – Week 1 Journal Entry and Journal Submission

NURS6640 Walden Week 4 Substance Abuse Cognitive Behavioral Therapy Journal Entry Assignment 2


This is complicated because you have to build your own story. if you cannot do this it is ok.

For this pt .

My clinical is at a an addiction treatment centre

DX: substance abuse, bipolar disorder , and anxiety; you can add more diagnosis if you need to.

Assignment 2: Practicum – Week 1 Journal Entry and Journal Submission


Students will:
  • Analyze nursing and counseling theories to guide practice in psychotherapy
  • Develop goals and objectives for personal practicum experiences
  • Create timelines for practicum activities
  • Develop diagnoses for clients receiving psychotherapy
  • Analyze legal and ethical implications of counseling clients with psychiatric disorders
  • Develop diagnoses for clients receiving psychotherapy
  • Evaluate the efficacy of cognitive behavioral therapy for clients
  • Analyze legal and ethical implications of counselling clients with psychiatric disorders

The Learning Objectives are related to the Practicum Journal Assignments presented in Weeks 1, 2, and 4.

Week 4 Journal Entry
Select a client that you observed or counselled this week. Then, address the following in your Practicum Journal:

  • Describe the client (without violating HIPAA regulations) and identify any pertinent history or medical information, including prescribed medications.
  • Using the DSM-5, explain and justify your diagnosis for this client.
  • Explain whether cognitive behavioural therapy would be effective with this client. Include expected outcomes based on this therapeutic approach. Support your approach with evidence-based literature.
  • Explain any legal and/or ethical implications related to counselling this client.

Note: Be sure to use the Practicum Journal Template, located in the Learning Resources.





Practicum Experience-Journal Entries-Weeks One, Two, and Four


Advanced Practice Care of Adults

NURS 6531

Walden University

March 24, 20XX


Student Name:


Preceptor’s Name: Preceptor’s Number:

Preceptor’s Email:

Journal Entry, Week 1-March 3, 20XX

The key to success as an aspiring advanced practice nurse (APN) is the ability to apply experience from the classroom and knowledge obtained from literature to practicum experience. Application of this concept will promote professional growth and will provide knowledge necessary for providing care to a multicultural patient population that is competent and effective. In order to care for patients with diverse cultural backgrounds, the APN may select a nursing theory to guide decisions and care provided in practice.

The purpose of this paper is to select a nursing theory to guide practice, compose a list of goals and objectives for practicum experience, and based on practicum requirements; generate a timeline of practicum activities.

Pender’s Model-Health Promotion

Using the Pender’s model, the APN will promote the health of the individual through improving degree of well-being. The Pender’s model concentrates on experiences and characteristics based on the individual, perceptions and affect specific to behavior, and behavioral consequences. Each individual possess experiences and characteristics that influences following actions. Applying critical thinking when communicating, making decisions, and solving problems will allow the APN to apply skills when providing care. Using knowledge and skills to educate and motivate, the individual will display health-promoting behaviors that will lead to improved health, quality of life, and functional capacity (Petiprin, 2016).

The Pender’s model is instrumental with identifying and providing data to create interventions, identifying and eliminating risk factors for disease, and to practice and implement changes in health and health promotion techniques for patients (Heydari & Khorashadizadeh, 2014). The campaign to assist the patient to assume more responsibility and accountability for personal health depends on care provided by the APN and other healthcare professionals that is based on evidence-based practice (Alligood, 2018).

Goals and Objectives for Practicum Experience

Keeping the seven domains of practice in mind, I have composed the following goals and objectives, which will be used to guide practice throughout practicum experiences.

1. I will perform a complete head to toe exam on a patient during practicum while my preceptor observe and evaluate my performance and skills.

2. I will review the patient’s chief complaint and use critical thinking skills before assessing the patient to present a primary diagnosis with differential diagnoses and a treatment plan with guidance from my designated preceptor.

3. I will integrate the Pender’s health promotion model by educating the patient on ways to promote health and prevent the development or progression of disease.

4. By the end of my practicum rotation, I will perform a complete head-to-toe exam and interview with a patient without my preceptor and provide differential diagnoses and a treatment plan for the patient.

5. I will identify a patient with a common disorder such as hypertension, cardiovascular disease, and diabetes mellitus. Using critical thinking skills, I will utilize pertinent screening techniques and educate for this patient specific to the disorder.

6. Using research that is evidence-based, I will assist the preceptor in educating a patient to promote positive and healthier outcomes for the patient showing evidence through accurate documentation.

7. Using the Pender’s health promotion model, I will gain cultural competence, enhance communication skills, identify and utilize resources, and use skills obtained to communicate effectively with patients from diverse cultural environments.


As I progress through this journey to provide care for adult patients, the confidence, skills, experience and knowledge gained through my practicum experience and assignments throughout the course will allow me to provide quality care to patients in the clinical setting. Integrating the Pender’s health promotion theory into practice will allow me to provide care to individuals of multicultural backgrounds, identify individual behaviors, and provide education to promote healthier decisions in behaviors to improve health outcome of the patient. Through the practicum experience, I will gain the skills needed to enhance critical thinking and to appropriately diagnose and treat disorders presented by the patient.


Practicum Activity Timeline

Week 1:

• Discussion due by Wednesday, replies due by Saturday.

• Complete journal entry related to Theory for Practice.

• Clinical: Wednesday-2/28/18.

Week 2:

• Discussion due by Wednesday, replies due by Saturday.

• Quiz must be completed by day 7

• Complete journal entry related to pattern recognition in diagnosis.

• Clinical: Thursday-3/8/18.

Week 3:

• Assess a hypertensive patient for week 3 discussion board post. Make notation of the patient’s past medical history, social history, medication regimen, dietary and activity routines, family history, allergies, and any other pertinent factors. Provide suggestions to the patient for health promotion and strategies for managing hypertension.

• Complete first SOAP note.

• Discussion post due by Wednesday, replies due by Saturday.

• Preceptor on vacation March 12-16, no clinical time scheduled.

Week 4:

• Discussion 1 is due by Wednesday and Discussion 2 due by Thursday. Replies due by Saturday.

• Quiz due by day 7.

• Complete journal entry related to a cardiovascular disorder.

• Submit week 1, 2, and 4 journal entries and week 3 SOAP note.

• Clinical: Monday-3/19 and Wednesday-3/21.

Week 5:

• Discussion due by Wednesday, replies due by Saturday.

• Assignment 1: Pulmonary Function Testing (2-3 page paper). Due by day 7.

• Journal entry related to asthma. (Due in week 7)

• Clinical: Wednesday-3/28.

Week 6:

• Discussion due by Wednesday, replied due by Saturday.

• Quiz due by day 7.

• Journal entry related to abdominal pain. (Due week 7)

• Clinical: Monday-4/2 and Wednesday-4/4.

Week 7:

Discussion due by Wednesday, replied due by Saturday.

• Quiz due by day 7.

• SOAP note due by day 7.

• Week 5 and 6 journal entries due by day 7.

• Clinical: Wednesday-4/11 and Friday.-4/13.

Week 8:

• Discussion due by Wednesday, replies due by Saturday.

• Assignment 1: Chronic Kidney Disease (2-3 page paper) (due week 9).

• Journal entry related to a renal disorder. (Due week 10)

• Clinical: Monday-4/16 and Wednesday-4/18.

Week 9:

• Discussion due Wednesday, replies due by Saturday.

• Quiz due by day7.

• Assignment: Chronic Kidney Disease. Due by day 7.

• Journal entry related to musculoskeletal disorder. (Due week 10)

• Clinical: Monday-4/23, Wednesday-4/25, and Friday-4/27.

Week 10:

• Assignment: Patient Education on Stroke Prevention (Media presentation) due week 11.

• Discussion due by Thursday, replies due by Saturday.

• Submit SOAP note.

• Submit week 8 and 9 journal entries.

• Clinical: Monday-4/30 and Wednesday-5/2.

Week 11:

• Discussion due by Wednesday, replies due by Saturday.

• Assignment started in week 10 is due by day 7.

• Quiz due by day 7.

• Clinical: Wednesday-5/9 and Friday-5/11.



Alligood, M. R. (2018). Nursing theorists and their work (9th ed.). St. Louis, MO: Elsevier. Retrieved from’s health promotion model&ots=yVrGXYJMf9&sig=geSYFGZQuiKZa7Js1NrZvcj8CbE#v=onepage&q=pender’s health promotion model&f=false.

Heydari, A. & Khorashadizadeh, F. (2014). Pender’s health promotion model in medical research. JPMA. The Journal of the Pakistan Medical Association, 64(9), 1067-1074. Retrieved from

Petiprin, A. (2016). Health promotion model. Retrieved from


Week Two Journal Entry-Pattern Recognition-March 10, 20XX

Completion of practicum this week has given me 16 clinical hours with Dr. So and So. I am now familiar with the clinical setting, clinical staff, and basic routine of patient flow. I have had the opportunity to see patients along with Dr. So and So with chief complaints including headaches, dizziness, high blood pressure, chronic back pain, elevated blood sugars, numbness and tingling in extremities, and more.

I have identified the established pattern of Dr. So and So where he first reviews the patient’s chief complaint. He then reviews the previous office note, the patient’s past medical history, current laboratory results compared to previous values, and the patient’s medication regimen assessing for changes in either of these factors. Once he has reviewed the data, he will establish a preliminary primary diagnosis and treatment options based on diagnosis.

Next, Dr. So and So enters the room and begin to converse with the patient asking about their family, hobbies and interests, and chief complaint. He further questions the patient on onset and duration of chief complaint, worsening or alleviating factors, and any associated factors related to the chief complaint. Once the patient has voiced all concerns, Dr. So and So performs a focused physical assessment based on the chief complaint. All physical examinations performed by Dr. So and So includes an assessment on the cardiovascular and pulmonary systems. The physical examination is an important aspect in the encounter between the patient and provider. Performing a physical exam allows the provider to collect vital information needed to accurately diagnose the patient, perform necessary testing, and prescribing accurate treatment (Mookherjee, Pheatt, Ranji, & Chou, 2013).

Pattern recognition is recognizing parallels between the presenting complaints and illnesses in memory from previous patients and/or literature. This recognition allows the provider to develop diagnoses early in the patient encounter. Pattern recognition leads to differential diagnoses and diagnostic assumptions followed by the provider collecting additional information that confirms or disprove the diagnostic assumption. Verifying this diagnostic hypothesis requires analytic reasoning to match the elements of the illness script with findings of the case at hand (Mamede & Schmidt, 2017).

An example of using pattern recognition of an illness is recognizing a patient’s complaint of facial pain, nasal congestion, runny nose, headache and/or sinus pressure and forming a diagnostic assumption of sinusitis. Another example is identifying signs and symptoms such as chest pain, pain in left arm, shortness of breath, or pain in the jaw and forming a diagnostic assumption of a myocardial infarction.


Pattern recognition is exhibited through identifying signs and symptoms that are common in certain illnesses. Using pattern recognition helps the provider to narrow down the diagnosis and prescribe necessary diagnostic testing which saves time and money for the patient. It also helps enhance critical thinking skills and decisions leading to proper diagnosis and treatment of disorders.



Mamede, S. & Schmidt, H. G. (2017). Reflection in medical diagnosis: A literature review. Health Professions Education, 3(1), 15-25. Retrieved from

Mookherjee, S., Pheatt, L., Ranji, S. R., & Chou, C. L. (2013). Physical examination education in graduate medical education—A systematic review of the literature. Journal of General Internal Medicine, 28(8), 1090–1099. Retrieved from


Week Four Journal Entry-Cardiovascular Disorder-March 24, 20XX

One patient in particular that presented in the office during my practicum experience was a 65-year-old-male with a history of mitral valve prolapse that led to mitral valve replacement surgery at age 58. Many individuals are affected by mitral valve prolapse and it is considered harmless unless regurgitation occurs and the patient becomes symptomatic (American Heart Association, 2018). Additional medical history on this patient included diabetes type 2 (diet controlled), hypertension, and osteoarthritis. The patient’s family history was positive for heart murmur with his father and hypertension with his mother. Social history was negative for alcohol, tobacco, or illicit drug use. The patient also stated that he exercised three to four times weekly and consumed a healthy diet.

This patient’s mitral valve was replaced with a mechanical valve and was prescribed aspirin 325mg daily and warfarin 5mg daily for to prevent platelet aggregation and clot formation on the mechanical valve. The patient was also taking metoprolol tartrate 25mg twice a day for blood pressure. In patients with mechanical valves, lifelong vitamin K antagonist such as warfarin is required. Direct oral anticoagulants such as dabigatran, rivaroxaban, apixaban, and edoxaban are contraindicated with mechanical valves (Gaasch & Konkle, 2017). The patient is now on routine monitoring for international normalized ratio (INR) levels. The patient’s INR was tested in office and his INR level was 2.5. The patient’s warfarin dosing was considered therapeutic and he was to follow-up in office in one month for another INR level check. Therapeutic range for INR levels with warfarin therapy is between two to three. The patient should be educated that foods rich in vitamin K, such as broccoli, cabbage, collards, and spinach may be consumed with moderation and consistency. In addition, strict adherence to warfarin therapy should be followed and no drastic changes in alcohol and food intake (Wigle, Bloomfield, Tubb, & Doherty, 2013).


American Heart Association (2018). Heart valve problems and causes. Retrieved from

Wigle, P., Bloomfield, H. E., Tubb, M., & Doherty, M. (2013). Updated guidelines on outpatient anticoagulation. American Family Physician, 87(8):556-566. Retrieved from

Gaasch, W. H. & Konkle, B. A. (2017). Antithrombotic therapy for prosthetic heart valves: Indications. Retrieved from


Assignment 2: Practicum – Week 1 Journal Entry and Journal Submission

Shelley Ison

NURS- 6650-1: Psychotherapy with Groups and Families

Walden University

September 10, 2019

Assignment 2: Practicum – Week 1 Journal Entry and Journal Submission

Student Name: Shelley Ison

E-mail Address:

Practicum Placement Agency’s Name: Kentucky River Community Care, Letcher Outpatient

Preceptor’s Name: Cheryl Mefford LSW

Preceptor’s Telephone: 606-436-5761

Preceptor’s E-mail Address: Cheryl.Mefford@KRCCNET.COM

Journal Entry Week 1

Time Log







Total Hours for This Time Frame



Learning Objective(s) Addressed
1 8/28 8am-4pm 8 Orientation, Shadowed Preceptor, Observed Clients Biological basis of psychotherapy and influences of psychotherapy treatment within a group setting.
1 8/29 8am-4pm 8 Shadowed Preceptor, Observed Clients Gained clinical skills by observing supportive group psychotherapy techniques.
Total Hours Completed: 16

Nursing Theory

Hildegard Peplau’s Interpersonal Relations Theory:

Hildegard E. Peplau is known as “mother of psychiatric nursing” built the framework for psychodynamic nursing. Hildegard Peplau’s Interpersonal Relations Theory emphasizes the focus on the interpersonal process and therapeutic relationship that develops between the nurse and the client (Jones, 2014). Within Peplau’s theory there are four phases of the nurse-patient relationships; orientation, identification, exploitation, and resolution. Through these phases the nurse can strengthen the nurse-patient relationship and begin the clients healing process. The goal of therapy is to build client trust, respect, and foster core values. Peplau’s interpersonal relations theory was chosen because it supports adaptability in any nurse-patient interaction, fosters trust and cooperation, facilitates communication, improves socialization, and develops positive outcomes (William & James, 2016). I also appreciate Peplau’s thought that nurses can take on many different roles, thus inspiring me to be the best advanced practice nurse I can be.

Counseling Theory

Humanistic Psychology Theory:

Humanistic psychology theory is a psychological perspective that emphasizes the study of the whole person rather than what is wrong with people. Carl Rogers a co-founder of the humanistic psychology theory believed people are genuinely good and always seek growth (Cherry, 2017). Wheeler (2014), acknowledges the humanistic psychology theory as a theory that focuses on the client holistically, emphasizing on positive behaviors and characteristics. One of the objectives in humanistic psychology is to promote self-direction and independence. The humanistic approach of therapy sees the client from the individual’s perspective to promote healing, growth and fulfillment, not from a therapist’s perspective. I chose the humanistic psychology theory because this theory played a significant role in eliminating some of the stigma encompassing mental illness (Cherry, 2017). It was once thought that therapy was only to be provided to persons with mental illness, the humanistic approach to therapy allowed people to acknowledge psychotherapy could also be used to explore the mind and behavior of any individual (Cherry, 2017). I feel that a humanistic approach to psychotherapy empowers the client to change allowing a growth-promoting environment.

Practicum Goals and Objectives


· Integrate classroom knowledge and practicum skills into a group/family therapy setting.

· Become more familiar with therapeutic communication skills to facilitate a rapport with clients in a group/family therapy setting.

· Expand my knowledge in psychotherapy perspectives, theories, and models relevant to the group/family therapy setting.


· Act as lead therapist in at least one group/family therapy session before the end fall 6650N practicum.

· Acting as lead therapist in a group/family therapy session use therapeutic communication skills learned in 6650N to facilitate rapport with the clients.

· Use a psychotherapy theory/model from 6650N resources in a group/family therapy session with clients.

Practicum Timeline
Week Learning Objective(s)
1 Introduction to preceptor, biological basis of psychotherapy in group and family therapy. Consider legal and ethical considerations in a group therapy setting.
2 Assess families and gain clinical skills in supportive psychotherapy in a group setting. Begin facilitating rapport with clients.
3 Understand and assess the effectiveness of therapeutic communications in a group setting. Continue facilitating rapport with clients.
4 Gain clinical skills in supportive group psychotherapy. Consider the advantages in using structural family therapy versus strategic family therapy. Continue facilitating rapport with clients.
5 Gain clinical skills in supportive group psychotherapy using CBT technique. Continue facilitating rapport with clients.
6 Understand the application current literature to clinical practice. Continue facilitating rapport with clients.
7 Evaluate strategies with receptor for management of intragroup conflict. Continue to gain clinical skills in supportive group psychotherapy. Continue facilitating rapport with clients.
8 Continue to gain clinical skills in supportive group psychotherapy. Evaluate and discuss the use of cognitive behavioral therapy for groups to cognitive behavioral therapy for families with preceptor. Continue to facilitate rapport with clients.
9 Evaluate and participate in psychotherapeutic approaches to group therapy for addiction. Continue to facilitate rapport with clients.
10 Act as lead therapist in the group setting with preceptor present for assistance. Final week of practicum.
11 Finalize any course material required. Complete course exit survey.


Cherry, K. (2017). Humanistic psychology: definition and history. Explore Psychology. Retrieved from

Jones, J. S. (2014). Interpersonal relations in nursing theory. In J. J. Fitzpatrick & G. McCarthy (Eds.), Theories guiding nursing research and practice: Making nursing knowledge development explicit. (pp. 173–182). New York, NY: Springer Publishing Company. Retrieved from

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.

William H., D., & James A., F. (2016). Incorporating Peplauʼs Theory of Interpersonal Relations to Promote Holistic Communication Between Older Adults and Nursing Students. Journal of Holistic Nursing, (1), 35.


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