Pediatric Rotation Journal Entry.

Critical reflection of your growth and development during your practicum experience in a clinical setting has the benefit of helping you identify opportunities for improvement in your clinical skills while also recognizing your clinical strengths and successes.Pediatric Rotation Journal Entry.

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This week, you will write a Journal Entry reflecting on your clinical strengths and opportunities for improvement.

Based on your experience,
Describe an interesting case or a case that you have never seen before.
Explain what you found challenging.
Explain what you would do differently from your Preceptor.
Explain the cultural differences you found challenging.Pediatric Rotation Journal Entry.

Case Description

During my pediatric practicum rotation, I attended pediatric patients of different ages, diagnoses, and cultures.  I was particularly excited to listen to pediatric clients from different ethics, backgrounds, and learning about their families. I have always been interested in psychiatry and I think the most interesting experience was attending to pediatric clients with psychiatric issues despite the many issues that emerged in making psychiatric diagnoses and management. In the initial weeks, my preceptor introduced me to an 8-year-old girl, whom I shall hypothetically call Joy. As the youngest in the family, Joy reportedly hit his other siblings and when her mother tried to discipline her, she threatened to do the same opposite of what she was instructed to do. She used words such as “you have no control over me’ ‘I do not care what you think’ and despite these utterances, she never meant that she wanted to die, she frequently used these expressions to manipulate her mother.Pediatric Rotation Journal Entry.

Her mother became worried when she started to bite her nails constantly, to the extent that she left marks on her fingertips. She wet the bed four nights every week, which caused her mother to disrupted sleep with loads of laundry. Although it was difficult to identify the exact time of the night that she wet her bed, she thought that it was more as it approached morning because as she woke up, she was wet with fresh urine.Pediatric Rotation Journal Entry.

Joy’s behavioral issues extended to the classroom and caused trouble in school. She had trouble learning, was easily frustrated, and gradually became disinterested in school. Besides, she could hardly focus and could frequently throw temper tantrums, she did not follow instructions. A review of her homeopathic symptoms revealed that she had a craving for eggs and thus, could eat them 1-3 times daily. During the night, it was difficult for mum to her to sleep and this repeat pattern was exhausting for her mother. From my diagnostic perspective, I was certain that Joy suffered from the predominant hyperactive-impulsive ADHD type (Sayal et al., 2018). Although I am not a pediatric psychiatrist, I highly suspected that she could also have an oppositional defiant disorder. My biggest worry was that she could develop a conduct disorder and with time, might be involved in criminal and drug-related activities in the teenagehood.  After thoughtful deliberation with my preceptor, we decided to refer Joy to a pediatric psychiatrist for further management and initiation of therapy.Pediatric Rotation Journal Entry.

Challenges

The greatest challenge that I encountered when working with pediatric clients was in the process of establishing a rapport. A rapport builds trust between a provider and a patient. The more a provider gets to know a pediatric patient, the more the patient gets to know the provider and hence, the patient is more likely to disclose information leading to better interaction. Building a good rapport with pediatric patients has been associated with numerous benefits such as acceptance to recommended forms of treatment, compliance, perceived better care, and it reduces anxiety. Going forward, I will attend to as many pediatric clients and continue learning about communication tips for pediatric patients.Pediatric Rotation Journal Entry.

What I Would Do Differently

To reduce healthcare-induced anxiety when dealing with pediatric clients going forward, I will adopt Lerwick (2016) four major principles using the CARE (choice, agenda, resilience, and emotion) process. These principles will enhance my ability to provide emotionally safe care to pediatric patients in the following ways;Pediatric Rotation Journal Entry.

Choices- giving the child power in a powerless environment

Agenda- informing the child and caregiver/family what is expected of them and what to expect

Resilience-build on each child’s strengths and reframing negatives

Emotions-identifying and normalizing common responses and fears

Challenging Cultural Differences

As highlighted by Bainbridge at al. (2015), the most challenging cultural difference was associated with communication techniques. Since the patient was an Asian American, I was a bit hesitant to respond and ask questions without thoughtful deliberation that could unknowingly be disrespectful to the patient.Pediatric Rotation Journal Entry.