THE ROLE OF A PRECEPTOR IN MY

CLINICAL PRACTICE
An attitude is an important thing. It can shape the way the
individual sees an experience and how observers see the
individual. An attitude can entirely make or break an experience.
This is as true in clinical experiences as it is in life. My experience
in my first week as a nurse with preceptorship was without a
doubt unique but I feel its uniqueness was in what I made of it,
something every nurse can do for themselves. If there is one
lesson to gain from reading about my experiences it should be
that the success of a clinical, whether a preceptorship or group
experience, is entirely what the orientee makes of it.
Our day started when our unit coordinator oriented us about the
area. I was exposed already in this area but then Im missing
some important points before. I can really say that Im now
knowledgeable about the area. We have our own preceptor every
day.
I learned so much this week. I keep asking questions if I have any
doubts. My preceptor gave some insights and important tips on
how to manage my time and be alert at all times. She said that
our job is serious that every day we are dealing with different
lives. We are saving them as well as preventing harm or injury.
We should think first before we do any actions.
I have this one patient who caught my attention. She is 75 years
old, diagnosed with Essential Hypertension II and Delusional
Disorder. She is risk for fall with suicide precaution. We always
make sure we raised the side rails and we visit the patient from
time to time.

Delusional disorder, previously called paranoid disorder, is a type

of serious mental illness called a "psychosis" in which a person
cannot tell what is real from what is imagined. The main feature
of this disorder is the presence of delusions, which are unshakable
beliefs in something untrue. People with delusional disorder
experience non-bizarre delusions, which involve situations that
could occur in real life, such as being followed, poisoned,
deceived, conspired against, or loved from a distance. These
delusions usually involve the misinterpretation of perceptions or
experiences. In reality, however, the situations are either not true
at all or highly exaggerated. function normally, apart from the
subject of their delusion, and generally do not behave in an
obviously odd or bizarre manner. This is unlike people with
other psychotic disorders, who also might have delusions as a
symptom of their disorder. In some cases, however, people with
delusional disorder might become so preoccupied with their
delusions that their lives are disrupted.
Although delusions might be a symptom of more common
disorders, such as schizophrenia, delusional disorder itself is
rather rare. Delusional disorder most often occurs in middle to
late life and is slightly more common in women than in men.

A challenge in the treatment of delusional disorders is that most

patients have limited insight, and do not acknowledge that there
is a problem. Most patients are treated as out-patients, although
hospitalization may be required in some cases if there is a risk of
harm to self or others.Individual psychotherapy is recommended
rather than group psychotherapy, as patients are often quite
suspicious and sensitive. Antipsychotics are not well tested in
delusional disorder, but they do not seem to work very well, and
often have no effect on the core delusional belief. Antipsychotics
may be more useful in managing agitation that can accompany
delusional disorder.

Psychotherapy for patients with delusional disorder can

include cognitive therapy which is conducted with the use
of empathy. During the process, the therapist can ask
hypothetical questions in a form of therapeutic Socratic
questioning. This therapy has been mostly studied in patients
with the persecutory type. The combination of pharmacotherapy
with cognitive therapy integrates treating the possible underlying
biological problems and decreasing the symptoms with
psychotherapy as well. Psychotherapy has been said to be the
most useful form of treatment because of the trust formed in a
patient and therapist relationship. The therapist is there for
support and must not show any signs implying that the patient is
mentally ill.
Supportive therapy has also been shown to be helpful. Its goal is
to facilitate treatment adherence and provide education about the
illness and its treatment.
Furthermore, providing social skills training has helped many
persons. It can promote interpersonal competence as well
as confidence and comfort when interacting with those individuals
perceived as a threat.Insight-oriented therapy is rarely indicated
or contraindicated; yet there are reports of successful
treatment. Its goals are to develop therapeutic alliance,
containment of projected feelings of hatred, impotence, and
badness; measured interpretation as well as the development of a
sense of creative doubt in the internal perception of the world.
The latter requires empathy with the patient's defensive position.
Later on, we noticed that the patient starting sharing stories and
a feeling of getting well or better. She said that she want to go
home and do her daily activities and that she misses her family.
After 5 days of rendering care, the patient has a new order that
she may go home. We are so happy that she can now go home
and spend some time with her family.

We all get tired, we all have challenges outside this hospital, but
with a positive attitude about learning and a little determination
to succeed we can all get through any clinical experience, learn a
great deal from it, and enjoy the learning. I cant say it enough;
any clinical experience will be what you make of it. Two nurses in
the same clinical group can have incredibly different experiences
if one goes in positively and the other negatively. Nurses will
notice who are the new orientee that want to learn, they will seek
you out to teach you if they think you want to be taught. There
will always be the one intimidating, scary, or grumpy nurse on
the floor. From my experiences I have learned that they usually
can be won over if you show them that you are a serious nurse,
there to learn from them, not to judge the way they practice. If
nurses notice that you are just stuck on autopilot, doing only what
is absolutely required of you in clinical, they wont have an
interest in teaching you, and why should they?
They say life is what you make of it, well, it is my opinion that the
same is true for clinical and preceptorship experiences. The more
you as a nurse advocate for yourself, the more experiences you
gain exposure to, the better nurse you will be. You will be more
prepared for your eventual practice and feel more comfortable
joining the professional world. Remember that you are more
prepared for clinical than you think. You will make mistakes, we all
do, and nurses with years of experience still make mistakes. The
important thing to do is look at your mistakes, learn from them,
and move forward. Keep a positive attitude and realize that you
are learning. Never be afraid to try a skill again just because you
made a mistake, you should in fact force yourself into this
experience again, so that you know you can do it.

References
1.

Jump up^ Semple.David."Oxford Hand Book of

Psychiatry" Oxford Press. 2005. p 230

2.

^ Jump up to:a b c d e American Psychiatric Association.

(2013). Diagnostic and Statistical Manual of Mental
Disorders, (5th ed., text revision). Washington, DC: American
Psychiatric Association.

3.

^ Jump up to:a b c d e f g h i j k l Hales E and Yudofsky JA,

eds, The American Psychiatric Press Textbook of Psychiatry,
Washington, DC: American Psychiatric Publishing, Inc., 2003

4.

^ Jump up to:a b Winokur, George."Comprehensive

Psychiatry-Delusional Disorder"American Psychiatric
Association. 1977. p 513

5.

Jump up^ Winokur, G (1977). "Delusional Disorder

(Paranoia)". Comprehensive Psychiatry 18 (6):
513. doi:10.1016/s0010-440x(97)90001-8.