| Course | NSG 221 Mental Health Nursing |
|---|---|
| Unit | Unit 2 |
| Paper type | Observation-to-wording table |
| Length | About 490 words, 4 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | BSN |
| Updated | October 2026 |
Free sample paper for NSG 221 Unit 2
Ten Jotted Notes Rewritten From What Could Be Seen, Heard, Counted, or Timed: An Observation-to-Wording Table for a Young Man in First-Episode Psychosis
Student Name
Department of Nursing, Herzing University
NSG 221: Mental Health Nursing
Instructor Name
January 22, 2026
Ten Jotted Notes Rewritten From What Could Be Seen, Heard, Counted, or Timed: An Observation-to-Wording Table for a Young Man in First-Episode Psychosis
Where the Notes Came From
The notes were jotted on a pocket sheet during a day shift with the composite 23-year-old patient from Unit 1, now on his third hospital day. They are reproduced as first written, before any correction, because the point of the exercise is the distance between the first version and the second. Each row gives the jotted note, the rewrite built only from observable detail with his speech quoted, and the words in the original that carried a judgment. The reason this matters goes beyond style: in an experiment with physicians in training, reading a chart note written with stigmatizing language led to more negative attitudes toward the patient and less aggressive treatment of his pain than reading a neutral note about the same patient (Goddu et al., 2018).
The Table
Left: the note as jotted. Middle: the rewrite. Right: the words that carried a verdict.
| Jotted note | Rewrite | Verdict words |
|---|---|---|
| Pt agitated this am | 0845: pacing the corridor from his room to the day room and back, about 20 lengths in 10 minutes; fists clenched; spoke loudly, "Turn that TV off," twice | "agitated" |
| Paranoid about meds again | 0900: declined oral medication, saying, "It's how they're tracking me." Took two steps back from the cart. Accepted a cup of water | "paranoid," "again" |
| Refused breakfast, being difficult | 0830: breakfast tray delivered; ate two bites of toast, left the rest; said, "I don't know who made this" | "refused," "being difficult" |
| Responding to internal stimuli | 1015: sitting alone in the day room, looking toward an empty corner, lips moving, paused as if listening, then laughed briefly; when asked, said, "Nothing, just thinking" | "internal stimuli" (an inference presented as a finding) |
| Poor hygiene | Hair uncombed, same shirt as yesterday, noticeable body odor; declined an offer of a shower at 1100 | "poor" |
| Isolative | Stayed in his room from 1130 to 1400 except to use the bathroom; door closed; answered through the door when staff knocked | "isolative" |
| Manipulative with staff | 1400: asked three different staff members, one after another, whether he could have a pass to go outside; each said the team would decide at rounds | "manipulative" |
| Slept well | Checks every 15 minutes overnight: eyes closed and breathing regularly at 13 of 32 checks between 2300 and 0700; awake at the others | "well" (unsupported by the checks) |
| Denies SI | 1500: asked, "Since yesterday, has any part of you wanted to hurt yourself or to stop living?" Answered, "No. I just want them to leave me alone" | "denies" (implies doubt) |
| Calmer after prn | 1530: received the as-needed medication at 1505; at 1530 seated, speaking at normal volume, hands open, pacing stopped | "calmer" (acceptable, but less useful than the description) |
What the Rewrites Changed
Three patterns run through the verdict column. First, labels that claim to know intent: "manipulative" and "being difficult" say why he acted, which the observer did not know. The rewrite shows that asking three staff members for a pass is also what an anxious young man who wants fresh air might do. Second, labels that close a question: "responding to internal stimuli" states a conclusion; the rewrite gives the observations that suggest it and his own answer, leaving the next reader to weigh both. Third, words that bend a count: "slept well" was written about a night in which he was awake for most checks. That one was simply wrong, and only the rewrite revealed it.
Some short words survive. "Declined" replaces "refused" because it records the act without the tone. "Calmer" is not wrong, but the description beside it can be compared with the next as-needed dose, and the single word cannot.
The course text sets out the same principle for psychiatric documentation: record behavior and speech, not interpretations of motive (Halter, 2022). A related study of physicians' notes identified several themes of negative language, including questioning patients' credibility and expressing disapproval of their reasoning (Park et al., 2021), which match the words in the right-hand column.
Using the Rewrites
The rewritten entries were used the same afternoon. At the 1500 team meeting, the psychiatrist asked how he had slept; the jotted note would have answered "well," and the rewrite showed he had slept at only 13 of 32 checks, which changed the plan for his evening medication. The social worker, planning a family meeting, read the pass requests as a sign he wanted contact with the outside, not as manipulation, and arranged a supervised walk in the courtyard. Neither decision would have been reached from the first version of the notes. The patient is a composite, and no real chart was used.
References
Goddu, A. P., O'Conor, K. J., Lanzkron, S., Saheed, M. O., Saha, S., Peek, M. E., Haywood, C., & Beach, M. C. (2018). Do words matter? Stigmatizing language and the transmission of bias in the medical record. Journal of General Internal Medicine, 33(5), 685-691. https://doi.org/10.1007/s11606-017-4289-2
Halter, M. J. (2022). Varcarolis' foundations of psychiatric-mental health nursing: A clinical approach (9th ed.). Elsevier.
Park, J., Saha, S., Chee, B., Taylor, J., & Beach, M. C. (2021). Physician use of stigmatizing language in patient medical records. JAMA Network Open, 4(7), Article e2117052. https://doi.org/10.1001/jamanetworkopen.2021.17052
NSG 221 Unit 2 instructions, in plain terms
Unit 2 asks you to rewrite subjective notes about a patient into objective, observable language. Expect to present the original notes, give rewrites based on what was seen, heard, counted or timed, identify the words that carried judgment and explain the patterns. Many versions ask how many notes to include and whether quotations count as observation. Check whether your section supplies the notes. Patient quotations are observations and are often the most useful entries. Replace labels such as agitated, noncompliant or attention-seeking with behavior, times and counts. Note words that claim to know intent. Explain how the rewritten notes help the team make decisions. Times written in the 24-hour format make sequences easy to read.
Inside the NSG 221 Unit 2 example
The table lists ten notes as jotted, each beside a rewrite and the verdict word removed. Rewrites use counts, times and quotations, such as paced the hallway for 20 minutes at 1030. The patterns section groups verdict words into three types, which helps a student recognize them in future notes. The usage section shows the rewritten notes answering questions in the team meeting, which demonstrates why objective wording matters. The exercise is short and practical. Every rewrite could go into a chart as written, and none guesses at motive. The structure makes the change from verdict to observation easy to see, which is the skill the unit builds.
Reading the NSG 221 Unit 2 rubric
Herzing's rubric for an observation-to-wording exercise typically covers accuracy of rewrites, identification of verdict words, use of counts, times and quotations, explanation of patterns and relevance to care. Each rewrite is checked for any remaining judgment or guess at motive. Verdict identification points reward naming the exact word. Count and time criteria look for measurable detail. Quotation use earns credit, since a patient's words are observations. Pattern points go to grouping the kinds of verdict found. Relevance earns credit when the rewrites are shown supporting decisions. Non-stigmatizing language is expected. The exercise draws on Varcarolis and on guidance about stigmatizing language in health records.
NSG 221 Unit 2 help before you submit
Observation exercises in Unit 2 commonly lose points by replacing one label with another, such as uncooperative with resistant. Another frequent problem is rewrites without counts or times. Students often keep words that claim to know intent, such as trying to get attention. Quotations are paraphrased. Patterns are not explained. The team use of the notes is left out. Some rewrites become longer without becoming more specific. Finally, ask whether another nurse could verify each rewrite, because graders reward wording that describes what happened and leaves interpretation to the team. Another weak spot is removing the patient's own words, which are often the most useful observation in the note. Rewrites that guess at a diagnosis, such as hearing voices when he was only seen looking around, add a new verdict. Some students rewrite only the easy notes and leave the hardest labels untouched.
Get a NSG 221 Unit 2 example written to your instructions
Send the Unit 2 instructions and the rubric from your NSG 221 classroom, together with the scenario or observation set the assignment provides. We write a custom example that keeps the columns level, rewrites using observable detail only, names the conclusion in every row and works the hard conversions underneath. First custom sample free, back in 24 to 48 hours.
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NSG 221 Unit 2 questions, answered
Is interpreting anything at all wrong in this unit?
Not wrong, only kept in its place. The exercise separates description from conclusion so both stay visible, and most sections want the conclusion named rather than banned outright. What loses credit is a verdict sitting inside the descriptive column with no marker on it, since a later reader has no way of separating the observation from the assumption riding on it.
How much of the patient's speech should be quoted?
Enough that a reader hears the person rather than a summary of them, and never more than the scenario actually supplies. Recorded speech is the one part of the entry needing no rewrite, which makes it valuable, but inventing a line to fill a row destroys that value. Where the scenario gives none, write the observation and say speech was not recorded.
Will my clinical site word things the same way?
Often it will not, and the difference deserves a sentence in the document. Conventions vary between units, electronic systems and organizations, and an exercise naming the format it followed is easier to mark than one asserting a single correct phrasing. If your course supplies a documentation guide, work from that and note where the site departs from it.
Where can I find a free NSG 221 Unit 2 sample paper?
Read the complete NSG 221 Unit 2 observation table here at no charge, ten notes rewritten with the verdict words named. An exercise based on your own notes can be prepared on request.
How do I document behavior objectively in mental health nursing?
Write what you saw or heard, with counts, times and the patient's own words, and avoid labels that judge intent or character. This sample rewrites manipulative as asked for a pass three times in one hour.