| Course | NU 674 Psychiatric Mental Healthcare II |
|---|---|
| Unit | Unit 1 |
| Paper type | Treatment team disagreement record |
| Length | About 1,060 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN Psychiatric Mental Health Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NU 674 Unit 1
Injection, Housing, or Choice First? A Treatment Team Disagreement About a Man With Schizophrenia After His Second Relapse in 18 Months
Student Name
Department of Nursing, Herzing University
NU 674: Psychiatric Mental Healthcare II
Instructor Name
January 22, 2026
Injection, Housing, or Choice First? A Treatment Team Disagreement About a Man With Schizophrenia After His Second Relapse in 18 Months
The Patient and the Question
Mr. W. is a composite 36-year-old man with schizophrenia diagnosed at 20, enrolled for three years in a county full service partnership program in California, an intensive community team that provides psychiatric care, case management, and housing support. He was discharged two weeks ago after his second psychiatric hospitalization in 18 months. Both admissions followed his stopping oral risperidone within a few months of discharge. He also uses cannabis most days. His mother, with whom he lived, has told him he cannot return home, and he is staying on a friend's couch. The team met on January 15 to decide the plan. It could not agree, and this record sets out each position and how the disagreement was worked through.
Position 1: The Team Psychiatrist, Dr. Harris
Mr. W. should be offered a long-acting injectable antipsychotic now, before anything else changes, because both relapses followed stopping oral medication and each relapse has cost him his housing, his relationships, and weeks in hospital. Pooling randomized, cohort, and pre-post studies of injectable versus oral antipsychotics, a large review found that injectables reduced hospitalization or relapse, most clearly in the study designs closest to real-world practice (Kishimoto et al., 2021). If he refuses, Dr. Harris proposed that the team consider referral for a conservatorship evaluation, since another relapse may leave him unable to care for himself.
Position 2: The Case Manager, Ms. Grant
Stable housing should come first, because without it nothing else will hold. On a friend's couch, he has nowhere to keep medication, no routine, and a high chance of losing contact with the team. Housing First programs, which provide permanent housing without requiring treatment adherence first, have kept people with serious mental illness and substance use housed at higher rates than treatment-first approaches (Tsemberis et al., 2004). Ms. Grant argued that pushing the injection now, while he is newly homeless and angry about the hospitalization, risks him leaving the program altogether.
Position 3: The Peer Support Specialist, Mr. Brooks
Mr. W. has said clearly that he does not want injections, because a previous injection was given against his will in an emergency department and he experienced it as an assault. Any plan built around the injection starts by overriding what he has said. Shared decision making, in which the person's values and preferences are central to treatment choices, is described as an ethical obligation in mental health care, not an optional courtesy (Drake & Deegan, 2009). Mr. Brooks argued that the team should start from what Mr. W. wants, which is his own place and to "stop being locked up," and build the plan from there.
Also Heard: His Mother
His mother, invited with his consent, said she loves him but cannot live with him when he is ill, and she wants him hospitalized long-term. The team acknowledged her exhaustion and explained that long-term hospitalization is neither available nor legally justified while he is not currently a danger to himself or others or gravely disabled.
How the Disagreement Was Worked
The nurse practitioner, as team lead for this meeting, first asked each person to state the outcome they wanted in six months. All four said the same thing in different words: Mr. W. housed, out of hospital, and still working with the team. With a shared outcome agreed, the disagreement narrowed to sequence and to who decides.
The team agreed on three points. First, none of the positions excluded the others; housing, medication, and his choice were all needed. Second, conservatorship was not supported by the current facts, since he is not gravely disabled now, and raising it would damage trust without legal grounds; it was set aside unless his condition changes. Third, the decision about the injection belongs to Mr. W., and the team's job is to make the choice real by offering it properly, with the reasons, alternatives, and his past experience discussed, rather than by pressing it.
The resulting plan, taken to Mr. W. the next day: the case manager starts an application for supported housing this week; the nurse practitioner meets him to discuss medication options, including the injectable, an oral option with daily support, and what worked and did not work before; the peer specialist attends that meeting at his request; and the team reviews in four weeks.
Mr. W.'s Response the Next Day
When the plan was brought to him, Mr. W. said he was surprised that no one was insisting on the shot. He agreed to the housing application immediately and asked whether he could have a room on his own rather than a shared unit. On medication, he said he would restart oral risperidone with daily support from the team for now, and that he would "think about" the injection if he could choose the arm and have it given by someone he knew, rather than in an emergency department. He wanted his housing details kept from his mother until he had moved in. The nurse practitioner recorded his choices in his words, and the team accepted them as the working plan.
What the Team Learned About Its Own Process
Two lessons were recorded for future disagreements. First, the team had been arguing about means before agreeing on ends; once the shared six-month outcome was stated, three of the four positions turned out to be compatible. Second, the person whose life the plan concerned had not been in the room, and his account of the earlier forced injection, which the peer specialist knew and the psychiatrist did not, changed how the injection option was understood. Future team meetings about major decisions will invite the patient for at least part of the discussion, or will begin with his stated views read aloud.
What Remains Unresolved
Dr. Harris continues to believe that the injectable should be the team's clear recommendation, and that presenting it as one option among several underplays the evidence. That view is recorded here, and it was agreed that Dr. Harris will explain the evidence to Mr. W. directly if he wants to hear it. The team also agreed on what would reopen the question: stopping oral medication again, early signs of relapse, or loss of contact for more than a week.
References
Drake, R. E., & Deegan, P. E. (2009). Shared decision making is an ethical imperative. Psychiatric Services, 60(8), 1007. https://doi.org/10.1176/ps.2009.60.8.1007
Kishimoto, T., Hagi, K., Kurokawa, S., Kane, J. M., & Correll, C. U. (2021). Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia: A systematic review and comparative meta-analysis of randomised, cohort, and pre-post studies. The Lancet Psychiatry, 8(5), 387-404. https://doi.org/10.1016/S2215-0366(21)00039-0
Tsemberis, S., Gulcur, L., & Nakae, M. (2004). Housing First, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health, 94(4), 651-656. https://doi.org/10.2105/AJPH.94.4.651
NU 674 Unit 1 instructions, in plain terms
Unit 1 asks you to document a disagreement within a treatment team and how it was worked through. Expect to describe the patient and the question, record each party's position with its reasoning, describe the process used, report the patient's response, reflect on what the team learned and name what remains unresolved. Many versions ask whether the record must reach agreement; it does not, if the process is fair and the remaining disagreement is stated. Check whether your section allows a disagreement from your placement, de-identified. Present each position at its strongest. Include the patient's and family's views. Explain your own role in facilitating, since PMHNPs often lead these meetings and the process matters as much as the outcome.
How the NU 674 Unit 1 example is put together
It starts by naming Mr. W. and the decision the team faced. Each position has its own section with the person's reasoning and evidence, presented without caricature. The psychiatrist's case cites injectable relapse data; the case manager's cites Housing First; the peer specialist's centers the patient's stated wishes. The mother's view is included with its limits. The process section describes how the facilitator separated desired outcomes from proposed means, which revealed shared goals. The patient's response shows that a plan built on choice changed his stance. The lessons section names two process insights for future meetings. The final section records the psychiatrist's continuing view, which keeps the record honest about what was not resolved.
Where the points sit in the NU 674 Unit 1 rubric
Herzing's rubric for a disagreement record usually covers the description of the patient and question, fair representation of positions, the facilitation process, patient and family voice, reflection and acknowledgment of unresolved issues. Fair representation is checked first, because a record that weakens one position to favor another loses credibility. Process points reward a described method, such as separating outcomes from means. Patient voice criteria look for the patient's own view and response. Reflection earns credit for lessons about team process. Unresolved issues should be stated plainly. Evidence for each position strengthens the record. Kishimoto's injectable meta-analysis and Tsemberis's Housing First trial belong in the APA 7 list.
Common NU 674 Unit 1 mistakes, and how to avoid them
Disagreement records in Unit 1 commonly lose credit by presenting the writer's preferred position as reasonable and the others as obstacles. Another frequent problem is leaving out the patient's voice. Students often describe the outcome without the process that produced it. Family input is ignored or given too much weight. Evidence is cited for one position only. The record claims full agreement when some remained. Team roles are described vaguely. Finally, explain what the team learned about its own process, because graders reward reflection that would help the next disagreement go better, not just a summary of who won. The facilitator's own bias should be named too; a nurse practitioner who leans toward one plan should say so in the record.
Get a NU 674 Unit 1 example written to your instructions
Send the Unit 1 instructions and the rubric from your NU 674 classroom, and say which disciplines sit on the team your course describes. We write a custom example that states the disagreement first, argues each position at full strength, sorts facts from values, and names who held the decision. First custom sample free, back in 24 to 48 hours.
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NU 674 Unit 1 questions, answered
Can the disagreement come from my own placement?
No. Build the team from roles that recur across settings and say in a line that the case is composite and de-identified. What colleagues said in a meeting you attended belongs to that setting, and repeating it in a graded file exposes people who never agreed to appear there. A constructed team also lets you build the exact impasse the record needs.
Does the record have to reach agreement?
Not always, and forcing one often weakens the submission. Many sections accept an unresolved dispute provided the document says what would settle it, who holds authority in the meantime and when the team returns to the question. An impasse written honestly, with the dissent preserved, usually reads as better clinical judgment than a resolution the reader can see was manufactured.
How many parties belong in the record?
Three or four argued properly tends to beat six listed, unless a count is specified for you. Every party you add needs its own reasoning, its own evidence and its own place in the sorting, and thin coverage everywhere is the usual result of adding more. Keep the patient and any family member among them, since their positions carry weight the criteria look for.
Where can I find a free NU 674 Unit 1 sample paper?
The full NU 674 Unit 1 team disagreement record is free on this page, every position, the facilitation and what remains unresolved. A record for a different team decision can be written on request.
How should a PMHNP handle disagreement on a treatment team?
Ask each member what outcome they want before debating means, include the patient's view and record any remaining disagreement honestly. This sample shows a team finding shared goals for a man with schizophrenia after starting from three different plans.