| Course | NU 674 Psychiatric Mental Healthcare II |
|---|---|
| Unit | Unit 6 |
| Paper type | Shared decision making record |
| Length | About 1,010 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 6
Shared Decision Making Record After a 14-Day Hold: What Was Offered, What Mr. W. Accepted, What He Declined, and the Plan Built on His Partial Agreement
Student Name
Department of Nursing, Herzing University
NU 674: Psychiatric Mental Healthcare II
Instructor Name
March 3, 2026
Shared Decision Making Record After a 14-Day Hold: What Was Offered, What Mr. W. Accepted, What He Declined, and the Plan Built on His Partial Agreement
Context
Mr. W., whose schizophrenia is managed by a county partnership team in California, was discharged on February 26 after a 72-hour hold and a 14-day certification for grave disability, during which he accepted aripiprazole and recovered well. He returned to his supported housing apartment, which the team had protected during his admission. On March 2, the nurse practitioner met him at his apartment, with his peer specialist present at his request, to agree on the plan for the coming months. The meeting followed a three-step model of shared decision making: making clear that a choice exists, describing the options with their benefits and harms, and supporting the person to decide (Elwyn et al., 2012).
What Made the Conversation Possible
Three conditions were in place before the meeting, and each was deliberate. It took place in his apartment, not the clinic, a week after he left the hospital, when he was well enough to weigh options and no longer under a hold; decisions made during detention carry the weight of that setting. His peer specialist was present, someone he trusts who has also been hospitalized involuntarily and who could say, when he hesitated, "You can take time on that one." And the team had agreed beforehand which options it could genuinely accept if he chose them, so that nothing was offered as a choice that would later be withdrawn. Offering the oral option only as a formality, while intending to push the injection, would have made the whole record a pretense.
Decision 1: How to Take the Antipsychotic
What was offered, in the words used: "You've done well on aripiprazole twice now. There are two ways to take it. One is a pill every day, like before. The other is an injection once a month, the same medicine, so you don't have to remember it every day. The injection makes it less likely you'd end up back in the hospital if you stopped the pills without meaning to. The downside is a shot every month, and I know what happened with the injection in the ER years ago."
What he accepted: daily oral aripiprazole, with a weekly pill organizer that his case manager checks.
What he declined, and what he said: the monthly injection. "Not now. Every time someone's given me a shot, I didn't have a choice. Maybe later, if I get to pick who does it."
Reading the refusal: this was a hesitation with conditions rather than a firm no. He named what would make the injection acceptable, choice of person and control over the circumstances. That is recorded for a future conversation.
Decision 2: What to Do if the Warning Signs Return
What was offered: a written relapse plan listing his early signs, what he would like the team to do at each stage, and whether he would prefer crisis residential care to the hospital if things got worse.
What he accepted: all of it. His plan lists shorter sleep as the first sign, missing peer group as the second, and "thinking people are messing with my food" as the third. At the first sign, he wants daily visits; at the second, he agrees to talk about restarting or increasing medication; at the third, he would go to the crisis residence voluntarily rather than wait for a hold. "I don't want to get to the point where they take me again."
What he declined: nothing in this decision.
Decision 3: Cannabis
What was offered: a range of goals, from stopping entirely to reducing use, with an explanation that heavier use in the past came before some of his relapses.
What he accepted: no cannabis before 5 p.m., and tracking his daily use for the team.
What he declined: stopping. "It's the only thing I have that's mine."
Reading the refusal: a firm no to abstinence, with genuine agreement to a harm reduction goal. The team accepts the goal he chose and will revisit it if use rises or his relapse signature appears.
Decision 4: His Mother's Involvement
What was offered: inviting his mother to a meeting to share the relapse plan, so that she would know what to watch for.
What he accepted: that she may be told his early warning signs and the team's phone number.
What he declined: a joint meeting for now. "We're not there yet."
The Plan Built From These Decisions
Daily oral aripiprazole with a weekly organizer check; the relapse plan, signed by him, with copies to his case manager and, for the warning signs section, his mother; cannabis tracking with a before-5-p.m. limit; peer group twice a week; and a review in one month. Every element is something he agreed to, and he kept a copy of the whole plan on his refrigerator. The team's preferences, the injection and abstinence from cannabis, are recorded as offered and declined, with his reasons and the conditions under which he might reconsider.
Shared decision making in psychosis has been associated with improvements in empowerment-related outcomes in a systematic review and meta-analysis (Stovell et al., 2016), and it is described as an ethical imperative in mental health care, not a technique for gaining compliance (Drake & Deegan, 2009). Here, it produced a plan he helped write, including a voluntary pathway to crisis care that he chose himself, which may matter more in the next relapse than any single medication decision.
What the Team Gave Up, and Why
The team's first choice was the monthly injection, supported by strong evidence for preventing relapse. By accepting his choice, the team accepts a higher risk that he will stop medication again. It judged that risk worth taking, because a plan he owns, with a relapse plan he wrote and a route to voluntary crisis care, addresses the same risk from another direction, and because pressing the injection now would repeat the experience he describes as the worst of his treatment.
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
Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., Cording, E., Tomson, D., Dodd, C., Rollnick, S., Edwards, A., & Barry, M. (2012). Shared decision making: A model for clinical practice. Journal of General Internal Medicine, 27(10), 1361-1367. https://doi.org/10.1007/s11606-012-2077-6
Stovell, D., Morrison, A. P., Panayiotou, M., & Hutton, P. (2016). Shared treatment decision-making and empowerment-related outcomes in psychosis: Systematic review and meta-analysis. British Journal of Psychiatry, 209(1), 23-28. https://doi.org/10.1192/bjp.bp.114.158931
Reading the NU 674 Unit 6 instructions
Unit 6 asks you to document a shared decision making conversation with a patient. Expect to describe the context and conditions, record each decision with what was offered, the patient's response and the reasoning, describe the resulting plan and reflect on trade-offs. Many versions ask what to do if the patient refuses the whole plan and whether capacity belongs in the record. Check how much quotation your section expects. Use a model such as Elwyn's three-talk approach. Record options in the words you used, since that shows whether choices were genuine. A plan built on partial agreement is still shared decision making. Name what the team gave up, because honesty about trade-offs is part of a real shared decision.
How this NU 674 Unit 6 example is built
The record opens with context and the conditions that made the conversation possible, each chosen deliberately. Each decision has its own section with options offered, quoted, and the patient's answer. The medication decision shows the injection offered alongside oral medication, with his reasons for choosing oral. The relapse plan decision lists his early signs in his words. The cannabis decision offers a range of goals. The family decision respects his refusal for now. The plan section assembles his choices into a coherent whole. The final section names the trade-off: accepting oral medication gives up some relapse protection but gains his engagement. The structure shows the team followed his lead where it could.
Where the points sit in the NU 674 Unit 6 rubric
Herzing's rubric for a shared decision record typically covers the conditions for the conversation, presentation of options, the patient's responses, the resulting plan, use of a model and reflection on trade-offs. Presentation of options draws careful reading, since graders check that alternatives were genuine and explained in plain words. Conditions points reward attention to setting and support. Response criteria look for the patient's own reasons. Plan points go to a plan that reflects his choices. Model use earns credit for applying a named framework. Trade-off reflection should be honest. Elwyn's three-talk model and Drake and Deegan's paper belong in the APA 7 references.
Common NU 674 Unit 6 mistakes, and how to avoid them
Shared decision records in Unit 6 commonly lose points by presenting one option and recording agreement. Another frequent problem is not quoting what was offered, so the grader cannot tell whether choices were real. Students often treat partial agreement as failure. Capacity is ignored when it matters. The plan does not match the patient's choices. Trade-offs are hidden. The conditions for the conversation are not described. Finally, name what the team gave up, because graders reward honesty about the cost of following the patient's preference. Capacity should be noted briefly, especially soon after a hold, since a choice made without capacity is not a shared decision. Copies of the relapse plan should go to the people he named, not to everyone the team would like. A follow-up date for revisiting declined options, such as the injection or his mother's involvement, shows the decision stays open.
Get a NU 674 Unit 6 example written to your instructions
Send the Unit 6 instructions and the rubric from your NU 674 classroom, with the decision your case turns on. We write a custom example that puts the proposal in the words used, separates acceptance from refusal from uncertainty, keeps capacity as its own question and builds a plan from what was agreed. First custom sample free, returned in 24 to 48 hours.
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NU 674 Unit 6 questions, answered
What if the patient refuses the whole plan?
Then the record documents that and describes what remains: continued contact, a smaller agreement, an open door and a stated point of return. Many sections give credit for exactly this, because a total refusal handled without abandonment shows more than a case where everything is accepted. What loses ground is a document that ends when the answer is no.
How much of the conversation should be quoted?
Enough for a reader to hear the difference between a firm refusal and a hesitation, which usually means a few short exchanges rather than a transcript. Since the patient is composite, write the quoted lines to hold precisely the ambiguity the record turns on, and add a line saying the material is constructed and de-identified.
Does capacity belong in this record?
As a separate question, yes, and kept short unless the instructions ask for more. Note how the question was approached and what the answer rested on, without turning the record into a formal evaluation. The point in this unit is to show that disagreement and incapacity were not treated as the same finding, which is where the credit sits.
Where can I find a free NU 674 Unit 6 sample paper?
This page carries the complete NU 674 Unit 6 shared decision record at no cost, four decisions with what was offered and chosen. A record for another patient or decision can be prepared on request.
What is shared decision making in psychiatric care?
It means presenting real options with their risks and benefits, learning what matters to the patient and building the plan together. This sample offers injectable and oral medication and builds the plan on the patient's choice of oral.