Where a primary care RN keeps a patient and where she hands off is settled in NU432's closing seminar reflection through one composite diabetes case and a positive hunger screen. Searches like "nu 432 unit 10 assignment example", "nu432 unit 10 sample" and "nu432 unit 10 example" land here.
Three Visits of Teaching and an A1c That Rose: A Seminar Reflection on What Primary Care Hands Off
[Student Name]
Purdue University Global
NU432: Primary Care in the Ambulatory Setting
Unit 10 Seminar Reflection
[Instructor Name]
[Date]
The case discussed is a composite prepared for teaching. Classmates are not named.
What
The case: a composite 57-year-old woman with type 2 diabetes, seen by me for three RN visits over five months. At each visit I taught, and documented teaching: meter technique, the plate method, how to read her readings. Her meter logs looked fine on the days she tested. Her A1c climbed anyway, from 8.1 to 10.2.
I arrived at the seminar with my position ready: the case had outgrown primary care, and she needed endocrinology. I said so in the first few minutes.
So What
A classmate asked, "What does she eat at the end of the month?" I did not know. I had never asked. When the practice later screened her with the two-item Hunger Vital Sign, which asks whether food ran out or was feared to run out before there was money to buy more, both answers were positive (Hager et al., 2010).
That changed how I read my three visits. Three visits of teaching had produced documentation of teaching and no change, because the plan assumed a stocked kitchen. She knew the plate method. What she did not have, in the last week of each month, was food to put on the plate. Food insecurity is associated with worse glucose control and with skipping medications to afford food (Berkowitz et al., 2014), and her logs looked fine partly because she tested less in the weeks when money ran out.
The seminar then asked a larger question: what does primary care hand off, and to whom? We reached an answer I now think is right. Primary care carries the relationship, the longitudinal record, the teaching and the coordination. It hands off diagnostic uncertainty and therapy beyond its scope to specialists. And it hands off needs it cannot meet in an exam room, such as food, to community partners. Her case had not outgrown primary care; it had outgrown the exam room.
Endocrinology stays in the plan, but as a conditional step: if her A1c has not moved in three months after the food need is addressed, she will be referred.
What Happened Next
After the seminar, the practice's community health worker met her in the clinic and connected her with a food pantry that stocks fresh produce two days a week and with an application for supplemental nutrition benefits. The RN visits changed too. Instead of reteaching the plate method, the next visit asked what food she had at home that week and built the plan from it: which pantry staples fit the plate, and what to eat on the days before benefits arrive. She also asked, for the first time, whether she could test less often without losing track, because test strips cost her money she needed for food. That question went to the clinician, who adjusted her testing schedule.
Her care now looks more like the chronic care model describes: a team that links clinical care with community resources, rather than a nurse and a patient repeating the same lesson (Coleman et al., 2009). The exam room is still where the relationship lives, but it is no longer where the whole plan lives.
Why I Missed It
I missed the food question because my visits were built around teaching, and teaching assumes the barrier is knowledge. When the numbers did not move, I reached for more expertise, a specialist, rather than for a different kind of question. I also noticed that I had treated her good logs as evidence of good control on the days she tested, without asking about the days she did not.
What unsettles me most is that the question was simple. It took one classmate a few seconds to ask it, and it took a two-item screen to answer it. I had three chances, and each time I chose to teach again instead of asking what had changed in her life since the last visit.
Now What
Two changes in my own practice follow:
1. I will screen for social needs, starting with food, before escalating any case where teaching has not produced change.
2. I will treat a referral to the practice's community health worker as a handoff in its own right, with a warm introduction and a follow-up call, not as a note in the chart.
I will check on [date], three months from now, whether I have screened every patient I escalated in that period, by reviewing my own referral list.
References
Berkowitz, S. A., Seligman, H. K., & Choudhry, N. K. (2014). Treat or eat: Food insecurity, cost-related medication underuse, and unmet needs. The American Journal of Medicine, 127(4), 303-310. https://doi.org/10.1016/j.amjmed.2014.01.002
Coleman, K., Austin, B. T., Brach, C., & Wagner, E. H. (2009). Evidence on the chronic care model in the new millennium. Health Affairs, 28(1), 75-85. https://doi.org/10.1377/hlthaff.28.1.75
Hager, E. R., Quigg, A. M., Black, M. M., Coleman, S. M., Heeren, T., Rose-Jacobs, R., Cook, J. T., Ettinger de Cuba, S. A., Casey, P. H., Chilton, M., Cutts, D. B., Meyers, A. F., & Frank, D. A. (2010). Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics, 126(1), e26-e32. https://doi.org/10.1542/peds.2009-3146
How this NU432 Unit 10 example is structured
Driscoll's model gives the reflection its spine, and each part does a different job. What is descriptive and brief, because the seminar already knows the case. So what carries the analysis: the author examines why three visits of teaching produced documentation of teaching and no change, and concludes that the plan assumed a stocked kitchen. That section draws the line the unit asks about. Primary care carries the relationship, the longitudinal record, the teaching and the coordination; it hands off diagnostic uncertainty and therapy beyond its scope to specialists, and needs it cannot meet in an exam room to community partners. Endocrinology stays in the plan as a conditional step if the A1c has not moved in three months. Now what is concrete and short, two practice changes and the date the author will check whether either happened.
Get an NU432 Unit 10 example written to your instructions
Seminars in this course often run as case conferences, and the reflection is written after, or instead of, attending. Tell the desk which case your section discussed, add the reflection prompt and rubric, and the sample follows your turning point rather than an invented one. Expect it within 24-48h, free if it is your first. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
NU432 Unit 10 questions, answered
Does the reflection have to use the seminar's case?
Use the seminar's case unless the prompt invites your own. The sample stays with the diabetes case the conference discussed, because the reflection is about how the discussion changed a view. A primary care experience of your own can appear as a brief comparison, composite and unidentifiable, in the So what section.
What is the Hunger Vital Sign?
A two-item food insecurity screen drawn from the USDA's longer survey, asking whether in the past year the household worried food would run out and whether it did run out before there was money for more. A response of sometimes or often true on either item is positive. It fits a primary care visit because it takes under a minute.
Should the reflection criticize the original plan?
Examine it rather than criticize it. The sample treats the three teaching visits as reasonable given what was known, then asks what was not known and why nobody asked. That tone reads as professional growth. Blaming the patient's adherence, or a colleague, tends to cost marks, because it ends the analysis at the point where it should start.