Rolfe's What, So what and Now what carry this entry from a late disclosure of possible sleep apnea to a change in how the author opens visits during the NU569 rotation. Searches like "nu 569 unit 3 assignment example", "nu569 unit 3 sample" and "nu569 unit 3 example" land here.
Hand on the Doorknob: A Reflective Journal Entry on a Disclosure That Came at Minute Fourteen
[Student Name]
Purdue University Global
NU569: FNP I Clinical - Lifespan Health Focus
Unit 3 Reflective Journal Entry
[Instructor Name]
[Date]
The patient and visit are composites; no real person is described.
I have organized this entry around the three questions of Rolfe's reflective model, what, so what and now what, because the third question keeps reflection from ending in regret (Rolfe et al., 2001).
What?
Mr. [H.], 58, drives a school bus on two long rural routes a day. He was booked for two weeks of low back pain. I took a focused history, examined his back, found no red flags and discussed activity and [naproxen] for a short course. As I stood and reached for the door, he said, "One more thing. My wife says I snore like a train and stop breathing at night. She makes me sleep in the other room." I sat back down. With my preceptor's help, I asked the STOP-Bang questions: loud snoring, yes; daytime tiredness, no, "not once I've had coffee"; observed pauses, yes; treated hypertension, yes; BMI above 35, no, at [32]; age above 50, yes; neck above 40 cm, no; male, yes. A score of [5]. He was referred for a sleep study.
So What?
Why did the most important disclosure arrive at minute fourteen? I considered three explanations.
The first was embarrassment. Snoring and a wife who sends him to another room are awkward things to raise with a stranger. That may have played a part, but he raised it easily enough when he did.
The second was his sense of what the visit was for. He had booked for his back. Many patients believe a visit has one purpose, and they wait to see if there is time for anything else. That fits his words, "one more thing."
The third was my opening. I began, "I see you're here for your back; tell me about it." I never asked what else he hoped to address. I opened with the chief complaint and closed the door on everything else before he had a chance to open it. Research on how clinicians elicit patients' agendas found that clinicians often redirect patients within seconds of their opening statement, and that concerns not elicited at the start tend to surface late in the visit, if at all (Marvel et al., 1999). The timing of his disclosure, right as I stood, fits that pattern exactly. I think the third explanation mattered most, because it was the one I could have changed.
The cost of that opening could have been high. The STOP-Bang questionnaire sorts patients by their likelihood of clinically important sleep apnea, and a total of 5 or higher places a patient in its high-risk group (Chung et al., 2016). Untreated sleep apnea causes daytime sleepiness and is associated with motor vehicle crashes. He drives children for a living. If he had not spoken at the door, or if I had been in more of a hurry, he might have left with a plan for his back and nothing for a condition that could put a busload of children at risk. His back pain may even be partly connected, since poor sleep lowers pain tolerance.
There was a second lesson in how the disclosure was handled once it came. My preceptor did not ask him to book another visit for it. She sat down, asked the questions and arranged the sleep study before he left, because a man who waited fourteen minutes to raise something might not come back to raise it again. She also asked him, gently, whether he had ever felt drowsy at the wheel. He said no, but she documented the question and his answer, and told him to pull over and call if he ever did.
I also noticed something in myself. When he spoke at the door, my first feeling was impatience; we were already over time. I am glad the feeling passed before I answered.
Now What?
One habit, tried at every visit for two weeks: after greeting the patient, before the chief complaint, I will ask, "What would you like to make sure we cover today?" and then, "Is there anything else?" until the answer is no. I will tally in my notes how often a second concern appears at the start instead of the end.
A limit is worth naming. A longer agenda also costs minutes that a family practice rarely has. Eliciting everything does not mean addressing everything today; it means choosing, with the patient, what fits and what gets its own visit. My preceptor said that knowing the whole list at minute one is what makes that choice possible. The alternative is learning it at minute fourteen with a hand on the door.
References
Chung, F., Abdullah, H. R., & Liao, P. (2016). STOP-Bang questionnaire: A practical approach to screen for obstructive sleep apnea. Chest, 149(3), 631-638. https://doi.org/10.1378/chest.15-0903
Marvel, M. K., Epstein, R. M., Flowers, K., & Beckman, H. B. (1999). Soliciting the patient's agenda: Have we improved? JAMA, 281(3), 283-287. https://doi.org/10.1001/jama.281.3.283
Rolfe, G., Freshwater, D., & Jasper, M. (2001). Critical reflection for nursing and the helping professions: A user's guide. Palgrave Macmillan.
How this NU569 Unit 3 example is structured
Rolfe's framework supplies the order, and the entry gives each question a different kind of writing. What is description only, kept to one paragraph so interpretation stays out. So what turns analytic and does most of the work: the author tests three explanations for the late disclosure, embarrassment, the patient's sense of what a back-pain visit was for, and the author's own opening, and argues from the timing and the research that the third mattered most. It also weighs the cost of that opening, a near miss on an untreated sleep disorder in a man who drives children for a living. The Now what section stays concrete and small: one opening question tried at every visit for two weeks, tallied in the author's notes. A closing paragraph names a limit, since a longer agenda also costs minutes a family practice rarely has.
Get an NU569 Unit 3 example written to your instructions
Paste the reflection prompt for your Unit 3 entry and name the model your section expects, Rolfe, Gibbs or none. We write an entry on a composite encounter in that structure with the event invented; the entry you submit still comes from your own clinic day. Free the first time, back in 24-48h. 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.
NU569 Unit 3 questions, answered
Does the reflection have to follow a named model?
Only when the prompt names one. A model such as Rolfe's or Gibbs's helps because it forces movement from event to meaning to action, and graders can see each step. Without a required model, a clear three-part order does the same job. What graders penalize is an entry that stays in description, whatever headings it uses.
What moment from clinic makes a good entry?
A small one with something unresolved in it. A late disclosure, a plan that changed after the preceptor asked one question, or a visit where you misjudged the time usually yields more analysis than a dramatic day. The moment should involve your own decision or action, because an entry about what someone else did leaves little to examine.
Can I include the patient's age and job?
Only if they cannot identify the person, and many sections prefer that details be altered or combined. A school bus driver in a small district might be recognizable where the same job in a large city is not. Our samples invent every detail, so they show format without any risk of pointing to a real patient.