Dignity of risk, weighed against a team's fear of a third fall, frames NU585's Unit 5 reflection on a resident refusing alarms and night supervision, and on its author's changed view. Searches like "nu 585 unit 5 assignment example", "nu585 unit 5 sample" and "nu585 unit 5 example" land here.
No Alarm, No Walker at Night, No One at the Door: A Reflection on Dignity of Risk After a Second Fall
[Student Name]
Purdue University Global
NU585: AGNP II Clinical - Frail Elderly Focus
Unit 5 Seminar Reflection
[Instructor Name]
[Date]
The resident is a composite used in the seminar; no real person is described.
The Case
Mr. [B.], 88, a retired machinist, lives in long-term care with mild cognitive impairment. The team agrees his judgment about his own routines is sound. He has fallen twice in three weeks, both times on the way to the bathroom after midnight, unwitnessed, with nothing worse than a bruised forearm. The staff proposed a bed alarm, a walker at night and an aide waiting outside the bathroom. He refused all three: "I've been going to the toilet by myself for eighty-eight years."
Where I Started
I favored a position alarm and scheduled toileting rounds. Two falls in three weeks felt like a warning, and I thought the alarm was the least we could do. I was also thinking, honestly, about the facility's liability if he fell again and broke a hip.
What the Seminar Brought
A classmate summarized federal survey guidance for nursing facilities, which cautions that position-change alarms can restrict a resident's movement, disturb sleep and function as a restraint if the resident avoids moving to avoid setting them off (Centers for Medicare & Medicaid Services, 2024). She added that in a large hospital trial, increasing bed alarm use did not reduce falls (Shorr et al., 2012). I had assumed alarms prevented falls; the evidence did not support that assumption.
The facilitator introduced the phrase "dignity of risk," coined by Perske (1972) in writing about people with intellectual disabilities: that protecting a person from every risk denies them the dignity of ordinary life, including the right to take reasonable risks. Mr. B.'s refusal was not noncompliance; it was a man with sound judgment choosing independence over safety, which he has the right to do.
Then the group debated negotiated risk agreements, documents in which a resident acknowledges a risk and the facility records the discussion. Some classmates saw them as respectful; others worried that they shift responsibility onto residents without reducing harm. We did not settle it.
Where I Ended
I no longer think the alarm was the least we could do. It might have been the most harmful: waking him, frightening him, and making him less likely to get up when he needed to, or more likely to rush. What I came to think instead is that the goal was not to stop him walking to the bathroom at night, but to make the walk safer on his terms. That meant asking him what would help, not telling him what he had to accept.
I also had to admit the liability thought for what it was. Protecting the facility is not the same as protecting him, and a plan built on the first may not serve the second.
What the Night Staff Said
When the compromise was proposed at a care conference, the night charge nurse objected. She had found him on the floor the second time, and she was the one who would find him if it happened again. Her worry was real, and it deserved an answer rather than a lecture about dignity. The team agreed that night staff would check on him at their usual rounds without waiting at the bathroom door, that the lower bed and night light would be in place before the week was out, and that any third fall would bring everyone, including him, back to the table. She said she could live with that. Dignity of risk does not mean the staff stop caring; it means they care in a way he can accept.
The Compromise He Accepted
When asked what might make the night walk easier, Mr. [B.] agreed to three things: a motion-activated night light along the path to the bathroom, a urinal at the bedside for the nights he feels unsteady, and a lower bed so that getting up is easier. He also agreed to a review of his evening medicines, since one of them makes him urinate at night. He declined the walker and the aide at the door, and his choices are recorded in his care plan with the conversation that produced them.
What I Will Carry Forward
Before proposing a safety measure, I will ask what the person would accept and what the measure would cost him. I will check whether the measure works before assuming it does. And I will separate the resident's risk from the institution's discomfort, because they are not the same, and a plan that confuses them will usually protect the building at the expense of the man living in it.
References
Centers for Medicare & Medicaid Services. (2024). State operations manual, Appendix PP: Guidance to surveyors for long term care facilities. https://www.cms.gov/medicare/provider-enrollment-and-certification/guidanceforlawsandregulations/nursing-homes
Perske, R. (1972). The dignity of risk and the mentally retarded. Mental Retardation, 10(1), 24-27.
Shorr, R. I., Chandler, A. M., Mion, L. C., Waters, T. M., Liu, M., Daniels, M. J., Kessler, L. A., & Miller, S. T. (2012). Effects of an intervention to increase bed alarm use to prevent falls in hospitalized patients: A cluster randomized trial. Annals of Internal Medicine, 157(10), 692-699. https://doi.org/10.7326/0003-4819-157-10-201211200-00005
How this NU585 Unit 5 example is structured
Its arc runs from what the author wanted to do to him toward what the author now thinks should be done with him, and the entering position is stated without softening. The seminar section credits each idea to its source by role, classmate or facilitator, and gives the most room to the one that unsettled the author: an alarm meant to protect him might keep him in bed from fear, which makes it a restraint by another name. Dignity of risk is then applied narrowly, not as a slogan; the author separates his informed refusal from hazards he cannot see, and notes that nobody on the team had asked why he walks at night. The revised position favors reducing the danger inside the choice he has made. Its final paragraph admits that another fall may still happen, and that accepting this possibility is part of the plan.
Get an NU585 Unit 5 example written to your instructions
Which refusal did your Unit 5 seminar take up, and did you attend live or complete the written alternative? Send that with the rubric. We write the reflection around a composite resident, starting from a stated position and ending on a compromise the resident accepts. First sample free, returned inside 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.
NU585 Unit 5 questions, answered
What is dignity of risk?
A principle that people have a right to take reasonable risks in their own lives, and that removing all risk can strip away dignity and independence. Robert Perske named it in 1972 in writing about people with intellectual disabilities, and it has since spread into aging services. Cite the source, and apply it with limits, since it does not cover hazards a person cannot recognize.
What if I completed the written alternative instead of the live seminar?
Many sections offer one, and the reflection then responds to the prompt and readings rather than to classmates' comments. The structure still works: state where you started, what in the readings challenged it, and where you ended. Credit ideas to their authors instead of to seminar voices. The sample can be built either way once you tell us which route you took.
Is a negotiated risk agreement legally binding?
Not reliably, and its standing varies by state and setting. Assisted living communities use such agreements more often than nursing facilities, and they are not generally treated as a waiver of the duty of care. A reflection can discuss them as a communication tool while saying plainly that their legal force is uncertain, bracketed as State where the prompt names none.