In this NU585 Unit 9 narrative, a weight-loss note written without the patient's voice is retold, its hidden assumption named, and one habit adopted: hearing addressed before any history. Searches like "nu 585 unit 9 assignment example", "nu585 unit 9 sample" and "nu585 unit 9 example" land here.
One Sentence Through a Borrowed Amplifier: A Reflective Narrative on a Weight-Loss Note Written Around a Resident's Silence
[Student Name]
Purdue University Global
NU585: AGNP II Clinical - Frail Elderly Focus
Unit 9 Reflective Narrative
[Instructor Name]
[Date]
The resident is a composite; no real person is described.
The First Visit
The dietitian had flagged a weight loss of [3.2] kg over two months for Mrs. [D.], 92, who spent forty years as a switchboard operator. When I asked her how she was eating, she looked at me and said nothing, then looked at the aide. The aide answered for her: "She just doesn't finish her plate anymore. She's been more confused." I took the rest of the history from the aide. My note described weight loss in a resident with dementia and proposed a calorie supplement and a swallow evaluation.
The Return Visit
A week later my preceptor, passing the activities room, borrowed a pocket amplifier with headphones and handed it to me. I placed the headphones on Mrs. [D.], spoke into the microphone and asked, "How is eating these days?" She said, clearly, "My bottom teeth have been rubbing a sore, and it hurts to chew." On examination there was an ulcer on the lower gum where her denture pressed. She had not been confused; she had not heard me.
The Assumption
I had not forgotten to ask. I had asked, and when she did not answer, I decided without noticing that the aide's account would serve. My assumption was that her silence was dementia, and I held it so easily that I never tested it. Mezirow's term for this is a disorienting dilemma: an event that cannot be made to fit how one already sees things, and that pushes a person to look at beliefs so familiar they had gone unnoticed (Mezirow, 1991). Her sentence through the amplifier was that dilemma. It unsettled more than one visit, because I realized I had probably made the same assumption before, in other rooms, with other residents who did not answer.
The assumption was not only mine, and it is not rare. Hearing loss is very common in older adults, and in a large cohort, hearing loss was associated with faster cognitive decline over six years (Lin et al., 2013). The Lancet Commission on dementia identified hearing loss as one of the largest modifiable risk factors for dementia (Livingston et al., 2020). If hearing loss can contribute to real cognitive decline, it can certainly be mistaken for it in a single conversation. An unanswered question in a noisy hallway, from a student standing at the foot of the bed, is not a test of cognition.
What the First Note Would Have Done
If the first note had stood, Mrs. [D.] would have received a calorie supplement she could not chew around and a swallow evaluation she did not need, and the sore would have kept her from eating. Her weight would likely have kept falling. The note's language, "more confused," would have followed her into the next quarterly assessment and perhaps into a conversation about her dementia progressing. A label written on the basis of one unanswered question can travel far in a long-stay record, and each clinician who reads it has less reason to test it. The amplifier did not only change one visit; it removed a word from her chart that did not belong there.
Why the Aide Answered
I do not blame the aide. She answered because she knows Mrs. [D.] well, because she wanted to help, and because the resident had turned to her. Her observation, that Mrs. [D.] was not finishing meals, was accurate and important. What she could not know was why, and neither could I, until someone asked the person who did.
The Change
From now on, before the first question, I address hearing: I sit at eye level, face her, reduce background noise, check whether hearing aids are in and working, and offer an amplifier if needed. And in every note, I record how the history was obtained: from the resident directly, with an amplifier, through an aide, or through family.
I tested the change. For four weeks I kept a tally in my own notes of whether I addressed hearing before the first question. In the first week I remembered in [five] of [eight] visits; by the fourth, in [eight] of [eight]. The tally is mine, and it showed me that the habit takes practice, not just intention.
What Happened to Mrs. D.
The dentist relined her denture, the sore healed, and she began eating again. The calorie supplement was not needed. She has a new hearing aid battery routine, and the aides now check it each morning.
References
Lin, F. R., Yaffe, K., Xia, J., Xue, Q.-L., Harris, T. B., Purchase-Helzner, E., Satterfield, S., Ayonayon, H. N., Ferrucci, L., & Simonsick, E. M. (2013). Hearing loss and cognitive decline in older adults. JAMA Internal Medicine, 173(4), 293-299. https://doi.org/10.1001/jamainternmed.2013.1868
Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., Brayne, C., Burns, A., Cohen-Mansfield, J., Cooper, C., Costafreda, S. G., Dias, A., Fox, N., Gitlin, L. N., Howard, R., Kales, H. C., Kivimäki, M., Larson, E. B., Ogunniyi, A., ... Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet, 396(10248), 413-446. https://doi.org/10.1016/S0140-6736(20)30367-6
Mezirow, J. (1991). Transformative dimensions of adult learning. Jossey-Bass.
How this NU585 Unit 9 example is structured
The narrative is shaped around the gap between two visits. Events come first and are kept free of commentary, so a reader sees the first note as it was written before learning what it missed. Analysis follows in the third section, and it looks for the assumption rather than the error: the author did not forget to ask, but decided without noticing that an aide's account would serve. Mezirow's transformative learning theory is used for one idea only, that a disorienting dilemma prompts examination of an assumption held so long it had become invisible. The author checks that assumption against evidence that unaddressed hearing loss is common among residents and can be mistaken for cognitive decline. The change is stated as a sequence, then tested: for four weeks, the author's own notes record whether hearing was addressed first, and the tally stays with the writer.
Get an NU585 Unit 9 example written to your instructions
Describe the moment from your rotation that your Unit 9 narrative will turn on, in a sentence or two with names, places and dates altered, and include the prompt and rubric. The sample builds a composite episode of that kind, names the assumption behind it and states a change with a way to check it. Free the first time; 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 9 questions, answered
How is a reflective narrative different from a journal entry?
A narrative usually tells one episode in full and builds an argument from it, while a journal entry records a day's experience more briefly and often more loosely. Many rubrics for narratives expect a named moment, analysis of your own reasoning, a source that explains it, and a specific change. Check whether your section requires a particular reflection model before choosing one.
Which reflection theory works well for a narrative like this?
Whichever your section teaches. Mezirow's transformative learning theory suits a moment that exposed an assumption, Schon's reflection-on-action suits a decision reconsidered afterward, and structured models such as Gibbs or Johns suit a step-by-step account. Use one idea from the theory well rather than summarizing all of it, and cite its source so the grader can check it.
Can the narrative describe a mistake I made with a real resident?
It can describe the reasoning, but change or combine the details so no resident, staff member or facility could be recognized, and many faculty prefer a composite outright. Anything reportable, such as an error that caused harm, belongs with your site and preceptor, not only in coursework. The sample's episode is invented and involves no harm to anyone.