| Course | NU655 AGACNP Acute Care Diagnosis and Management Clinical III |
|---|---|
| Unit | Unit 9 |
| Paper type | End-of-life reflection |
| Length | About 790 words, 5 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU655 Unit 9
The Argument I Never Voiced: An End-of-Life Reflection on a Woman Who Chose to Stop Dialysis
[Student Name]
Purdue University Global
NU655: AGACNP Acute Care Diagnosis and Management Clinical III
Unit 9 End-of-Life Reflection
[Instructor Name]
[Date]
The patient and encounter are composite; dates and values are bracketed.
Description
Mrs. [D.] was a [71]-year-old retired teacher with end-stage kidney disease on hemodialysis three times a week for [six] years, heart failure and a below-knee amputation. She was admitted with fluid overload after missing two sessions. On the second day she told her nephrologist that she did not want to continue dialysis. She said she was tired of the chair, the needles and the drive, that she had missed her grandson's graduation because of a session, and that she had "done enough." Her daughter was present and, after a long silence, said she understood.
The nephrologist and the palliative care team met with her twice over [two] days. A psychiatrist assessed her for depression and found none that explained the choice. Her capacity was assessed and documented: she understood her condition, the choice and its consequence, which was death within days to weeks. She stopped dialysis on [Day 3], went home with hospice on [Day 4] and died on [Day 11], with her family present.
Reflection: What Was I Trying to Achieve, and Why Did I Feel as I Did?
Throughout those days I wanted someone to persuade her to continue. I thought her fatigue was treatable, that a different schedule or home dialysis might change her mind, and that she was giving up years she could have had. I did not say any of this. I stood in the room, wrote the notes and felt frustrated.
The source of that frustration is not hard to find. Before this program I worked for [nine] years on a trauma unit, where the whole team worked to keep people alive and where stopping felt like losing. I had brought a trauma nurse's definition of success into a room where the patient had a different one, and I judged her choice by mine.
Influencing Factors
Johns's model asks what internal and external factors shaped the response (Johns, 1995). Internally, I held a belief that treatment which can extend life should be continued unless the patient cannot tolerate it. Externally, I was a student, I felt I had no place in a conversation between a patient and her nephrologist, and the team seemed settled.
The evidence did not support my frustration. Her capacity had been assessed using the recognized elements of understanding, appreciation, reasoning and expressing a choice (Appelbaum, 2007). Depression had been considered and excluded. Her reasons were her own and consistent over two days. And she knew what would follow: in a study of patients who stopped dialysis and entered hospice, mean survival was about a week (O'Connor et al., 2013), which was what her team told her.
Alternatives: Could I Have Acted Differently?
I could have said something, and I now think I should have, though not to change her mind. What I should have done was take my question to my preceptor: I am uncomfortable, and I want to understand why the team is confident. That would have given me the answers I found only later, the capacity assessment and the psychiatry note, and it would have let me be present in the room without an argument running in my head.
What I should not have done is try to persuade her. The choice was hers, made with capacity and for reasons she could explain. I have also thought about what my silence may have communicated. Patients notice the faces in the room. If my frustration showed, Mrs. [D.] may have read it as disapproval at the moment she most needed the people around her to accept what she had decided. Her daughter, who struggled with the decision, may have read it as a sign that a clinician thought her mother was wrong. A feeling kept unspoken is not the same as a feeling kept private.
Learning
The feeling was not wrong. Wanting a patient to live is part of why I became a nurse. What I got wrong was keeping it silent, where it could only turn into judgment. From now on, when I disagree with a plan, I will say so to my preceptor, ask what I am missing and then decide whether my disagreement is about the patient or about me.
I also learned something about what a good death can look like. Mrs. [D.] went home, saw her grandson again and died with her family. By her own definition, that was a success, and it was hers to define.
References
Appelbaum, P. S. (2007). Assessment of patients' competence to consent to treatment. New England Journal of Medicine, 357(18), 1834-1840. https://doi.org/10.1056/NEJMcp074045
Johns, C. (1995). Framing learning through reflection within Carper's fundamental ways of knowing in nursing. Journal of Advanced Nursing, 22(2), 226-234. https://doi.org/10.1046/j.1365-2648.1995.22020226.x
O'Connor, N. R., Dougherty, M., Harris, P. S., & Casarett, D. J. (2013). Survival after dialysis discontinuation and hospice enrollment for ESRD. Clinical Journal of the American Society of Nephrology, 8(12), 2117-2122. https://doi.org/10.2215/CJN.04110413
NU655 Unit 9 instructions, in plain terms
The Unit 9 assignment asks for a reflection on an end-of-life experience during the rotation. You describe the event, examine your own responses and where they came from, consider the influencing factors, weigh alternatives and state what you have learned. Most prompts name a structured model such as Johns's and set about 900 words in the first person. Disagreement with a patient's or family's choice can be the subject, provided it is examined honestly rather than argued. Alter any detail that could point to a real patient or family, and bring in evidence only where it sharpens the analysis.
Inside the NU655 Unit 9 example
The example tells the event once and briefly, including the patient's own reasons and the team's assessments. Most of its words go to the author's response. A highlighted sentence names the source of the frustration. The influencing factors section tests the frustration against the capacity assessment, the psychiatry review and survival data after stopping dialysis. The alternatives section says what the author should have done, which was to raise the question with the preceptor, and what the author should not have done. A paragraph considers how the silence may have looked to the patient and her daughter. The learning section ends on her own definition of success.
Reading the NU655 Unit 9 grading rubric
The Unit 9 rubric generally weighs the honesty of the reflection, use of the reflective model, analysis of influencing factors, consideration of alternatives and learning. Honesty earns full points when uncomfortable feelings are stated plainly. Use of the model counts when its cue questions organize the reflection. Analysis is judged on whether the author's response is tested against evidence rather than simply described. Alternatives should be realistic for a student. Learning should be specific and connected to future practice, such as how to raise a disagreement with a preceptor. Reflections that consider how their author's response was seen by the family often show the greatest depth.
NU655 Unit 9 help from the desk
A common mistake is turning an end-of-life reflection into an argument that the patient's choice was wrong. Another is describing the event at length and the author's response briefly. Students often skip influencing factors from their own background, which are usually the most revealing. Capacity is sometimes questioned without evidence. Some reflections end with a general statement about respecting autonomy. And reflections that never consider how the author's response might have looked to the patient miss an important dimension of the experience. Name the source of your own reaction, since that is usually where the insight lies. And test your view against what the team actually assessed, such as capacity. Finally, say what you will do the next time you disagree, and with whom you will raise it.
Get an NU655 Unit 9 example written to your instructions
End-of-life encounters belong to the student alone, and the sample respects that by modeling a different composite death. Tell us whether yours ended in a death or in a decision to withhold or stop treatment, which reflective model is required and what the rubric asks. A first reflection is free within 24-48h and examines the feeling at its center. 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.
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NU655 Unit 9 questions, answered
Is it acceptable to admit disagreement with a patient's choice?
Yes, if it is examined rather than argued. The sample states the author's frustration in its first analytic paragraph and spends several sections tracing it, while the patient's decision stands unchallenged throughout. Rubrics for this unit generally reward that honesty. Your own reflection should describe your own response to an encounter that was yours.
What reflective model does the sample use?
Johns's model for structured reflection, whose cue questions move from description through influencing factors and alternatives to learning. Many sections assign Gibbs's cycle or another model instead. If your prompt names one, the reflection is rebuilt around its stages so each section answers the questions that model asks.
Where can I find a free NU655 Unit 9 sample paper?
This page holds the complete NU655 Unit 9 end-of-life reflection, organized by Johns's cue questions, with the author's unvoiced disagreement examined. A free reflection on your own end-of-life experience can be written from the details you share.
How long do patients live after stopping dialysis in NU655 Unit 9?
In the study the sample cites, patients who stopped dialysis and entered hospice lived a mean of about 7.4 days. The patient in the sample died eight days after stopping, which matches what her team told her.
Should the NU655 Unit 9 reflection say the patient was wrong?
No. The sample states the author's disagreement honestly, then tests it against her capacity assessment and her own reasons, and concludes the choice was hers to make. The fault it finds is in the author's silence, not in her decision.