| Course | NU677 PMHNP Diagnosis and Management Across the Lifespan III |
|---|---|
| Unit | Unit 5 |
| Paper type | Seminar reflection |
| Length | About 800 words, 5 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU677 Unit 5
Which Version of Her to Honor: A Seminar Reflection on a Psychiatric Advance Directive Written When Well and Refused When Manic
[Student Name]
Purdue University Global
NU677: PMHNP Diagnosis and Management Across the Lifespan III
Unit 5 Seminar Reflection
[Instructor Name]
[Date]
The patient and seminar group are composite; details are bracketed.
The Case
Our case was Ms. [B.], a [41]-year-old structural bridge inspector with bipolar I disorder and three prior manic episodes, the last of which cost her a job and a relationship. Two years ago, during a period of stability and with her outpatient clinician's help, she completed a psychiatric advance directive. It named her sister as her agent, listed early signs of mania, and said: "If I become manic and refuse medication, I want to be treated anyway, even if I say I don't. That person is not me."
Her sister brought her to the emergency department after [four] sleepless nights, driving to three states to "inspect bridges nobody asked me to inspect." She was grandiose, rapid in speech and irritable. She refused lithium, which had helped before, and said: "I wrote that when I was depressed and scared. I'm finally myself. It doesn't count anymore."
My Starting View
I came to the seminar with a clear answer: honor the directive. She wrote it when well, she anticipated exactly this situation, and she explicitly asked us to override her future refusal. To me this was the whole point of an advance directive, the same logic as a living will. I said so early, and several classmates agreed.
What the Discussion Raised
The facilitator asked what makes the earlier self more authoritative than the present one. A classmate, [Omar], pointed out that people revise their views over time and that we would not normally hold someone to a decision made two years earlier if they now had capacity and disagreed. The question, he said, was not which self to honor but whether she has capacity now.
That reframed the problem for me. Capacity is decision-specific and can be assessed: it asks whether she grasps the facts about her illness and treatment, sees that they apply to her, weighs the options and can state a choice (Appelbaum, 2007). If she has capacity now, her present refusal generally stands, and a directive cannot override a capable refusal. If she lacks capacity, which seemed likely given her grandiosity and her inability to appreciate the risks of driving without sleep, the directive becomes the best evidence of what she would want, and her agent can use it.
The directive was never meant to let the well self overrule a capable present self; it was meant to speak when the present self cannot.
A second classmate, [Hana], raised a different concern: some patients complete directives to refuse treatment, and if we honor directives that request treatment we must honor those that refuse it. The facilitator noted that state laws differ on whether and when a psychiatric advance directive can be overridden, and that many allow override in emergencies or under civil commitment standards.
The Evidence the Group Found
We looked at what directives and similar plans actually achieve. In a randomized trial, a facilitated session helped patients with serious mental illness complete psychiatric advance directives that contained useful treatment information, and those who completed one reported a stronger working alliance with their clinicians a month later (Swanson et al., 2006). In another trial, joint crisis plans, written with the patient and team ahead of a crisis, reduced compulsory admission and treatment in people with severe mental illness (Henderson et al., 2004). Both suggest that the value of planning ahead lies partly in the conversation and relationship it creates, not only in the document.
How My View Changed
I still think the directive should guide her treatment, but for a different reason and by a different route. My first answer skipped a step: a capacity assessment. I also treated the directive as a contract rather than as evidence of her values. The seminar moved me to see it as the clearest statement of what she wants when she is able to weigh her illness, which becomes decisive only when she cannot.
Changes I Will Make
1. When a patient refuses treatment that an advance directive requests, I will assess and document capacity for that decision before relying on the directive.
2. I will involve the named agent early, since the directive gives her a role.
3. I will check the state's law on psychiatric advance directives rather than assuming they work like medical living wills.
4. When I help a well patient complete a directive, I will discuss exactly this scenario, a future self who disagrees, so the document says how the patient wants it handled.
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
Henderson, C., Flood, C., Leese, M., Thornicroft, G., Sutherby, K., & Szmukler, G. (2004). Effect of joint crisis plans on use of compulsory treatment in psychiatry: Single blind randomised controlled trial. BMJ, 329(7458), Article 136. https://doi.org/10.1136/bmj.38155.585046.63
Swanson, J. W., Swartz, M. S., Elbogen, E. B., Van Dorn, R. A., Ferron, J., Wagner, H. R., McCauley, B. J., & Kim, M. (2006). Facilitated psychiatric advance directives: A randomized trial of an intervention to foster advance treatment planning among persons with severe mental illness. American Journal of Psychiatry, 163(11), 1943-1951. https://doi.org/10.1176/ajp.2006.163.11.1943
Reading the NU 677 Unit 5 instructions
For Unit 5 you reflect on a seminar discussion of an ethical or legal dilemma and describe how your thinking changed. Prompts usually ask for your first view, the arguments and evidence raised, the moment your view shifted, your revised position and what you will do differently. Around two to three pages written in the first person suits the task, and it should cite sources for the frameworks and evidence discussed. Graders reward reflections that show why the first view was attractive and precisely what changed it, and that handle law carefully by naming where it varies by state. A revised position that is conditional, stating when it applies, is often stronger and more honest than a new flat answer that replaces the old one.
How this NU677 Unit 5 example is built
The case is presented through her directive's own words and her words in the emergency department. The author's first view is stated plainly, with the reason it seemed obvious. The discussion section records a classmate's question about which self has authority, applies the four abilities of capacity assessment, and a highlighted sentence restates what the directive was for. A second classmate's point about directives that refuse treatment follows, with the note on state law. The Swanson and Henderson trials show what planning ahead achieves. The author then describes exactly where the earlier answer gave way, and four commitments carry the lesson into practice, including discussing this scenario whenever a directive is written.
Reading the NU677 Unit 5 grading rubric
Reflections on ethical cases are generally marked on honesty about the first view, the moment of change, accuracy about law and capacity, use of evidence and commitments for practice. Honesty scores highest when the writer shows why the first answer felt right. The moment of change is expected to rest on a specific question or argument from the seminar. Accuracy rewards correct use of the capacity framework and careful handling of state variation. Evidence points go to studies of advance directives and crisis plans used to inform the view, not only cited. Practical learning credit goes to commitments that would change how the author acts in the emergency department and when helping patients write directives in the first place.
Common NU677 Unit 5 mistakes, and how to avoid them
A frequent weakness is answering the dilemma with a principle, honor the directive or honor the present refusal, without assessing capacity. Another is treating psychiatric advance directives as identical to medical living wills, which they are not in many states. Students often forget the named agent, who has a defined role. Some reflections cite the ethics literature without saying how it changed their view. Others end with a new absolute answer instead of a conditional one. And leaving out the classmates' arguments that challenged the author removes the most important evidence that the reflection is genuine rather than written after the fact. Some reflections also forget that the patient herself is the best source on what the directive meant, and asking her once she is well closes the loop the seminar opened.
Get an NU677 Unit 5 example written to your instructions
Say which ethics scenario the Unit 5 seminar in your NU677 section argued over, and your stance going in. A short summary works, or the written route's prompt, plus the rubric. Within 24-48h a free first reflection follows, giving that early position its strongest form, the moment your mind changed and the objection still unanswered. 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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NU677 Unit 5 questions, answered
What is a psychiatric advance directive?
A document written while a person has capacity that records treatment preferences, and sometimes names a decision-maker, for a future crisis. States regulate them differently, including whether a person can bind themselves against revoking the directive while unwell. Describe the directive in the case accurately, note that state law governs its legal force, and link any use of it to a capacity finding.
Must the reflection finish on a firm position?
It can end on a conditional position, which is often stronger than a flat one. Say what you now think and under what circumstances it would change. Instructors want to see a view that moved for a stated reason. An ending that surveys both sides without committing reads as avoidance, while a qualified commitment shows judgment.
How should a seminar reflection treat law it cannot settle?
Name the legal question, bracket the state-specific answer and avoid presenting law as uniform. Seminar reflections are about reasoning, not legal advice, so describe how the legal uncertainty affected the group's conclusion. Where a statute would decide the case, say which kind of provision would matter and leave its content to the jurisdiction the prompt names.
Where can I find a free NU677 Unit 5 sample paper?
This page holds the complete NU677 Unit 5 seminar reflection, from the author's first answer through the classmates' arguments, the capacity framework, the trial evidence, the revised view and four commitments, with three references listed after it. Help with a reflection on a different seminar dilemma is available.
When does a psychiatric advance directive guide treatment in NU677 Unit 5?
When the person lacks capacity for the decision. If she has capacity now, her present refusal generally stands; if she does not, the directive is the best evidence of her wishes and her named agent can act on it, within state law.