| Course | NU677 PMHNP Diagnosis and Management Across the Lifespan III |
|---|---|
| Unit | Unit 8 |
| Paper type | Capacity assessment |
| Length | About 720 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 8
One Decision Only: A Capacity Assessment of an 81-Year-Old Retired Bookbinder With Vascular Neurocognitive Disorder Who Refuses Assisted Living
[Student Name]
Purdue University Global
NU677: PMHNP Diagnosis and Management Across the Lifespan III
Unit 8 Capacity Assessment
[Instructor Name]
[Date]
The patient is composite; scores, dates and details are bracketed.
The Decision in Question
Where to live after discharge: return home alone, with or without services, or move to assisted living. The assessment does not address her capacity for any other decision, such as finances or medical treatment.
Background
Mrs. [O.], [81], a retired bookbinder and widow, has been alone in her narrow two-story house since her husband died. Her diagnosis is vascular neurocognitive disorder, mild to moderate, diagnosed [two] years ago after two small strokes; her most recent Montreal Cognitive Assessment was [17]. In [January] she left a pan on the stove and her kitchen caught fire; a neighbor put it out. She has fallen twice since, once on the stairs. She was admitted after the second fall with a wrist fracture. The team recommends assisted living. She says: "I'm going home. I've lived there forty years."
Capacity is not the same as a cognitive test score. A person with a low score may still be able to make a particular decision, and a person with a normal score may not. Assessment should focus on the specific decision and the abilities it requires (Moye & Marson, 2007).
The Four Abilities
The assessment used the four abilities commonly applied in clinical capacity assessment: understanding, appreciation, reasoning and expressing a choice (Appelbaum, 2007). Structured tools such as the MacArthur Competence Assessment Tool for Treatment were built around the same four abilities (Grisso et al., 1997); here each was tested with open questions after the options were explained in plain words.
1. Understanding. Asked to explain the choice in her own words, she said: "They want me in a home because of the fire and because I fell. I could go home, or go to that place with the apartments." She described the main risks of going home: "I might fall again, or forget the stove." She understands the options and their main consequences.
2. Appreciation. Asked whether these risks apply to her, she said: "The fire was a one-time thing. I've cooked for sixty years." Asked about the falls: "Everyone falls." When the second fall and the wrist fracture were pointed out, she said, "That was the rug. I'll move the rug." She does not accept that her memory or her strokes contribute to either risk, and says her memory is "as good as anybody's."
3. Reasoning. She compared the options: at home she has her garden, her books and her cat; in assisted living she would lose them. She weighed these against the risks, but because she does not accept the risks as hers, the comparison gives them almost no weight.
4. Expressing a choice. Clear and consistent across two conversations on different days: she will go home.
She understands the risks in general and states a consistent choice, but she does not accept that the risks apply to her, and it is that gap in appreciation that shapes her reasoning.
Conclusion for This Decision
Mrs. [O.] has an impairment in appreciation that likely reflects her vascular neurocognitive disorder, which limits her capacity to decide about returning home alone without supports. The impairment is partial, not absolute: her values, home, garden, independence, are clear and consistent and should guide what is done.
What Follows From the Conclusion
A finding of limited capacity does not by itself mean she must go to assisted living. It means her surrogate, her son, who holds her health care power of attorney, becomes involved in the decision, guided by her known values. The team and her son agreed to explore the least restrictive option first: a trial return home with daily home care visits, a stove shut-off device, a medical alert pendant, removal of the stair rug and a stairlift assessment, and a review in [four] weeks. If another fall or fire occurs, the decision will be revisited with her son.
Reassessment
Capacity can change. She will be reassessed for this decision if her condition changes or if she accepts help at home that alters the risks.
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
Grisso, T., Appelbaum, P. S., & Hill-Fotouhi, C. (1997). The MacCAT-T: A clinical tool to assess patients' capacities to make treatment decisions. Psychiatric Services, 48(11), 1415-1419. https://doi.org/10.1176/ps.48.11.1415
Moye, J., & Marson, D. C. (2007). Assessment of decision-making capacity in older adults: An emerging area of practice and research. The Journals of Gerontology: Series B, 62(1), P3-P11. https://doi.org/10.1093/geronb/62.1.P3
What the NU677 Unit 8 assignment asks for
In Unit 8 you assess a patient's capacity to make one specific decision and document the process and conclusion. Most prompts ask you to define the decision, give the background, test understanding, appreciation, reasoning and choice with the patient's own words, reach a conclusion for that decision only, and say what follows. A note of two to three pages will usually do. Graders reward assessments that avoid equating a cognitive score with capacity, that quote the patient, and that respond to limited capacity with the least restrictive option consistent with her values. Noting that capacity can change and when it will be reassessed completes the note and protects the patient from a permanent label.
Inside the NU677 Unit 8 example
The note opens by defining the decision and excluding all others. Background covers her diagnosis, her MoCA of 17, the fire and the falls, with Moye and Marson on why capacity is decision-specific. The four abilities follow, introduced with Appelbaum and the MacCAT-T, and each is tested with her answers quoted, from her description of the options to her explanations for the fire and the fall. A highlighted sentence names the gap in appreciation. The conclusion limits itself to this decision, and the next section describes her son's role and a trial return home with daily visits, a stove shut-off, an alert pendant and a stairlift assessment.
Where the points sit in the NU677 Unit 8 rubric
Capacity assessments are generally scored on definition of the decision, testing of each ability, use of the patient's words, the conclusion and the response to it. Definition earns full points when the note states exactly which decision is assessed. Testing rewards separate evidence for understanding, appreciation, reasoning and choice. Use of words is judged on quotations that let a reader check the conclusion. The conclusion should be specific to the decision and, where impairment is partial, say so. The response row rewards the least restrictive option that honors the patient's values, involvement of the legal surrogate and a plan to reassess if circumstances or her condition change.
NU677 Unit 8 help: mistakes that cost points
The most common mistake is concluding that a patient with dementia lacks capacity because of the diagnosis or a low test score. Another is assessing capacity globally rather than for one decision. Students often record understanding and choice but skip appreciation, which is where many patients with cognitive impairment struggle. Some notes treat a finding of limited capacity as a decision in itself, moving the patient without considering alternatives. Others fail to involve the named health care agent. And forgetting to plan reassessment can turn a temporary conclusion into a permanent one, which the patient and her family may never have agreed to. Remember that a surrogate decision should still follow her values, so the note should record what she cares about as carefully as it records her answers to each question.
Get an NU677 Unit 8 example written to your instructions
Name the decision your NU677 Unit 8 case puts in question, whether placement, a procedure or a medication, then supply the case and rubric. Within 24-48h a free first assessment follows, fixing that decision in its first line, removing obstacles before judging, and working through all four abilities using the patient's own words. 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 8 questions, answered
How do capacity and competence differ?
Capacity is a clinical judgment about a person's ability to make a specific decision at a specific time. Competence is a legal status decided by a court. Clinicians assess capacity; they do not declare anyone incompetent. A written assessment should use the clinical term, name the decision and avoid language suggesting a legal ruling has been made.
Does a diagnosis of dementia mean a person lacks capacity?
No. Many people with dementia retain capacity for many decisions, especially earlier in the illness or for simpler choices. The assessment has to show how the condition affects the specific abilities needed for this decision. A paper that concludes incapacity from the diagnosis alone has skipped the assessment the assignment asks for.
What happens after a finding of incapacity?
A surrogate decides, usually a health care agent named in advance or a relative under the state's hierarchy, guided by the person's known values and current preferences. Identify who that is under the applicable law, bracketed, record the person's wishes for the surrogate to weigh and set a date for reassessment, since capacity can return.
Where can I find a free NU677 Unit 8 sample paper?
This page holds the full NU677 Unit 8 capacity assessment, with the decision defined, each ability tested in her words, the conclusion for this decision only and the least restrictive plan, plus three references. An assessment for your own patient's decision can be requested.
Which ability was impaired in NU677 Unit 8?
Appreciation. She understood the options and their risks in general and stated a consistent choice, but did not accept that the risks applied to her, attributing the fire to chance and the fall to a rug, which shaped her reasoning.