| Course | NU678 PMHNP Diagnosis and Management Across the Lifespan Clinical III |
|---|---|
| Unit | Unit 2 |
| Paper type | Reflective log narrative |
| Length | About 1,000 words, 6 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU678 Unit 2
"He's Been Having a Few More Since the Funeral": A Reflective Log Narrative on the Mirtazapine Increase I Deleted for a 73-Year-Old Retired Tugboat Captain
[Student Name]
Purdue University Global
NU678: PMHNP Diagnosis and Management Across the Lifespan Clinical III
Unit 2 Reflective Log Narrative
[Instructor Name]
[Date]
The patient and family are composite; doses, scores and dates are bracketed.
What
Mr. [K.], [73], is a retired tugboat captain whose wife died [five] months ago. He came to the clinic [four] weeks earlier with low mood, poor sleep and weight loss, and was started on mirtazapine [15] mg at bedtime. At this follow-up he said his sleep was a little better and his appetite had returned, but his mood was "about the same." His PHQ-9 had fallen only from [17] to [15]. I typed the plan my preceptor and I had discussed in advance: increase to [30] mg, recheck in four weeks.
As they stood to leave, his daughter said, almost as an aside, "He's been unsteady and a bit muddled this week. He's been having a few more since the funeral." I asked them both to sit down again. With his agreement I asked the three AUDIT-C questions. His score was [7]. He was drinking [four to five] glasses of rum most evenings, up from "one on a Saturday" before his wife died, and had fallen once in the bathroom [ten] days earlier without injury. I deleted the increase, kept the current dose, and changed the plan with my preceptor.
So What
Looking back, I wanted to know first why a remark at the door changed the plan when a structured visit had not. The honest answer is that I had never asked him about alcohol. His intake form from four weeks before recorded "social drinker," and I had carried that forward without checking it against the biggest change in his life. A grieving older man living alone for the first time in fifty years is exactly the person whose drinking might change, and I had not asked.
The second question was why I nearly let the remark pass. For a moment, while standing, I thought of it as a daughter's worry, the sort of thing families say at the end of a visit, and I thought "unsteady and muddled" might be the depression or simply his age. That thought is worth examining, because it is the same thought that leads clinicians to miss substance use in older adults. A review of substance use in later life described how misuse among older adults has been under-identified for decades, partly because clinicians do not expect it and partly because its signs, such as falls, confusion and poor sleep, are easily put down to aging or to other illnesses (Kuerbis et al., 2014). My momentary thought fits that pattern precisely.
I had been about to double a sedating medicine for a man who was already falling, because I had asked about his mood and not about his evenings.
The third question was what the increase would have done. Mirtazapine is sedating, and alcohol adds to that sedation. Raising the dose at bedtime in a man drinking heavily in the evening, who had already fallen at night, could have made another fall more likely and more serious. The lack of improvement in his mood might itself have been partly due to the alcohol rather than to a dose too low. Raising the dose would have treated the wrong problem.
I also thought about why the AUDIT-C was the right tool in the moment. It is three questions long and can be asked in a minute, and it was developed and tested as a brief screen for problem drinking in outpatients (Bush et al., 1998). It gave me a number I could put in the note and a structure for a conversation he was willing to have. It did not diagnose an alcohol use disorder, and I was careful not to say that it had.
Finally, I remembered a patient from my first rotation, a [68]-year-old woman whose worsening memory had been charted for weeks as early dementia before a nurse found empty wine bottles during a home visit. At the time I had thought of that as someone else's mistake. This visit showed me it could easily have been mine.
What Happened Next
My preceptor and I talked with Mr. [K.] about the link between the evening rum, his unsteadiness and his sleep, without lecturing. He said he drank because the house was "too quiet at night." We agreed on a plan: keep mirtazapine at [15] mg; aim to cut back to no more than one drink in the evening, with his daughter's help removing most of the rum from the house; check blood counts and liver tests; a follow-up in [two] weeks rather than four; and a referral to a bereavement group that meets at his church. His daughter agreed to call if he fell again. At the two-week visit he reported [two] drinks a week, no falls, and a PHQ-9 of [12].
Now What
Three changes in my practice have followed, and I have kept to them since.
1. I ask every adult about alcohol at every follow-up, not only at intake, using the AUDIT-C questions, and I ask again whenever there has been a loss, a move or a retirement.
2. Before I increase any sedating medicine in an older adult, I ask about falls, alcohol and other sedating medicines, including over-the-counter sleep aids.
3. When a family member makes a remark at the door, I treat it as history, not as an afterthought, and I ask them to sit down again.
What I take from this visit is not that the plan was wrong when I wrote it, but that it rested on a history I had not updated. Reflection in the moment, prompted by one sentence, was enough to change it, and reflection afterward is how that moment becomes a habit (Rolfe et al., 2001).
References
Bush, K., Kivlahan, D. R., McDonell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Archives of Internal Medicine, 158(16), 1789-1795. https://doi.org/10.1001/archinte.158.16.1789
Kuerbis, A., Sacco, P., Blazer, D. G., & Moore, A. A. (2014). Substance abuse among older adults. Clinics in Geriatric Medicine, 30(3), 629-654. https://doi.org/10.1016/j.cger.2014.04.008
Rolfe, G., Freshwater, D., & Jasper, M. (2001). Critical reflection for nursing and the helping professions: A user's guide. Palgrave Macmillan.
Reading the NU 678 Unit 2 instructions
Unit 2 asks for a reflective narrative written over one of your clinical log entries, examining a decision you made during a shift. Most versions name a framework, such as Rolfe, Gibbs or Johns, and expect a short account of events, an extended analysis of your reasoning, links to evidence, and a concrete change in your practice. Somewhere between 700 and 1,000 words is normal. The rubric favors narratives that locate the turning point exactly, examine the moment you nearly made a different choice, and describe habits you now practice rather than intentions. Keep the log itself separate; the reflection is about your thinking, and the log's dates, hours and encounter details are records that belong to you and your site, so they never appear in the narrative itself.
How the NU 678 Unit 2 example is put together
The what section tells the visit in two paragraphs: four weeks of mirtazapine, a slightly lower PHQ-9, the planned increase, the daughter's remark and an AUDIT-C of 7. So what is the longest section. It asks why the history had not been updated, why the student almost let the comment pass, and what the higher dose might have done to a man already falling at night. It cites a review on under-identified substance use in older adults and the AUDIT-C validation study, and carries the highlighted sentence about asking about mood and not about evenings. An earlier patient whose drinking was charted as dementia adds a history. A short section records the revised plan and the two-week result, and now what lists three habits.
Where the points sit in the NU678 Unit 2 rubric
Reflective narratives in this course are commonly scored on description, analysis, use of evidence, self-awareness and change in practice. Description scores best when brief and factual, leaving space for analysis. Analysis is judged by how precisely the writer reconstructs the reasoning, including doubts and near misses. Evidence points go to sources tied to the decision, such as a screening tool or a review of risk, rather than general references. Self-awareness rewards honesty about what the writer failed to do, stated without excessive self-criticism. Change in practice is marked highest when the narrative describes habits already in use, with enough detail that a preceptor could observe them on the next shift, rather than promises about the future that no one could check.
Common NU678 Unit 2 mistakes, and how to avoid them
A common problem is retelling the shift at length and leaving little room for reflection. Another is writing only about feelings without examining the reasoning behind a choice. Some narratives present a good outcome as proof that the decision was right, when the reflection should examine what nearly went wrong. Others cite a framework but ignore its structure, so the so-what section never appears. Many students forget to connect the decision to evidence, which weakens the analysis. And a now-what section that says only I will be more careful gives the grader nothing to assess. Name the habit, when you use it and how you would know it is working, and the section becomes something a preceptor could confirm.
Get an NU678 Unit 2 example written to your instructions
What reflective framework does your NU678 log use, Rolfe, Gibbs or the section's own headings, and how long can each narrative run? Send that and the rubric; the log itself is yours. A narrative written over a composite shift shows one decision traced to its reasons; the first costs nothing and takes 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.
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NU678 Unit 2 questions, answered
Which reflective framework should the narrative follow?
Whichever your section names. Rolfe's three questions are compact and suit short entries; Gibbs's six-stage cycle adds explicit stages for feelings and evaluation; Johns's model suits longer pieces. The framework matters less than the proportions: brief description, extended analysis of one decision, and a concrete change in practice at the end.
Can a sample write my clinical log entries?
No. The log, including dates, times, hours and encounter details, belongs to you and is never drafted here. A sample shows only the reflective narrative written over a log entry, built on a composite patient, so the structure of the analysis is visible. Your own narrative has to come from a shift you worked.
How long should a reflective log narrative be?
Often several hundred words up to about a thousand, depending on the section. Length should go to analysis: what happened can usually be told in a paragraph, while the reasoning behind the decision, the standard it touches and the change that followed deserve most of the space. A long retelling with a short reflection inverts what graders reward.
Where can I find a free NU678 Unit 2 sample paper?
This page carries the full NU678 Unit 2 reflective log narrative under Rolfe's three headings, with the visit, the reasoning behind the deleted increase, the revised plan and three habits, plus three references. A narrative on a decision from your own shift can be drafted.
Why was the AUDIT-C used in NU678 Unit 2?
It is three questions long, can be asked in about a minute, and was validated as a brief screen for problem drinking in outpatients. It gave a score for the note and a structure for the conversation, without claiming to diagnose an alcohol use disorder.