| Course | NU743 Clinical Decision-Making and Collaboration |
|---|---|
| Unit | Unit 10 |
| Paper type | Integrated case report |
| Length | About 1,130 words, 7 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | September 2026 |
Free sample paper for NU743 Unit 10
Heavy Legs, Two Days: An Integrated Case Report of Metastatic Spinal Cord Compression in a 71-Year-Old Retired Machinist, Following the Reasoning and the Negotiation Among Four Services Day by Day
[Student Name]
Purdue University Global
NU743: Clinical Decision-Making and Collaboration
Unit 10 Integrated Case Report
[Instructor Name]
[Date]
The patient, family and services are composite; examination findings, doses and times are bracketed. Quotations are attributed by service only.
Day 1
Reasoning. Mr. [G.], [71], a retired machinist, has prostate cancer with known bone metastases, treated with androgen deprivation for [two] years. He came to the emergency department with [three] weeks of mid-back pain, worse lying down, and [two] days of legs that felt "heavy" on stairs. The emergency note recorded back pain and weakness. On my examination, hip flexor strength was [4/5] on both sides, knee extension [5/5], reflexes brisk at the knees, and pinprick sensation reduced below a level near [T10]. He had no urinary retention on a bladder scan. The combination of known bone metastases, back pain worse lying flat, bilateral weakness and a sensory level meant spinal cord compression until proven otherwise, and the first task was to find it before function was lost. I gave dexamethasone [10] mg intravenously, continued at [4] mg every [six] hours, and ordered whole-spine MRI within [24] hours, since compression at more than one level is common.
Negotiation. The night radiology team initially offered an MRI the next afternoon. I called and explained the examination findings; the scan was moved to [0700].
Day 2
Reasoning. MRI showed epidural compression at [T9] with deformation of the cord, from a metastasis in the vertebral body with some collapse, and no compression at other levels. The Spinal Instability Neoplastic Score, which combines location, pain, bone quality, alignment, vertebral body collapse and posterior involvement, was [8], in the indeterminate range between stable and unstable, for which surgical consultation is advised (Fisher et al., 2010). His strength was unchanged.
Negotiation. I paged neurosurgery and radiation oncology in the morning and medical oncology at noon. Each saw him separately that day. By evening, each had written a different plan.
By the end of day two the diagnosis was settled; the decision was not, because four services were each answering a different question.
Day 3
Reasoning. The plans differed because each service weighed different elements. A framework for treating spinal metastases organizes the decision around four considerations: neurologic findings and the degree of epidural compression, the tumor's expected response to radiation, mechanical stability, and systemic disease and survival (Laufer et al., 2013). Using that framework helped me see that the services were not disagreeing about facts but about which element should lead.
Negotiation. Neurosurgery proposed decompression and stabilization followed by radiation: "He's walking now. If we wait and radiation doesn't work fast enough, he may not be." Radiation oncology argued for radiation alone: "Prostate cancer usually responds to radiation. Surgery at seventy-one isn't small." Medical oncology estimated his survival at [twelve to eighteen] months, given that his cancer was still responding to hormone therapy. I asked each service to state what would change its recommendation.
Day 4
Reasoning. The central evidence was a randomized trial of patients with spinal cord compression from metastatic cancer, which found that direct decompressive surgery followed by radiation allowed more patients to walk after treatment, and to keep walking longer, than radiation alone (Patchell et al., 2005). Its participants had compression at a single area, had not been paralyzed for more than [48] hours and were expected to live at least three months, and tumors highly sensitive to radiation, such as lymphoma, were excluded. Mr. [G.] met each condition. His SINS score added a mechanical reason for surgery. The strongest argument for radiation alone was the responsiveness of prostate cancer to radiation, and it was a fair one. But with a partly collapsed vertebra and indeterminate stability, radiation alone would treat the tumor without addressing the mechanics.
Negotiation. I arranged a meeting at [1400] with all three services, Mr. [G.] and his daughter. I asked Mr. [G.] what mattered most. He said: "Walking to my workshop. I'll take the risk to keep that." His daughter asked about recovery time. Radiation oncology said that, given his wishes and the stability score, it would support surgery followed by radiation. Neurosurgery agreed to a posterior decompression and stabilization the next morning.
Day 5
Reasoning and outcome. Surgery went as planned. On the evening of day five, he stood with a walker and his hip flexor strength was [4+/5]. Radiation was scheduled to start after the wound healed.
Negotiation. Before discharge planning began, the services agreed on who would lead follow-up: radiation oncology for the next course, neurosurgery for the wound, and medical oncology for systemic treatment, with me coordinating until transfer to rehabilitation.
What the Two Strands Show Together
The reasoning strand shows a diagnosis made on day one from an examination, confirmed on day two, and a treatment decision built from evidence that fit him. The negotiation strand shows that the evidence did not decide the case alone. Each service was right about the element it cared most about. What brought them together was a shared framework, a trial whose inclusion criteria he met, and the patient's own statement of what mattered, heard by all of them in the same room.
The Hospitalist's Role Between Services
None of the three consulting services was responsible for the whole decision; each was responsible for its own recommendation. As the hospitalist nurse practitioner, I was the only clinician who had examined him on day one, spoken with each service and heard the patient's goals. That position carried two duties. The first was to keep the clinical clock visible: spinal cord compression is a condition in which function lost over hours may not return, and each day of disagreement carried a risk that his strength would fall. I examined him twice a day and shared the findings with all three services, so the debate stayed tied to his current state. The second duty was to make sure the decision was made with him, not about him. The separate consultations had each asked him questions, but none had asked him what he would trade for walking. Bringing everyone into one room was less a matter of authority than of making sure the question was asked in front of those who needed to hear the answer.
What I Would Do Again and Differently
I would again examine for a sensory level in any patient with known bone metastases and back pain, and push for MRI within hours. I would call the meeting on day three, not day four; a day of separate consultations produced three plans that had to be reconciled later.
References
Fisher, C. G., DiPaola, C. P., Ryken, T. C., Bilsky, M. H., Shaffrey, C. I., Berven, S. H., Harrop, J. S., Fehlings, M. G., Boriani, S., Chou, D., Schmidt, M. H., Polly, D. W., Biagini, R., Burch, S., Dekutoski, M. B., Ganju, A., Gerszten, P. C., Gokaslan, Z. L., Groff, M. W., . . . Fourney, D. R. (2010). A novel classification system for spinal instability in neoplastic disease: An evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine, 35(22), E1221-E1229. https://doi.org/10.1097/BRS.0b013e3181e16ae2
Laufer, I., Rubin, D. G., Lis, E., Cox, B. W., Stubblefield, M. D., Yamada, Y., & Bilsky, M. H. (2013). The NOMS framework: Approach to the treatment of spinal metastatic tumors. The Oncologist, 18(6), 744-751. https://doi.org/10.1634/theoncologist.2012-0293
Patchell, R. A., Tibbs, P. A., Regine, W. F., Payne, R., Saris, S., Kryscio, R. J., Mohiuddin, M., & Young, B. (2005). Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: A randomised trial. The Lancet, 366(9486), 643-648. https://doi.org/10.1016/S0140-6736(05)66954-1
NU743 Unit 10 instructions, in plain terms
The final NU743 assignment asks you to integrate clinical reasoning and interprofessional collaboration in one complex case. Most versions want a timeline organized by decision point, the reasoning behind each decision, the negotiation among services and with the patient, evidence applied where it shaped choices, and a synthesis that judges each decision by what was known at the time. Around 2,500 words is typical. Faculty reward reports in which the two strands are visible and connected, services are quoted by role, the patient's voice appears in the decision, and the author's own role and errors are examined. If the case comes from your practice, move the setting, alter dates and remove anything that could identify the patient or colleagues.
Inside the NU743 Unit 10 example
Day one records the examination that changed the question, a sensory level and bilateral weakness, and the push for MRI within hours. Day two gives the MRI result, the spinal instability score and three separate consultations, with the highlighted sentence on why the decision was not yet settled. Day three uses the NOMS framework to show that the services disagreed about which element should lead, and records each service's position. Day four applies the randomized surgery trial, whose criteria he met, and brings everyone together with the patient, who names walking to his workshop as his goal. Day five records surgery and follow-up roles. A synthesis, a section on the hospitalist's role and a closing reflection follow.
Where the points sit in the NU743 Unit 10 rubric
Integrated case reports are commonly assessed on organization, clinical reasoning, collaboration, use of evidence and synthesis. Organization earns credit when the timeline is clear and the reasoning and negotiation strands can each be followed. Clinical reasoning is judged on how each decision followed from findings. Collaboration rewards an accurate account of each service's position and how agreement was reached, with the patient included. Evidence is credited when trials and frameworks are applied at the point of decision, including whether the patient met a trial's criteria. Synthesis scores well when it judges each decision fairly and names what the author would do differently. Protecting the privacy of patients and colleagues is assessed throughout.
Common NU743 Unit 10 mistakes, and how to avoid them
A frequent weakness is separating the clinical story from the teamwork story, so the reader cannot see how they affected each other. Another is presenting disagreement between services as one side being wrong. Some reports apply trial results without checking whether the patient resembled the trial population. Others leave the patient out of the decision entirely. Many syntheses retell the case rather than judging it. And authors rarely examine their own delays. Organize by decision point, keep both strands visible each day, quote services by role, check that the evidence fits your patient, include what the patient wanted, and end by naming what you would do sooner next time.
Get an NU743 Unit 10 example written to your instructions
Capstone cases differ a great deal from section to section, so include the case materials or the scenario you plan to use, the required length and the rubric. Your first custom sample costs nothing and comes back within 24-48h, reasoning and negotiation kept on one timeline so each can be seen shaping the other. 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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NU743 Unit 10 questions, answered
Can the integrated case come from my own practice?
Often it is expected to, which is where the confidentiality obligation becomes yours. Move the setting, alter the dates and remove anything else that would identify the patient or colleagues, while the clinical sequence and each person's discipline stay intact, since the reasoning and the negotiation both rest on them. The sample is entirely composite, with brackets marking every value and drug so nothing reads as a treatment recommendation.
How long should the integrated case report be?
Longer than earlier units in most sections, since it draws on their work, though your prompt sets the figure. Length should come from the number of decision points rather than from background. The sample spends almost nothing on prostate cancer in general and nearly all of its words on the five days of decisions and who made them.
What makes the synthesis different from a summary?
A summary retells; the synthesis judges. It answers whether each decision was reasonable with what was known at the time, and whether every party, the patient included, had a fair say. The sample finds faults in both strands, one delay in reasoning and one in consulting the patient, and that willingness is usually what faculty are looking for.
Where can I find a free NU743 Unit 10 sample paper?
The full NU743 Unit 10 integrated case report is on this page, with five days each carrying a reasoning and a negotiation strand, a synthesis, the hospitalist's role and what the author would do again and differently, plus three references. A report built on your own complex case can be drafted.
Why was surgery chosen in NU743 Unit 10?
He met the criteria of a randomized trial showing that decompressive surgery plus radiation kept more patients walking than radiation alone, his spinal instability score was indeterminate, and he said walking was worth the surgical risk.