NRNP 6644 Week 11 Reflection Example

Reflection: The Habit of Writing the Parent's Account as the Record and the Child's as a Symptom

Student Name

College of Nursing, Walden University

NRNP 6644: Psychiatric Mental Health Advanced Practice Nursing Care of Children Through Young Adults

Instructor Name

Month Day, Year

Reflection: The Habit of Writing the Parent's Account as the Record and the Child's as a Symptom

The Habit

In my early work this term, the guardian's account was the history, and the young person's account was evidence of the problem the history described. I did not decide to write this way. It was how my notes came out when a parent was the one who called, booked, and spoke first, and I did not see it until it was pointed out.

Three Quotations From My Own Submissions

Week 1, from my first draft of the intake: "Mother reports patient refuses school." The sentence gives the mother's words the standing of fact and gives the boy no words at all.

Week 2, from the history as I first submitted it: "Patient states he is scared, consistent with anxiety." Here his account appears, but only as a symptom that supports his mother's version, not as a second account of what happens.

Week 3, from my draft collateral summary, before revision: "Teacher and child minimize morning difficulties." The word minimize assumes the mother's version is the true one and marks the other two as falling short of it.

Set side by side, the three show the same move: one account is the record, and the others are measured against it.

What Changed It

Two things, both outside me. First, my instructor's comment on the week 3 draft: "Minimize compared to what? Each of these people sees a different part of his day." Second, the reading that comment sent me to. De Los Reyes and Kazdin (2005) argue that disagreement between informants is not simply error to be averaged away; it can reflect that a child behaves differently in different settings, and that informants hold different perspectives on what matters. A later meta-analysis of 341 studies found that informants' reports about the same young person agree only at low to moderate levels, with a mean correlation of about .28, and that this disagreement often carries valid information about where a problem appears (De Los Reyes et al., 2015). The comment showed me the habit; the reading gave me a reason to believe the habit was costing the record information and not just style.

The Changed Practice, Already Visible

I now record each account separately, attributed and close to the speaker's words, before writing anything that compares or reconciles them. The revised week 3 summary shows it: mother, father, teacher, and the boy each have their own block, and the conflicts are listed as conflicts, with no one described as minimizing. The same practice shaped my week 5 diagnostic paper, where each criterion names its informant, and my week 10 transition document, where the young woman's history is written first in her own account, and her mother's differing date for the first episode is recorded as hers. In the week 7 care plan, the boy's goal appears in his own sentence, and the plan is judged by whether it reaches it.

What Recording Separately Does Not Solve

Recording each account separately stops me from choosing one too early, but it does not tell me what to do when accounts point to different plans. In cross-informant research, the correlation between a child's own report and a teacher's report is among the lowest of any pair (Achenbach et al., 1987), so this situation is not rare.

It also does not remove the practical pull toward the parent's version. The parent consents, pays, drives, and fills in the forms; the parent is the one who calls when things get worse. A record can give the young person's account equal space on the page and still, when the plan is written, lean on the person who will carry it out at home. I have started to check my plans for this lean by asking, for each task, whose account it answers to. In the week 7 plan, two of the three problems were defined by what the parents and school saw, and only the sleepover goal came from him. That balance may be right for an 11-year-old, but I had not chosen it on purpose.

The Case I Still Find Hard

A 14-year-old says she is fine at school and that her problem is at home, with her stepfather. Her school describes a girl who is withdrawn, eats lunch alone, and has stopped turning in work. Her mother agrees with the school. My changed practice records all three accounts without ranking them. But the plan must choose where to begin: with the home, where she says the trouble is, or with the school, where two adults see it. Neither account has an obvious edge, and choosing one may confirm to her, again, that adults decide whose version counts. I do not yet know how to start that plan without repeating the habit this reflection is about.

References

Achenbach, T. M., McConaughy, S. H., & Howell, C. T. (1987). Child/adolescent behavioral and emotional problems: Implications of cross-informant correlations for situational specificity. Psychological Bulletin, 101(2), 213-232. https://doi.org/10.1037/0033-2909.101.2.213

De Los Reyes, A., Augenstein, T. M., Wang, M., Thomas, S. A., Drabick, D. A. G., Burgers, D. E., & Rabinowitz, J. (2015). The validity of the multi-informant approach to assessing child and adolescent mental health. Psychological Bulletin, 141(4), 858-900. https://doi.org/10.1037/a0038498

De Los Reyes, A., & Kazdin, A. E. (2005). Informant discrepancies in the assessment of childhood psychopathology: A critical review, theoretical framework, and recommendations for further study. Psychological Bulletin, 131(4), 483-509. https://doi.org/10.1037/0033-2909.131.4.483