| Course | PA 505 Behavioral Medicine I |
|---|---|
| Week | 8 |
| Paper type | Capacity determination note |
| Length | About 870 words, 6 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 505 Week 8
Capacity Determination Note: Whether a 68-Year-Old Recovering From Pneumonia and a Resolved Delirium Can Decline Two Weeks of Rehabilitation and Go Home Alone
Student Name
Chamberlain University
PA 505: Behavioral Medicine I
Instructor Name
Month Day, Year
Capacity Determination Note: Whether a 68-Year-Old Recovering From Pneumonia and a Resolved Delirium Can Decline Two Weeks of Rehabilitation and Go Home Alone
One Decision, Named First
Decision assessed: whether W.T. can decide to decline the recommended transfer to a skilled nursing facility for about two weeks of rehabilitation after a hospital stay for pneumonia, and go home instead. This note does not assess W.T.'s capacity for any other decision, such as managing money, driving or future medical choices.
Assessed on hospital day 6, a Friday, at 10:15 a.m. and again at 2:30 p.m., by the PA student with the attending hospitalist, for about twenty-five minutes in total.
Conditions of the Conversation
W.T. had hearing aids in and glasses on. The delirium documented on day 2 had cleared by day 4; a Confusion Assessment Method screen by the day nurse at 8 a.m. on day 6 was negative (Inouye et al., 1990). No sedating medicine had been given since day 3. The room was quiet, the roommate's television was off, and at W.T.'s request the daughter, Jo, was on speakerphone for the morning conversation and said little.
What Was Done to Give It a Chance
The physical therapist's findings were explained in plain terms: W.T. needed a walker, could walk about 60 feet before stopping, and had needed help getting up from a low chair. The recommendation and the reasons were given in two short parts, with a pause after each, and the options were written on a whiteboard in large letters: rehabilitation for about two weeks; home with home health visits and a walker; home without services.
Understanding
Asked to explain the recommendation back, W.T. said: "You want me in the rehab place two weeks because I'm weak and I could fall, and if I fall out there nobody finds me till morning." This contains the recommendation, the reason and the main risk.
Appreciation
Asked whether this applied to W.T. personally, W.T. said: "I know I'm weaker. I got winded walking to the bathroom yesterday. I'm not saying I'm fine." W.T. did not deny the weakness or the risk, and related it to the house: "The bedroom's on the main floor. The bathroom's right there. The steps are the problem, three of them at the back door."
Reasoning
Asked to compare the options, W.T. weighed them aloud. For rehabilitation: "I'd get stronger faster, I know that." Against it: the facility is fifty miles away, the neighbor cannot feed the cattle alone for two weeks, and "the last time I was somewhere strange I didn't know where I was," referring to the delirium. For going home: the neighbor comes at six every morning, and Jo offered to stay the first four nights. W.T. asked whether home health could come the first week and whether a rail could be put at the back steps. Those questions are themselves evidence of weighing: W.T. was changing the home option to reduce the risk named.
Expressing a Choice
In the morning, W.T. chose to go home with home health and a walker. At 2:30 p.m., without the daughter on the call, W.T. made the same choice and gave the same reasons. The choice was clear and stable across the day.
A Refusal Is Not the Finding
W.T. is declining the team's recommendation, and the team's view remains that rehabilitation is the safer option. That disagreement is not evidence of incapacity. Capacity is shown by the abilities to understand, appreciate, reason and choose, not by agreeing with the recommendation (Appelbaum, 2007). A person who takes in the information, weighs it aloud and declines has shown the very abilities being assessed.
What Was Not Relied On
Two things were deliberately left out of the evidence. The first is the earlier delirium itself: having been confused on day 2 does not mean W.T. lacks capacity on day 6, and the note relies on what W.T. showed this morning and this afternoon, not on the history of the stay. The second is the known depression. Depression can distort how a person weighs a future, for example if someone declines care because they no longer care what happens. I asked about this directly. W.T. said, "I want to get stronger, I want to be home for it," and named the cattle, the daughter's visit and the spring planting as reasons. Nothing in the answers suggested the choice came from not caring whether recovery happened. The depression is recorded and will be followed in clinic, but it did not take away the abilities this decision requires.
Conclusion With an Hour on It
At 10:15 a.m. and 2:30 p.m. on day 6, W.T. had the capacity to decide to decline transfer to rehabilitation and go home with services. The conclusion covers this decision on this day. Because delirium can return, particularly in the evening and with any new illness, the conclusion should be revisited if W.T. becomes confused before discharge or if the decision changes in a way W.T. cannot explain.
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
Inouye, S. K., van Dyck, C. H., Alessi, C. A., Balkin, S., Siegal, A. P., & Horwitz, R. I. (1990). Clarifying confusion: The confusion assessment method. A new method for detection of delirium. Annals of Internal Medicine, 113(12), 941-948. https://doi.org/10.7326/0003-4819-113-12-941
PA 505 Week 8 instructions, in plain terms
The final week asks for a note determining whether a patient has the capacity to make one specific decision. Name the decision in the first line and say what the note does not cover. Record when and by whom the assessment was made and the conditions of the conversation, such as hearing aids, time of day, sedating medicines and who else was present. Describe what was done to give the patient the best chance, such as plain explanations or written options. Then give evidence for each element, understanding, appreciation, reasoning and expressing a choice, in the patient's own words where possible. Judge the reasoning rather than whether the choice is the one the team prefers, with a source for that standard. State the conclusion for that decision at that time, and say what would make it need revisiting.
How the PA 505 Week 8 example is put together
The note names its decision at once: declining transfer to a skilled nursing facility for about two weeks of rehabilitation in favor of going home. It records two conversations on hospital day 6, at 10:15 a.m. and 2:30 p.m., with hearing aids and glasses in place, no sedatives since day 3 and a negative delirium screen at 8 a.m. The physical therapy findings are explained in two parts and the options written on a whiteboard. W.T.'s words then carry each element: the risk of a fall with nobody finding them until morning, the walk to the bathroom that left them winded, the fifty-mile distance, the cattle and the daughter's offer to stay four nights, and questions about home health and a back-step rail. The same choice is made in the afternoon. A section explains why declining is not incapacity, another sets aside the earlier delirium and tests whether depression drove the choice, and the conclusion is limited to that day.
PA 505 Week 8 rubric: what full points look like
A note that decides a person in general rather than a decision in particular loses the most, because capacity granted or removed that way cannot be acted on safely. Next comes a conclusion drawn from the answer rather than the reasoning, where a refusal is treated as the finding even though the patient took in the information, weighed it aloud and chose. Further deductions follow for elements asserted with nothing under them, most often reasoning; for missing conditions of the conversation; for the patient's words replaced by a summary; for no record of efforts to help the patient understand; and for a conclusion with no time attached. Strong notes name one decision first, record conditions and supports, give quoted evidence for each element, separate the content of the choice from the abilities behind it and limit the conclusion to that decision at that hour, with a trigger for reassessment.
PA 505 Week 8 help from the desk
Capacity notes are short, but each element needs its own evidence, and reasoning is the element most often claimed without being shown. From your case we can help pin down the decision precisely, set out the conditions and the steps taken to help the patient understand, and choose the quotations that show understanding, appreciation and weighing. Separating a refusal from incapacity is a section we can help draft too, a point many students blur. When a case includes depression, delirium or another condition, we can help you explain how you tested whether it affected the decision. The conclusion and its wording are yours. If your template asks for a single line, the custom sample places the reasoning in supporting sections underneath it so the line stands on evidence.
Get a PA-505 Week 8 example written to your instructions
Send the assignment, the rubric, any template your section issues and the scenario it supplies, along with the decision the note is meant to cover. A custom PA-505 Week 8 note is written into those headings and returned inside 24-48h, the first one free. It is built around a constructed encounter throughout.
More PA 505 papers and MPAS samples
- PA 505 Week 1: Where Depression Is First Met
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- PA 505 Week 3: PHQ-9 Score Interpretation
- PA 505 Week 4: Criteria Application Exercise
- PA 505 Week 5: Delirium Versus Depression
- PA 505 Week 6: Substance Use History Brief
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- PA 504 Week 8: Consultant Letter
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PA 505 Week 8 questions, answered
Our patient refuses. Does that settle the note?
It settles nothing by itself, and treating it as decisive is the error this week exists to teach out. Record what the person was told, how they gave it back, and what they weighed against what. A refusal reached through that process is a decision. A refusal with no reasoning visible behind it is a reason to keep assessing rather than a conclusion to write down.
Our template wants a single conclusion. Where does the reasoning go?
In the element passages above it, which is where a reader will look for it anyway. A one-line conclusion is fine as long as every element it rests on has been evidenced separately further up the note. What fails is the reverse: a confident conclusion with four elements asserted in a sentence each and nothing the person actually said underneath any of them.
Can one note cover more than one decision?
Only where the assignment sets it out that way, and then each decision is assessed and concluded separately inside the same document. Somebody can hold capacity for one choice and not for another put to them in the same conversation, so a note running the two together produces a conclusion neither decision earned. Say which is which in the headings.
Where can I find a free PA 505 Week 8 sample paper?
You can read a complete PA 505 Week 8 capacity note on declining rehabilitation after pneumonia, with the patient's own words for each element, on this page.
Does refusing the team's recommendation mean the patient in the PA 505 Week 8 sample lacks capacity?
No. The patient understood, related the risk to their own home, weighed the options aloud and chose consistently, which shows the abilities being assessed.