Essay 2: Neurological And Musculoskeletal Disorders
You have already made three decisions. The paper appraises them against the evidence, which means saying what you expected, what the media piece showed, and where the two diverged.
Editorial process
Last reviewed · August 22, 2026
A retrospective appraisal, not a treatment plan
The exercise has already happened, which changes what the paper is. You are not planning care; you are reporting three decisions you made in sequence and appraising them. That structure matters because each decision was made on the information available at that point, and the media piece then told you what followed. So handle each decision the same way: what you chose, what you were hoping to achieve, what the evidence says about that choice, and what actually happened. Where the outcome differed from what you expected, say so plainly, since a paper that reports three correct decisions and no surprises has usually smoothed the account. Length discipline matters here too: one to two pages across three decisions is roughly two hundred words each, so the case summary has to be brief and the appraisal has to carry the paper rather than the narrative. Say what you were aiming at before saying what happened.
Be specific about what supported by the evidence-based literature means, because the phrase invites vagueness. It means naming a guideline or a trial and saying what it recommends for a patient like this one, not asserting that the choice was evidence-based. In a psychopharmacology decision tree the recurring issues are the same few: whether a first-line agent was chosen before a second-line one, whether an adequate dose and trial duration were given before switching, whether a side effect was managed or the drug abandoned prematurely, and whether comorbidity or an interaction should have ruled the agent out. The brief also asks about co-morbid physical factors and patient factors, so address at least one: renal or hepatic function, cardiac history, age, pregnancy, adherence, cost or a metabolic profile that makes one agent harder to justify than another. Close by saying what you would decide differently now.
Likely learning objectives
- Report decisions made under sequential uncertainty rather than a completed plan.
- Appraise each choice against a named guideline or trial.
- Address comorbid physical and patient factors affecting the decision.
- State honestly where the outcome diverged from expectation.
Assignment instructions
Read the full question
Review every instruction before using the planning guidance that follows.
Review the interactive media piece assigned by your Instructor. Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece. Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment. Write a 1- to 2-page summary paper that addresses the following: Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented. Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources. What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources. Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.
Course-wide instructions that accompany this question
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes. Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages. Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor. The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument
Turn the brief into deliverables
- 01A brief summary of the assigned case.
- 02Each of the three decisions, stated as taken.
- 03What you hoped to achieve with each.
- 04An appraisal of each against named evidence.
- 05At least one comorbid physical or patient factor considered.
- 06A statement of what you would do differently.
- 071 to 2 pages with outside references.
The case, the three decisions, then what you expected
The case in brief
Summarise presentation and the information available at the first decision point.
What the assessor is likely looking for
What was known at decision one rather than what was known at the end.
Decision one and its rationale
State the choice, the aim, and the evidence for or against it.
What the assessor is likely looking for
A named guideline or trial rather than a claim of evidence.
Decisions two and three
Report the subsequent choices and how new information changed them.
What the assessor is likely looking for
A decision that responds to what the previous one produced.
Comorbid and patient factors
Identify the physical or personal factors that constrained the options.
What the assessor is likely looking for
A factor that would rule out an otherwise reasonable agent.
What you would change
Say which decision you would revisit and on what basis.
What the assessor is likely looking for
A revision justified by evidence rather than by outcome alone.
Where the prescribing evidence for your case sits
Recommended databases
- PubMed Central
- NCBI Bookshelf
- NIMH
- Walden Library
Search sequence
- 1.Identify the disorder in the media piece, then find its current first-line treatment.
- 2.Check the recommended dose range and adequate trial duration before judging a switch.
- 3.Look up the interaction or comorbidity relevant to your patient.
- 4.Find one trial rather than only a guideline, so the appraisal has primary evidence.
Reference shortlist
These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.
Mental Health Medications
National Institute of Mental Health · 2024
Medication classes and their indications, for appraising the agent chosen.
Cognitive Behavior Therapy
StatPearls, NCBI Bookshelf · 2023
Cognitive behavioural therapy, for the non-pharmacological arm of a decision tree.
Carbamazepine Therapy and HLA Genotype — Medical Genetics Summaries
National Center for Biotechnology Information, NCBI Bookshelf · 2018
A pharmacogenetic example, for a patient factor that changes the choice of agent.
Which psychotherapy is most effective and acceptable in the treatment of adults with a (sub)clinical borderline personality disorder?
Psychological Medicine · 2023
A comparative treatment review, for evidence that one agent outperforms another.
Medication Errors and Adverse Drug Events
AHRQ Patient Safety Network · 2024
Adverse drug events, for the safety dimension of a prescribing decision.
Before you submit this paper
Common mistakes
- Writing a treatment plan instead of appraising decisions already made.
- Asserting decisions were evidence-based without naming the evidence.
- Reporting only successful decisions and no surprises.
- Ignoring the comorbid and patient factors the brief asks about.
- Omitting what you hoped to achieve, which is asked for separately.
Submission checklist
- Are all three decisions reported, including any that went badly?
- Is a guideline or trial named for each appraisal?
- Have you said what you hoped to achieve, separately from what happened?
- Is at least one patient or comorbid factor addressed?
- Is the paper within the length limit?
Use this guide to plan and review your own work. Follow your institution's rules and read Brinevia's academic-integrity policy.
Written by
Maren Caldwell
MSN, RN, CNE
Medical-surgical nursing, pharmacology and NCLEX preparation
Maren is a registered nurse with over 15 years of clinical and educational experience in medical-surgical nursing. She writes on NCLEX preparation, patient care fundamentals, pharmacology and evidence-based practice.
Reviewed by
Dr. Tessa Redmond
DNP, RN, CNE
Evidence-based practice and clinical education
Tessa is a doctorally-prepared nurse educator. She reviews Brinevia content for clinical accuracy and alignment with current evidence-based guidelines.