DNP 820 Topic 6 DQ 2: preference against expertise
Mediate does not mean persuade. The strongest posts show a process that reaches a decision both parties can live with, including when the decision is the one the clinician would not have chosen.
Editorial process
Last reviewed · August 15, 2026
Mediate is the verb, and it is not a synonym for persuade
Read the verb carefully, because a great many answers to this prompt describe persuasion and call it mediation. Mediating means holding two legitimate positions and finding a way through that respects both, which is a genuinely different activity from explaining the evidence more clearly until the patient agrees. The three-component model treats patient preference as a constituent of evidence-based practice rather than as an obstacle to it, so a decision that overrides preference is not more evidence-based, it is less. Build a scenario with a real conflict: a patient declining anticoagulation despite atrial fibrillation because a relative bled, a family wanting continued feeding when the team judges it futile, a patient preferring a less effective regimen with fewer side effects, or a refusal of a screening test the guideline recommends. Each of those refusals is reasonable from where the patient is standing, which is the condition that makes mediation the right word.
Then show the process rather than the outcome. The steps that make it mediation are identifiable: establish what the preference actually is, since a refusal is often about something adjacent — cost, a previous experience, fear of dependency, or a family member's story — rather than about the intervention itself; check that the patient's understanding of the evidence is accurate, because a preference formed on a misunderstanding is not yet an informed preference; present absolute rather than relative risk, since a fifty per cent reduction sounds different from two events in a hundred; look for an option that satisfies both, which usually exists and is usually not the first thing anyone proposed; and document the discussion. Then be honest about the ending: if the patient has capacity, is informed and still declines, that is the resolution, not a failure of mediation, and saying so is what separates a mature post from one that treats agreement as the only acceptable result.
Likely learning objectives
Inferred from the brief — check these against your own rubric.
- 01Treat patient preference as a component of evidence-based practice rather than an obstacle.
- 02Distinguish mediation from persuasion.
- 03Identify what a stated preference is actually about.
- 04Accept an informed refusal as a legitimate resolution.
Read the full question
Review every instruction before using the planning guidance that follows.
Course-wide instructions that accompany this question
Important information for writing discussion questions and participation Hi Class, Please read through the following information on writing a Discussion question response and participation posts. Contact me if you have any questions. Important information on Writing a Discussion Question Your response needs to be a minimum of 150 words (not including your list of references) There needs to be at least TWO references with ONE being a peer reviewed professional journal article. Include in-text citations in your response Do not include quotes—instead summarize and paraphrase the information Follow APA-7th edition Points will be deducted if the above is not followed Participation –replies to your classmates or instructor A minimum of 6 responses per week, on at least 3 days of the week. Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article Each response needs to be at least 75 words in length (does not include your list of references) Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count. Follow APA 7th edition Points will be deducted if the above is not followed Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points. Here are some helpful links Student paper example Citing Sources The Writing Center is a great resource Welcome to class DNP 820 Topic 6 DQ 2 Often, patient preference and clinical expertise are at odds with each other, Describe a scenario where you might need to mediate this issue Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to. I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you. Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. 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Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week. I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course! Name: Discussion Rubric Grid View List View Excellent 90–100 Good 80–89 Fair 70–79 Poor 0–69 Main Posting: Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. 40 (40%) – 44 (44%) Thoroughly responds to the Discussion question(s). Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. No less than 75% of post has exceptional depth and breadth. Supported by at least three current credible sources. 35 (35%) – 39 (39%) Responds to most of the Discussion question(s). Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module. 50% of the post has exceptional depth and breadth. Supported by at least three credible references. 31 (31%) – 34 (34%) Responds to some of the Discussion question(s). One to two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Cited with fewer than two credible references. 0 (0%) – 30 (30%) Does not respond to the Discussion question(s). Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible references. Main Posting: Writing 6 (6%) – 6 (6%) Written clearly and concisely. Contains no grammatical or spelling errors. Adheres to current APA manual writing rules and style. 5 (5%) – 5 (5%) Written concisely. May contain one to two grammatical or spelling errors. Adheres to current APA manual writing rules and style. 4 (4%) – 4 (4%) Written somewhat concisely. May contain more than two spelling or grammatical errors. Contains some APA formatting errors. 0 (0%) – 3 (3%) Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style. Main Posting: Timely and full participation 9 (9%) – 10 (10%) Meets requirements for timely, full, and active participation. Posts main Discussion by due date. 8 (8%) – 8 (8%) Meets requirements for full participation. Posts main Discussion by due date. 7 (7%) – 7 (7%) Posts main Discussion by due date. 0 (0%) – 6 (6%) Does not meet requirements for full participation. Does not post main Discussion by due date. First Response: Post to colleague’s main post that is reflective and justified with credible sources. 9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. 8 (8%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting. 7 (7%) – 7 (7%) Response is on topic and may have some depth. 0 (0%) – 6 (6%) Response may not be on topic and lacks depth. First Response: Writing 6 (6%) – 6 (6%) Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. 5 (5%) – 5 (5%) Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English. 4 (4%) – 4 (4%) Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited. 0 (0%) – 3 (3%) Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited. First Response: Timely and full participation 5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation. Posts by due date. 4 (4%) – 4 (4%) Meets requirements for full participation. Posts by due date. 3 (3%) – 3 (3%) Posts by due date. 0 (0%) – 2 (2%) Does not meet requirements for full participation. Does not post by due date. Second Response: Post to colleague’s main post that is reflective and justified with credible sources. 9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. 8 (8%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting. 7 (7%) – 7 (7%) Response is on topic and may have some depth. 0 (0%) – 6 (6%) Response may not be on topic and lacks depth. Second Response: Writing 6 (6%) – 6 (6%) Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. 5 (5%) – 5 (5%) Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English. 4 (4%) – 4 (4%) Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited. 0 (0%) – 3 (3%) Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited. Second Response: Timely and full participation 5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation. Posts by due date. 4 (4%) – 4 (4%) Meets requirements for full participation. Posts by due date. 3 (3%) – 3 (3%) Posts by due date. 0 (0%) – 2 (2%) Does not meet requirements for full participation. Does not post by due date. Total Points: 100 Name: Discussion Rubric
Turn the brief into deliverables
- 01A scenario with a genuine conflict between preference and expertise.
- 02The steps of a mediation process.
- 03How the evidence would be communicated.
- 04A resolution, including the case where the patient still declines.
The scenario, the conflict, then the mediation
The scenario
Set out a conflict where both the preference and the clinical position are reasonable.
What the preference is about
Explore the reason behind the stated position before responding to it.
Communicating the evidence
Present absolute risk and check understanding rather than restating.
Resolution
Find an option satisfying both, and state what happens if the refusal stands.
Shared decision making with an evidence base
Recommended databases
- CINAHL
- PubMed Central
- AHRQ shared decision making resources
- ANA Code of Ethics
Search sequence
- 1.Read one paper on shared decision making before describing your process.
- 2.Find the absolute risk figures for the intervention in your scenario.
- 3.Search decision aid AND your condition to see whether a tool already exists.
- 4.Check the professional code's provisions on autonomy for the refusal case.
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.
Nothing here is cleared for citation until you have read it.
- 01
Personalized care planning and shared decision making in collaborative care programs for depression and anxiety disorders: A systematic review
PLOS One · 2022
Shared decision making in a real care programme, which is the evidence base for the process rather than the sentiment.
- 02
2025 Code of Ethics for Nurses
American Nurses Association · 2025
The autonomy provisions that make an informed refusal a legitimate ending rather than a failure.
- 03
Health Literacy Universal Precautions Toolkit
Agency for Healthcare Research and Quality · 2024
Techniques for checking understanding, which is the step that distinguishes mediation from repetition.
- 04
Impact of patient satisfaction ratings on physicians and clinical care
Patient Preference and Adherence · 2014
How patient satisfaction pressures shape clinical decisions, a useful complication for the mediation account.
Review before submission
Common mistakes
- Describing persuasion and calling it mediation.
- Treating patient preference as an obstacle to evidence-based care.
- Presenting relative risk reduction, which overstates benefit to a patient.
- Assuming agreement is the only successful outcome.
- Never asking what the preference is actually about.
Submission checklist
- Is the conflict genuine on both sides?
- Does your process differ from explaining the evidence again?
- Have you used absolute risk?
- Do you address the case where the patient still declines?
- Is documentation included?
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