NUR 560 Module 10 Journal Example

Reviewed by Delia Ravenscroft, MSN, RN

This NUR 560 Module 10 Journal sample reflects on the thinking errors behind the diagnoses a clinician almost misses. It fits the final journal in SNHU NUR 560, Advanced Health Assessment and Clinical Reasoning, the MSN course listed as NUR-560. The writer, a composite emergency department nurse now training for family practice as an NP, looks back on three cases from the term: a dizzy man whose normal limb exam nearly ended the search for a stroke, a hot knee where finding crystals almost closed the question of infection, and an anemic man who could easily have been sent home with iron tablets. Each is tied to a named cognitive error, anchoring or premature closure, and to a course reading. The writer closes with the specific habit the writer will use to guard against these errors in early practice as a new nurse practitioner.

CourseNUR 560 Advanced Health Assessment and Clinical Reasoning
ModuleModule 10
Paper typeClosing reflective journal
LengthAbout 430 words, 3 pages
FormatJournal entry with APA 7 citations
SchoolSouthern New Hampshire University
ProgramMSN
UpdatedSeptember 2026

Free sample paper for NUR 560 Module 10

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Module Ten Journal

The Answer That Arrives Too Early

Before this course I thought of missed diagnoses as knowledge problems: someone did not know a fact. Working through the cases this term changed that view. In almost every near miss I studied, the knowledge was there. What failed was the thinking. Croskerry (2003) describes two errors that I now recognize in my own practice: anchoring, holding on to an early impression despite new information, and premature closure, calling a case settled while the evidence is still incomplete. I have done both, usually on busy shifts, and usually without noticing.

The vertigo milestone showed me anchoring. My first impression of a man with vomiting and spinning was an inner-ear problem, and his normal strength and speech felt like confirmation. Only the HINTS examination, with its normal head impulse, pulled me away from that anchor. What unsettled me was learning that the bedside exam had been more sensitive than an early MRI (Kattah et al., 2009). My instinct had been to trust the scan and the absence of weakness. I now trust a validated examination more than a reassuring impression.

What this page is doingThe entry opens with a changed belief about why diagnoses are missed, defines both errors with a source and shows anchoring through a specific course case.
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The hot knee was premature closure. When the crystals appeared under the microscope, part of me felt the case was solved. But a synovial white count above 50,000 still shifted the odds of infection substantially (Margaretten et al., 2007), and the culture grew Staphylococcus aureus. If I had stopped at the crystals, the joint would have been damaged. The fatigue case taught the same lesson in slower motion: iron would have corrected the blood count and hidden a colon cancer.

Looking back, I can also see why these errors feel so natural. Each first answer was reasonable, common and supported by some of the evidence. Anchoring and premature closure do not feel like mistakes while they are happening; they feel like efficiency. On a crowded shift, stopping early is rewarded. That is why I no longer trust the feeling that a case is finished. The feeling tells me I have an explanation, not that I have the right one.

The habit I am taking into practice is a question I now ask before I accept any diagnosis: what else could this be, and what finding would prove me wrong? Croskerry (2003) calls strategies like this cognitive forcing, deliberately interrupting the first answer long enough to test it. It takes less than a minute. As a new nurse practitioner working alone in a clinic, without a team to question my first impression, I expect that minute to be the most important one in many visits.

What this page is doingThe second half shows premature closure in two cases and ends with a concrete habit linked to the source and to the writer's future practice setting.
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References

Croskerry, P. (2003). The importance of cognitive errors in diagnosis and strategies to minimize them. Academic Medicine, 78(8), 775-780. https://doi.org/10.1097/00001888-200308000-00003

Kattah, J. C., Talkad, A. V., Wang, D. Z., Hsieh, Y.-H., & Newman-Toker, D. E. (2009). HINTS to diagnose stroke in the acute vestibular syndrome: Three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke, 40(11), 3504-3510. https://doi.org/10.1161/STROKEAHA.109.551234

Margaretten, M. E., Kohlwes, J., Moore, D., & Bent, S. (2007). Does this adult patient have septic arthritis? JAMA, 297(13), 1478-1488. https://doi.org/10.1001/jama.297.13.1478

What the NUR 560 Module 10 instructions ask for

The NUR 560 closing journal usually asks you to reflect on how your assessment and clinical reasoning skills developed over the term and how you will apply them in advanced practice. Prompts often invite you to name specific cases, identify reasoning strengths and weaknesses and connect them to course readings. Journals are typically 300 to 600 words, written in the first person and supported with APA 7 citations where you draw on sources. The strongest entries are specific: they describe a real moment from a case and explain exactly what changed in your thinking and why, rather than listing topics the course covered. Keep the focus on your own growth and support each claim about it with a case moment.

How this NUR 560 Module 10 journal example is built

The sample is written by a composite emergency nurse preparing for family practice. It opens with a changed belief, that most missed diagnoses are thinking errors rather than knowledge gaps, and defines anchoring and premature closure using a well-known source on cognitive error. Anchoring is shown through the vertigo milestone and the HINTS exam; premature closure through the hot knee and the anemia case. Each moment is linked to a course reading. The entry closes with a concrete habit, asking what else a problem could be and what would prove the first answer wrong, and connects it to working alone in a clinic after graduation. Its brief paragraph on why these errors feel natural adds the honest self-examination that separates reflection from summary.

Where the NUR 560 Module 10 rubric puts the points

Reflective journals are generally graded on depth of reflection, specific connections to course content and cases, accurate use of sources and clear application to future practice. Graders reward entries that identify a specific change in thinking and show evidence for it, and they tend to mark down entries that summarize the course or stay general. Naming a recognized concept, such as a cognitive bias, and applying it honestly to your own practice demonstrates the self-awareness these assignments are designed to assess. A concrete plan for applying the insight, tied to a realistic setting, usually earns the application points. Correct APA 7 citation and clear writing complete the marks. Entries that explain why an error happens, not only that it happened, often score highest for depth.

NUR 560 Module 10 help: the mistakes that cost points

Journal entries often lose points by being too general, by praising the course rather than reflecting on growth or by omitting sources and a plan for practice. Choose two or three specific moments from your cases, name what changed in your reasoning, link each to a reading and end with one concrete habit you will use. Write honestly in the first person, including mistakes you noticed in your own thinking, since that candor is exactly what reflective rubrics reward. If your prompt asks about different skills or cases, send it along with the rubric and we can prepare a journal entry that reflects on your own term. We can also review your draft and suggest where to add specificity.

Get NUR 560 Module 10 written to your instructions

Send the journal prompt and the rubric. A specific, first-person reflection linked to your cases and readings, with a concrete plan for practice, is ready in 24 to 48 hours, and the first one is free. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.

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NUR 560 Module 10 questions, answered

Where can I find a free NUR 560 Module 10 Journal sample?

The entry on this page is free to read: a closing reflection on anchoring and premature closure through three course cases, with APA 7 citations and a habit for practice.

What is anchoring in clinical reasoning?

Holding on to an early impression of a diagnosis despite new information that should change it.

What is premature closure?

Accepting a diagnosis before it has been fully verified, so that other possibilities are no longer considered.

What is a cognitive forcing strategy?

A deliberate step, such as asking what else a problem could be, that interrupts the first answer long enough to test it.

How long is the NUR 560 closing journal?

Journals are typically 300 to 600 words, in the first person, with APA 7 citations where sources are used.