D346 Advanced Psychiatric Mental Health Care of Adults and Older Adults Across Care Settings, catalog number NURS 6439, is a three-CU PMHNP specialty course on evidence-based mental healthcare for adults, older adults and families, using age-appropriate advanced assessment and diagnostic reasoning. Two phrases in that title carry most of the scoring weight: older adults, because geriatric psychiatry is not adult psychiatry in an older body, and across care settings, because the same patient needs a different plan in an emergency department, a clinic and a residential facility.
What NURS 6439 is actually testing
The adult half of this course extends what D344 and D345 built: assessment, formulation and treatment for the conditions that make up most of an outpatient psychiatric caseload. What is added is management over time rather than at a single visit, which brings in partial response, relapse, adherence, comorbid physical illness and the long relationship between a prescriber and a person with a chronic condition.
The older adult half is genuinely different and it is where papers lose points. Four things change. Pharmacokinetics and pharmacodynamics shift, so the same dose does not do the same thing. Presentation changes, so depression can present as cognitive complaint and infection can present as agitation. Cognitive assessment becomes routine rather than exceptional, and distinguishing delirium from dementia from depression is a core skill rather than an occasional one. And decision-making capacity becomes a live clinical and legal question rather than an assumption.
Across care settings adds a third scored dimension. An inpatient unit, an emergency department, a primary care clinic, a nursing facility and a telehealth appointment differ in what assessment is possible, what treatment can be started safely, who else is involved, and what happens after you close the encounter. Written work is expected to say why the plan is shaped by the setting rather than only by the diagnosis.
Turning scored aspects into a section plan
Rubric detail lives in your Course of Study rather than the WGU catalog. Count the aspects before you write. Each is scored independently on a three-point scale and each needs a 2, which is why the setting aspect and the age-specific aspect both need their own deliberate sections rather than a mention inside the management plan.
The word budget, worked. Take seven scored aspects and directions asking for about 2,300 words. Reserve 130 for a case summary and 110 for the close, leaving 2,060 across seven aspects, or about 294 each. Then weight it. The differential aspect needs 380, because in an older adult the differential has to include medical and cognitive causes as well as psychiatric ones. The treatment aspect needs 360, since age-adjusted dosing and interaction burden both live there. That leaves 1,320 for five aspects at about 264 each.
One planning decision saves the most rework: choose an older adult case rather than an adult one when the directions allow either. Older adult cases exercise every aspect the course cares about, and a straightforward adult case leaves the age-specific aspects with nothing concrete to work on.
A structure that fits an adult and older adult psychiatric case
Task directions win where they specify a format. Where they leave it open, this arrangement keeps age and setting visible as reasoning rather than as background.
| Section | What belongs in it | What earns the aspect |
|---|---|---|
| Presentation and setting | De-identified case, age, the care setting and what that setting makes possible | The setting named as a constraint, not as scenery |
| Medical and medication review | Physical conditions, full medication list, recent changes | Included before any psychiatric conclusion, since both can produce the presentation |
| Cognitive and functional status | Screening result, baseline function, informant account of change | A named instrument with its result, and a timeframe for the change |
| Differential | Psychiatric, medical, cognitive and substance causes ranked | Delirium, dementia and depression separated with a stated basis |
| Risk and capacity | Suicide risk, vulnerability, self-neglect and decision-making capacity | Capacity assessed for a specific decision rather than declared globally |
| Treatment plan | Pharmacologic and non-pharmacologic care, age-adjusted | Dosing reasoning that reflects age-related changes and interaction load |
| Setting-specific plan | What is done here, what is deferred, what transfers with the patient | A handover plan; care that ends at the door is not care across settings |
| Family and caregiver | Who is involved, what they are told, consent handled | Consent and confidentiality addressed explicitly |
| References | APA list of guidelines, instruments and prescribing sources | Age-specific guidance cited where it exists |
Do not let the older adult sections collapse into a caution about starting low and going slow. That phrase is true and it is not analysis. The analysis is which specific change in absorption, distribution, metabolism, elimination or receptor sensitivity applies to the agent you chose.
Evidence craft in adult and older adult psychiatry
The sourcing challenge here is that much of the psychiatric evidence base was built in adults under 65, and the population you are writing about was frequently excluded.
- Check the age range of every trial or guideline you rely on, and say so when your patient sits outside it.
- Use geriatric-specific guidance where it exists, including published lists of agents to avoid in older adults, cited to their issuing body with an edition year.
- Cite cognitive screening instruments to their original publication and note what score means what in which population, including education and language effects.
- Name the informant for any account of functional change. Cognitive and behavioural history is usually collateral history, and its reliability matters.
- Keep capacity language precise. Capacity is decision-specific and time-specific, and writing about it globally is a legal as well as a clinical error.
- Quote sparingly. Criteria and instrument items are reproduced everywhere, and WGU runs submissions through a similarity check.
The habit that lifts a paper in this course is treating polypharmacy as a diagnosis to consider rather than a background fact. Where an older adult presents with new psychiatric symptoms, the medication list is a differential item, and a paper that reviews it explicitly, names a plausible culprit and proposes a deprescribing step is doing exactly what geriatric psychiatry asks for.
What separates Competent from a submission sent back
Aspects score on their own. In D346 the returns cluster on the differential and on the setting section.
- The differential separates delirium, dementia and depression with stated reasoning, and includes medical and medication causes.
- Cognitive status is assessed with a named instrument and interpreted with its limitations.
- Capacity, where relevant, is assessed for a specific decision.
- Dosing reasoning reflects age-related pharmacology rather than a general caution.
- The plan says what happens when the patient leaves this setting.
WGU performance assessment work can be revised and resubmitted with no grade penalty, so a return costs calendar rather than standing. Calendar is what the PMHNP sequence is short of, since the internships sit behind the population care courses. Terms run six months at a flat rate, so a course that overruns tends to cost you a second course in the same term.
Six mistakes that cost time in D346
- Treating an older adult as an adult with a higher number. Pharmacology, presentation and differential all change, and the aspects are written to test that.
- Skipping the medication review. In this population the medication list is frequently the answer, and omitting it undermines the differential.
- Declaring capacity rather than assessing it. Capacity is specific to a decision and needs a stated basis.
- Using start low go slow as the whole geriatric analysis. Name the actual pharmacokinetic or pharmacodynamic change involved.
- Writing the setting as scenery. Where the encounter happens changes what assessment is possible and what treatment can be started safely.
- Leaving family involvement to a single sentence. Consent, confidentiality and caregiver burden are all scoreable and all easy to write once the case is chosen well.
How support works on this course
D346 rewards case selection more than any other course in the PMHNP specialty. Send the rubric out of your Course of Study with the task directions and the first pass is choosing a case that actually exercises the age-specific and setting-specific aspects, because a case that does not makes those sections impossible to write well. From there you get an aspect-mapped write-up, a differential built to separate delirium, dementia and depression explicitly, age-adjusted prescribing reasoning tied to named pharmacology, and instruments and guidance located and cited to their issuing bodies.
The boundaries are fixed. Objective assessments at WGU are proctored, so we prepare only, never sit them, and never ask for portal credentials. On any field-based course we never complete clinical hours, contact preceptors or sites, sign placement paperwork or fill in hour logs.
Questions students ask about D346
Is D346 the same course as NURS 6439?
How much geriatric content does D346 actually carry?
Does across care settings mean I have to write about several settings?
Choosing a case for D346?
Send your Course of Study rubric and the task directions. We pick a case that exercises the age and setting aspects, then build the write-up against the rubric.
Where D346 sits in WGU's programs
The July 2026 catalog places this code in 2 current WGU programs. Open a program page for the complete standard path and term positions. The live Degree Plan remains authoritative after transfer credit, substitutions, and mentor planning.
The assessments, one by one
The public catalog does not publish this course's PA/OA identity or task count. WGU Tutors publishes at most one PA manual per course and only from a WGU-controlled public rubric. Until that source exists, PA help begins from the student's real Course of Study and OA support remains preparation only.