Please read first the instructions and modify my thoughts. The highlighted parts are the main questions that need to address. Make sure to address and explain everything, you can add more if you want to, to depend my answers… Thanks.
Journal Entry Part 1
For the first part of your journal entry, reflect on the Five Wishes presented on the Five Wishes website and PDF and complete your Five Wishes. Explain your state’s requirements for advance directives, including whether your Five Wishes can be turned into a formal document. Then, explain how your experience of completing your Five Wishes advance directive will help you guide discussions with patients and their families. Finally, explain how you might apply the Five Wishes advance directives to your nursing practice. Include how this advance directive might benefit patients in decision making for specialized areas of care.
Most people think that advance directives are for old aged people only which is not really true. Younger people also need advance directives what if something happened to them like vehicular accidents, drowning or fall that they would need a life-saving mechanical ventilator. Usually, patients communicate their wishes directly to their primary physicians, but when a person can no longer sufficiently communicate, another process for decision-making is needed, that’s why advance directive is significant to guide the patient, family, and health care providers in making end-of-life care decisions. If there is no advance directive prepared, the next of kin may be called upon to make health care decisions that the patient may not want (Shapiro, 2015).
My Five Wishes are the following. My spouse will be the one to make a decision for me in the event that I could not make decisions for myself. If in case, I would have cardiorespiratory arrest and be left in severely debilitated state, I only want emergency medications given to me and no shock, compressions, or mechanical ventilators. I want to live comfortably with no pain and have my favorite religious songs be played until my last breath. I want to die in my home with my family around me and have the priest to bless me before I die. After my death, I would like my body to be buried beside my youngest brother.
For a living will or power of attorney to be effective, it must comply with state law as many states have specific forms for the people to complete. In state of Texas, living will and POA must be written in standardized way, appropriately signed, and witnessed. The Five Wishes that I made are all in accordance with the Texas State law (Aging with Dignity, 2011).
The Five Wishes advance directive would be very helpful to patients and families when making decisions for their health. It is not only for those who are dying nor people who are old aged. It is for everyone who are over 18 years old and above in preparation of unexpected circumstances or life-threatening situations. It will serve as a guide and a legal document to follow and it would be easier for the patient and family to decide what needs to be done. It will avoid them the confusion and conflict when decision needs to execute. If there is advance directive on hand, family or surrogate decision maker knows already what to do and it lessen the guilt feeling that they may have in the end if they made decisions opposite to the patient’s desire.
As a nurse practitioner, we have a pivotal role in explaining advance directive to our patients especially if they don’t have one. Since we are dealing most of the frail elders and geriatric patients every day, the living will and durable medical power of attorney will allow the patient’s wishes to be considered if something happened to them. Also, it will ensure that appropriate treatments or actions will implement, right decisions will be made, and appropriate people will take care of the patient.
Aging with Dignity. (2011). Five wishes sample. Retrieved from http://www.agingwithdignity.org/forms/5wishes.pdf
Shapiro, S. P. (2015). Do Advance Directives Direct?. Journal Of Health Politics, Policy & Law, 40(3), 487-530. doi:10.1215/03616878-2888424
Journal Entry Part 2
For the second part of your journal entry, reflect on geriatric patients from your practicum site with disorders related to specialized areas of care, such as oncology, nephrology, urology, gynecology, and neurology. Describe a case of a frail elder patient who must make decisions related to specialized areas of care. Then, explain potential patient outcomes and include whether treatments would be beneficial and how they would impact the patient’s quality of life. Finally, describe the patient’s wishes in terms of treatments and interventions for the disorder (Was there an advanced directive?) and how the patient might want to spend any remaining time. Include how environmental factors, such as family, caregivers, ethnicity, culture, religion, and/or personal values, might impact decision making for treatments and interventions. If you did not have an opportunity to evaluate a patient with this background during the last 9 weeks, you can select a related case study or reflect on previous clinical experiences.
In this week’s journal, I would be reflecting to patient with neurological disorder. This is an 85 year old Hispanic male patient with history of stroke with right hemiplegia, hypertension, and hyperlipidemia, came in to clinic with complaint of fever, loss of appetite and generalized weakness for 2 weeks already. Mr. MF was aphasic, lethargic, and hard to follow simple commands. He had a recent massive stroke 2 months ago according to the daughter. The daughter who was the source of information told me that Mr. MF has not been eating well for the past two weeks. She said that she wanted a peg placement for her dad as recommended by speech therapist. During the interview, he daughter told me that her dad did not want to do anything if he will be severely debilitated. But because the speech therapist recommended a peg placement, the daughter thought that patient will regain his strength and normal neurological status once the patient will get the peg. Also, the daughter mentioned that she was very closed to her dad and she was not yet ready to lose him.
As a nurse practitioner of Mr. MF, I would be more empathetic and be a good listener on her feelings about her dad’s condition. I will let the daughter tell her stories, verbalized her feelings and thoughts and find the reason why she wanted peg placement of her dad despite of his severely debilitated state. Being a good listener and empathetic to her feelings will help her be more comfortable in discussing the prognosis of the patient. Nurse practitioners should have the ability to listen which is the most valuable skill that can be used and allow them the opportunity to tell “their story.” End-of-life issues are very sensitive. That is when we are all most vulnerable, cared and thinking of what we did or did not do in our lifetime. Nurse practitioners who can be empathetic and “be” with the patient at this very important time will have one of the most rewarding experiences of their career (Knox, 2010). I will respect her decision but at the same time I will explain to her thoroughly the minimal benefits that Mr. MF could get if will do the peg placement. I will be more realistic to her and show her the outcome if Mr. MF will go for peg placement or other aggressive procedures. I will make a reasonable effort to clarify her doubts, questions, and communicate with her the risk and its potential benefits. Considering the Mr. MF’s advanced age and poor prognosis, I will have her a clear understanding of the patient’s prognosis and the pros and cons of doing peg placement. Although all patients who require peg placement have severe acute illness by virtue of needing peg, there may be differences in the type or severity of the acute illness that could influence outcomes (Holroyd-Leduc & Reddy, 2012). I will emphasize to her the minimal benefits that the patient gets from such procedures. Also, I will explain to her about advance directives and take into consideration of her dad’s wish. Since her dad mentioned that he did not want anything to be done when he would be severely debilitated, I would recommend palliative hospice care for Mr. MF. I will explain to her the advantages and benefits that the patient gets from palliative care and the quality of life that he would have on his last days of his life. The final months of the patient is the most precious one and we want the patient to spend the rest of his life in a comfortable and peaceful way of living (Ehlenbach, et al, 2009).
Ehlenbach, W. J., Barnato, A. E., Curtis, J. R., Kreuter, W., Koepsell, T., Deyo, R., & Stapleton, R. (2009). Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly. The New England Journal of Medicine, 361(1), 22–31.
Note: Retrieved from the Walden Library databases.
Holroyd-Leduc, J., & Reddy, M. (Eds.). (2012). Evidence-based geriatric medicine: A practical clinical guide. Hoboken, NJ: Blackwell Publishing.
Knox, P. (2010). Palliative Care Nurse Practitioners. Retrieved from http://nurse-practitioners-and-physician-assistants.advanceweb.com/features/articles/palliative-care-nurse-practitioners.aspx