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. Advanced Directives in Nursing Essay Paper
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.
Please include and intro and conclusion.
USE WISCONSIN AS THE STATE TO EXPLAIN ADVANCED DIRECTIVE LAWS.
USE FOLLOWING REFERENCE AS 1 OF THE 4:
Resnick, B. (Ed.). (2016). Geriatric nursing review syllabus: A core curriculum in
advanced practice geriatric nursing (5th ed.). New York, NY: American Geriatrics
Advanced Directives in Nursing
An advance directive provides an individual’s choices regarding their desired or undesired treatments or their healthcare decisions if one is incapacitated or cannot express their wishes. This paper will present two journal entries regarding advance directives. The first entry will provide a reflection on the Five Wishes as an advance directive while the second journal entry will describe a geriatric patient who must make treatment decisions. Advanced Directives in Nursing Essay Paper
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Journal Entry Part 1
In Wisconsin, anyone aged 18 years and above can give their advance directives. Wisconsin law has two forms for an advance directive, namely the power of attorney for health care and the living will. A living will allows the person to choose the type of life-sustaining care they would want when in terminal or vegetative state without any hope of recovery. On the other hand, a health care power of attorney allows an individual to choose a person who will make all their healthcare decisions when they lose the decision-making ability.
The Five Wishes document is a legal document. After signing, the document meets the legal prerequisites for an advance directive according to the Wisconsin laws. For the Five Wishes document to be legal, it should be signed the presence of two witnesses. Therefore, my Five Wishes document cannot be turned into a formal document because it was not signed in the presence of two witnesses.
The experience of completing my “Five Wishes advance directive” has helped me understand the requirements when completing this document. Therefore, this will enable me to appropriately guide patients and families who would wish to complete the “Five Wishes” document. During practice, I will ensure that I provide the advance directive information before the patient deteriorates if they do not have an advance directive already. This is because it is important for the patient and the families to understand the information in advance directives to ensure patients make informed decisions regarding their end-of-life wishes. Therefore, the advance directive will enable the patient to make informed decisions regarding their end-of-life care or any other health decision when the patient may not be in a position to make his/her healthcare decisions.
Journal Entry Part 2
The reflection is on an 80-year-old Caucasian man with stage-4 lung cancer. The patient responded to chemotherapy treatment but relapsed. The healthcare team believed that further chemotherapy may have been possible even though the patient had only a few weeks to live. Due to the advanced stage of the disease, there is a likelihood of the vital organs failing including the heart. The healthcare team believed that the patient was likely to have a heart attack and thus resuscitation would not be suitable. This is because resuscitation was not likely to succeed and would also damage the ribs due to cancer deposits on the ribs, and also due to the looming death from cancer. However, the patient insisted on everything being done for him, even resuscitation. The patient wished to spend his last moments surrounded by his family members. Moreover, the patient had an advance directive when he had indicated that he would prefer anything possible to be done including resuscitation and being put in a life support machine in his end-of-care. Advanced Directives in Nursing Essay Paper
Environmental factors significantly influence one’s decision-making on treatment. For example, the family and caregivers may encourage a patient to choose a particular treatment decision. Religion and personal values may influence an individual’s decision-making. For example, in some religions and personal beliefs, being put in a life support machine is not acceptable. Similarly, some cultures believe dying in peace and may not support the idea of being put in a life support machine or being resuscitated.
The Five Wishes document is a legal document that enables a person to make their end-life decisions and treatments. It is important to adequately educate patients about advance directives to ensure they make informed decisions. The second journal entry presents an elderly patient with stage-4 lung cancer and whose medical team believed resuscitation would not be appropriate. However, the patient chose to be resuscitated regardless of the involved risks and indicated in his Five Wishes form.
Aging with Dignity. (2018). Five Wishes < https://fivewishes.org/docs/default-source/default-document-library/product-samples/fwsample.pdf?sfvrsn=2>
Bern-Klug M & Byram E. (2017). Older Adults More Likely to Discuss Advance Care Plans With an Attorney Than With a Physician. Gerontol Geriatric Med. 3(1).
Courtright K, Madden V, Gabler N, Cooney E, Kim J, Scott H, & Dember L. (2017). A randomized trial of expanding choice sets to motivate advance directive completion. Med Decis Making. 37(5), 544–554.
Fischer S, Sauaia A, Min S & Jean K. (2013). Advance Directive Discussions: Lost in Translation or Lost Opportunities? J Palliat Med. 15(1), 86–92. Advanced Directives in Nursing Essay Paper