Assignment: Practicum – Week 9 Journal Entry
Learning objectives for the week are to-Assess patient outcomes
Analyze patient care and treatment options
Evaluate the use of advanced directives in nursing practice*
Evaluate patient outcomes for frail elders receiving treatment for specialized areas of care*
Evaluate the impact of environmental factors on decision making for treatment and interventions*
An advance directive is a legal document that defines a patient’s wishes for medical care. This document is a way for patients to share their wishes with family members and health care providers when their illness or mental capacity prevents them from making decisions. As an advanced practice nurse who has care discussions with patients and their families, you need to not only be familiar with the process of completing an advance directive, but also understand how this document might impact your role in patient care and treatment)
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.
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.
References/Required Readings
Resnick, B. (Ed.). (2019). Geriatric nursing review syllabus: A core curriculum in advanced practice geriatric nursing (6th ed.). New York, NY: American Geriatrics Society.
Chapter 54, “Nephrology” (pp. 435-446)
This chapter describes changes in kidney function related to aging. It also presents guidelines for diagnosing, treating, and managing kidney diseases and disorders, including electrolyte disorders, acute renal failure, chronic kidney disease, and end-stage kidney disease.
Chapter 54 “Gynecology” (pp. 452-459)
This chapter presents guidelines for gynecologic examinations for older adult females. It also examines strategies for diagnosing, treating, and managing gynecologic diseases and disorders, such as menopausal symptoms, urogenital symptoms, disorders of the vulva, disorders of pelvic floor support, and postmenopausal vaginal bleeding.
Chapter 56, “Prostate Disease and Cancer” (pp. 455-464)
This chapter examines treatment and management strategies for benign prostatic hyperplasia, prostate cancer, and chronic prostatitis. It also describes the controversy surrounding prostate cancer screening.
Chapter 61, “Neurology” (pp. 507-517)
This chapter examines treatment and management strategies for neurologic conditions, such as cerebrovascular disease, headaches, movement disorders, and epilepsy.
Chapter 67, “Oncology and Hematologic” (pp. 574-590)
This chapter explores risk factors for developing cancer and the increased prevalence of cancer in older adults. It also describes treatment options, such as surgery, radiation, chemotherapy, and biology therapy, for a variety of specific cancers including breast and colon cancer.
Alfonso, H. (2009). The importance of living wills and advance directives. Journal of Gerontological Nursing, 35(10), 42–45.
This article emphasizes the importance of creating a living will and advance directive, focusing on the impact of not having a living will and potential barriers to creating living wills. It also examines the nurse’s role in educating patients about living wills.
Casey, D. A., & Walker, D. M. (2011). The clinical realities of advance directives. Widener Law Review, 17(2), 429–442.
This article examines federal law regarding advance directives and issues related to advance directives. It also provides recommendations for implementing advance directives in clinical settings.
Watson, E. (2010). Advance directives: Self-determination, legislation, and litigation issues. Journal of Legal Nurse Consulting, 21(1), 9–14.
This article examines types of advance directives including the living will and do-not-resuscitate orders. It examines reasons for nonimplementation of an advance directive and common causes of action claims for nonimplementation of advance directives by health care providers.
Aging with Dignity. Five wishes.
This website provides information related to advance directives and living wills for individuals, their families, and health care professionals. It includes advice for creating living wills and how to address health care needs at the end of life.
Aging with Dignity. (2011). Five wishes sample.
This sample Five Wishes document outlines the Five Wishes and includes considerations for each wish. It also provides background information on Five Wishes, including who should use it and how it can be implemented.
