ESSAY: An advance directive is a legal document that defines a patient’s wishes for medical care.

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.

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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.


Journal 9

Five Wishes

          Five wishes is an advanced directive which defines a patient wants that should be considered in case an illness condition worsens making it hard to for communication (Cohen, 2017). The document is legal and should be written by the patient that addresses proper care and spiritual matters. The five wishes include:

  1. The person a patient wants to make care decisions on his behalf when he is unable to speak for himself and make clear judgment.
  2. Type of medical treatment preferred (Cohen, 2017). For instance, elderly patients need proper treatment in their end of life care which can never be understood if they cannot communicate at the moment and never wrote an advanced directive.
  3. What makes the patient feel comfortable? This section entails pain management type, how he should be groomed, bathed and if he is interested at the end of life care.
  4. The treatment he expects from people. This section explains personal and spiritual matters (Butler et al., 2014). It gives instructions whether the patient wants to stay in the hospital or get treatment from home and whether to be prayed for severally or not.
  5. The last wish states what the patient wants the family to know (Lyon, Jacobs, Briggs, Cheng & Wang, 2014). It is characterized by what he wishes to be remembered for, funeral arrangements and asking for forgiveness from whomever the patient offended.

          Anyone eighteen years and above who can converse with the family is eligible to start writing an advanced directive. Anything can happen anytime, and a person can get seriously ill to the extent that communication becomes difficult (Yaday et al., 2017). To know what the patient wishes are during the treatment process an advanced directive is essential.

          Taking care of patients with an advanced directive makes work easy for the advanced nurses (Lyon et al., 2014). It helps them avoid difficulty in guessing the type of treatment you are interested in and whether to initiate the end of life care.

          There was a case of a frail elderly patient probably eighty years old undergoing oncology treatment, and there were no signs of recovery, decisions for specialized health care were necessary. End of life care had to start to help the patient through the last stage of life. The nurses had an easy task since he had a well written advanced directive that would guide them in the treatment process. According to his five wishes, the patient wanted to spend his last days at home with his family (Yaday et al., 2017). All the medical decisions were to be made by the wife. He was ready to start the end of life care which made both the patient and the family comfortable during the painful moment. A proper understanding of the process attracted consistent support from medical practitioners, friends, and family.


Cohen, A. L. (2017). End of Life Care: Writing Up Your Five Wishes Document.

Butler, M., Ratner, E., McCreedy, E., Shippee, N., & Kane, R. L. (2014). Decision aids for advance care planning: an overview of the state of the science. Annals of internal medicine161(6), 408-418.

Lyon, M. E., Jacobs, S., Briggs, L., Cheng, Y. I., & Wang, J. (2014). A longitudinal, randomized, controlled trial of advance care planning for teens with cancer: anxiety, depression, quality of life, advance directives, spirituality. Journal of adolescent health54(6), 710-717.

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