Posted: December 5th, 2022
Journal Entry Part 1: Five Wishes Essay
Title Here, up to 12 Words, on One to Two Lines]
The “five wishes” is a great tool to aid in the decision-making processfor goals of care and end of life care. It considers one’spersonal, emotional and spiritual needs as well as your medical wishes. It lets you choose the person you want to make health care decisions for you if you are not able to make them for yourself.The “five wishes” allows patients to name a healthcare proxy, identifies the medical treatment options you want, code status (CPR vs. DNR), goals of care, end of life care, and what they want their loved ones to know (Aging with Dignity, 2017). Texas is one of only eight states in the nation that require you to take an additional step after you have completed your Five Wishes.Journal Entry Part 1: Five Wishes Essay . State law mandates you use a government-approved form and words to express your own wishes. As a clinician, utilizing the five wishes will allow me to make discussions with my patients and their familieseasily, and help them to identify goals for their care later in life. Nurses often build trust and strong relationships with their patients and as a result have more opportunity to have challenging conversations with patients and their families. The five wishes document allows patients to identify specific areas and portions of care that they would like or not like more carefully than some legal versions of advanced directives. Journal Entry Part 1: Five Wishes Essay
Aging with Dignity (2017). Texas. Retrieved from https://www.agingwithdignity.org/texas
Aging with Dignity (2011). Five Wishes. Retrieved from
[Title Here, up to 12 Words, on One to Two Lines]Journal Entry Part II: Oncology Disorders
Patients who need the care of an oncologist often have challenging decisions to make related to their care, especially if their disease is in advanced stages. One of my patient seen in practicum is JH, a 70-year-old man with a history of a Gleason 9 (4 + 5) adenocarcinoma 10 years before that was treated with a radical prostatectomy presented to his primary care physician with a complaint of rectal pain that had persisted for several weeks. A large palpable mass was found on a digital rectal exam and was noted on sigmoidoscopy to cause extrinsic compression of the rectum. A biopsy of the perirectal mass was consistent with metastatic carcinoma that was consistent with a recurrent metastasis of his previous prostate adenocarcinoma, now with small-cell transformation. A computed tomography scan showed the perirectal mass arising from the prior prostatectomy bed, as well as a large hepatic mass and bilateral lung nodules that were consistent with metastatic disease. He had lost 20 lbs over 3 to 4 weeks and complained of progressive fatigue, poor appetite, severe tenesmus, and rectal pain. Journal Entry Part 1: Five Wishes Essay
Mr. JH presented to the medical oncology department for an initial consultation. Given his significant rectal pain and declining functional status, he was referred for palliative pelvic radiation to be given with concurrent single-agent chemotherapy. The patient had been living independently on the West Coast but had relocated to Texas to be closer to his adult children. He stressed that his wishes were to remain as independent and functional as possible. He named his eldest son as his health care proxy but did not have an advance directive or living will. After the visit, the patient’s daughter approached the oncologist with concerns about discussing “CPR” (cardiopulmonary resuscitation) and “life support,” and indicated that this discussion would be overwhelming for her father.
As part of the palliative care team, we received a consult from the attending physician to discuss goals of care and end of life care with the patient and family. We provided support to the patient’s children fostered a shared understanding of his prognosis and goals. We stressed that, although discussions about EOL care can be difficult, they are integral to providing care that is compatible with the patient’s wishes. Over the course of several visits, the patient’s daughter became more comfortable with discussing these often emotionally fraught topics. On completion of therapy, the patient reported near resolution of his pelvic pain. Scans demonstrated stability of the rectal mass but enlarging pulmonary and hepatic metastases. Although he remained asymptomatic, we reaffirmed the incurable nature of his cancer and his limited prognosis. We also discussed treatment options, including second-line chemotherapy and palliative care with home hospice, emphasizing that all options were palliative in nature. The patient desired a break from any further therapy for several weeks and some time to consider options for care.Journal Entry Part 1: Five Wishes Essay
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Four weeks later, repeat imaging showed progressive metastases, although the patient remained asymptomatic. Although he wanted to keep the option of future therapy open, he stated that his immediate goals were to spend time with his family and friends, and he deferred chemotherapy. During the following few weeks, he verbalized to his children and care team that he preferred to die at home and avoid resuscitation in the event of cardiopulmonary arrest. We documented these wishes in the electronic medical record. He ultimately enrolled in home hospice when his functional status declined, and he died surrounded by his family three weeks later. Journal Entry Part 1: Five Wishes Essay
Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2017). Primary care: A
collaborative practice (5th ed.). St. Louis, MO: Elsevier.
Resnick, B. (Ed.). (2016). Geriatric nursing review syllabus: A core curriculum in advanced
practice geriatric nursing (5th ed.). New York, NY: American Geriatrics Society.
Journal Entry Part 1: Five Wishes
Five wishes is a tool that an individual uses to make decisions regarding his/her personal, emotional, spiritual, as well as medical wishes. The tool helps an individual to select the person one wishes to make their medical decisions in case one lacks the capacity to do so (Miller, 2017).
In Washington DC, the Five Wishes meet the legal prerequisites for an advance directive. Therefore, people in Washington can utilize the Five Wishes to express how they would wish to be treated if they are very sick and not in a position to express themselves. After signing and witnessing of the Five Wishes, it becomes a legal document in Washington DC(Miller, 2017). Journal Entry Part 1: Five Wishes Essay
As a healthcare provider, use of the Five Wishes will enable me to identify the wishes of my patients and discuss with their families regarding the patients’ wishes; and then easily make decisions depending on the patient’s wishes. In addition, Five Wishes will be essential in nurturing a positive patient experience as it will nurture and support values-baseddiscussions with my patient and their families regarding what matters most to individuals at the end of their lives(Fischer et al, 2014). During my practice, a personal advance directive such as the Five Wishes will make it easier for me to start the delicate work of discussing regarding the end-of-life care decisions with patients and the family as well. In addition, the Five Wishes document will enable the patient to identify certain aspects of care they would want and hence ensures that the patient is provided care, in accordance with their wishes (Fischer et al, 2014).
Fischer S, Min S &Kutner J. (2014).Advance Directive Discussions: Lost in Translation or Lost Opportunities?J Palliat Med. 15(1), 86–92.Journal Entry Part 1: Five Wishes Essay
Miller, B. (2017).Nurses in the Know: The History and Future of Advance Directives.OJIN: The Online Journal of Issues in Nursing. 22(3).
Journal Entry Part 2: Nephrology
Elderly patients with an impaired renal function may be forced to make decisions regarding their care, especially if the renal disease is at the advanced stages (Tejwani et al, 2015). During my practicum, an 85-year-old woman was admitted with mental status and positive blood cultures. During the next three days, the condition of the patient deteriorated with fewer persistent fewer spikes, acute renal failure, no recognizable source of infection, and inadequate response to antibiotic treatment. Due to the patient’s deteriorating condition, the son who was the patient’s lawful surrogate decision-maker asked for a do-not-resuscitate order. Nonetheless, the hospital and the doctor declined to provide the order because there was not the patient’s copy regarding advance directive indicating the wishes of the patient. A few minutes later, the nursing home faxed the patient’s advance directive that stated “I would want CPR in all circumstances.” When the patient’s condition continued deteriorating and her breathing or heartbeat stopped, the physician and other healthcare performed cardiopulmonary resuscitation for the patient as per her advance directive. However, the resuscitation procedure was not successful and the patient was declared dead a few minutes later on. In this case, the patient’s wish to have a cardiopulmonary resuscitation performed was respected (Keeley, 2017).Journal Entry Part 1: Five Wishes Essay
Environmental factors, personal values, culture, family and religious beliefs may influence an individual’s decision making for their treatments (Keeley, 2017). For example, some cultural and religious beliefs may view advance directive as a taboo. Other patients may opt for the family members to make their treatment decisions.
Keeley M. (2017). Family Communication at the End of Life.BehavSci (Basel). 7(3), 45.
Tejwani V, Wu Y, Serrano S, Luis S, Michael B &Qian Q. (2015). Issues surrounding end-of-life decision-making.Patient Prefer Adherence. 1(7), 771–775. Journal Entry Part 1: Five Wishes Essay
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