NR 579 Week 3 Goals of Care Write-Up Example

Course	NR 579 Palliative Care in Adult-Gerontology Across the Spectrum
Week	3
Paper type	Goals of care write-up
Length	About 860 words, 5 pages
Format	APA 7 student paper
School	Chamberlain University
Program	MSN, Adult-Gerontology Primary Care NP (AGPCNP)
Updated	October 2026

Free sample paper for NR 579 Week 3

Goals of Care Write-Up: Sunday Dinner at the Table, Sleeping Beside the Spouse and Talking to the Grandchildren, and What a 66-Year-Old With ALS Will Trade to Keep Them

Student Name

College of Nursing, Chamberlain University

NR 579: Palliative Care in Adult-Gerontology Across the Spectrum

Instructor Name

Month Day, Year

What this page is doingThe write-up states the aim as things a person could be seen doing, then the exchange rate: what the patient will accept in return and what they will not, so the note can be used on the night it is tested.

Goals of Care Write-Up: Sunday Dinner at the Table, Sleeping Beside the Spouse and Talking to the Grandchildren, and What a 66-Year-Old With ALS Will Trade to Keep Them

The Conversation

Held in the ALS clinic on a Tuesday afternoon, about 50 minutes, with the patient, the spouse and the palliative care nurse practitioner, with me present as the student. The patient typed answers on a tablet; long answers were typed during pauses and read aloud by the tablet. The spouse is the patient's named health care agent. The approach followed the structure of serious illness conversations: understanding first, then what matters most, then trade-offs (Bernacki & Block, 2014).

The Aim

Symptom care for ALS is best delivered by a multidisciplinary clinic (Miller et al., 2009b), which is where this conversation took place. The aim, in the patient's words and as things a person could be seen doing: to sit at the dining table for Sunday dinner with the two grandchildren; to sleep in the bedroom beside the spouse; and to keep talking with the grandchildren, by voice while that lasts and by the tablet after.

When asked what would make life no longer worth living, the patient typed: "Not being able to tell them anything. If I can't talk and I can't type, I'm done."

What this page is doingWriting the aim as Sunday dinner, a shared bedroom and conversations with the grandchildren makes it something two readers would act on the same way.

The Exchange Rate

What the patient will accept in order to keep those things:

Drowsiness in the afternoon in return for less pain, but not in the evening, when the grandchildren call or visit.

The breathing mask for up to 20 hours a day, including at the table if needed.

A gastrostomy for feeding, "if it means I can keep coming to dinner and not choke." Undecided; to be discussed at a family meeting.

A hospital admission for a treatable infection such as pneumonia, if it can be treated without a breathing tube.

What the patient will not accept:

A tracheostomy and long-term ventilation through it. The patient typed: "I watched my uncle on one for two years in a nursing home. No."

A breathing tube through the mouth, even for a short time.

Moving out of the house to receive care.

Resuscitation if the heart stops.

What Was Not Agreed

The feeding tube remains undecided. The patient leans toward yes; the spouse is unsure; the son, who was not present, has asked for "everything done." That disagreement is recorded rather than smoothed over.

How the Patient Communicated

All of the patient's answers were typed on the tablet with the left hand, which still works well enough for short sentences. Long answers took a minute or more, and the team waited without filling the silence. Twice the patient typed an answer, deleted it and typed a shorter one; the shorter versions are the ones recorded here. The spouse did not answer for the patient at any point.

The Spouse's Account

The spouse, asked separately at the end, said the aim matched what the patient had said at home for months, and added one thing: the patient's biggest fear is not dying but choking in front of the family. That is consistent with the patient's own words about drooling and dinners.

Why the Aim Is Written This Way

An aim such as quality of life or comfort could mean anything to the next reader. Sunday dinner at the table, sleeping in the shared bedroom and talking with the grandchildren are things a nurse, a doctor in the emergency department or the spouse could each check on a given day. When a decision comes up at night, the question becomes whether it protects those three things, and that is a question anyone can answer.

What this page is doingExplaining why the aim is written as observable activities shows how the note is meant to guide a decision at night.

What This Changes in the Plan

The symptom plan's limit on evening sedation stays. The breathing plan aims to keep the mask working as long as possible and treats infections at home or in hospital without intubation. A family meeting is planned for the feeding tube, with the son present.

What this page is doingRecording what was not agreed, and who disagrees, keeps the note honest about the one decision that is still open.

Questions the Patient Asked

The patient asked two questions. The first: "How long?" The palliative care nurse practitioner said that nobody could say exactly, that the breathing tests suggested months rather than years, and that the team would keep the patient informed as things changed. The second: "Will it hurt at the end?" The answer was that breathlessness and fear at the end can be treated well with medicine at home, and that hospice would be there for that.

How the Note Will Be Used

A copy goes to the ALS clinic, the primary care practice, the home health agency and the emergency department through the shared record. It will be reviewed at every clinic visit and sooner if the patient's breathing or swallowing changes. Advance care planning is a process that is revisited as the illness changes, not a single conversation (Sudore et al., 2017).

References

Bernacki, R. E., & Block, S. D. (2014). Communication about serious illness care goals: A review and synthesis of best practices. JAMA Internal Medicine, 174(12), 1994-2003. https://doi.org/10.1001/jamainternmed.2014.5271

Miller, R. G., Jackson, C. E., Kasarskis, E. J., England, J. D., Forshew, D., Johnston, W., Kalra, S., Katz, J. S., Mitsumoto, H., Rosenfeld, J., Shoesmith, C., Strong, M. J., & Woolley, S. C. (2009b). Practice parameter update: The care of the patient with amyotrophic lateral sclerosis: Multidisciplinary care, symptom management, and cognitive/behavioral impairment (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 73(15), 1227-1233. https://doi.org/10.1212/WNL.0b013e3181bc01a4

Sudore, R. L., Lum, H. D., You, J. J., Hanson, L. C., Meier, D. E., Pantilat, S. Z., Matlock, D. D., Rietjens, J. A., Korfage, I. J., Ritchie, C. S., Kutner, J. S., Teno, J. M., Thomas, J., McMahan, R. D., & Heyland, D. K. (2017). Defining advance care planning for adults: A consensus definition from a multidisciplinary Delphi panel. Journal of Pain and Symptom Management, 53(5), 821-832. https://doi.org/10.1016/j.jpainsymman.2016.12.331

What the NR 579 Week 3 assignment asks for

The Week 3 write-up is usually shorter than people expect. One paragraph holds the aim, written as something a person could be seen doing, such as eating dinner at the table or being awake enough for a grandchild's visit. A second paragraph holds the exchange rate: what the patient will accept in return for that aim and what they will not. Most rubrics mark down a document that reports agreement without naming what was agreed, or that records a wish to stay at home without saying what the patient will accept to stay there. The patient's own words are welcome, and anything not yet agreed should be recorded as such.

How the NR 579 Week 3 example is put together

The write-up sets the place, length and participants, and notes the tablet the patient types on. The aim appears in the patient's words as three observable activities, with the patient's answer about what would make life not worth living. The exchange rate lists what the patient will accept, from afternoon drowsiness to an admission without intubation, and what the patient will not, from a tracheostomy to resuscitation. A section explains why the aim is written this way. The undecided feeding tube and the son's absence are recorded. The spouse's account, how the patient communicated, the patient's questions, the changes to the plan and how the note will travel close it.

Where the points sit in the NR 579 Week 3 rubric

A trade with only one side costs most: a note saying the patient wants to stay home, without what the patient will accept to stay there, is unusable on the night the decision is tested. This note gives both sides. An aim written as an abstraction comes next, because no two readers act on it the same way; here the aim is three activities. A document reporting agreement without naming what was agreed loses another row. Recording what remains undecided, and who disagrees, earns honesty credit. The patient's own words, and a plan for where the note goes, complete the criteria. Keeping the note short is itself part of the mark, since it must be read quickly at night.

NR 579 Week 3 help: mistakes that cost points

Weak NR 579 Week 3 write-ups record goals as comfort or quality of life, which nobody can act on. Others list wishes without trade-offs. Many smooth over disagreement, saying the family is in agreement when one member is not. Some leave out what the patient will refuse. Notes that are too long bury the aim. If your patient's goals differ, send the patient's words for what matters and what they would not accept; a short write-up can be built with an aim and an exchange rate. Write the aim as something that could be filmed, give both sides of the trade, and record anything not yet agreed with the name of whoever disagrees. Keep it to a page or two.

Get a NR 579 Week 3 example written to your instructions

Send the case your classroom gave you, the rubric and any template it names, and a custom goals of care write-up built around that patient is with you inside 24-48h, no charge on the first. Mention the page limit as well, since this genre is graded on compression at least as much as on content.

More NR 579 papers and AGPCNP samples

NR 579 Week 3 questions, answered

Can the write-up use the patient's own words?

It should, sparingly and inside quotation marks. One or two short lines carry more than a paragraph of paraphrase, because a grader can tell the difference between a sentence somebody said and a sentence a writer built on his behalf. Use the phrasing the vignette supplies rather than improving it, since the awkwardness is usually the point.

What if the case gives no clear aim?

Then the absence is itself the finding and the write-up says so. A patient who has not decided, or who cannot yet hear the question, is a real situation with a real next step: what would be asked, when, and by whom. Inventing a tidy aim the vignette does not support costs more than recording an open one.

How long should it be?

Shorter than most drafts. Two or three pages is common where a page count is given, and the reason is structural rather than stylistic. Everything except the aim, the trade, his understanding and the agreement can be found somewhere else in the chart. Length here should come from what the chart cannot already tell you.

Where can I find a free NR 579 Week 3 sample paper?

The full goals of care write-up for the patient with ALS, with the aim in observable terms and the exchange rate, is on this page.

What will the patient not accept in the NR 579 Week 3 write-up?

A tracheostomy with long-term ventilation, a breathing tube even briefly, moving out of the house for care and resuscitation if the heart stops.