| Course | NRNP 6540 Advanced Practice Care of Older Adults |
|---|---|
| Week | Week 10 |
| Paper type | Goals of care note |
| Length | About 800 words, 5 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Master of Science in Nursing (MSN) |
| Updated | October 2026 |
Free sample paper for NRNP 6540 Week 10
Goals of Care Note: An 86-Year-Old Woman With Advanced Heart Failure Who Wants to Stay Home and Recognize Her Son
Student Name
College of Nursing, Walden University
NRNP 6540: Advanced Nurse Practice in Primary Care Adult Gerontology II
Instructor Name
Month Day, Year
Goals of Care Note: An 86-Year-Old Woman With Advanced Heart Failure Who Wants to Stay Home and Recognize Her Son
Who Was Present
The patient, S.N., a composite 86-year-old retired postal clerk with advanced heart failure, took part in the conversation in her living room during a home visit. Her son joined by phone from another state. Her neighbor and close friend sat beside her. Before starting, she was asked whether she wanted both of them present for the whole conversation, and she said yes.
Her Understanding, Before Anything Was Added
Asked what she understands about her health, she said: "My heart is worn out. The water keeps coming back in my legs and lungs, and every time I go to the hospital I come home weaker. I don't think I'm going to get better." Starting with her understanding, rather than with information, is the sequence recommended for serious illness conversations (Bernacki & Block, 2014).
What She Was Told
In plain words: that she understands her illness well; that her heart failure has reached a stage where medicines help less than before; that she has been hospitalized three times in six months; and that, while no one can say exactly how much time she has, it is possible she could become much sicker in the coming months. She was asked how much detail she wanted, and she wanted to know "straight."
The Conversation, Following the Serious Illness Conversation Guide
What matters most: "Being in my own house, with my cat and my garden window."
Fears and worries: "Dying hooked up to machines in a hospital. And being a burden to my son."
Abilities so critical she cannot imagine living without them: "Knowing my son. If I didn't know him when he calls, that wouldn't be living." She also named being able to talk and to get from her bed to her chair.
Trade-offs for more time: she would accept medication adjustments and home nursing visits, and a short hospital stay if it were likely to get her home again quickly and feeling better. She would not want to be on a breathing machine, have chest compressions, or be in intensive care, or go to a nursing home, if the chance of returning home and being herself were small.
Family: she has talked with her son about some of this before, but not about machines. Her son said on the phone that he had not realized how clear she was, and that he would honor it.
Surrogate
She named her son as her health care agent, and he accepted. Her neighbor is named as a second person to be contacted if her son cannot be reached. A health care power of attorney form was completed and witnessed.
Recommendation, Tied to Her Goals
Based on what she said, the clinician recommended: care focused on staying at home and comfort, with continued heart failure medications as long as they help her feel better; a do-not-resuscitate order and no intubation, because both are unlikely to return her home and able to know her son; hospital transfer only for problems that could be treated quickly and would likely get her home, such as a treatable infection; and a referral to home-based palliative care now, which adds a team focused on symptoms and support alongside her ongoing care rather than replacing it (Kelley & Morrison, 2015), with hospice discussed as an option when she chooses. She agreed. A POLST form was completed with her and signed, recording do not attempt resuscitation, selective treatment, and no intubation. POLST translates these wishes into actionable medical orders that travel with her across settings (Bomba et al., 2012). A copy was placed on her refrigerator and sent to her cardiologist and the local hospital.
Symptoms and Practical Plans at Home
Staying home safely requires a plan for the symptoms most likely to bring her back to the hospital. Breathlessness: her diuretic plan was reviewed, with a sliding instruction tied to her daily weight, and a small fan was suggested, which can relieve the sensation of breathlessness. Swelling and fluid: the home health nurse will visit weekly and call the practice if her weight rises. Anxiety at night, which she said makes her breathing feel worse: a routine and a number to call at any hour through the palliative care program. Her son will arrange for a neighbor or aide to check on her each evening. She was reassured that choosing comfort-focused care does not mean choosing no care, and that she can revisit any of these decisions at any time, including changing her mind about the hospital.
Follow-Up
Home-based palliative care intake within one week. Follow-up home visit in four weeks, or sooner if her symptoms change, to revisit her goals, which may shift as her illness progresses.
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
Bomba, P. A., Kemp, M., & Black, J. S. (2012). POLST: An improvement over traditional advance directives. Cleveland Clinic Journal of Medicine, 79(7), 457-464. https://doi.org/10.3949/ccjm.79a.11098
Kelley, A. S., & Morrison, R. S. (2015). Palliative care for the seriously ill. New England Journal of Medicine, 373(8), 747-755. https://doi.org/10.1056/NEJMra1404684
Reading the NRNP 6540 Week 10 instructions
The tenth week of NRNP 6540 typically asks for a goals of care note for an older adult with serious illness. You document who was present, the patient's understanding, information shared, values and goals in her words, surrogate decision maker, a recommendation tied to those goals, symptom plans and follow-up. Faculty want the patient's own voice preserved. Cite a structured conversation guide and palliative care evidence in APA 7. Code status alone is not a goals of care note. Forms such as POLST may be included. Family roles and practical supports should be recorded. NRNP 6540 faculty want her understanding recorded before any information was added. Name the surrogate and how she chose him. Record the recommendation and her response. Include plans for symptoms at home and who to call at night.
How this NRNP 6540 Week 10 example is built
The note opens with who was present, her son by phone and her neighbor beside her, and whether she wanted them there. Her understanding of her illness is quoted before any information was added, then what she was told, in plain words. The Serious Illness Conversation Guide supplies the sequence that follows: what matters most, her fears, the abilities so critical she cannot imagine living without them, and the trade-offs she would accept for more time. She names being able to stay at home and recognize her son. Her surrogate is identified. The clinician's recommendation is recorded, tying the goals to specific choices about future hospital care, and a POLST form is noted as completed with her. A follow-up date closes the entry.
Where the marks sit in the NRNP 6540 Week 10 rubric
Her own voice has to survive into the record, and a note stating that she wants comfort care without one quoted statement hands graders a conclusion without its source. This example quotes her at each key point. Credit also depends on structure; following a recognized conversation guide makes coverage verifiable. The recommendation section earns distinct credit, because rubrics at this level expect the clinician to offer a recommendation rather than a menu of options. A note recording only code status falls short, as does one without an identified surrogate or one whose goals never become orders. Language matters as well: phrases implying that care is being withdrawn rather than redirected tend to cost points on communication.
NRNP 6540 Week 10 help: mistakes that cost marks
Goals of care notes lose most when they state that the patient wants comfort care without quoting her. Record her words. Another common gap is recording code status and nothing else. Capture values, fears and trade-offs. Writers also leave out the clinician's recommendation, though patients often want one. Offer it and tie it to her goals. Avoid medical jargon in quotations. Name the surrogate clearly. Include symptom plans for breathlessness and swelling at home. Close with follow-up and who to call. Writers also forget the neighbor's role, though she may be the first to notice a change. Record it. Another frequent slip is a note that never says when the conversation will be revisited. Set a time. Keep the POLST choices consistent with what she said.
Get a NRNP 6540 Week 10 example written to your instructions
Forward the Week 10 prompt, the rubric, and the scenario your section provided. A conversation note comes back that quotes the patient at each turn, follows a recognized guide, and separates her words from the recommendation. Your first custom sample is free and delivered within 24-48 hours, with forms named as your state or course names them.
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NRNP 6540 Week 10 questions, answered
Does a goals of care note only record code status?
No, and notes that stop there usually lose credit. Code status is one output of a much broader conversation about understanding, priorities, fears, and acceptable trade-offs. The example documents all of these before recording any order. Graders reward a note that shows how the preferences were reached, not only what they turned out to be at the end.
Why include a recommendation from the clinician?
Because leaving an older adult to choose from a list of treatments without guidance places the burden of medical judgment on her. The example records a recommendation that follows from her stated goals and labels it clearly as the clinician's. Rubrics for serious illness communication commonly assess whether a recommendation was made and whether it matched the goals expressed.
What is a POLST form?
A portable medical order form, known by several names across states, that translates a seriously ill person's treatment preferences into orders other clinicians and emergency responders can follow. The example notes it as completed with the patient. Requirements vary by state and by course, and the sample describes the form in general terms unless your prompt specifies a particular version.
Where can I find a free NRNP 6540 Week 10 sample paper?
S.N.'s goals of care note is shown here with who was present, her understanding, the guided conversation, the surrogate, the recommendation and home plans.
What does the patient want in NRNP 6540 Week 10?
To stay at home and to keep recognizing her son, wishes recorded in her own words during the conversation.