| Course | NURS 6910 Introduction to Palliative Care: Principles of Hospice and Palliative Care |
|---|---|
| Week | Week 5 |
| Paper type | Goals of care plan |
| Length | About 1,080 words, 6 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Master of Science in Nursing (MSN) |
| Updated | September 2026 |
Free sample paper for NURS 6910 Week 5
Questions Before Choices: A Goals of Care Plan for a 57-Year-Old Carpenter With ALS as His Breathing Weakens
Student Name
College of Nursing, Walden University
NURS 6910: Introduction to Palliative Care: Principles of Hospice and Palliative Care
Instructor Name
Month Day, Year
Questions Before Choices: A Goals of Care Plan for a 57-Year-Old Carpenter With ALS as His Breathing Weakens
Situation
The patient in this composite case is a 57-year-old self-employed carpenter diagnosed with amyotrophic lateral sclerosis (ALS) two years ago. He walks with a cane, his hands have weakened so that he can no longer use his tools, and at his last clinic visit his breathing tests had declined and he reported waking at night short of breath. His speech remains clear. He lives with his wife, and their daughter and six-year-old grandson live nearby. The ALS clinic team, including the nurse writing this plan, expects decisions about breathing support and nutrition within months.
Practice guidance for ALS recommends discussing these decisions early, while the person can still communicate easily, and revisiting them as the disease changes (Miller et al., 2009). This plan prepares that conversation. It sets out the questions first, records his answers and then shows how the answers narrow the options the team will offer.
The Question Map
The questions are ordered so that understanding and values come before any option is named. Serious illness conversation guides place questions about understanding, information preferences, goals, fears, valued abilities and trade-offs before recommendations, because a recommendation made without them has nothing to align with (Bernacki & Block, 2014).
1. Tell me what you know about how the ALS is changing right now. Asked first, so the team starts from his picture rather than its own, and phrased as an invitation because he tends to answer yes-or-no questions briefly.
2. How much information about what may be ahead would you like? Some patients want detail; others want the headline. His answer sets the depth of everything that follows.
3. If things get harder, what are you hoping for? Hope is asked about before fear so the conversation does not open in loss.
4. What worries you most about the future? Fears often reveal the decisions that matter most to him.
5. What abilities are so important that you cannot imagine living without them? This question turns values into something a treatment choice can be tested against.
6. Who should make decisions for you if you cannot speak for yourself? Asked last, after he has said what matters, so the person he names is chosen to carry those values.
His Answers
His understanding is accurate and plain: "It is getting into my breathing now, and it only goes one way." He wants to know what is ahead "without the medical words, but not sugarcoated." He hopes to keep working in his workshop in some form, even if only by teaching his grandson to sand and finish wood, and to keep talking with the boy. His biggest worry is "living attached to a machine with no way out," which he connects to watching his father spend months on a ventilator after a stroke. The abilities he names are speaking with his family and being at home. He names his wife as his health care proxy, and adds that his daughter should be with her when decisions are made.
Two answers deserve attention because they shape everything after them. His fear is specific, a machine with no way out, not machines in general, which leaves room for support that can be stopped. His valued abilities are social rather than physical: he did not name walking or working with his own hands, abilities he has already begun to lose, but talking and being home. The team reads this as a person who has already adapted once and can adapt again if the adaptation protects what he named.
Aligning Care With His Values
The REMAP framework organizes the alignment: reframe why the situation calls for a decision now, expect emotion, map what is important, align with those values and propose a plan (Childers et al., 2017).
Reframe. The clinician explains that his night-time breathlessness is the first sign that the muscles of breathing are weakening, and that decisions about breathing support are best made before a crisis forces them.
Expect emotion. When he goes quiet, the clinician names it: "This is a lot to hear." The team waits before moving on.
Map. His values are stated back to him: talking with his family, being at home, time in the workshop and avoiding long-term dependence on a machine without a way to stop.
Align. The clinician links these values to the decisions ahead. Breathing support through a mask at night may ease his breathlessness and help him stay at home and keep talking, and it can be adjusted or stopped. Ventilation through a tracheostomy is the kind of long-term dependence he fears. A feeding tube may protect his strength once swallowing weakens, and he can decide about it when that point is nearer.
Plan. The composite clinician in the scenario recommended starting mask ventilation at night, with an explicit agreement that he can stop it at any time, and recorded that he does not want tracheostomy ventilation. The feeding tube decision was deferred to a visit planned for when his swallowing changes.
Documentation
A consensus panel defined advance care planning as an ongoing process that supports adults in knowing and communicating what they value and want from future medical care, which means its forms should record a conversation, never stand in for one (Sudore et al., 2017). The plan therefore records: his named health care proxy, with his wish that his daughter be present; his values in his own words; his decision to try mask ventilation at night with the right to stop it; his decision against tracheostomy ventilation; and the deferred feeding tube decision with a trigger for revisiting it. The team will complete his state's portable medical order form once he is ready, and will give a copy of the conversation summary to his wife.
The plan also sets review points. The conversation will be revisited at each clinic visit, when his breathing tests change and whenever he asks. His answers today are his answers today; the plan treats them as a starting point that he can revise.
Limits of This Plan
This is an academic plan for a composite patient, not guidance for any person with ALS. Decisions about breathing support and nutrition belong to patients and the clinicians treating them, and they depend on details this case does not include. What the plan demonstrates is a method: understanding before information, values before options and a record that keeps the patient's own words at the center.
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
Childers, J. W., Back, A. L., Tulsky, J. A., & Arnold, R. M. (2017). REMAP: A framework for goals of care conversations. Journal of Oncology Practice, 13(10), e844-e850. https://doi.org/10.1200/JOP.2016.018796
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. (2009). Practice parameter update: The care of the patient with amyotrophic lateral sclerosis: Multidisciplinary care, symptom management, and cognitive/behavioral impairment (an evidence-based review). 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. C., 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 NURS 6910 Week 5 instructions ask for
Goals of care assignments in Week 5 typically ask you to plan or document a conversation with a seriously ill patient about values, goals and upcoming decisions, using a recognized framework. Papers often run three to five pages. Start by writing the questions you would ask and the order you would ask them in, and explain the order. Record the patient's answers in his own words where the scenario supplies them. Use a framework, such as REMAP or a serious illness conversation guide, to connect values to specific decisions. Document the proxy, the preferences and a plan for revisiting them. Keep clinical recommendations within the scenario and your role, and state clearly that the plan does not replace clinical judgment.
How this NURS 6910 Week 5 example is built
A situation section introduces the patient and cites Miller and colleagues' ALS practice parameter on early discussion. The question map cites Bernacki and Block's review of serious illness communication and lists six questions with a reason for each position. His answers follow, with a paragraph noting that his fear is specific and his valued abilities are social. The alignment section walks through Childers and colleagues' REMAP stages, linking mask ventilation, tracheostomy and a feeding tube to his values and recording the clinician's recommendation. Documentation cites Sudore and colleagues' definition of advance care planning and lists what is recorded. A limits section closes the plan.
Where the marks sit in the NURS 6910 Week 5 rubric
Goals of care plans are generally evaluated on communication skill, alignment of care with values, use of a framework and documentation. Communication earns the most when questions are open, ordered with reasons and phrased as they would be spoken. Alignment is credited when each upcoming decision is linked to something the patient said, rather than to what the team prefers. Framework use scores when the stages organize the work instead of being listed. Documentation criteria reward a named proxy, preferences in the patient's words and a plan for review. Ethical awareness earns credit when the writer keeps within the nursing role and acknowledges uncertainty. Formatting in APA and logical headings account for the final points.
NURS 6910 Week 5 help from the desk
Goals of care plans lose marks when they start with a menu of treatments and ask the patient to choose. Another loss is recording values in the writer's words instead of the patient's, which hides what he actually said. Some plans ask for the proxy first, which produces a name without the values behind it. Others slip into recommending treatments the scenario never supports. Map questions with reasons, record answers in the patient's voice, link each decision to a value, document the proxy and review points and state the plan's limits. The desk can prepare a plan for the patient and illness your prompt describes. Avoid medication or ventilator settings; they are outside this assignment.
Get a NURS 6910 Week 5 example written to your instructions
Upload the Week 5 instructions and rubric and say which diagnosis the case names; ALS, advanced cancer and organ failure each reorder the questions differently. A plan comes back with its question map, the patient's quoted answers and a documented proxy, delivered in 24-48 hours, and your first one is free.
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NURS 6910 Week 5 questions, answered
What does REMAP stand for?
Reframe, expect emotion, map what matters, align with those values, and plan care that matches them. It is a VitalTalk roadmap for goals of care conversations, and the example uses its stages as the headings of the alignment section. A course teaching a different conversation model gets the same logic of values before choices, set under that model's headings.
Why is the proxy question asked last?
Because a surrogate is most useful when chosen by someone who has just said what matters to him. Asking for a name first produces a relative; asking after values produces a person the patient trusts to carry those values. Some prompts require the proxy earlier for legal reasons, and the example marks where that order can shift without losing the reasoning.
Does the plan recommend a feeding tube or ventilation?
No. It records the decisions ahead, links each to the values he named, and documents the recommendation the composite clinician made in the scenario. It is an academic artifact, not guidance for any real patient with ALS. Clinical choices about breathing support and nutrition belong to the people treating a person, and the plan says so plainly.
Where can I find a free NURS 6910 Week 5 sample paper?
The full plan, question map, his answers, the REMAP alignment and documentation, can be read on this page without cost. A plan for the patient in your own prompt can be requested.
What did the patient in the NURS 6910 Week 5 plan decide about ventilation?
To try mask ventilation at night with the right to stop it at any time, and to decline tracheostomy ventilation; the feeding tube decision was deferred until his swallowing changes.