| Course | NU 627 Geriatric Healthcare |
|---|---|
| Unit | Unit 6 |
| Paper type | Goals of care conversation record |
| Length | About 860 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN Family Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NU 627 Unit 6
Goals of Care Conversation Record: An 84-Year-Old Woman With Oxygen-Dependent COPD After Her Third Admission
Student Name
Department of Nursing, Herzing University
NU 627: Geriatric Healthcare
Instructor Name
February 27, 2026
Goals of Care Conversation Record: An 84-Year-Old Woman With Oxygen-Dependent COPD After Her Third Admission
Who Was Present and How It Came About
Date: two weeks after hospital discharge, in the clinic, 45 minutes. Present: Mrs. L., a composite 84-year-old retired seamstress with severe chronic obstructive pulmonary disease on 2 liters of home oxygen; her son Robert, 58, who lives with her; and her daughter Anne, 55, by speakerphone from another state. The conversation was offered because this was her third hospital admission in eight months, each for an exacerbation, and she had asked during the last stay, "How many more times can I do this?" The Serious Illness Conversation Guide was used as a framework, in the order of setting up, assessing understanding, sharing prognosis, exploring what matters, and closing (Bernacki & Block, 2014).
Her Understanding
Asked what she understood about her lungs, she said: "They're worn out. The doctors keep fixing me up, but each time I come home weaker." Asked what she thought might happen next, she said: "I think one of these times I won't come home." Robert said he thought the hospital stays were "setbacks" and that pulmonary rehabilitation would get her back to where she was last year. Their understandings differ, and that difference is recorded rather than resolved here.
Information Shared and How Much She Wanted
She was asked, "How much information about what is likely to happen with your illness would you like from me?" She answered: "Tell me straight, but I don't want numbers." She was told: "I'm worried that your lungs are getting weaker, and that these flare-ups may keep happening and each one may take more out of you. I hope rehab helps, and I'm also worried that time may be shorter than we would like, perhaps a year or so rather than many years." She nodded and said, "That's what I thought." She declined further detail about survival estimates, and that choice is recorded because it tells future clinicians how she prefers to receive hard news.
What Matters to Her
Asked what is most important if her health worsens, she said: "Being in my own house. My sewing room. Having Robert and the grandkids come by for Sunday dinner." Asked what she fears most: "Being on a breathing machine. My husband was on one for three weeks before he died, and he never knew we were there." Asked about her sources of strength: "My church, and my sewing. I'm making a quilt for each grandchild and I have two left." She has a specific near-term goal: to finish those two quilts.
Trade-Offs She Would and Would Not Accept
Asked, "If you become sicker, how much are you willing to go through for the possibility of more time?" she said she would go back to the hospital for antibiotics, steroids, and the mask machine (bilevel noninvasive ventilation) "if it will get me home again," but she would not want a breathing tube or to be kept on a ventilator. Asked what abilities are so important she cannot imagine living without them: "Knowing who my family is, and being able to sit in my own chair." She said that more time in an intensive care unit, unaware of her surroundings, would not be worth it to her. She would accept being on more oxygen and needing help with bathing.
Family Views and Where They Diverge
Robert said he wants his mother to "do everything" and that he worries she is giving up. Anne said she agrees with her mother and has heard her say the same things for years. Mrs. L. told Robert directly: "I'm not giving up. I'm telling you what I want so you don't have to guess." Robert said he understood but needed time. This disagreement was not smoothed into consensus in the record; it is noted so that future clinicians will know Robert may find decisions difficult, and a follow-up conversation with him alone was offered and accepted.
Decisions and Documents
Decisions made today: she does not want intubation or mechanical ventilation; she does want hospital treatment including noninvasive ventilation if it offers a reasonable chance of returning home; she does not want cardiopulmonary resuscitation, because she understands it would likely lead to a ventilator. A Physician Orders for Life-Sustaining Treatment form reflecting these choices was completed and signed. She named Robert as health care agent, with Anne as alternate, understanding that Robert may need support to follow her wishes. A referral to palliative care for symptom management of breathlessness was made and accepted. Advance care planning is a process that prepares patients and surrogates for decisions rather than a single form (Sudore & Fried, 2010), and it is defined as supporting adults in understanding and sharing their values and preferences (Sudore et al., 2017), and the conversation will be revisited at her next visit and after any further admission.
Next steps: pulmonary rehabilitation as planned; palliative care consultation; follow-up visit with Robert in two weeks. What she chose not to hear, survival figures, and her request that bad news be given "straight, but without numbers," are both recorded for future conversations.
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
Sudore, R. L., & Fried, T. R. (2010). Redefining the "planning" in advance care planning: Preparing for end-of-life decision making. Annals of Internal Medicine, 153(4), 256-261. https://doi.org/10.7326/0003-4819-153-4-201008170-00008
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
Reading the NU 627 Unit 6 instructions
The Unit 6 assignment asks you to document a goals of care or advance care planning conversation with an older adult and their family. Expect to record who was present, the setting and length, and how the conversation began. The patient's understanding of their illness should be recorded before information is shared, and many sections ask you to note how much information the patient wanted. What matters most to the patient and the trade-offs they would accept are central and should use their own words where possible. Family views, especially where they differ, should be documented. Decisions made and documents completed or planned belong at the end. Name the framework you followed, with its citation; a record like this usually runs shorter than a full paper.
How the NU 627 Unit 6 example is put together
The record opens with the date, place, length and people present, and explains that the conversation followed a recent discharge. Her understanding is recorded in her words: her lungs are worn out and she comes home weaker each time. The next section shows that she was asked how much she wanted to know and asked to be told directly, so the prognosis was shared plainly. What matters to her is written in quotation. The trade-offs section records that she would return to the hospital for treatment with a mask but would not want a breathing tube. Family views are documented without taking sides, noting her son's wish to do everything and her daughter's agreement with her mother. Decisions and documents close the record, including the forms completed and the plan to share them.
Where the points sit in the NU 627 Unit 6 rubric
Herzing rubrics for a goals of care record generally reward structure, patient understanding, information sharing, values and trade-offs, family communication, decisions and documentation quality. Structure points go to records that follow a recognized framework. Understanding is credited when the patient's own view is recorded before information is given. Information sharing earns points when the clinician asks permission and matches the patient's preference. Values and trade-offs tend to decide the grade, and the patient's own words count for more than any clinician summary. Family points depend on accurate, neutral documentation of differing views. Decision points require clear choices and named documents. Documentation quality covers concise wording, use of quotation and APA citation of the framework used.
Common NU 627 Unit 6 mistakes, and how to avoid them
Conversation records commonly lose points by summarizing the patient's wishes in clinical language instead of quoting them. Students also record a code status decision without the values behind it. Another frequent gap is skipping the patient's understanding and going straight to information. Prognosis shared without asking what the patient wants to know misses a criterion in many rubrics. Family disagreement is sometimes left out or presented as the clinician taking a side. Decisions without follow-up, such as forms completed but not shared with the hospital, weaken the record. Finally, avoid writing the conversation as a script of the clinician's lines; the grader is looking for the patient's voice and the decisions that come from it.
Get a NU 627 Unit 6 example written to your instructions
Send the Unit 6 instructions and the rubric from your NU 627 classroom, plus the patient case your conversation record covers. We write a custom example that establishes understanding first, captures values as trade-offs and preserves the patient's language, returned in 24 to 48 hours. The first custom sample is free.
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NU 627 Unit 6 questions, answered
Why record the patient's actual words?
Because they carry meaning the paraphrase loses. A patient saying they do not want to end up like their mother is telling you something specific that becomes unrecoverable once it is written as declines aggressive intervention. Future clinicians reading the record need what was meant, and quotation is the only form that preserves it.
Why check understanding first?
Because preferences depend on it. Somebody who believes their condition is curable will answer questions about intervention entirely differently from somebody who knows it is not, and recording their preference without recording their understanding produces a document that misleads later. Ask what they understand, note the gap if there is one, and address it before going further.
What if the patient does not want to discuss it?
Record that, because it is a finding rather than a failed conversation. Some patients decline prognostic information, some want a family member to receive it instead, and both are legitimate positions that should guide how future conversations happen. Note what they declined, whether they nominated somebody else, and when they would be willing to revisit it.
Where can I find a free NU 627 Unit 6 sample paper?
This page presents the entire NU 627 Unit 6 conversation record free, with her understanding, the information she asked for, her values, the trade-offs, family views and the decisions. For a record built on your own case, request a custom version at no charge; it usually comes back within two days.
How do I document a goals of care conversation?
Record who was present, the patient's understanding in their own words, how much information they wanted, what matters most, the trade-offs they accept or refuse, family views and the decisions made, with any forms completed.