A clinic nurse, a woman recently diagnosed with Alzheimer's disease and her unmarried partner speak in NU475's Unit 7 transcript, which follows PREPARE's five steps and adds a staged dementia directive. Searches like "nu 475 unit 7 assignment example", "nu475 unit 7 sample" and "nu475 unit 7 example" land here.
Naming Him Before It Matters: An Advance Care Planning Dialogue With a Retired Chemistry Teacher Four Months After an Alzheimer's Diagnosis
[Student Name]
Purdue University Global
NU475: Providing Transition Care - Chronic Disease and Palliative/Hospice Spheres
Unit 7 Assignment
[Instructor Name]
[Date]
Composite patient and partner written as a model document. Speakers are identified by role only; no legal form is reproduced.
Setting
A 40-minute primary care visit, booked for this purpose. Present: the nurse, the patient, and her partner. The conversation follows the five steps of the PREPARE program: choosing a medical decision maker, deciding what matters most, deciding how much flexibility that person has, telling others, and asking clinicians the right questions (Sudore et al., 2017a). Annotations follow each part.
Part 1: The Decision Maker
Nurse: Last time you said you wanted to talk about planning ahead. Where would you like to start?
Patient: With him. I want him to be the one.
Nurse: Then let's make sure the law sees it that way too. Do you have a health care power of attorney now?
Patient: No. We always said we'd get around to it.
Nurse: In this state, if you can't speak for yourself and there's no signed form, the law lists who decides, and a partner you aren't married to may come after your son, or may not be on the list at all.
Partner: I didn't know that.
Patient: Neither did I. That settles it.
Nurse: The state has an official form. I'll give you a copy today, and our social worker can help you complete and witness it. I won't fill it in for you, because it's a legal document.
Patient: Can I name my son second?
Nurse: Yes, as an alternate.
Annotation. The agent question comes first because, without a signed form, everything else she says today could be decided by someone she did not choose. The nurse explains the gap and leaves the form itself to the state's official version.
Part 2: What Matters Most
Nurse: What makes a day a good day for you now?
Patient: Reading. Crossword. Explaining something to someone and seeing it land. I taught chemistry for 34 years.
Nurse: Is there a point where you would want your care to change, where the goal would be comfort rather than keeping you going as long as possible?
Patient: There's a periodic table on my kitchen wall. When it means nothing to me, when I look at it and don't know what it is, that's when.
Partner: She's said that before.
Nurse: I'll write it in your words.
Annotation. Values are drawn out through her own history, so the answer is concrete and hers. The nurse records the quotation verbatim.
Part 3: Choices by Stage
Nurse: Some people with your diagnosis find it helps to think about three stages, mild, moderate and severe, and say what they would want at each.
Patient: Go on.
Nurse: At a mild stage, like now, would you want all reasonable treatment, including a hospital stay and intensive care if needed?
Patient: Yes. I'm still me.
Nurse: At a moderate stage, when you might need help with dressing and might not recognize some people?
Patient: Treat infections and things like that. No intensive care. No breathing machine.
Nurse: At a severe stage, when you might not recognize him or speak much?
Patient: Comfort only. No hospital unless I'm in pain that can't be handled at home. No feeding tube.
Nurse: Would you like me to read those back?
Patient: Please.
Annotation. The nurse uses a dementia-specific directive of the kind Gaster et al. (2017) proposed, which asks for preferences at each stage of the disease rather than about a single imagined emergency. Her answers are kept as she said them.
Part 4: Checking Capacity
Nurse: Before we go on, can you tell me in your own words what we've decided?
Patient: He's my decision maker. When the periodic table stops making sense, I want comfort. And three stages, each with its own answer.
Nurse: Why do you think it matters to do this now?
Patient: Because I won't be able to later. That's the whole point of the diagnosis.
Nurse: If he disagrees with one of your choices, what would you want?
Patient: I'd want him to do what I said. But I'd want him to talk to the doctors first.
Annotation. The nurse checks the four abilities that clinicians commonly assess when judging decisional capacity: communicating a choice, understanding the information, appreciating how it applies to her, and reasoning about options (Appelbaum, 2007). Each is tested with a plain question rather than a formal instrument.
Part 5: Flexibility and Telling Others
Nurse (to partner): Could you follow one of her wishes if you disagreed with it?
Partner: The feeding tube. I'm not sure I could say no to that.
Patient: You'd have to.
Partner: Then I will.
Nurse: How much leeway would you like him to have?
Patient: Some. If the doctors think something I haven't imagined would help, he can decide.
Nurse: Who else should know about these choices?
Patient: My son. My sister.
Nurse: Would you like to tell them yourself, or together here?
Patient: Myself. I'll call them this week.
Part 6: Questions for Clinicians
Nurse: What would you want to ask your doctors at future visits?
Patient: How fast is this going. And will you tell me when I've crossed from mild to moderate.
Nurse: I'll note both for your next visit with your physician.
Analysis
The dialogue follows PREPARE's five steps in order, and advance care planning here is treated in the sense a multidisciplinary Delphi panel gave it: an ongoing process in which a person comes to understand and then shares what she values and wants from future care (Sudore et al., 2017b), rather than a single form. Two things were deliberately left out. A POLST form was not completed, because it turns preferences into medical orders and is intended for people who are seriously ill or frail now; at a mild stage, her own directive is the right tool. Prognosis was not discussed, because she did not ask for it today and her question about pace is recorded for her physician.
Sample Chart Note
Advance care planning visit, 40 minutes, patient and partner present. Patient chose her partner as health care agent, son as alternate; state form provided, social work to assist with completion and witnessing. Values, in her words: "When the periodic table on my kitchen wall means nothing to me, that's when" care should focus on comfort. Staged preferences: mild, full treatment; moderate, treat infections, no intensive care or ventilation; severe, comfort only, no feeding tube, hospital only for uncontrolled pain. Capacity for these decisions assessed and present. Partner agrees to follow her wishes. Patient will tell son and sister. Questions for physician: rate of progression; when stage changes. Revisit at each annual visit or with a change in condition.
References
Appelbaum, P. S. (2007). Assessment of patients' competence to consent to treatment. New England Journal of Medicine, 357(18), 1834-1840. https://doi.org/10.1056/NEJMcp074045
Gaster, B., Larson, E. B., & Curtis, J. R. (2017). Advance directives for dementia: Meeting a unique challenge. JAMA, 318(22), 2175-2176. https://doi.org/10.1001/jama.2017.16473
Sudore, R. L., Boscardin, J., Feuz, M. A., McMahan, R. D., Katen, M. T., & Barnes, D. E. (2017a). Effect of the PREPARE website vs an easy-to-read advance directive on advance care planning documentation and engagement among veterans: A randomized clinical trial. JAMA Internal Medicine, 177(8), 1102-1109. https://doi.org/10.1001/jamainternmed.2017.1607
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. (2017b). 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
How this NU475 Unit 7 example is structured
Sequence is the argument here. The agent question comes first, before values, because without a signed durable power of attorney for health care her partner may rank below her son, or not appear at all, in her state's default surrogate list; the transcript shows the nurse explaining that gap while leaving the legal form itself to the state's official version. Values follow, drawn out through her teaching years: she names the day the periodic table on her kitchen wall means nothing to her as the moment care ought to change. The staged directive turns that into three answers, one per stage of the disease. Flexibility is handled as a direct question to her partner, who is asked whether he could follow a wish he disagreed with. The analysis then explains two deliberate omissions, a POLST form and any prognosis talk.
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NU475 Unit 7 questions, answered
Does the dialogue have to follow a specific framework?
Most prompts expect one, whether named or implied. PREPARE suits an early conversation because its steps start with choosing a decision maker, while other models fit later, more serious talks. If your course assigns a particular guide, send its name; the sample can be rebuilt around that framework, with annotations pointing to its steps instead of these.
Why include a dementia-specific directive?
Standard living wills often describe terminal illness or permanent unconsciousness and say little about the long middle of dementia. A staged directive asks what the person wants at mild, moderate and severe points, which gives her agent far clearer guidance. If your case involves a different condition, the sample would swap in whatever document fits that illness better.
Should a POLST form be completed in this conversation?
Usually not at this stage. POLST is a medical order intended for people with serious illness or frailty, for whom a clinician would not be surprised by death within about a year. Someone with an early diagnosis and good function typically needs an advance directive and a named agent first. The sample explains that choice in its analysis section.