Reflect on the Five Wishes presented on the Five Wishes website and PDF and complete your Five Wishes. Explain your state’s requirements for advance directives, including whether your Five Wishes can be turned into a formal document.
Directions*** week 9 and 10 are separate assignments and each need their own reference list. At least 2 references requires for each week. APA format. No certain page requirement as long as it covers the topics
Week 9 Journal
An advance directive is a legal document that defines a patient’s wishes for medical care. This document is a way for patients to share their wishes with family members and health care providers when their illness or mental capacity prevents them from making decisions. As an advanced practice nurse who has care discussions with patients and their families, you need to not only be familiar with the process of completing an advance directive, but also understand how this document might impact your role in patient care and treatment.
Journal Entry Part 1
For the first part of your journal entry, reflect on the Five Wishes presented on the Five Wishes website and PDF and complete your Five Wishes. Explain your state’s requirements for advance directives, including whether your Five Wishes can be turned into a formal document. (**I will message you the state i live in) Then, explain how your experience of completing your Five Wishes advance directive will help you guide discussions with patients and their families. Finally, explain how you might apply the Five Wishes advance directives to your nursing practice. Include how this advance directive might benefit patients in decision making for specialized areas of care.
** Five wishes reference https://class.waldenu.edu/bbcswebdav/institution/USW1/201750_27/MS_NURS/NURS_6540/readings/USW1_NURS_6540_fiveWishSample_Week%209.pdf
Journal Entry Part 2
For the second part of your journal entry, reflect on geriatric patients from your practicum site with disorders related to specialized areas of care, such as oncology, nephrology, urology, gynecology, and neurology. Describe a case of a frail elder patient who must make decisions related to specialized areas of care. Then, explain potential patient outcomes and include whether treatments would be beneficial and how they would impact the patient’s quality of life. Finally, describe the patient’s wishes in terms of treatments and interventions for the disorder (Was there an advanced directive?) and how the patient might want to spend any remaining time. Include how environmental factors, such as family, caregivers, ethnicity, culture, religion, and/or personal values, might impact decision making for treatments and interventions. If you did not have an opportunity to evaluate a patient with this background during the last 9 weeks, you can select a related case study or reflect on previous clinical experiences.
Week 10 Journal
Elder abuse is any intentional or negligent behavior that results in physical, sexual, emotional, pharmacological, and/or financial abuse. Unfortunately, abuse is sometimes difficult to identify, and elders are often hesitant or unable to report abuse themselves (Administration on Aging, n.d.). This makes it important for health care providers to regularly monitor for signs of abuse and react according to local and state laws.
Journal Entry Part 1
For the first part of your journal entry, select and describe one of the following types of elder abuse: physical, sexual, mental/emotional/verbal, pharmacological, or financial. Explain strategies for identifying this abuse. Then, explain how you would proceed based on your local and state laws once you have identified this abuse in a patient. Describe resources in your community that assist victims of this type of abuse and explain how you, as the advanced practice nurse, might apply these resources for abused elders who are identified in the clinical setting.
Journal Entry Part 2
For the second part of your journal entry, reflect on the different cultures—ethnic, religious, regional, or generational—of the elder patient population at your practicum site. Describe the cultures you have observed and explain the influence of these cultures on the prevalence and detection of elder abuse. Then, explain how culture might impact the way you would implement resources for preventing or addressing abuse.
 

Physicians R Us (the “Company”) is proposing to build an ambulatory surgical treatment center (“ASTC”) that will provide outpatient ambulatory surgery and ancillary services. To help with financing the ASTC, Company intends to sell shares of the company to physician investors who will utilize the facility and refer patients to the ASTC (the “Proposed Arrangement”). As members of the Physicians R Us Advisory Board (the “Board”), you have been asked to give an advisory opinion regarding the Proposed Arrangement.
Specifically, the Board is being asked to opine whether a physician’s referrals for certain services are prohibited under section 1877 of the Social Security Act (the “Act”). In your response, address the following questions:
1. Would the investment in and ownership of the ASTC by physicians, who will refer patients to the ASTC and who will perform surgeries at that ASTC, violate the prohibition in section 1877 of the Act against certain physician referrals?
2. Is the proposed location of the ASTC a rural area under the rural provider exception in section 1877(d)(2) of the Act (referencing the rural definition in section 1886(d)(2)(D) of the Act)?
3. Would the rural exception in section 1877(d)(2) of the Act apply to the proposed ASTC arrangement?
4. Under section 1877 of the Act, can non-surgeon physician investors in the ASTC refer patients there without violating the Federal prohibition against referring patients to an entity with which a physician has a financial relationship?
In issuing your written opinion, you may rely solely on the facts and information presented to you. There is no need to undertake an independent investigation of such information or to address specific issues of state law. Please limit your opinion to the facts presented.
In building the ASTC, the Company formed an ASTC Investment Team comprised of the CEO and other Company executives to work of the details of the Proposed Arrangement. The CEO has requested that the Board meet with the ASTC Investment Team to discuss the Proposed Arrangement and the Board’s findings. The Chair, on behalf of the Board, should be prepared to lead the discussion regarding the Board’s findings, including the applicable law and how the Board arrived at its opinion.
FACTUAL BACKGROUND
Physicians R Us, a newly formed limited liability company in the state of Dixon, is proposing to build and operate an ambulatory surgical treatment center (“ASTC”). CEO indicates that the ASTC will provide outpatient ambulatory surgery as well as ancillary services such as clinical laboratory services, radiology services, ultrasound, parenteral nutrients, and outpatient prescription drugs. It is expected that physician investors will refer some patients for services furnished by the ambulatory surgical center located
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within the ASTC. These ambulatory surgical services will be furnished by the part of the facility that meets the ambulatory surgical center conditions and requirements in section 42 C.F.R. Part 416. In addition, physician investors will also refer patients for other services to parts of the facility that are not included within the ambulatory surgical center.
The ASTC will be located in Mason, Dixon, which is in Dansbury County. The Company expects that substantially all of the designated health services provided by the ASTC will be furnished to individuals residing in a rural area. The Company indicates that, upon completion, the ASTC will be the first such center located in Dansbury, County.
In order to finance the construction and operation of the ASTC, the Company will sell shares of the company to investors. The investors will be physicians who will refer patients to the ASTC. Further, some of these physicians will perform medical and surgical procedures at the ASTC. The Company expects that physician investors will refer Medicare beneficiaries to the ASTC.