Module 05 Advanced Directives Essay: rubric-first guide

Read the scoring rubric before the questions, because it redistributes the work in a way the questions themselves hide. Four criteria, ten points: the relationship to the Bill of Rights is worth three, the nurse's role is worth three, and *Discussion of personal advanced directives* is also worth three. The section that feels like a postscript carries thirty per cent of the mark, the same as either knowledge section. Submissions routinely spend eight hundred words on the first two questions and close with four sentences saying the writer has not thought about this yet, which is a full point grade lost on the part that needed no research at all. Budget the personal section as one third of the paper from the outset, and the rubric stops being a surprise at the end. Reading the rubric first also tells you that nothing here rewards length: ten points, four criteria, and no word count stated anywhere in the brief.

The third and fourth questions are branches, not a pair. You answer the one that is true of you — either you already have advance directives and describe finalising them, or you do not and describe how you would proceed — and the rubric collapses both branches into the single criterion *Discussion of personal advanced directives*. Answering both to be safe reads as padding and gains nothing, because there is only one line on the rubric to score it against. Pick the branch honestly, then give it the depth the three points justify: who you consulted or would consult, in what order, and what specifically was or would be difficult about the conversation rather than the paperwork. Whichever branch you take, the marker is reading for deliberation, and the honest answer to not having done this is a plan with names in it rather than an apology.

The brief uses two different names for the same idea and they are not interchangeable documents. The question asks about the Client or Resident Bill of Rights; the rubric says Patient Bill of Rights. Resident rights are federal regulation with force of law — 42 CFR 483.10 binds every long-term care facility that takes Medicare or Medicaid, and it names the right to formulate an advance directive explicitly. The American Hospital Association's Patient's Bill of Rights is not regulation, and it was retired in 2003 and replaced by The Patient Care Partnership. Citing the retired document as though it were current is the commonest factual error in this assignment, and it is easy to avoid once you know the two texts are different in kind. If your setting is acute care rather than a nursing home, say so and cite the hospital document instead, because both answers are defensible and only one of them matches where you work.

For the nurse's role, what earns marks is scope rather than enthusiasm. The Patient Self-Determination Act obliges facilities to ask about advance directives at admission, to document the answer, and to provide written information about state law — so the nurse's role begins as a legal duty and not a preference. Then say what the nurse does and does not do: educates, facilitates values clarification, documents expressed wishes, and ensures the directive reaches the record and travels with the patient. The boundary matters too. In many states a nurse employed by the facility may not witness the document, and no nurse completes it on the patient's behalf. Naming that limit shows you understand the role rather than admiring it. Both halves are needed: the duty explains why the conversation happens at all, and the limit explains why the nurse's job is to make the decision possible rather than to make it.

Two small things finish the paper. The rubric's fourth criterion pays a point for APA format, fewer than three grammar errors, and — stated outright — *Used subheadings*. That is a mark for structure handed to you, so take the four rubric criteria as your four subheadings and the grader can find every point without hunting. And keep the personal section concrete: a named surrogate and why that person, a specific decision such as tube feeding or ventilation, a real obstacle such as a relative who disagreed or a form your state requires notarised. Generic statements about wanting your wishes respected are true of everyone and score as the placeholder they are. None of this takes long and all of it is scored, which makes the last half hour of work on this paper the best paid half hour in it.