NRS-460 Benchmark – Case Study: Timothy Smith – Discharge Planning

Nurses will also monitor for signs of infection or complications. Given his non-weight-bearing status, a wheelchair must be properly fitted, and instructions provided for safe transfers using a stand-pivot technique with his right leg only. Physical and occupational therapy referrals will be vital to support his mobility, prevent deconditioning, and adapt his living environment for safety.

Nutritional needs must also be addressed, as Mr. Smith is transitioning to a pureed diet. A consultation with a dietitian will help ensure he meets his dietary requirements while avoiding complications such as aspiration. Telehealth visits with his psychiatrist and PCP must be facilitated, ensuring he has access to the necessary technology and support.

The nurse will also assess his overall health status and report any complications to his primary care provider. Second, a physical therapist (PT) will focus on mobility and strengthening exercises tailored to his non-weight-bearing status. The PT will teach Mr. Smith how to safely transfer from his wheelchair using a stand-pivot technique, helping to prevent falls and promoting gradual rehabilitation of his injured leg.

Additionally, an occupational therapist (OT) will work to adapt Mr. Smith’s living environment and ensure he can safely perform daily activities despite his mobility restrictions (Bakerjian & Wasserman, 2024). This may include recommending assistive devices and modifying his home setup to accommodate his wheelchair.

During the visit, I would assess the wound for signs of infection, such as redness, swelling, or drainage, and evaluate the integrity of the dressing. I would educate Mr. Smith and his caregiver on how to perform dressing changes as needed, reinforcing proper hygiene and infection prevention techniques. PICC line maintenance is another top priority to prevent complications such as bloodstream infections or line occlusion.

I would inspect the site for signs of infection or irritation and ensure that the line is securely in place. Education would include instructions on flushing the line, recognizing signs of complications, and avoiding activities that might disrupt its positioning.

Acknowledging and supporting his emotional well-being is essential. To address his psychosocial needs, the nurse can facilitate open communication, encouraging Mr. Smith to express his concerns and fears. Referrals to support groups or counseling services may help him connect with others facing similar challenges, fostering a sense of community.

Additionally, ensuring access to his scheduled telehealth psychiatric follow-up can provide professional guidance for managing any mental health concerns (García-Navarro et al., 2023). Regarding spiritual needs, the nurse can explore Mr. Smith’s beliefs and values by asking open-ended questions about what brings him comfort or purpose during this difficult time.

If appropriate, the nurse could coordinate with a chaplain or spiritual advisor to provide support. Encouraging activities that align with his spiritual or religious practices, such as prayer, meditation, or reading inspirational texts, can also foster a sense of hope and resilience.

Reporting the incident ensures that similar errors are less likely to occur in the future, as it allows for an examination of the factors that contributed to the mistake, such as systemic issues in order entry or communication gaps between providers and the pharmacy. A just culture encourages open communication about errors and near misses, empowering all staff to raise concerns without fear of retribution.

This approach builds trust among team members and fosters collaboration to enhance patient safety (Soori, 2024). By focusing on system improvement rather than punitive measures, the organization demonstrates respect for its healthcare professionals while prioritizing the well-being of patients. In this instance, the nurse’s actions underscore the importance of vigilance and teamwork in ensuring that processes are safe and reliable, ultimately benefiting both the care team and the patients they serve.

Nurses must consistently apply their knowledge of pharmacology, patient conditions, and treatment protocols when reviewing electronic orders. Recognizing discrepancies, interpreting data accurately, and consulting with other professionals are essential aspects of this process.

Additionally, clinical judgment enables nurses to evaluate the broader context of a patient’s care, ensuring that decisions align with evidence-based practices and individual patient needs. While ICTs enhance efficiency, they must complement—not replace—the expertise and intuition of healthcare professionals. Combining technology with critical thinking ensures optimal outcomes and safeguards against errors.

PTSD-related triggers, such as feelings of helplessness or loss of control, may exacerbate Mr. Smith’s reaction, making it crucial to address these risks proactively (Meena et al., 2023). Potential risks also include a breakdown in the therapeutic relationship between Mr. Smith and the care team.

Continued hostility can lead to communication barriers, reducing the effectiveness of his care. Furthermore, unresolved tension could create a stressful environment, negatively impacting team morale and overall patient outcomes.

For instance, calmly explaining the importance of respectful interactions and reinforcing that aggression is unacceptable ensures expectations are clear. Encouraging Mr. Smith to use relaxation techniques or offering to reschedule tasks until he feels calmer may also help.

To ensure future safety, the care team should implement strategies such as trauma-informed care training, developing individualized care plans that address PTSD triggers, and creating a protocol for handling aggression. Regular team debriefings and promoting an open, supportive work culture can further safeguard both patients and providers.

The nurse should begin by providing a step-by-step demonstration of how to navigate the portal, highlighting features such as medication reminders, appointment scheduling, and telehealth access. A printed or digital guide with screenshots can reinforce this teaching. Assessing Mr. Smith’s comfort level with technology is crucial, and if he has limited experience, additional practice and support may be needed.

If a caregiver is available, including them in the teaching process ensures he has a support system (Meena et al., 2023). Accessibility features such as text enlargement or voice-to-text functions should be demonstrated, especially if Mr. Smith experiences fatigue or cognitive difficulties. Emphasizing the importance of securely storing login credentials and protecting his personal health information adds another layer of education. These considerations ensure Mr. Smith can fully benefit from the portal while at home.

The ability to message his providers directly reduces barriers to communication and ensures timely responses to any questions or concerns. For the care team, the portal streamlines communication, allowing them to efficiently share updates and receive feedback from Mr. Smith.

It also enhances coordination across disciplines, as all team members can access updated notes and care plans (Meena et al., 2023). This improved communication strengthens the patient-provider relationship, builds trust, and supports better health outcomes by promoting adherence to treatment plans.

Physical barriers, such as limited mobility or dexterity issues from prolonged immobility, could also impact his ability to use a computer or smartphone (Meena et al., 2023). If Mr. Smith lacks reliable internet access or an appropriate device, this would further restrict his ability to utilize the portal.

To overcome these challenges, the nurse and care team should ensure that the portal is user-friendly and accessible, provide ongoing technical support, and explore alternative methods for communication if needed. Identifying these obstacles early allows for tailored interventions that support his engagement with this valuable resource.

The nurse should verify that the telehealth platform is installed and functional on his device and provide a step-by-step demonstration of how to log in and navigate the platform. A printed or digital guide with troubleshooting tips would serve as a helpful reference (Meena et al., 2023).

Additionally, Mr. Smith should have a quiet, private space at home where he can participate in the session without interruptions. The nurse should confirm that he knows the appointment time and has the necessary link or login credentials. Mr. Smith should also prepare any relevant health information, including an updated medication list, recent symptoms, and questions or concerns he wishes to address with the psychiatrist.

Bakerjian, D., & Wasserman, M. R. (2024). Interdisciplinary Care and Care Coordination. In Geriatric Medicine: A Person Centered Evidence Based Approach (pp. 1469-1485). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-030-74720-6_99

Brenne, B. A., Hedlund, M., & Ingstad, K. (2024). Nurses’ professional discretion in the purchaser‐provider split in home care in Norway. Journal of Advanced Nursing, 80(2), 612-627. https://doi.org/10.1111/jan.15828

Connor, J., Flenady, T., Massey, D., & Dwyer, T. (2023). Clinical judgement in nursing–An evolutionary concept analysis. Journal of Clinical Nursing, 32(13-14), 3328-3340. https://doi.org/10.1111/jocn.16469

García-Navarro, E. B., Navarro, S. G., Sousa, L., José, H., Caceres-Titos, M. J., & Ortega-Galán, Á. (2023). Nursing students’ perceptions of spiritual needs at the end of life. A qualitative study. Frontiers in Psychiatry, 14, 1132581.

Meena, J. S., Choi, S. B., Jung, S. B., & Kim, J. W. (2023). Electronic textiles: New age of wearable technology for healthcare and fitness solutions. Materials Today Bio, 19, 100565. https://doi.org/10.1016/j.mtbio.2023.100565

Rahman, M. G., Khwaja, M., & Balachandra, S. (2023). Prevention and Management of Violence in Inpatient Psychiatric Settings. The Prevention and Management of Violence: Guidance for Mental Healthcare Professionals, 118.

Soori, H. (2024). Errors in Medical Procedures. In Errors in Medical Science Investigations (pp. 205-224). Singapore: Springer Nature Singapore. https://doi.org/10.1007/978-981-99-8521-0_11

During care coordination and transition of care planning, it is important to consider the type and level of care a patient might need.

Providing holistic nursing care for patients with complex conditions requires that the nurse takes into account the patient’s psychosocial and spiritual needs.

The patient is due to receive his IV antibiotic prior to discharge. As the nurse reviews the electronic orders, she notices that the antibiotic dose seems incorrect. Upon discussion with the provider and pharmacy, it is determined the dose entered was incorrect.

As Mr. Smith is waiting for the nurse, he becomes impatient and starts to verbally attack the patient care technician as she obtains his vital signs.

The nurse is helping Mr. Smith log in to the Patient Portal (i.e. MyChart) before discharge.

Mr. Smith is scheduled for a telehealth appointment with the psychiatrist upon discharge.