NRS-460 Benchmark – Case Study: Timothy Smith – Discharge Planning
Mr Smith is ready to be discharged from the hospital. Timothy has been weaned off of oxygen.
Use the “Case Study: Timothy Smith – Discharge Planning” template to complete the assignment.
This case study has indirect care experience requirements. The “NRS-460 – Case Studies: Indirect Care Experience Hours” form, found in the Topic 1 Resources, will be used to document the indirect care experience hours completed in the case study. As progress is made on the case study, update this form indicating the date(s) each section is completed. This form will be submitted in Topic 5.
You are required to cite a minimum of three sources to complete this assignment. Sources must be published within the past 5 years and appropriate for the assignment criteria and relevant to nursing practice.
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
NRS-460 Benchmark – Case Study: Timothy Smith – Discharge Planning
Directions: Read the case study below. Evaluate the information and formulate a conclusion based on your evaluation. Complete the critical thinking table and submit the completed template to the assignment dropbox.
It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the complex management of disease during the discharge of a patient, and the additional aspects of communication and safety in the work environment. The purpose of this assignment is to participate in discharge planning for a patient utilizing communication and information technology, and in a scenario where patient and provider safety is a concern.
PART I: Health History and Medical Information
Evaluate the health history and medical information for Timothy Smith, presented below.
Mr. Smith is ready to be discharged from the hospital. Timothy has been weaned off of oxygen. His tube feedings have been discontinued and he is tolerating a pureed diet. To facilitate safe discharge, the hospital case manager has set up services with a transitional care manager from a Home Health agency. The goal is for Mr. Smith to attain safe recovery and rehabilitation.
- Broken left leg status
- Weight bearing status: non-weight bearing, stand pivot with right leg only
- Assistive devices: wheelchair
- PICC line present for discharge
- Left upper leg wound care: dressing changes as needed for open reduction internal fixation (ORIF) on leg
- Psychiatrist telehealth follow-up scheduled for a Zoom call upon discharge
- Telehealth follow-up visit scheduled two weeks after discharge with Primary Care Physician (PCP)
Lab Tests and Vitals
- Room air, respiratory rate 16 breaths per minute
- Vital signs are within normal limits
Expert Answer and Explanation
PART II: Critical Thinking Activity
Home Health Care and Rehabilitation Therapy | ||
Discharge plan | Mr. Smith requires comprehensive support due to his non-weight-bearing status on his left leg, the presence of a PICC line, and ongoing wound care needs following an ORIF procedure. Additionally, his discharge plan must incorporate telehealth follow-ups with his psychiatrist and primary care physician to address both physical and mental health aspects. The first priority is arranging for skilled nursing services through the Home Health agency to oversee the care of his PICC line and manage dressing changes for his leg wound (Brenne et al., 2024).
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. |
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Interdisciplinary roles that will be essential in supporting Mr. Smith’s home health and rehabilitative care needs. | Several interdisciplinary roles will be essential in supporting Mr. Smith’s home health and rehabilitative care to ensure his recovery and safety. A home health nurse will play a pivotal role in managing his clinical needs. This includes monitoring and maintaining his PICC line, performing dressing changes for his left leg wound, and educating him and his caregivers on infection prevention and wound care (Bakerjian & Wasserman, 2024).
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. |
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Areas of concern for initial visit following discharge. | During my initial visit as the home health nurse assigned to Mr. Smith, I would prioritize two critical areas: managing his wound care and ensuring the proper maintenance of his PICC line. Wound care management is essential due to the risk of infection and delayed healing associated with his left upper leg injury and ORIF procedure.
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. |
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Psychosocial and Spiritual Considerations | ||
Ways in which the nurse can take into account Patient psychosocial and spiritual needs | Addressing Mr. Smith’s psychosocial and spiritual needs is a vital component of holistic care, especially given his complex health situation. The physical challenges of being non-weight-bearing and reliant on a wheelchair, combined with the demands of wound care and PICC line management, can lead to feelings of frustration, isolation, or depression (García-Navarro et al., 2023).
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. |
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Just Culture | ||
Reporting the Near Miss and Its Contribution to a Just Culture | Reporting the near miss involving the incorrect antibiotic dose is a critical action that fosters a just culture, which emphasizes accountability, learning, and system improvement over individual blame (Soori, 2024). In this scenario, the nurse’s diligence in identifying and addressing the error demonstrates a commitment to patient safety and reinforces a culture of civility and respect within the healthcare team.
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. |
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Application of Clinical Judgment and Critical Thinking. | Clinical judgment and critical thinking remain indispensable even with the use of advanced information and communication technologies (ICTs). While electronic systems are invaluable for reducing errors and streamlining workflows, they are not infallible and require human oversight to ensure their accuracy (Connor et al., 2023). In this case, the nurse’s critical thinking allowed them to question an incorrect antibiotic dose, highlighting the importance of maintaining an analytical approach to care delivery.
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. |
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Levels of Risk | ||
Actual and Potential Levels of Risk | Mr. Smith’s verbal aggression poses both actual and potential risks to the care team, heightened by his history of PTSD. The immediate actual risk is emotional harm or distress to the patient care technician, which may affect their confidence and job performance. Additionally, there is a potential for the situation to escalate into physical aggression, creating a safety risk for the technician and others nearby.
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. |
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Steps to Diffuse the Situation and Ensure Safety | To diffuse the situation, the nurse should intervene promptly and calmly. Using a non-confrontational approach, the nurse can acknowledge Mr. Smith’s frustration, validate his feelings, and redirect his attention to understanding the care process. Statements like, “I understand this is a stressful time for you; let’s work together to address your concerns,” can help de-escalate tension. Establishing clear communication and setting boundaries is essential (Rahman et al., 2023).
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. |
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Patient Portal | ||
Ensuring Patient Portal Usability at Home | When helping Mr. Smith log in to the Patient Portal, it is important to ensure he can independently and effectively use this tool at home. Given his recent injury and the associated physical and psychosocial challenges, the nurse must provide clear instructions and ample support. Since Mr. Smith has been recovering from a left leg injury, relies on a wheelchair, and has a history of PTSD, he may face both physical and cognitive barriers to using the portal.
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. |
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Benefits of Using Information and Communication Technology | The Patient Portal offers several benefits for both Mr. Smith and his care team. For Mr. Smith, the portal provides easy access to his health information, such as lab results, discharge instructions, and follow-up appointments. This fosters a sense of autonomy and helps him stay engaged in his care.
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. |
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Potential Obstacles to Using the Patient Portal | Several obstacles may hinder Mr. Smith’s use of the Patient Portal. His PTSD and history of emotional distress may make him feel overwhelmed by technology or reluctant to engage with unfamiliar tools. Cognitive fatigue or concentration difficulties due to his recovery process might limit his ability to navigate the portal effectively.
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. |
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Telehealth | ||
Information and Resources | To prepare Mr. Smith for his telehealth appointment with the psychiatrist, the nurse should ensure he has the necessary information, resources, and tools to facilitate a smooth and productive session. First, Mr. Smith needs access to the appropriate technology, such as a smartphone, tablet, or computer, equipped with a camera, microphone, and reliable internet connection.
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. |
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References
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 |
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PART II: Critical Thinking Activity
Use the findings from your evaluation to complete the following:
Home Health Care and Rehabilitation Therapy
During care coordination and transition of care planning, it is important to consider the type and level of care a patient might need. |
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You are the transitional care manager assigned to Mr. Smith prior to discharge. Based on Mr. Smith’s assessment findings, develop a discharge plan that encompasses his care needs following discharge. Your response should be a minimum of 200 words. | ||
Discuss three to five interdisciplinary roles that will be essential in supporting Mr. Smith’s home health and rehabilitative care needs. Your response should be a minimum of 150 words. | ||
You are the home health nurse assigned to treat Mr. Smith. Identify two areas of concern that you might prioritize during your initial visit with him following discharge. Your response should be a minimum of 150 words. | ||
Psychosocial and Spiritual Considerations
Providing holistic nursing care for patients with complex conditions requires that the nurse takes into account the patient’s psychosocial and spiritual needs. |
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Given the patient’s current situation, discuss ways in which the nurse can take into account and address the patient’s psychosocial and spiritual needs. Your response should be a minimum of 150 words. | ||
Just Culture
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. |
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Discuss how reporting this near miss will help contribute to a just culture reflecting civility and respect. Your response should be a minimum of 200 words. | ||
Discuss how clinical judgement and critical thinking should be applied despite the use of information and communication technologies. Your response should be a minimum of 150 words. | ||
Levels of Risk
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. |
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Identify actual and potential levels of risk to the care team within this situation given the patient’s history of PTSD. Your response should be a minimum of 150 words. | ||
What can the nurse do to diffuse this situation? What steps can be put in place to ensure safety for both patients and providers in the future? Your response should be a minimum of 150 words. | ||
Patient Portal
The nurse is helping Mr. Smith log in to the Patient Portal (i.e. MyChart) before discharge. |
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Explain the considerations for ensuring the patient would be able to use this resource at home. In your discussion include considerations related to the patient’s condition and cognitive status based on his assessment findings and history of injury reviewed in previous topics. Your response should be a minimum of 200 words. | ||
Discuss the benefits for both the patient and the care team in using information and communication technology to support the patient-provider relationship. Your response should be a minimum of 150 words. | ||
What obstacles might hinder his use of the Patient Portal? Your response should be a minimum of 150 words. | ||
Telehealth
Mr. Smith is scheduled for a telehealth appointment with the psychiatrist upon discharge. |
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Discuss the information and resources that the nurse should ensure the patient has available in preparation for his visit. Your response should be a minimum of 150 words. | ||
References (Please include working hyperlinks.) |