NRS 460 Benchmark – Case Study Assignment: Timothy Smith – Hospice/Palliative Care

NRS 460 Benchmark – Case Study Assignment: Timothy Smith – Hospice/Palliative Care

NRS 460 Benchmark – Case Study Assignment: Timothy Smith – Hospice/Palliative Care

NRS-460 Benchmark – Case Study: Timothy Smith – Hospice/Palliative Care
PART II: Critical Thinking Activity
Use the findings from your evaluation to complete the following:
Clinical Assessment and Interventions
Answer the following questions based on Mr. Smith’s presentation and history.
Discuss the conditions that could be causing Mr. Smith’s shortness of breath given his clear chest x-ray. Your response should be a minimum of 150 words. Mr. Smith’s shortness of breath is due to deep venous thrombosis. Deep venous thrombosis is a common complication associated with fractures, prolonged immobilization, and lower limb surgery. Mr. Smith has the three risk factors for deep venous thrombosis. His decline in mobility, lower limb surgery after the accident, and fractured limb predisposed him to deep venous thrombosis. Patients with deep venous thrombosis experience symptoms, including leg swelling, pain, tenderness, increased warmth, unexplained shortness of breath, and skin discoloration in the affected limb (Zhao et al., 2021). A clear chest radiograph rules out causes such as pulmonary embolism in Smith’s case. Similarly, the absence of fever rules out fat embolism. Radiological findings in fat embolism would include the presence of diffuse interstitial infiltrates in a chest x-ray and diffuse vascular congestion and pulmonary edema when a chest CT scan is ordered (Lempert et al., 2021). The absence of these findings implies that Mr. Smith most likely has deep venous thrombosis, a complication of lower limb surgery, fracture, and prolonged immobility.

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Identify possible interventions that would be needed to address Mr. Smith’s shortness of breath. Include the timeframe for each intervention in your discussion. Your response should be a minimum of 150 words. One of the possible interventions that would be implemented to address Mr. Smith’s shortness of breath is supplemental oxygenation. Supplemental oxygen will be administered to Mr. Smith via a nasal cannula or face mask to assist in body tissue perfusion. The oxygen will be administered until the oxygen saturation levels are maintained above 90% when Mr. Smith is off oxygen and has no signs of respiratory distress. The second intervention is the administration of anticoagulants and blood thinners. Blood thinners such as warfarin will be administered to dissolve the blood clot. Oral anticoagulants such as heparin might also be administered to dissolve the blood clots. Anticoagulants and blood thinners will help ease the respiratory symptoms by eliminating blood occlusion by the clots. Warfarin can be taken for a long period because of its reduced risk of bleeding. Mr. Smith can be prescribed warfarin for 3-6 months (Frank et al., 2023). However, heparin is associated with an increased risk of bleeding. Therefore, he should be prescribed 5-7 days.
Prioritize three to five additional interventions that would be needed to address Mr. Smith’s immediate health needs. Your response should be a minimum of 200 words. One of the prioritized interventions that should be implemented for Mr. Smith is ensuring that he is kept in an appropriate position. Mr. Smith is experiencing shortness of breath. The nurse should place him in a semi-fowlers position to ease the respiratory effort. Close respiratory monitoring should also be performed to detect changes in respiratory status and any signs of pulmonary embolism. The second intervention that should be implemented for Mr. Smith is the administration of antibiotics. Mr. Smith has a lower limb wound. He is at risk of infection, hence, the need for administering the prescribed antibiotics and analgesics. The third intervention that would be needed to address Mr. Smith’s immediate health needs is wound cleaning and dressing. The nurse should clean and dress the wound in the left lower limb to prevent septicemia. Mr. Smith’s cognitive function has declined. The decline places him at risk of harm from falls (Sabbagh et al., 2020). The nurse should ensure environmental safety and keep re-orienting Mr. Smith to prevent aggression and risk for injury.
Building Rapport Through Respect, Compassion, and Empathy
Establishing caring relationships is vital for the nurse-patient relationship, especially when taking care of patients with complex, chronic needs.
Discuss the steps needed to build rapport and mutual understanding when providing care to Mr. Smith, given his distrust of healthcare providers and his lack of a support system. Your response should be a minimum of 150 words. The nurse should consider several steps to build rapport and mutual understanding when providing care to Mr. Smith. One of the steps is incorporating active listening into Mr. Smith’s care. Active listening will enable the nurse to understand Mr. Smith’s needs. The nurse should let Mr. Smith express his concerns, fears, and experiences. The nurse should also respect and acknowledge them. The second strategy is empathy. The nurse involved in Mr. Smith’s care should empathize with his feelings, distrust of healthcare providers, and the lack of social support. Empathy will make Mr. Smith feel that the nurse understands his experiences, which will influence the nurse-patient relationship. The nurse should also strive to ensure cultural sensitivity in Mr. Smith’s care as a way of building rapport and strengthening mutual understanding. Mr. Smith’s cultural values, beliefs, and preferences affect his attitude and uptake of healthcare services. The nurse should assess the diverse cultural factors that influence Mr. Smith’s health and incorporate them into the care plan. Lastly, the nurse should educate and involve Mr. Smith in his care as a strategy for building rapport and mutual understanding (English et al., 2022). Education and involvement will increase Mr. Smith’s knowledge about his health needs and empower him to be proactively involved in meeting them.
Explain the strategies that would be useful when establishing a respectful nurse-patient relationship demonstrating qualities of compassion and empathy. Your response should be a minimum of 150 words. Several strategies are useful when establishing a respectful nurse-patient relationship that demonstrates qualities of compassion and empathy. One of the strategies is open communication. Nurses should encourage open communication between them and Mr. Smith. There should be two-way communication to ensure that Mr. Smith expresses his concerns, fears, and views on how to meet his health needs. The second strategy for establishing a respectful nurse-patient relationship is adopting a non-judgmental attitude in Mr. Smith’s care. Nurses should maintain a non-judgmental attitude toward Mr. Smith despite his choices, status, or lifestyle. Assumptions should not inform care decisions made in his care. Lastly, the nurse should ensure patient-centeredness when striving to establish a respectful nurse-patient relationship. Patient-centeredness entails the development of care plans that address both prioritized and potential patient needs. Care interventions should be tailored toward the patient’s goals, needs, and preferences (Afriyie, 2020). Mr. Smith should be involved in the assessment, planning, implementation, monitoring, and evaluation of care plans to ensure sustained outcomes in his treatment.
Effective Communication
Caring for patients with complex needs requires the nurse to possess effective communication skills. You are assigned as Mr. Smith’s primary nurse during his most recent hospitalization. Consider Mr. Smith’s most recent assessment findings in addressing the following questions.
When communicating with Mr. Smith, identify which of his values and beliefs would be important to consider to ensure effective communication. Use information from this and previous case studies in this course. Your response should be a minimum of 150 words. Mr. Smith’s values and beliefs should be considered to ensure effective communication. One of them is respect. The nurse should respect Mr. Smith’s preferences, views, beliefs, and practices that influence his health outcomes and the uptake of health interventions. The values and beliefs should be incorporated into his care plan. Secondly, the nurse should be non-judgmental when caring for Mr. Smith. Mr. Smith has a history of being verbally abusive when being cared for by a patient attendant. Therefore, such patient encounters should not inform the nurses’ attitude toward Mr. Smith. The nurse should also consider Mr. Smith’s cultural and religious beliefs. Culturally tailored interventions should be implemented to augment Mr. Smith’s care goals. Respecting cultural diversity will eliminate misunderstandings in Mr. Smith’s care. Religious beliefs and practices influence healthcare decisions (Afriyie, 2020). The nurse should be sensitive to Mr. Smith’s religious beliefs, and incorporate them into the treatment decisions, and care plans.
Emotional intelligence helps us maintain an awareness of our own emotions and enables us to effectively interact with others in an empathetic manner. When admitting Mr. Smith to the hospital, how would the nurse demonstrate emotional intelligence in her interactions with him? Your response should be a minimum of 150 words. Emotional intelligence is an important aspect that nurses should demonstrate when caring for Mr. Smith. One of the behaviors that the nurse should demonstrate when caring for Mr. Smith is being empathetic. Empathy is one of the emotional intelligence aspects that promote compassionate care in nursing. The nurse should listen actively to Mr. Smith, acknowledge his concerns, and validate his experiences. Empathy would make Mr. Smith feel valued during his hospital stay. The second aspect of emotional intelligence that the nurse should demonstrate when caring for Mr. Smith is self-awareness. The nurse should be aware of his/her values, beliefs, and preferences and their impact on care decisions. Nurses should be able to manage their values, beliefs, and preferences and ensure they do not affect care decisions for Mr. Smith. Lastly, the nurse should be professional when interacting with Mr. Smith. The nurse should be able to control his/her emotions regardless of their experiences with Mr. Smith (Dugué et al., 2021). For example, the nurse should be calm and demonstrate effective de-escalation strategies if Mr. Smith becomes aggressive or violent.
Psychosocial and Spiritual Considerations
Providing holistic nursing care for patient with complex conditions requires that the nurse take into account the patient’s psychosocial and spiritual needs.
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. The nurse should be competent in addressing Mr. Smith’s psychosocial and spiritual needs. The nurse can address these needs by incorporating several strategies into his care. Firstly, the nurse should incorporate active listening and the use of effective communication strategies into Mr. Smith’s care. Active listening will enable the nurse to understand Mr. Smith’s prioritized and potential needs and develop patient-centered care plans. Effective communication strategies such as the use of verbal and non-verbal communication would help create a therapeutic nurse-patient relationship and establish trust and rapport. Secondly, the nurse should provide care that aligns with Mr. Smith’s spiritual and religious preferences. For example, a clergy might be involved in providing the spiritual and religious care that Mr. Smith might need during his hospitalization. Thirdly, nurses should incorporate interprofessional collaboration into Smith’s care as a way of addressing his psychosocial and spiritual needs (Ghorbani et al., 2021). Healthcare providers, including counselors, social workers, community health nurses, and chaplains among others should be involved in Smith’s care to address his complex spiritual and psychosocial needs.
Hospice/Palliative Care Management
You are assigned as the nurse case manager for Mr. Smith.
Explain the difference between hospice and palliative care. Based on Mr. Smith’s current assessment findings, discuss the type of care (i.e., palliative, hospice, rehabilitative, etc.) that would be most appropriate for him. Your response should be a minimum of 150 words. Hospice and palliative care aimed at improving the quality of life of patients. However, the two differ. Patients suffering from any serious condition require palliative care. The care does not consider a patient’s prognosis. Palliative care aims at symptom relief and promotion of the physical, emotional, and psychosocial needs of patients. Patients with terminal illness or poor prognosis require hospice care. This includes patients whose life expectancy is less than six months. Hospice care promotes dignified death, comfort, and a better quality of life in periods before death. Hospice care is also given to patients who have proven unresponsive to curative care (Tatum & Mills, 2020). Palliative care is the most appropriate care for Mr. Smith. Mr. Smith has not been diagnosed with any terminal illness. The physician has also not determined his prognosis. Curative treatments are still effective for Mr. Smith’s condition. As a result, palliative care is the most appropriate for the management of his physical symptoms, emotional, and psychosocial needs.
Develop a plan to address Mr. Smith’s needs including living environment, health care needs, mental health needs, and financial resources. In your plan, include a discussion of the type of support Mr. Smith needs now that he no longer has a support system and struggles to comprehend his current health needs and management. Your response should be a minimum of 200 words. Mr. Smith’s living environment should promote safety. The home environment should be free from clutter and any slippery material that would predispose him to falls. The home should have adequate lighting to minimize the risk of falls. Mr. Smith’s healthcare needs should be prioritized in the discharge process. This includes ensuring that a wound care nurse is involved in his care to provide the required wound cleaning and dressing. The nurse would also ensure that Smith’s medication needs are met. Mr. Smith’s access to mental healthcare after discharge should be maintained. This includes ensuring his close contact with the psychiatrist nurse and providing regular physical and virtual follow-up. Mr. Smith’s financial needs should be incorporated into his discharge plan. Currently, Mr. Smith does not work and lacks a source of financial support (Ghorbani et al., 2021). Therefore, the case manager should implement strategies such as providing transportation services to Mr. Smith to ease the challenges experienced in accessing his care.
Mr. Smith requires emotional support. He requires emotional support to cope with his changing functional status. Healthcare providers, social workers, support groups, and counselors should be involved in his care to ensure that he receives adequate emotional support. Mr. Smith also requires social support. He requires support from close family members, community, and community support groups for people with chronic illnesses. Mr. Smith should be linked to different social support groups for his psychosocial and emotional needs. Lastly, Mr. Smith requires medication management support. He should be educated on medication instructions such as dosage and side effects (English et al., 2022). A home health nurse should be involved to ensure his medication management needs are met.
Identify two care team members who you would need to collaborate with to ensure effective coordination of care for Mr. Smith. Your response should be a minimum of 150 words. One of the care team members that I would need to collaborate with to ensure effective care coordination for Mr. Smith is a home health nurse. A home health nurse will be required to provide the necessary care for Mr. Smith and assist him in undertaking activities of daily living. The home health nurse will provide information about how Mr. Smith is coping with his health needs. The nurse will also coordinate with other members of the care team to ensure the delivery of safe and high-quality care to Mr. Smith. The other member of the interprofessional team that would be needed for effective care coordination is a psychiatric nurse specialist. The psychiatric nurse will provide psychiatric care for Mr. Smith. The nurse will assess, plan, implement, monitor, and evaluate the effectiveness of different treatments adopted for Mr. Smith’s mental health problems. The nurse will also provide information about Smith’s mental health and needs, that will inform his treatment decisions.
Community Resources and Support Network
Appropriate resources and a support network are important for Mr. Smith and will be imperative in promoting optimal outcomes.
Discuss the options that are still available to assist Mr. Smith. Your response should be a minimum of 150 words. Several options that can assist Mr. Smith exist. One of them is religious institutions. Religious institutions in Mr. Smith’s locality can provide different forms of support such as financial, emotional, and spiritual support. Mr. Smith can also still benefit from the hospital’s counseling services. He can still access counseling services for his psychosocial needs should he need them after his hospital discharge. Mr. Smith can also benefit from social support groups. Specifically, he can be linked to social support groups and programs for patients with chronic illnesses. The social support groups and programs will impart him with the knowledge and skills he needs to overcome his challenges. Non-governmental organizations can also provide the support that Mr. Smith needs (Rousseau et al., 2021). For example, these institutions can provide food supplies and transport to the hospital for follow-up visits and assessments should Mr. Smith need them. Therefore, these options should be explored to address Mr. Smith’s health needs.
Suppose this patient was a part of your community. What community resources are offered to enhance his quality of life? Your response should be a minimum of 150 words. My community has resources that could have benefited Mr. Smith. Firstly, Mr. Smith could have accessed community support groups for people with chronic illnesses or disabilities. The support groups provide a platform for interaction among people with chronic conditions and disabilities. Mr. Smith would have learned of effective coping strategies and community resources to facilitate recovery. Mr. Smith could have also benefited from local religious institutions supporting those in need. Religious institutions provide different forms of support such as spiritual and religious support, food, and financial assistance to the vulnerable. A not-for-profit organization was also recently started in the community. The organization offers support to the vulnerable through housing, food, transportation, and financial assistance to those with terminal illnesses. It also has an online platform where patients and healthcare providers connect to ensure access to healthcare services. Therefore, linking Mr. Smith with these services would have improved his health outcomes significantly.
References
Afriyie, D. (2020). Effective communication between nurses and patients: An evolutionary concept analysis. British Journal of Community Nursing, 25(9), 438–445. https://doi.org/10.12968/bjcn.2020.25.9.438
Dugué, M., Sirost, O., & Dosseville, F. (2021). A literature review of emotional intelligence and nursing education. Nurse Education in Practice, 54, 103124. https://doi.org/10.1016/j.nepr.2021.103124
English, W., Gott, M., & Robinson, J. (2022). The meaning of rapport for patients, families, and healthcare professionals: A scoping review. Patient Education and Counseling, 105(1), 2–14. https://doi.org/10.1016/j.pec.2021.06.003
Frank, C., Ratchford, E. V., & Moll, S. (2023). Vascular Disease Patient Information Page: A guide for patients with newly diagnosed deep vein thrombosis or pulmonary embolism. Vascular Medicine (London, England), 28(5), 481–486. https://doi.org/10.1177/1358863X231154756
Ghorbani, M., Mohammadi, E., Aghabozorgi, R., & Ramezani, M. (2021). Spiritual care interventions in nursing: An integrative literature review. Supportive Care in Cancer, 29(3), 1165–1181. https://doi.org/10.1007/s00520-020-05747-9
Lempert, M., Halvachizadeh, S., Ellanti, P., Pfeifer, R., Hax, J., Jensen, K. O., & Pape, H.-C. (2021). Incidence of Fat Embolism Syndrome in Femur Fractures and Its Associated Risk Factors over Time—A Systematic Review. Journal of Clinical Medicine, 10(12), Article 12. https://doi.org/10.3390/jcm10122733
Rousseau, A.-F., Prescott, H. C., Brett, S. J., Weiss, B., Azoulay, E., Creteur, J., Latronico, N., Hough, C. L., Weber-Carstens, S., Vincent, J.-L., & Preiser, J.-C. (2021). Long-term outcomes after critical illness: Recent insights. Critical Care, 25(1), 108. https://doi.org/10.1186/s13054-021-03535-3
Sabbagh, M. N., Boada, M., Borson, S., Chilukuri, M., Dubois, B., Ingram, J., Iwata, A., Porsteinsson, A. P., Possin, K. L., Rabinovici, G. D., Vellas, B., Chao, S., Vergallo, A., & Hampel, H. (2020). Early Detection of Mild Cognitive Impairment (MCI) in Primary Care. The Journal of Prevention of Alzheimer’s Disease, 7(3), 165–170. https://doi.org/10.14283/jpad.2020.21
Tatum, P. E., & Mills, S. S. (2020). Hospice and Palliative Care: An Overview. Medical Clinics, 104(3), 359–373. https://doi.org/10.1016/j.mcna.2020.01.001
Zhao, K., Zhang, J., Li, J., Meng, H., Hou, Z., & Zhang, Y. (2021). Incidence of and risk factors for new-onset deep venous thrombosis after intertrochanteric fracture surgery. Scientific Reports, 11(1), 17319. https://doi.org/10.1038/s41598-021-96937-w

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Assessment Traits

Benchmark

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Assessment Description

Use the “Case Study: Timothy Smith – Hospice/Palliative Care” 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.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies and professional standards:

RN-BSN

2.1: Engage with the individual in establishing a caring relationship.

2.9: Provide care coordination.

American Association of Colleges of Nursing Core Competencies for Professional Nursing Education

This assignment aligns to AACN Core Competencies 2.1, 2.2, and 2.9.

Attachments

NRS-460-RS-T5-Benchmark-CaseStudy-HospicePalli

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