Discharge Planning for Joseph Russo: A Case Study

This assignment elaborates on the discharge planning of Joseph Russo, who had been admitted to the hospital after being found unconscious inside his car. It discusses the patient's situation, gathering information, issue identification, discharge planning, residential care packages, culturally safe care, and ethical and legal considerations.

Running head: CNA 345
Nursing assignment
Name of the Student
Name of the University
Author Note

1CNA 345
Introduction- Most patients often require help after they leave the healthcare setting
and with adequate planning, most patients can leave the centres much earlier, with a
comfortable recovery at their homes. Trip to hospitals have been found to be intimidating for
patients, their family members and friends. The word discharge planning most commonly
refers to the procedure that is employed for deciding what are the requirements and
preferences of the patients, for a hassle free transition from one domain of care to other
(Cameron 2018). In the words of Gonçalves‐Bradley et al. (2016) the discharge planning
involves several concepts namely, (i) evaluation, (ii) discussion, (iii) planning, (iv)
determining, (v) referral, and (vi) arranging. This assignment will elaborate on the discharge
planning of Joseph Russo, who had been admitted to the hospital after being found
unconscious inside his car.
Considering the patient situation- Joseph Rousseau was born in Manarola, Italy in
1950 and was the youngest office siblings and close to his parents. He had been brought to
the Emergency Department after Emma discovered light in his shed, and found him sitting
unconscious inside the car. Following several days of treatment Joseph has now been
declared medically fit and is ready to be discharged from the hospital.
Collecting cues- Joseph got married at the age of 17 to Sophia and migrated to
Australia in 1970 for better work prospects. He worked hard for several years and gradually
established his small business, and was known in the community as a likeable, happy and
hard working man. They became father to Antonio in 1971 and Emma, a year later. Sophia
enter a state of grief and sorrow in 1979 when she found that her third side will stillborn at
full term, which resulted in heavy smoking, isolation and loss of appetite. While Joseph's son
Antonio dropped out of University and started working for his father, his daughter Emma
started a family with her partner and gave birth to Thomas, who was diagnosed with ASD.
Antonio had huge gambling problem that resulted in massive financial crisis, followed by his

2CNA 345
departure from Australia. Joseph currently cares for Sophia, who has been diagnosed with
heart failure and COPD. On arrival of the ambulance, Joseph was found unresponsive could
not breathe and manifested a weak carotid pulse.
Gathering information- An analysis of the data presented in the case study suggests
that carbon monoxide poisoning was the primary reason that resulted in admission of the
patient to the Emergency Department. Exposure to the gas for prolonged period results in
severe neurological damage, which might also lead to death (Grandjean & Landrigan 2014).
Joseph’s state can be accredited to the fact that large exposures result in arrhythmia, seizures,
loss of consciousness and death (Beppu 2014). This exposure was also responsible for the
development of hypotensive symptoms, where the blood pressure readings were below
normal. This required the administration of vasopressors and intravenous fluids for achieving
mean arterial pressure higher than 65-70 mmHg. Other noticeable symptoms were, increased
body temperature and increased heart rate, commonly referred to as tachycardia. Hence,
medications and catheter ablation were performed in the patient for preventing episodes of
increased heart rate.
Issue identification- A complete discharge assessment of Joseph should encompass
several issues that are necessary to be reported in the discharge summary namely, (i) blister
on left heel, (ii) lack of participation in discussions, (iii) delirium, (iv) apathy and withdrawal,
(v) residential care facilities, (vi) Sophia’s current health, and (vii) Emma and her difficulties
in managing all her responsibilities, including her child Thomas, who has been diagnosed
with ASD (Nurjannah et al. 2014). The fact should be taken into consideration that although
Joseph used to provide full-time care to his wife Sophia, and also performed the entire daily
chores of the household, his current physical and mental state will not allow him to perform
his duties. This calls for the need of addressing Sophia’s health condition, as well while
promoting valuable discharge planning measures that would enhance their quality of life.

3CNA 345
Discharge planning- There is mounting evidence for the fact that absence of
congruence between preferences and demands of the patients and the care services that they
are delivered, calls for the need of investigating the opinion of the patients, as well as their
friends and family members, during the initial stages of discharge planning (Bowles et al.
2014). This calls for the need of involving Emma in all decisions that are taken, with regards
to discharge of Joseph from the hospital, in order to gain a sound understanding of her
observations, preferences, and concerns related to her family members. This in turn will help
in attaining the primary goal of continuity maintenance in quality of care between the hospital
and community.
Residential care packages- Residential care services has provisions of providing
meal services, lodging, and assistance with daily living activities to people who are in need of
them. People suffering from mental health problem, learning difficulties, or the frail and aged
are often cared for at such retirement apartments, where they are able to function
autonomously, while getting assistances with their daily activities such as, dressing, eating,
personal hygiene, and walking. Owing to the fact that Sophia is suffering from COPD and
depression, besides the current mental and physical state that Joseph has been diagnosed
with, there is a need to refer them to assisted living facilities, where depending on their
demands and requirements, skilled professionals will be able to supervise the ongoing
medical care, and help them live a meaningful and purposeful life (Tao, Cheng & Dai 2014).
Sophia must also be referred to a similar child disability care service for her son Thomas.
Such care services will comprise of a team of therapists, caregivers, and teachers who look
after children with special needs, and provide them the much needed professional care
(Jokanovic et al. 2015). Depending on the eligibility of Joseph and Sophia for different types
of care packages, assistance will be provided them in forms of medication reminder transport
appointment palliative care and social outings.

4CNA 345
Culturally safe care- Healthcare services must be delivered in an environment that is
socially, spiritually, physically, and emotionally safe, when there will be no denial, challenge,
or assault of the identity of patients, what they need, and who they are (Douglas et al. 2014).
Therefore, the discharge plan must be enforced in a manner that all the care services given to
Joseph, Sophia and Thomas, are able to acknowledge the relationship between the patient and
the provider, while the clients or service users are experiencing some illness or are under
mental stress. According to Shay & Lafata (2015) seeking preferences and advices from the
family members of the client helps in formulation of an effective patient provider therapeutic
collaboration, and allows the family members to adorn the role of partners in the overall care
methods, with the objective of accomplishing the intended goals. All pertinent information
related to the discharge process will be disseminated in a manner that is in alignment with the
culture and values of the family, and respects the perception and principles of Joseph and his
wife. Hence, there is a need to acknowledge the beliefs and values of the clients, owing to the
fact that they never developed a sense of belonging to Australia.
Ethical and legal consideration- According to Brown (2018) transfer of care
typically refers to the process where a physician entitled with the responsibility of providing
management for all the problems of a patient, relinquishes this duty to another healthcare
professional, found to explicitly agree to accept this, and is not involved in providing any
form of consultation from the initial encounter. Enhancement of the transfer of care has been
identified as an important shared responsibility and some of the essential principles that must
be shown compliance to, concomitant with the discharge of the patient from the hospital are
given below:
 Equity in accessing shared services
 Strength based approaches
 Interdisciplinary approaches

5CNA 345
 Strong coordination and linkage across different sectors
 Family-centred and person-centred care (Primary Health Tasmania 2017)
Hence, while referring the patient from one position to another for assuming the
responsibility of care management, efforts must be taken to ensure that patient care will be
improved and encouraged with the use of technical and professional document standards.
This will allow the latter professionals to gain a comprehensive understanding of the
presenting problems, and preferences of the client family that must be taken into
consideration while providing treatment or other forms of assistance.
Conclusion- Thus, it can be concluded that besides referring Joseph, Sophia, and
Thomas for different care facilities, they must also be educated on the potential advantages
of the intervention search service that they will gain access to. Educating Sophia and Thomas
on the different self management strategies for depression, COPD, and ASD, respectively,
will help in reducing the responsibilities that Emma has to fulfil when maintaining her work
life balance. Joseph should also be given a clear understanding of the benefits that residential
care services will have to offer. Adequate provisions must be created for seeking counselling
consultations, in order to understand the adverse impacts of depression, apathy and social
withdrawal. development of an effective patient provide a relationship is therefore crucial for
accomplishing these goals which in turn will help the professionals to make informed
decisions and facilitate the entire discharge process.

6CNA 345
References
Beppu, T., 2014. The role of MR imaging in assessment of brain damage from carbon
monoxide poisoning: a review of the literature. American Journal of Neuroradiology, vol.35,
no.4, pp.625-631.
Bowles, K.H., Hanlon, A., Holland, D., Potashnik, S.L. & Topaz, M., 2014. Impact of
discharge planning decision support on time to readmission among older adult medical
patients. Professional case management, vol.19, no.1, p.29.
Brown, M.M., 2018. Transitions of Care. In Chronic Illness Care (pp. 369-373). Springer,
Cham.
Cameron, B., 2018. The impact of pharmacy discharge planning on continuity of care. The
Canadian journal of hospital pharmacy, vol.47, no.3.
Douglas, M.K., Rosenkoetter, M., Pacquiao, D.F., Callister, L.C., Hattar-Pollara, M.,
Lauderdale, J., Milstead, J., Nardi, D. & Purnell, L., 2014. Guidelines for implementing
culturally competent nursing care. Journal of Transcultural Nursing, vol.25, no.2, pp.109-
121.
Gonçalves‐Bradley, D.C., Lannin, N.A., Clemson, L.M., Cameron, I.D. & Shepperd, S.,
2016. Discharge planning from hospital. Cochrane Database of Systematic Reviews, vol.1,
pp.1-105.
Grandjean, P. & Landrigan, P.J., 2014. Neurobehavioural effects of developmental
toxicity. The lancet neurology, vol.13, no.3, pp.330-338.
Jokanovic, N., Tan, E.C., Dooley, M.J., Kirkpatrick, C.M. & Bell, J.S., 2015. Prevalence and
factors associated with polypharmacy in long-term care facilities: a systematic
review. Journal of the American Medical Directors Association, vol.16, no.6, pp.535-e1.

7CNA 345
Nurjannah, I., Mills, J., Usher, K. & Park, T., 2014. Discharge planning in mental health care:
an integrative review of the literature. Journal of Clinical Nursing, vol.23, no.9-10, pp.1175-
1185.
Primary Health Tasmania., 2017. Guidelines for Shared Transfer of Care. Available from
https://www.primaryhealthtas.com.au/sites/default/files/Guidelines%20for%20Shared
%20Transfer%20of%20Care.pdf [Accessed on 23 September 2018].
Shay, L.A. & Lafata, J.E., 2015. Where is the evidence? A systematic review of shared
decision making and patient outcomes. Medical Decision Making, vol.35, no.1, pp.114-131.
Tao, Z.L., Cheng, Y. and Dai T, Q., 2014. Measuring spatial accessibility to residential care
facilities in Beijing. Progress in Geography, vol.33, no.5, pp.616-624.

8CNA 345
Appendix
Service Target
audience
Location Benefits Cost
BaptistCare Shalom
Centre
Older people Macquarie Park They are
passionate about
life transforming
care and deliver
award winning
care services
$69.49/day
Grace
Sham Counselling
Service
Psychologically
distressed
Melrose Park Helping with
spiritual and
psychological
needs
-
Drummoyne Meals
On Wheels
All individuals Crane Street provides
nutritionally
balanced meal to
aged and
disabled people,
and their carers
$5.00 approx
Meadowbank
children's centre
Children See Street Positive learning
environment for
children,
promoting self-
esteem
-

9CNA 345