A thirty-two-year-old female presented in the emergency department (ED) with a headache, ringing in the ears, nausea, fatigue, and blurry vision. The patient claimed he fell from the stairs in her house and lost consciousness for less than a minute. After the incident, he was brought to the ED by her husband. When asked questions, the patient seemed confused, and her wife replied instead of him. The patient also tried to cover her mouth with her hand to cover the smell of alcohol from her breath.
After taking vital signs, performing the neurological examination, and conducting cognitive tests, a nurse practitioner (NP) revealed no signs of immediate danger to the patient’s well-being. The two most probable diagnosis was a mild concussion accompanied by alcohol intoxication. However, in fear of possible intimate partner violence (IPV), the NP decides to transfer the patient to hospital settings for further observations. The NP expected that additional information could be obtained from the patient the next morning after the symptoms of intoxication disappear.
The following morning, the patient presented clear signs of withdrawal; however, after taking Tylenol, she was able to answer the questions of NP. Her speech was normal, and she could remember every detail about the events of the previous day. Brief screening for IPV and alcohol misuse revealed a moderate addiction to alcohol but no signs of IPV. The NP decided to refer the patient to a state-funded addiction treatment program. Two years after the incident, the patient was observed in the hospital for receiving prenatal care. By that time, the patient reported having stopped drinking alcohol for 14 months.
The importance of providing high-quality person-centered care is difficult to overstate. According to van der Meer et al. (2018), person-centered care leads to improved patient outcomes and improve job satisfaction of providers due to decreased stress and burnout. It is also vital that the principles of person-centered care are utilized throughout the care continuum, which can be achieved by efficient management of transitions.
Zangerle and Kingston (2016) state that the role of nurse leaders is central in the transition of care across settings, as they can use the latest technology and evidence to ensure top-quality care. The present paper analyzes a case study of transitioning a patient between settings in a case scenario, discusses the role of nurse leaders in provisioning safe, high-quality, patient-centered care across the continuum, and summarizes the main points in a brief conclusion.
Point of Care Transitions
In the case scenario presented in Part 1 of the present paper, the patient experienced two transitions. First, she was transferred from ED to hospital settings for further observations. The central outcome for the transition is that the care provider could conduct IPV screening. According to the Agency for Healthcare Research and Quality (AHRQ, 2015), such screening is vital because women of reproductive age often experience IPV.
Such screening would be impossible in ED since the patient experienced problems with cognitive functions due to trauma and intoxication. AHRQ (2015) states that screening can be achieved by using evidence-based tools, such as HITS (Hurt, Insult, Threaten, Scream), OVAT (Ingoing Violence Assessment Tool), and HARK (Humiliation, Afraid, Rape, Kick).
Second, the patient was referred to an addiction treatment facility to address the problem with alcohol misuse. The central outcome for the transition was that the patient managed to abstain from alcohol use for 14 months after undergoing treatment in an addiction treatment facility. The outcome can be facilitated by timely screening for alcohol misuse. According to the US Preventative Services Task Force (USPSTF, 2018), screening for unhealthy alcohol use in primary care settings in adults 18 years or older is necessary to reduce alcohol misuse. At the same time, the utilization of evidence-based tools can provide significant insights for addiction professionals to facilitate smooth transitioning.
There are certain factors that influence the safety, quality, and continuity of care for the transitions described. First, the patient may be uncomfortable talking about such sensitive matters as IPV and alcohol misuse (AHRQ, 2015). Second, care providers may not have enough time to provide sensitive care (AHRQ, 2015). Finally, providers may fear offending the patient or the partner (AHRQ, 2015). Care providers are to be aware of such risks and address them to improve patient outcomes.
Implications for Advanced Nursing Practice
Nurse leaders are central stakeholders in managing care transitions. According to Zangerle and Kingston (2016), “nurse leaders are natural collaborators and advocates, possessing unique capabilities that drive the success of care coordination and transition management initiatives” (p. 171). Nurse leaders are to facilitate collaboration among all the stakeholders and implement the principles of care coordination to improve patient outcomes.
In the case scenario, the NP used at least two of such principles. On the one hand, the provider adhered to the principle of individualization and addressed the unique needs of the patient to be isolated from her partner to perform IPV screening. On the other hand, the NP promoted the solution of systemic problems by referring her to addiction treatment instead of focusing on concussion only.
The case scenario described in the present paper is an excellent example of successful transition management. Providing safe transitioning among care providers is central to improving patient outcomes and the quality of care. Such transitioning can be achieved by implementing the latest evidence and principles of care coordination. Nurse leaders are natural care coordinators, and they have sufficient knowledge and experience to lead the process of care coordination.
Agency for Healthcare Research and Quality. (2015). Intimate partner violence screening. Web.
US Preventative Services Task Force. (2018). Unhealthy alcohol use in adolescents and adults: Screening and behavioral counseling interventions. Web.
van der Meer, L., Nieboer, A. P., Finkenflügel, H., & Cramm, J. M. (2018). The importance of person‐centred care and co‐creation of care for the well‐being and job satisfaction of professionals working with people with intellectual disabilities. Scandinavian journal of caring sciences, 32(1), 76-81.
Zangerle, C., & Kingston, M. B. (2016). Managing care coordination and transitions: The nurse leader’s role. Nurse Leader, 14(3), 171-173.