Christopher Strey, BSN, RN

A patient had an active discharge order and was transferred to the discharge unit. Christopher Strey was familiar with the patient, having cared for him during his inpatient stay. Upon arrival at the discharge unit, the patient was tearful. While this was not uncommon for him, on this occasion he was distressed because he did not know how he would manage at home. He stated, "I'm afraid to go home. I am an old man, and I can't take care of myself. I can't just go home. Please call my daughter—she guides me through everything."

Christopher contacted the patient's daughter, whom he had spoken with previously during the patient's hospitalization. She shared that she had expressed concerns multiple times about the safety of the discharge, stating that the patient had dementia and did not fully understand his situation. Christopher explained that the patient was alert and oriented and could make his own decisions, but assured her he would speak further with the patient about his concerns. During their conversation, the patient repeatedly stated that he could not care for himself at home. He shared that his wife had previously managed all household responsibilities and that, since her passing, he had struggled to meet his daily needs. He reported having no food at home, limited ability to prepare meals, and routinely skipping breakfast while relying on eating out for lunch and dinner.

Although he received assistance from a caregiver four times per week for two hours at a time, the caregiver did not prepare meals. During his inpatient stay, Case Management had recommended transition to a care facility, but the patient had declined. As Christopher continued to talk with the patient, the patient recalled a previous stay at an assisted living facility last year for a month, and by the end it was fantastic and an easy place to live, and he had no worries, but he was not in a state of needing that place yet at this time.

Recognizing that the patient's primary barrier was fear of leaving his home, Christopher engaged him in a thoughtful discussion about his goals, safety, and quality of life. Christopher said, "Well, it sounds like you have a place that will take all your anxiety and fears away; you are just afraid to leave your home since it is your home." The patient agreed that he was just afraid to leave home. Christopher asked the patient to consider what is more important: you or your house, and he said himself. After further discussion, the patient said he would agree to go to a facility, just not today or tomorrow, but if it was later in the week, he could talk himself into the mental idea of this life transition.

Christopher collaborated with the house supervisor, inpatient nurse, and unit nursing leadership. Together, they agreed that returning the patient to the inpatient unit for further evaluation and discharge planning was the safest course of action. Christopher then notified the physician, who agreed with the recommendation, spoke again with the patient's daughter, and readmitted the patient. Christopher's compassion, persistence, critical thinking, and advocacy ensured that the patient's concerns were heard and addressed. By taking the time to understand the patient's underlying fears, assist him with reflecting on his goals and needs, and coordinate with the interdisciplinary team, Christopher helped prevent a potentially unsafe discharge and promoted a safer, more patient-centered outcome.