Safety Unfolding Case Study: Jean

Purpose: The purpose of this assignment is for students to describe patient-centered care, to
identify safety interventions, to explain clinical forethought and to value seeing health care
through the patient’s eyes.
Stage I Unfolding Case Study:
Jean is an 88-year-old widow with four grown sons and numerous grandchildren. She was living
alone, caring for her own home for the past 35 years since her husband died. At home, Jean
could make meals, take care of her hygiene, pay her bills, and use the bathroom on her own.
She had enjoyed being at home and continued to take care of herself and her home. One day
she developed mild abdominal pain. She thought it was related to something she ate, but it
persisted, so she decided to go to her family doctor. She was not concerned about the cost of
seeing a doctor as she had excellent health care coverage under her deceased husband’s
insurance. Jean was taken to the clinic and underwent lab tests and a CT scan, for which her
doctor concluded she had ovarian cancer. Since the treatment would not provide a cure, she
opted to let cancer take its course. The clinic nurse told Jean to call if she needed anything. Jean
was a strong independent woman, as she had to be after becoming a widow at such a young
age. But now, she was facing an unexpected diagnosis of cancer.
Stage I Questions:
1. Underline the words in the case study that stands out for you as important. What is your
rationale?
2. What aspects of health are included in part I? How are these aspects related to patient-
centered care?
3. What activities of daily living are a part of Jean’s functional ability in the home setting?
Stage II
Jean had been living alone at home for two months after her diagnosis. One day when waking
up she developed lightheadedness. She called her son to help her. Her son insisted on driving
her to the emergency room, where the doctors decided she would be admitted for tests. A CT
scan revealed cancer had metastasized (spread) to her brain. The doctor and nurse discussed
the situation with her four sons. The four sons were unable to stay with their mother. Although
Jean was a very independent woman who wanted to go home, she would not be allowed to
return home, but instead, the social worker arranged for her to be admitted to a long-term care
facility.
Stage II Questions:
1. What interventions protect patients from falling in the long-term care setting?
2. How is the ability to perform activities of daily living (ADL’s) related to safety?
Stage III
Jean wanted nothing more than to live her final days at home. It was disappointing to her that
she went to the hospital for lightheadedness and now would never return home. In long term
care, she secretly hoped she would be able to return home, she thought, if she worked hard
enough. Her mood was uplifted when visited by her grandchildren. One evening, after her
visitors had left, Jean placed her call light on for assistance to use the restroom. She waited for
20 minutes and nobody came to help. She was worried she would be incontinent and soil her
underclothing, so she got up on her own. Unfortunately, she was too weak and dizzy and fell on
the carpeted floor. Now she was really scared. She thought she certainly wouldn’t be allowed to
return home after falling. Fortunately, she was not injured, but would not be allowed to leave
her bed without the help of others. She became depressed and sadly, died one week later in
the long-term care, surrounded by her family.
Stage III Questions
1. Reflect on your answers to part I of the case study. Did Jean’s desire for independence stand
out to you as important? If the staff knew Jean valued her independence, how could they have
used this information to promote safety?
2. Explain how clinical forethought is used to predict potential complications and what it means
to you as a future nurse.
3. Describe the value of seeing healthcare through the patient’s eyes. How can nurses have an
impact on the lives of patients like Jean?
4. In your opinion, did Jean receive patient-centered-care? Why or why not?
Retrieved from https://qsen.org/using-unfolding-case-studies-to-develop-clinical-forethought-
in-novice-nursing-students/
Evaluation- Rubric

Criteria Full Marks Partially correct Incorrect

Knowledge of Demonstrates in- Demonstrates Demonstrates
patient-centered depth, comprehensive knowledge of patient- inaccurate, weak or
care knowledge of patient- centered care but lacks missing explanation.
centered care. depth.
Points 0.20 0.10 0
Nursing Demonstrates an in- Demonstrates an Demonstrates an
interventions to depth, comprehensive accurate explanation of inaccurate, weak or
prevent falls. explanation of nursing how to prevent falls but missing explanation.
interventions to is not comprehensive.
prevent falls.
Points 0.20 0.10 0
Describes the Describes the value in Describes the value but Describes the value but
value of seeing an in-depth, lacks depth. lacks depth and
through the comprehensive, and comprehension.
patient’s eyes. insightful view.

Points 0.20 0.10 0

Explain the use Provides an in-depth, Provides a correct Demonstrates an
of clinical insightful explanation explanation of clinical inaccurate, weak or
forethought to of clinical forethought forethought but lacks missing explanation.
predict possible and reflects on how insight or explanation
complications. nurses predict of how it can be used
possible to predict possible
(Stage 3)
complications. complications.
Points 0.20 0.10 0
Total Points /1.0