NR 527 Week 4 Interprofessional Case Analysis Example

Interprofessional Case Analysis: Four Notes Written About Mrs. B.'s Mobility on the Day She Returned From Hospital, Read as Evidence of How Each Profession Measures Walking

Student Name

College of Nursing, Chamberlain University

NR 527: Communication and Collaboration for Advanced Nursing Practice

Instructor Name

Month Day, Year

Interprofessional Case Analysis: Four Notes Written About Mrs. B.'s Mobility on the Day She Returned From Hospital, Read as Evidence of How Each Profession Measures Walking

The Documents

Mrs. B., 86, with moderate Alzheimer dementia, returned to our skilled nursing facility after a five-day hospital admission for urosepsis. On the day of her return, four documents described how well she could walk and move. They were written by four different professionals within about twelve hours, and they do not agree. This analysis treats the disagreement as evidence about how each profession observes and records mobility, and asks which description the care team should act on.

The hospital discharge summary (hospitalist, 1030): "Ambulating independently with walker. Stable for discharge to SNF."

The facility physical therapy evaluation (physical therapist, 1600): "Sit to stand requires moderate assistance of one. Ambulated 6 feet with rolling walker and contact guard before requesting to sit. High fall risk."

The facility nursing admission note (registered nurse, 1400): "Resident alert, pleasant. Up to bathroom with walker, steady."

The facility nurse practitioner note (me, 1730): "Returned at baseline cognition per staff. Continue fall precautions."

What Each Note Actually Measured

Read closely, the four notes are not simply contradictory; they describe different observations.

The hospitalist's phrase "ambulating independently with walker" matches the hospital therapy note from two days earlier, which described Mrs. B. walking 40 feet with a walker and standby assistance on the day her fever broke. By discharge, the phrase had been carried forward into the summary; no one had watched her walk that morning. It described a best moment, not her state at discharge.

The physical therapist's evaluation was the only one based on a structured, timed observation at the facility, with a named level of assistance and a distance. It described Mrs. B. at 1600, after a long ambulance ride and several hours in a new room.

The registered nurse's note, "up to bathroom with walker, steady," recorded a single trip with the nurse beside her, which the nurse considered steady. It did not state the level of assistance.

My note repeated what staff told me about her cognition and said nothing measurable about mobility at all.

Why the Professions Wrote Differently

Each profession writes for its own purpose and in its own vocabulary. The hospitalist's summary exists to show readiness for discharge; "independent with walker" signals that she no longer needs acute care. The physical therapist writes to set a treatment plan and a fall risk level, so her note quantifies assistance and distance. The nurse's note records how a specific task went during a shift. My note focused on medical stability and cognition, the questions I was worried about after sepsis.

None of the writers was careless. The problem is that the word "independent" means one thing to a hospitalist summarizing readiness and something much stronger to a nursing assistant deciding whether a resident can walk to the bathroom alone at 0300. When a resident moves between settings, those differences in vocabulary become risks. In a study of nursing home transfers to an emergency department, activities of daily living and mobility were among the information most often missing, absent in roughly half of transfers (Cwinn et al., 2009). Here the information was present, but in four incompatible forms.

Which Description to Act On

The care team should act on the physical therapist's evaluation. It was the most recent, the only one based on a measured observation in the facility, and the one that stated the level of assistance. It is also the most cautious, which matters for a woman who has fallen once already this month and takes an anticoagulant. The hospital summary's "independent" should be treated as her pre-illness goal rather than her current state. The nursing note should prompt a question rather than a conclusion: steady with what assistance? My own note was the least useful of the four and should have recorded a mobility level.

What Happened That Night

The consequences of the mismatch were visible within hours. At 2330, a nursing assistant who had read the hospital summary during report heard Mrs. B. calling and found her trying to stand at the edge of the bed. Believing she walked independently, the assistant handed her the walker and stepped back to fetch a clean gown. Mrs. B.'s knees buckled; the assistant turned in time to guide her to the floor without injury. The incident report named the cause as "resident unsteady." A more accurate cause was a care plan built on the wrong document. The next morning, the physical therapist's level of assistance was added to the resident's care card, the assistant was told why, and the night staff huddle reviewed the difference between the hospital's word and the therapist's measurement. No harm came to Mrs. B., but the near miss showed that the choice of which note to trust is made at the bedside by whoever reads first, not by the professional who wrote the most careful note.

What Should Change

Three changes follow. First, the facility's admission template will require nurses to record the level of assistance for transfers and walking, using the same terms the physical therapists use, rather than descriptive words such as "steady." Second, the nurse practitioner's readmission note will include one line on mobility and fall risk, copied from or reconciled with the therapist's evaluation. Third, the return request sent with residents to the emergency department and hospital will ask for the level of assistance observed on the day of discharge, not a general statement of independence.

These changes reflect a core aim of interprofessional collaboration: communicating information in a form that other professions can use, and understanding how each profession's role shapes what it records (Interprofessional Education Collaborative, 2023). Focus groups across nursing homes, emergency departments and emergency services have described communication as the most frequently cited barrier to good care in these transitions (Terrell & Miller, 2006). A shared vocabulary for one measure, how much help a resident needs to walk, is a small, concrete place to start.

Limits of the Analysis

This analysis relies on four documents from one day and on what their writers told me afterward. It cannot show how often such mismatches occur at our facility or whether the proposed template change will prevent them. The next step is to review the readmissions of the past three months, comparing the hospital's mobility description with the therapist's first evaluation, to see how often they differ and in which direction.

References

Cwinn, M. A., Forster, A. J., Cwinn, A. A., Hebert, G., Calder, L., & Stiell, I. G. (2009). Prevalence of information gaps for seniors transferred from nursing homes to the emergency department. CJEM, 11(5), 462-472. https://doi.org/10.1017/S1481803500011660

Interprofessional Education Collaborative. (2023). IPEC core competencies for interprofessional collaborative practice: Version 3. https://www.ipecollaborative.org/ipec-core-competencies

Terrell, K. M., & Miller, D. K. (2006). Challenges in transitional care between nursing homes and emergency departments. Journal of the American Medical Directors Association, 7(8), 499-505. https://doi.org/10.1016/j.jamda.2006.03.004