A case management nurse at an acute care facility is conducting an initial visit with the client to identify needs prior to discharge home. After developing a working relationship with the client the nurse is engaging in the referral process. Which of the following should be the first action by the nurse?

• A. Monitor the client's satisfaction with the referral
• B. Provide client information to for referral agencies
• C. Review available resources with the client
• D. Identify referrals that the client needs

Answer: (D)

In discharge planning and case management, the first step is to identify the specific referrals the client will need. During the initial visit, the nurse gathers information about the client’s health status, living situation, functional abilities, safety concerns, caregiver support, finances, and transportation. This assessment reveals the needs that must be addressed after discharge, such as home health services, rehabilitation, durable medical equipment, social work resources, or community supports. Once these needs are identified, the nurse can tailor the referral plan, discuss options with the client, and then move on to reviewing available resources, providing referral information to agencies, and later following up on satisfaction with the referrals. If the needs aren’t identified first, information and resources might not align with what the client actually requires, potentially delaying or mis directing support.