Home > Simulations > Simulation 10: Jamaican

Scenario #10: Jamaican, Hosanna Boothe

Learner Group: PT, OT

Environment: Sub-Acute Rehab

Authors: Amanda Borynski and Karen Panzarella

Facilitator directions

Main focus

On-site two HCPs to jointly prioritize patient care needs
Identify and understand cultural barriers that could influence patient adherence to attend therapy sessions
Educate and broker with patient and family regarding therapy benefits
OT and PT jointly determine Plan of Care with patient and daughter

Performance measures

1	B	PT/OT to preplan strategy to intervene with patient and family regarding noncompliance
2	B	PT/OT to communicate and educate patient and family regarding rehab attendance
3	B	PT /OT to broker with patient and family regarding rehab attendance
5	B	PT/OT to decide upon alternatives to traditional rehab attendance

Skills/tasks/procedures

Team Planning
Situational Awareness/Cultural considerations
Patient Involvement
Accessing Resources
Decision Making

Imbedded challenges

Pre-planning/discussion of how to educate patient and family about rehab attendance
OT/PT to determine cultural barriers to treatment compliance
Education and brokering with patient to agree upon rehab goals and recommendations linked to D/C home
Possibilities of providing rehab intervention in room or hallway to avoid transfer to rehab department
Deciding course of action to proceed with care respecting patient cultural considerations

remove cultural barriers

Synopsis of scenario

Patient is a 88 year old female of Jamaican decent who fell in her kitchen while doing dishes 3 weeks ago. Patient underwent a (L) total hip replacement 2 weeks ago without complications. Patient was discharged from the hospital 1 week ago and has been in a sub-acute facility for 1 week. Patient has been attending OT and PT therapy daily for mobility training for goal D/C to home in one week.

Learner roles

Confederate roles and scripting

Role	Tone	Timing of participation	Lines / comments
Daughter: Mattie Smith	Persistant	Sitting in room at bedside	"My Mother should not have to participate in therapy today, is it a holiday in our country"

Patient information

Hosanna Boothe

Name: Hosanna Boothe
Age: 88
Weight: 120 lbs
Height: 5'2"
Gender: Female
Religion: Christian
Support: Daughter and 3 grandchildren

Past medical history

Osteoporosis for 8 years, mild CVA 5 years ago (slight weakness (R) UE, but functional)

History of present illness

Patient has been in sub-acute rehab for 1 week following a (L) THR. Since patient has arrived at the facility she has been compliant and participated in PT and OT therapy daily for functional mobility training to prepare for D/C to home.

Social history

Patient lives in a second story apartment near her daughter. She lives close to stores so she is able to walk for groceries etc.

Report to participants

PT and OT together:

Your patient, Hosanna Boothe, has been in sub-acute rehab for 1 week following a (L) THR. Since patient has arrived at the facility she has been compliant and participated in PT and OT therapy daily for functional mobility training to prepare for D/C to home. Mrs. Boothe has been in the USgc for 15 years. She came here from Jamaica to be close to her daughter and grandchildren following the death of her husband. Hosanna still shows extreme pride for her country and celebrates the 10 national holidays in Jamaica. Tomorrow is Emancipation Day in Jamaica. This holiday is not only celebrated on the day but festivities usually begin before the holiday and last for days after. Hosanna does not want to participate in OT or PT therapy today or the rest of the week since her family will be visiting each day to celebrate. You are work with patient and family to get patient to attend rehab. You can have a few minutes to pre-plan your strategy.

Technician staging

	Staged for learners	Available for learners to use
Manikin Gender: female Clothing: hospital gown Position: Supine	Black Female Street clothes Laying in bed; sitting up in bed with HOB at 65 degrees, head up (multiple pillows) (L) LE is donned with a compression stocking.
Environment	Sub-acute Patient Room
Equipment	Hospital bed Abduction pillow in place between LEs	Walker at bedside
Medications	Pain medicine PRN
Labs
Xrays
Other diagnostics

Progression of events

Manikin Actions	Performance Measures	Daughter Script
Auscultation sounds RRR Clear bilaterally Active x 4 quads Manikin vocals Mental status: alert, oriented x 3 Tone: calm Manikin voice: "oh no, not today, I don't want to go to therapy, it is Emancipation Day! We need to relax and celebrate"	PT/OT pre-huddle to plan strategy PT/OT enter room, introduce selves, explain purpose of visit PT/OT attempt to get patient to come to therapy dept. PT/OT to explain necessity of therapy visits and goals for D/C to home, insurance coverage etc.
Auscultation sounds No change No change No change Manikin vocals Mental status: Tone: very agitated Manikin voice: "hello"	PT OT introduce themselves to daughter and explain purpose of their visit and difficulties they are having with her mother PT/OT to explain necessity of therapy visits and goals for D/C to home, insurance coverage etc. PT/OT to compromise and perform therapy in patients room Daughter enters the room.	"Who are you?" "My Mother does not want to go to any therapy today or all this week due to our national holiday" "I don't see why you can't wait and do therapy next week?" "well if it so necessary can you do therapy here in the room?"

Manikin Actions

Performance Measures

Daughter Script

Auscultation sounds

RRR
Clear bilaterally
Active x 4 quads

Manikin vocals

Mental status: alert, oriented x 3

Tone: calm

Manikin voice: "oh no, not today, I don't want to go to therapy, it is Emancipation Day! We need to relax and celebrate"

PT/OT pre-huddle to plan strategy
PT/OT enter room, introduce selves, explain purpose of visit
PT/OT attempt to get patient to come to therapy dept.
PT/OT to explain necessity of therapy visits and goals for D/C to home, insurance coverage etc.

Auscultation sounds

No change
No change
No change

Manikin vocals

Mental status:

Tone: very agitated

Manikin voice: "hello"

PT OT introduce themselves to daughter and explain purpose of their visit and difficulties they are having with her mother
PT/OT to explain necessity of therapy visits and goals for D/C to home, insurance coverage etc.
PT/OT to compromise and perform therapy in patients room Daughter enters the room.

"Who are you?"

"My Mother does not want to go to any therapy today or all this week due to our national holiday"

"I don't see why you can't wait and do therapy next week?"

"well if it so necessary can you do therapy here in the room?"

Integrated debriefing guide

Threads	Performance Measures	Debriefing Prompt
Opening		Give us a quick summary of what happened. What went well? What didn't go so well?
Recognize a concern during patient interaction		What was concerning about this case? Please explain.
Understand cultural implications		What cultural influences may have been present in this case? How were they addressed? How should they be addressed?
Team Communication		How were the roles delegated? How could the workload be divided up differently? Were you functioning as a team?
Understand clinical presentation		What signs and symptoms with this patient following a recent THR? What other presentations can produce similar symptoms? Were patients desires adequately addressed? What are some solutions?
Identify contributing factors		What risk factors were present? What is important about this patient's history?
Assessment		Are there any specific assessments that are important to consider with this type of patient? Whom is to provide them?
Documentation		What is important to document? Whom documents what?
Decision Making Prioritization		What cultural considerations need to be explored? How were decisions made? Was the patient and family involved in the decision making process? What resources could be accessed? How was the family involved in the decision making process?
Communication		Would any other HCP be helpful in this case? When is it helpful to contact another provider? What additional information would you like to have to proceed with this case? What are some ways we could improve on sharing information?
Situational awareness	Cultural considerations	What are strategies for keeping the big picture in view? What are strategies to be a cultural broker in this scenario?
Leadership		Was there a clear leader?
Professional Behavior	To patient, and team of nurse/PT	How were we coming across? What was the team performance like? Was the patient included in the team conversations? What are some strategies for managing difficult interactions?
Closing		What would we do differently next time? Any other questions or comments?