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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

  1. On-site two HCPs to jointly prioritize patient care needs
  2. Identify and understand cultural barriers that could influence patient adherence to attend therapy sessions
  3. Educate and broker with patient and family regarding therapy benefits
  4. 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

  1. Team Planning
  2. Situational Awareness/Cultural considerations
  3. Patient Involvement
  4. Accessing Resources
  5. Decision Making

Imbedded challenges

  1. Pre-planning/discussion of how to educate patient and family about rehab attendance
  2. OT/PT to determine cultural barriers to treatment compliance
  3. Education and brokering with patient to agree upon rehab goals and recommendations linked to D/C home
  4. Possibilities of providing rehab intervention in room or hallway to avoid transfer to rehab department
  5. 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

  1. PT
  2. OT

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?"

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?