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Home > Simulations > Simulation 11: Jamaican

Scenario #10: Jamaican, Joseph Clarke

Learner Group: PT, OT

Environment: Outpatient Orthopedic Clinic

Authors: Amanda Borynski and Karen Panzarella

Facilitator directions

Main focus

  1. On-site two HCPs to preplan joint assessment
  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 wife

Performance measures

1 B PT/OT to preplan strategy to perform initial assessments
2 B PT/OT to communicate and educate patient and family regarding benefits of rehab
3 T PT /OT to begin medical history and tests and measures
5 B PT/OT to involve patient and wife in goal setting and POC

Skills/tasks/procedures

  1. Team Planning
  2. Situational Awareness/Cultural considerations

    Patient Education

  3. Family Involvement
  4. Communication with Patient
  5. Decision Making

Imbedded challenges

  1. OT/PT to preplan joint initial assessment
  2. OT/PT to determine cultural barriers to accessing treatment
  3. Patient is resistant to treatment and is only attending OT/PT at the request of his wife
  4. Education and brokering with patient and wife to agree upon rehab goals and recommendations for proceeding with initial assessments and treatment
  5. OT/PT to determine patient goals and incorporate into POC
  6. Deciding course of action to proceed with care respecting patient cultural considerations

    remove cultural barriers

Synopsis of scenario

Patient is a 60 year old male of Jamaican decent referred to physical therapy and occupational therapy for evaluation and treatment for adhesive capsulitis of the (R) shoulder. Due to his strong independent nature, he thought he could treat it himself. He used home remedies as he would use in Jamaica to try to fix his shoulder. When the remedies were not helping he decided to immobilize his (R) arm in a homemade sling. Mr. Clarke is extremely resistant to treatment. The only reason he came was because of his wife.

Learner roles

  1. PT
  2. OT

Confederate roles and scripting

Role Tone Timing of participation Lines / comments
Wife: Abigail Clarke Persistent Throughout scenario, sitting next to patient

"My husband needs therapy but he didn't want to come"

"you need to make him better"

"he cannot work or anything"

Patient information

Joseph Clarke

Name: Joseph Clarke
Age: 60 years old
Weight: 120 pounds
Height: 6'1"
Gender: male
Religion: Christian
Support: wife

Past medical history

None reported

History of present illness

Patient fell of a ladder 3 months ago while working and landed on his (R) side. Patient used home remedies to treat his shoulder. Patient went to his primary physician one month ago and was diagnosed with adhesive capsulitis of the (R) shoulder.

Social history

Patient lives with his wife and works 6 days a week painting houses. Patient has been unable to work for the past month due to (R) shoulder pain.

Report to participants

PT and OT together:

Your patient, Joseph Clarke recently emigrated from Jamaica to the US. While working here as a painter, 3 months ago, he fell off his ladder and landed on his right side. After a couple of months of not getting any better, Mr. Clarke decided to see his physician at the request of his wife. Patient has a script for "OT and PT evaluation and treatment for (R) shoulder adhesive capsulitis. You can have a few minutes to pre-plan how you will perform a joint assessment.

Technician staging

Staged for learners Available for learners to use

Manikin

Gender: Male

Clothing: street clothes

Position: Supine

Black Male

Street Clothes

Sitting on plinth

(R) UE in homemade sling

Environment Outpatient PT clinic
Equipment

Plinth

Sling

Goniometer, reflex hammer, tape measure

BP cuff and stethoscope

Medications
Labs
Xrays
Other Diagnostics

Progression of events

Manikin Actions Performance Measures Wife Script

Auscultation sounds

  • RRR
  • Clear bilaterally
  • Active X 4 quads

Manikin Vocals

Mental status: alert, oriented x 3

Tone: Calm

Manikin Voice: "I don't want to be here, I can take care of this by myself" "it feels okay when I have it in this holder"

  • PT/OT pre-huddle to plan strategy
  • PT/OT enter room, introduce selves, explain purpose of visit to patient and wife
  • PT/OT to explain necessity of therapy assessments and treatment
  • PT/OT attempt to get to comply with participating with initial OT/PT assessments
  • PT/OT begin to have subjective history and medical history

Interrupts:

"my husband doesn't listen to me, he needs to do this"

"he is not getting any better" "he wouldn't even go to the Doctor, he thinks he can fix everything himself"

" he never seeks help from anyone"

Auscultation sounds

  • No change
  • No change
  • No change

Manikin Vocals

Mental Status:

Tone: slightly agitated

Manikin Voice: " I can do this myself" "just show me what I need to do"

  • PT OT introduce themselves to wife and explain purpose of their assessment
  • PT/OT to involve patient and wife in POC and relate to goals of return to work

"Can't you just get to the treatment, make him better?"

"please tell him he must do this and I think he should move that arm"

"he just holds it at his side and doesn't use it"

"Please get him better"

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? What are some solutions?

Team Communication preplan strategy to perform initial assessments

Were you functioning as a team?

How were the roles delegated?

How could the workload be divided up differently?

Understand clinical presentation

What signs and symptoms would you expect with a patient with adhesive capsulitis?

What other presentations can produce similar symptoms?

Identify contributing factors

What risk factors were present?

What is important about this patient's history?

Assessment to perform initial assessments

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 communicate and educate patient and family regarding benefits of rehab

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 OT and PT jointly determine Plan of Care with patient and wife

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 wife

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?