Scenario #10: Jamaican, Joseph Clarke
Learner Group: PT, OT
Environment: Outpatient Orthopedic Clinic
Authors: Amanda Borynski and Karen Panzarella
- On-site two HCPs to preplan joint assessment
- 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 wife
|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|
- Team Planning
Situational Awareness/Cultural considerations
- Family Involvement
- Communication with Patient
- Decision Making
- OT/PT to preplan joint initial assessment
- OT/PT to determine cultural barriers to accessing treatment
- Patient is resistant to treatment and is only attending OT/PT at the request of his wife
- Education and brokering with patient and wife to agree upon rehab goals and recommendations for proceeding with initial assessments and treatment
- OT/PT to determine patient goals and incorporate into POC
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.
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"
Name: Joseph Clarke
Age: 60 years old
Weight: 120 pounds
Past medical history
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.
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.
|Staged for learners||Available for learners to use|
Clothing: street clothes
Sitting on plinth
(R) UE in homemade sling
|Environment||Outpatient PT clinic|
Goniometer, reflex hammer, tape measure
BP cuff and stethoscope
Progression of events
|Manikin Actions||Performance Measures||Wife Script|
Mental status: alert, oriented x 3
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"
"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"
Tone: slightly agitated
Manikin Voice: " I can do this myself" "just show me what I need to do"
"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|
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?
|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?
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?
What would we do differently next time?
Any other questions or comments?