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Scenario #12: Muslim, Asif Muhammad

Asif Muhammad

Learner Group: PT/OT Dietician students need not have not been to clinic yet

Environment: Phase I Cardiac Rehabilitation

Authors: Karen Panzarella, PT, Ph.D., Andrew McCauley

Facilitation Directions

Main Focus

  1. On-site PT and OT to preplan assessment; Dietician to discuss cardiac diet
  2. Identify and understand cultural barriers that could influence patient adherence to attend therapy sessions
  3. Educate and broker with patient and family regarding the necessity of treatment
  4. PT determines Plan of Care with patient and his son
C/T/B Performance Measures
1B PT to preplan strategy to perform initial assessments
2B PT to communicate and educate patient and son regarding rehab process and its necessity
3T PT to take the patients vitals and get patient out of bed to perform low level activities
5T PT to assist patient in performing necessary prayer rituals

Synopsis of Scenario

Pt. is a 64 y/o Muslim male, originally of Iranian descent, who suffered a myocardial infarction 3 days prior to evaluation. Pt. is stable and in phase I of cardiac rehabilitation. Pt. no longer believes he needs to be in hospital because his children and wife are more than capable of providing the necessary care. Additionally, the pt. is adamant about being able to pray during the physical therapist's evaluation. The physical therapist needs to check the patient's vitals and get the patient out of bed to perform low level activities. The patient's son is also uncooperative because he believes his father should be cared for at home.

Skills/Tasks/Procedures

  1. Planning
  2. Situational Awareness/Cultural considerations/Patient Education
  3. Family Involvement
  4. Communication with Patient
  5. Decision Making

Imbedded Challenges

  1. PT/OT to preplan initial assessment
  2. PT to determine cultural barriers to accessing treatment.
    Patient believes he can go home. Patient needs to be educated on the necessity of treatment and being cooperative. Dietician to educate importance of cardiac diet.
  3. Education and brokering with patient and son to agree upon rehab goals and recommendations for proceeding with initial assessments and treatment and compliance with diet
  4. PT communicates with patient about accommodations to perform prayer rituals
  5. Deciding course of action to proceed with care respecting patient cultural considerations remove cultural barriers

Learners Roles

Learners

  1. PT
  2. OT
  3. Dietician

Role Tone Lines/Comments
Son: AamilPersistent Arrives while the therapist is performing initial assessment

"My father needs to be home with his family"

"My father is fine. He doesn't need to be here anymore."

Patient Information

Name: Aisif Muhammad
Age: 64 y.o.
Weight:275 lbs.
Height:5'7"
Gender: Male
Religion: Muslim
Support: Son

Past Medical History:

HTN. Knee replacement 5 years prior.

History of Present Illness:

Pt. suffered a heart attack while painting his bedroom. Pt. has a history of HTN and obesity. It was an uncomplicated MI.

Social History:

Patient lives with his wife and two sons. Patient has been retired for 4 years, but was employed as a college professor. Patient admits to exercising very little and has been a smoker for 40 years.

Report to Participant (separately):

PT/ OT:Your patient Your patient, Aisif Muhammad is a 64 y/o Muslim man who suffered an uncomplicated MI 3 days prior. Patient needs to have vitals checked and should get out of bed for light exercise (2-3 METS). Patient should also be educated on the expectations for rehabilitation and informed of lifestyle changes.

Dietician:
Your patient, Aisif Muhammad is a 64 y/o Muslim man who suffered an uncomplicated MI 3 days prior. You are to educate about a cardiac diet.

Technician Staging

Staged for LearnersAvailable For Learners to Use

Manikin

Gender:Male

Clothing:Gown

Position: Supine

White Male

Gown

Laying on hospital bed

Conected to an EKG monitor

EnvironmentHospital-Cardiac Rehab
Equipment>

Hospital bed

EKGmonitor

Blood pressure cuff, gait belt, reflex hammer, stethoscope
MedicationsBeta-blockers
Labs
Labs
Xrays
Other Diagnostics

Progression of Events

Time Manikin Actions Performance Measures Son Script
0-7 Minutes

Ausculation sounds

Heart: RRR

Lungs: Clear bilaterally

Bowel: Active X 4 quads

Manikin Vocals

Mental status: alert, orientated x3

tone:calm

Manikin Voice:

"I need to be with my family." "I need to pray. I need you to help me get in a position to pray."

  • PT/OT to plan strategy
  • PT/OT enters room, introduces self, explains purpose of visit to patient.
  • PT/OT to explain necessity of checking vitals and performing light exercise
  • PT/OT attempts to get patient to comply
  • PT/OT begins to take vitals

Son walks in while therapist is taking vitals.

"My father needs to be at home with his family."

"We can take care of him just fine."

5-10 Minutes

Ausculation sounds

Heart: No change

Lungs: No change

Bowel: No change

Manikin Vocals

Mental status:

tone: silghtly agitated

Manikin Voice:

"I need to be able to pray. Can you assist me?"

  • PT/OT introduces themselves to patient's son
  • PT/OT explains the necessity of treatment to the patient's son
  • PT/OT trying to get compliance from patient and his son
  • PT/OT finish vitals
  • PT/OT discuss accomodations for pray in to light exercise plan
  • Dietician enters, introduces self and explains purpose of visit
  • All to educate patient and son on rehab/diet compliance, etc.

"Why does he need to be here?"

"When can he go home?"

"If this helps my father get home with his family, do what you must."

Integrated Debriefing Guide

What would we do differently next time?

Any other questions or comments?

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 CommunicationPreplan 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?

Assessmentto 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 Prioritizationcommunicate 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?
CommunicationOT and PT jointly determine plan of care with patient and wife.

Would any other healthcare professionals be helful in this case?

When is it helful to contact another provider?

What additional information would you like to have proceeded with this case?

What are some ways we could improve on sharing information?

Situational AawrenessCultural Considerations

What are strategies for keeping the big picture in view?

What are strategies to be a cultural broker in this scenario?

Prayer position?

LeadershipWas there a clear leader?
Professional BehaviorTo patient, and son

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