Scenario #12: Muslim, 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
- On-site PT and OT to preplan assessment; Dietician to discuss cardiac diet
- Identify and understand cultural barriers that could influence patient adherence to attend therapy sessions
- Educate and broker with patient and family regarding the necessity of treatment
- PT determines Plan of Care with patient and his son
|1||B||PT to preplan strategy to perform initial assessments|
|2||B||PT to communicate and educate patient and son regarding rehab process and its necessity|
|3||T||PT to take the patients vitals and get patient out of bed to perform low level activities|
|5||T||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.
- Situational Awareness/Cultural considerations/Patient Education
- Family Involvement
- Communication with Patient
- Decision Making
- PT/OT to preplan initial assessment
- 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.
- 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
- PT communicates with patient about accommodations to perform prayer rituals
- Deciding course of action to proceed with care respecting patient cultural considerations remove cultural barriers
|Son: Aamil||Persistent||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."
Name: Aisif Muhammad
Age: 64 y.o.
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.
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.
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.
|Staged for Learners||Available For Learners to Use|
Laying on hospital bed
Conected to an EKG monitor
|Blood pressure cuff, gait belt, reflex hammer, stethoscope|
Progression of Events
|Time||Manikin Actions||Performance Measures||Son Script|
Lungs: Clear bilaterally
Bowel: Active X 4 quads
Mental status: alert, orientated x3
"I need to be with my family." "I need to pray. I need you to help me get in a position to pray."
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."
Heart: No change
Lungs: No change
Bowel: No change
tone: silghtly agitated
"I need to be able to pray. Can you assist me?"
"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
|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? 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?
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 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 Aawreness||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 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?