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Home > Simulations > Simulation 13: Muslim

Scenario #13: Muslim, Aaliyah Madiyan

Aaliyah Madiyan

Learner Group: PT and Dietician

Environment: Sub-Acute Rehabilitation

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

Facilitation 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 the for nutrition and excercise treatment
  4. PT and Dietician develop plan of care for patient
Performance Measures
1B PT/Dietician to preplan strategy to perform initial assessments
2T PT to get patient to perform LE exercises
3B PT/Dietician to explain the necessity of treatment
4B PT/Dietician to explain the necessity of good nutrition

Synopsis of Scenario

Patient is a 65 year old Muslim woman who is in a sub-acute rehabilitation clinic post- total knee replacement. Patient is living in the rehabilitation center and receiving physical therapy twice a day until discharge. During this scenario, patient is receiving therapy in the late- afternoon. The patient is very lethargic and lazy during treatment due to an absence of nutrition during Ramadan. She refuses to eat or drink and does not adequately perform exercises.

Skills/Tasks/Procedures

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

Imbedded Challenges

  1. PT/Dietician to preplan joint initial assessment
  2. PT/Dietician to determine cultural barriers to performing treatments Patient is resistant to exercise due to exhaustion secondary to lack of nutrition
  3. PT/Dietician to determine patient goals and incorporate into POC
  4. PT/Dietician explain the importance of therapy and being properly nourished in regard to achieving goals
  5. Deciding course of action to proceed with care respecting patient cultural considerations
Learner Roles
Learners
  1. PT
  2. Dietician
Role Tone Lines/Comments
Patient's DaughterHelpful and friendly Comes in midway through treatment by therapist and dietician

“My mother is very stubborn.”

"I may be able to help.”

"My mother may feel more energized in the early morning"

Patient Information

Name: Aaliyah Madiyan
Age: 65 y.o.
Weight:120 lbs.
Height:5'5"
Gender: Female
Religion: Muslim
Support: daughter

Past Medical History:

osteoarthritis, DM

History of Present Illness:

Patient received a total right knee replacement and is currently in sub-acute rehabilitation. Patient is stiff and sore. Pain is a 4/10 on the VAS scale. Patient is also a type II diabetic.

Social History:

Patient is widowed and lives alone. She has two children, a daughter and a son, both of whom live in the neighborhood. She lives in a 2- story home and needs to be able to climb stairs before she goes home. She enjoys gardening and spending time with her grandchildren.

Report to Participant:

PT and Dietician together:Your patient, Aaliyah Madiyan, is a 65 y/o Muslim woman who is 5 days s/p total right knee replacement. You are seeing her in the sub-acute rehabilitation center. She comes down for therapy in the late afternoon. Additionally, patient is a type II diabetic. Patient should have her vitals taken prior to treatment. Your job is to educate her on the importance of adequately performing exercises and proper nutrition.

Technician Staging

Staged for LearnersAvailable For Learners to Use

Simulated patient

Gender:Female

Clothing:Muslim clothing, Burka

Position: sitting in w/c

EnvironmentSub-acute rehabilitation clinic
Equipment>

Pt. in w/c

Goniometer, reflex hammer, tape measure BP cuff and stethoscope, gait belt
Medications
Labs
Labs
Xrays
Other Diagnostics

Progression of Events

Time Actress Performance Measures Patient's Daughter
0-5 Minutes

Actress:

-Pt. appears tired, distressed, and in pain

-Pt.is lethargic, apathetic and slow moving

“My knee is so sore.”

“I don’t want to do any of this.”

“Can’t I just relax and lay down?”

  • PT/Dietician pre-huddle to plan strategy
  • PT asks the patient how she is feeling
  • ? PT takes the patients vitals prior to treatment
5-10 Minutes

Actress:

-After her vitals are taken, she is asked to perform LE exercises

Performs halfhearted exercises

Complains of being tired and pain

“I don’t know. I’m tired. I can’t do these exercises. My priority now is observing Ramadan requirements”

  • PT instructs patient to perform low level LE exercises
  • PT educates the patient on importance of performing the exercises
  • Dietician instructs patient on the importance of adequate nutrition
  • ? Schedule her next appointment for the early morning to comply with Ramadan

“Hello. How is my mother doing?”

“What seems to be the problem?”

“She is very stubborn. It is Ramadan and she is very strict with following the rituals.”

“She has more energy in the morning.”

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 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 daughter.

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?

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

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?