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Home > Simulations > Simulation 14: Chinese

Scenario #14: Chinese, Zhang Li

Zhang Li

Learner Group: PT

Environment: Outpatient Orthopedic Clinic

Authors: Karen Panzarella, PT, Ph.D., Shannon Kelly

Facilitation Directions

Main Focus

  1. On-site 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. PT takes thorough history with patient and wife
Performance Measures
1B PT to preplan strategy to perform initial assessment
2B PT to communicate and educate patient and family regarding benefits of rehab
3B PT to begin medical history and tests and measures
4B PT to engage patient during conversation/history taking

Synopsis of Scenario

Patient is a 35 year old male of Chinese decent referred to physical therapy for evaluation and treatment for low back pain. Due to his cultural beliefs he has avoided western medicine thus far, except for appointments with his primary care physician who is also of Chinese decent and maintains a practice in China Town where Zhang lives. He has previously attempted acupuncture to alleviate his symptoms, and although it has provided temporary relief the pain keeps coming back. When the remedies were not helping, his wife and MD convinced him it may be helpful to see a PT. Mr. Li is very quiet and does not offer details when asked questions. The only time he speaks more than a few words is to express his interest in homeopathic remedies such as Tai Chi and acupuncture.

Skills/Tasks/Procedures

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

Imbedded Challenges

  1. PT to plan initial assessment
  2. PT to determine cultural barriers to accessing treatment. Patient is resistant to treatment and is only attending PT at the suggestion of his MD.
  3. Education and brokering with patient and wife to agree upon rehab goals and recommendations for proceeding with initial assessments and treatment
  4. PT to determine patient goals, past medical history, and social history
  5. Deciding course of action to proceed with care respecting patient cultural considerations remove cultural barriers
Learner Roles
Learners
  1. PT
Role Tone Timing of ParticipationLines/Comments
Wife: Mei LeiQuiet Throughout scenario, sitting next to patient

Mei is also quiet, but offers more information than Zhang if prompted:

"Zhang would like to get back to work at his restaurant."

"Do you offer a Tai Chi program?"

Patient Information

Name: Zhang Li
Age: 35 y.o.
Weight:140 lbs.
Height:5'8"
Gender: Male
Religion: Taoism
Support: wife

Past Medical History:

Fx (R) Radius, 16 y.o., Mild IBS, Was involved in a major MVA 2 years ago, suffered minor bruising on the abdomen and face.

History of Present Illness:

Patient complains of intermittent low back pain that begin approximately 2 months ago. Believes the mechanism of injury was picking up a heavy box while working in his restaurant. Pain is increased when patient is sitting or lying on his side. Pain decreases when walking or lying on his back or stomach.

Social History:

Patient lives with his wife and 3-year old son in a 2-story duplex downtown. He owns a restaurant next to where he lives and works there 7 days a week. Patient has been unable to work his usual long hours due to the pain and has to hire extra help in order to keep the place running. He does not own a car and relies on public transportation if he needs to go elsewhere besides his restaurant.

Report to Participant:

Your patient, Zhang Li, emigrated from China to the US approximately 10 years ago. He lives in what can be considered "China Town" and still heavily embraces the Chinese culture. Zhang has been experiencing low back pain for the past 2 months however he has refused any therapy services except for acupuncture until today. His wife and MD have convinced him to seek out Physical Therapy for additional relief and treatment of his symptoms. You will have 20 minutes to take a history and perform a systems review.

Technician Staging

Staged for LearnersAvailable For Learners to Use

Simulated patient

Gender:Male

Clothing:Street clothes

Position: sitting on edge of plinth

EnvironmentOutpatient PT clinic
Equipment>

Plinth, rolling stool, chair

Goniometer, reflex hammer, tape measure BP cuff and stethoscope
Medications
LabsOTC ibuprofin
Xrays
Other Diagnostics

Progression of Events

Time Actor Actions Performance Measures Wife Script
0-5 Minutes

Actress:

Smiles slightly, appearing a bit confused

Nods head yes to almost everything

Avoids direct eye contact

Answers in as few words as possible (1-3 word responses)

Very aggreeable

Actor Vocals:

Mental status: alert, orientated x3

Tone: Calm, quiet

Actor Voice:

"Yes" (agrees often, even if truly doesn't)

"No."

"My Back Hurts"

  • PT to preplan strategy
  • PT enter room, introduce self
  • PT to explain necessity of therapy assessments and treatment
  • PT to take resting vitals
  • PT attempt to get patient to comply with participating with initial history
  • PT begin to have subjective history, medical history, and social history

Sitting in chair next to plinth

Interrupts:

"My husband is a hard worker, wants to get back to work"

"He is in a lot of pain"

"He has only received acupuncture"

"Acupuncture works temporarily"

5-10 Minutes

Actor:

Same as above

Manikin Vocals

Mental status:

Tone: Quiet, reserved

Actor voice:

Answers questions with as few words as possible

  • PT continues to attempt to get necessary information from patient
  • PT to compromise with patient about utilizing traditional PT as well as Tai Chi

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

"Yes, that's fine"

"Mhmm"

"How about Tai Chi, our neighbors say it works"

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 low back pain?

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?

CommunicationPT determines 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?

Professional BehaviorTo patient, and wife

How were we coming across?

Was the patient included in conversation?

What are some strategies for managing difficult interactions?

Closing

What would we do differently next time?

Any other questions or comments?