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Home > Simulations > Simulation 15: Chinese

Scenario #15: Chinese, Feng Li

Zhang Li

Learner Group: OT, PT

Environment: Home Care

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 OT to preplan strategy to perform initial assessments
2B OT/PT to communicate and educate patient and family regarding benefits of rehab
3T OT to begin typical therapy session
4B OT to involve patient and wife in goal setting and POC

Synopsis of Scenario

Patient is a 45 year old male of Chinese decent referred to occupational and physical therapy homecare for evaluation and treatment for post- operative care for below-knee amputation of the (R) LE one month ago. Due to his strong independent nature, patient thinks he does not need the help of others to return to his level of function prior to surgery. He is upset that he cannot currently care for his family and that he has to rely upon his wife for many of his basic needs. Mr. Li's wife has finally convinced him to take the MD's advice and seek PT/OT services however he is still reluctant.

Skills/Tasks/Procedures

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

Imbedded Challenges

  1. OT/PT to determine cultural barriers to accessing treatment.

    Patient is resistant to treatment and is only receiving at home OT at the request of his wife

  2. Education and brokering with patient and wife to agree upon rehab goals and recommendations for proceeding with initial assessments and treatment
  3. Education and brokering with patient and wife to agree upon rehab goals and recommendations for proceeding with initial assessments and treatment
  4. OT/PT to determine patient goals and incorporate into POC
  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Wife: Mei LeiQuiet, withdrawn Intermittent throughout scenario, constantly coming and going

"My husband needs therapy to get back to work and care for our family":

"He has been very angry lately/upset that I am in charge":

"Would you like something to eat or drink":

Patient Information

Name: Feng Li
Age: 45 y.o.
Weight:125 lbs.
Height:5'5"
Gender: Male
Religion: Taoism
Support: wife

Past Medical History:

None reported

History of Present Illness:

Patient suffered severe laceration to his (R) calf 2 months ago while working in his restaurant. Patient refused medical care at the time and attempted to treat wound with home remedies. The wound then became severely infected and it was deemed necessary to amputate before the infection spread further. A below knee amputation was performed 1 month ago, and that patient has been home for 2 weeks. Pt. refused rehab placement.

Social History:

Patient lives with his wife and daughter and works 7 days a week managing the restaurant that he owns. Patient has been unable to work for the past month due to surgery, hospital stay, and inability to ambulate. Patient's brother-in-law has taken over at the restaurant for the time being.

Report to Participant:

OT:Your patient, Feng Li, has lived in the United States for 20 years and he still embraces his Chinese culture. While working at the restaurant that he owns, 2 months ago, he suffered a deep cut on his lower (R) calf. After 3 weeks of not getting any better and using home remedies he developed an infection, Mr. Li's wife insisted he go to the ER to seek medical care. He was admitted to the hospital and a (R) below-knee amputation was performed 3 days later. Pt. received PT and OT in the hospital for 2 weeks, prior to discharge but has refused rehab placement and therapy and has returned home. Pt's wife has finally convinced him that home-care PT and OT will help him to become independent and return to work quicker. He especially needs assistance learning to dress, bathe, and cook independently. You can have a few minutes to pre-plan how you will perform your initial assessment.

PT:

You have an order for PT initial assessment for home care for your patient Feng Li. He underwent a BKA one month ago. You arrive at his home and the OT is there and has begun their initial assessment.

Technician Staging

Staged for LearnersAvailable For Learners to Use

manikin

Gender:Male

Clothing:Street clothes

Position: lying on Murphy Bed

(R) LE propped with pillows below the knee, stump wrapped

EnvironmentHome Care Setting
Equipment>

Murphy Bed, Walker

Goniometer, reflex hammer, tape measure BP cuff, stethoscope, and gloves
MedicationsHydrocodone
Labs
Xrays
Other Diagnostics

Progression of Events

Time Manikin Actions Performance Measures Wife Script
0-10 Minutes

Ausculation sounds:

Heart: RRR

Lungs: Clear bilaterally

Bowels: Active X 4 quads

Manikin Vocals:

Mental status: alert, orientated x3

Aggrivated

Manikin Voice:

"I don't want my wife to continue taking care of me. I can take care of myself!"

"I Need to get back to work. I can't have that brother-in-law of mine running the place for too long"

"Mei shut up, go away, I donít need your help"

  • OT pre-huddle to plan strategy for initial assessment
  • OT enters room, introduce self, explains purpose of visit to pt. and wife
  • OT to explain necessity of therapy assessments and treatment
  • OT attempt to overcome Pt's attitude and demeanor while performing initial OT assessment
  • OT to respond politely and correctly to Pt's wife as she periodically interrupts
  • OT begins examination

Interrupts:

"Would you like anything to drink or eat?"

"Are you sure you do not want anything to drink?"

"We have lots of good food and drink from the restaurant, let me get you some"

"my husband doesn't listen to me, he needs to do this"

"he is not very nice lately"

"he wants to be in control, does not like having to rely on me I still have to do everything for him"

10-20 Minutes

Ausculation sounds:

Heart: RRR

Lungs: Clear bilaterally

Bowels: Active X 4 quads

Manikin Vocals:

Mental status: alert, orientated x3

Aggrivated

Manikin Voice:

"Who are you? Why are there 2 of you?"

  • PT arrives at the home
  • PT enters room, introduce self, explains purpose of visit to pt. and wife
  • OT/PT to decide how to proceed with initial assessments

Interrupts:

"Would you like anything to drink or eat?"

"Are you sure you do not want anything to drink?"

"We have lots of good food and drink from the restaurant, let me get you some"

"my husband doesn't listen to me, he needs to do this"

"he is not very nice lately"

"he wants to be in control, does not like having to rely on me I still have to do everything for him"

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?