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Home > Simulations > Simulation 2: Haiti Earthquake

Scenario #2: Haiti Earthquake, Mrs. Nekita Lamour

Nekita Lamour

Learner Group: PT/OT students (SW)

Environment: Acute care hospital room

Authors: Karen Panzarella, PT, PhD, Nicki Silberman, PT, DPT

Facilitator Directions

Main Focus

  1. Safely organize hospital room, including lines/monitors and furniture for safe patient mobility
  2. Identify and communicate discharge disposition to team members including patient, family, case manager
  3. Determine if patient can safely participate in rehabilitation session and why she is reluctant to participate

Performance Measures

C/T/B Main Focus Performance Measures
1 B G Maintains professional behavior in verbal and nonverbal communication in all interactions
2 B G Introduces self to patient, family, team members
3 T/B G Sanitizes hands prior to patient contact
4 C/T G Confirms patient identity by verbalizing name and checking wrist band
5 C/T 3 Checks patient chart for Rehab orders (OOB, PT, OT, WB Status)
6 C 2/3 Determines that patient speaks limited English and refers to her daughter for translation
7 C/T 3 Conducts screening examination to ensure patient clear for participation in OT/PT (VS, ROM, Pain, skin inspection)
8 T 1 Moves all lines to 1 side of the bed for safe patient transfer
9 T 1 Sets up wheelchair and ensures locks on both chair and bed prior to transfer
10 C 2 Identifies patient not safe/ready for discharge to home, especially to travel back to Haiti
11 C/B 2 Responds appropriately to questions regarding discharge disposition to both family and team members
12 C/B 3 Recognizes the lack of patient participation in rehab may be culturally based

Synopsis of Scenario

Skills/Tasks/Procedures

  1. Screening assessment skills (VS, pain, ROM)
  2. Transfer training
  3. Gait training
  4. Team communication skills
  5. SW informs OT and PT to use her daughter for translation
  6. Knowledge of discharge disposition options
  7. Communication with patient

Imbedded Challenges

  1. Lines (Foley, IV, PCA) not set up on same side of bed
  2. Room not set up for safe transfer
  3. Daughter asks when mother will be able to return home to Haiti, she wishes to bring her home tomorrow
  4. SW informs OT and PT that patient should be DC today
  5. Patient complains of too much pain to walk and believing rest is necessary
  6. Patient speaks very limited English, primarily French

Learners Roles & Staging

Role Staging Info Given
1 PT Start of scenario goes into patient room with walker See FACILITATOR REPORT TO LEARNER
2 OT Is in the room at the start of scenario and has completed an ADL treatment session with patient has completed an ADL treatment session with patient, in room when PT arrives, OT gives hand off information

Confederate Roles & Scripting

Role Tone Timing of participation Lines / Comments
Daughter Concerned, anxious, cooperative

At bedside at start of scenario

When PT suggests it may not be today

When told she needs to be up and walking around before she goes home...

Does not translate for her mother until asked to do so

"I am all set for my mom to go back to Haiti tomorrow "

"I was prepared for tomorrow. I will take care of her, she has a bed in my home, etc..."

"no, I can care for her in bed until her pain goes away"

SW

Pleasant, but insistent about getting pt discharged tomorrow. Enters room after PT transfers patient to edge of bed "Oh great, I'm glad you're here. I just want to confirm the discharge plan to return home for Mrs. Lamour. Do you think she'll be able to receive rehab in Haiti? She's medically cleared, so we need to get her out tomorrow."

Facilitator Report to Primary Learner to Start Scenario

To OT student

Supervising OT meets OT student and reports, Please perform bedside ADLs with Mrs. Lamour this morning. I did the OT evaluation 2 days ago and she seems to be progressing. Touch base with PT and SW regarding her DC plans. One other thing, she speaks very limited English, but her daughter is available to translate for you, she is staying in the room with her mother.

To PT student

Supervising PT meets PT student and reports, "I'm so glad you have some extra time today. I need to you take Mrs. Lamour in 516 for me. She had a below knee amputation a few days ago, and was cleared for discharge back to Haiti. I did the eval 2 days ago and tried to see her yesterday, but she's been complaining of a lot of pain and would not cooperate to get out of bed or ambulate. Here's her chart, I think OT is in there now doing ADLs with her, you two figure out her D/C, I've got to run up to med-surg; thanks for covering." One other thing, she speaks very limited English, but her daughter is available to translate for you, she is staying in the room with her mother.

Technician Staging Directions

Staged For Learners Available for Learners to Use
Manikin 68 year old
Race Haitian
Gender Female
Clothes Hospital Gown
Position Supine in bed
Moulage

Right lower leg BKA, stump wrapped with ace wrap.

ID band

Foley catheter to left side of the bed

Environment

In-patient hospital room

Daughter seated at bedside

Bedside table with glasses, book, incentive spirometer, water

Equipment Normal headwall walker
Disposable Supplies Extra hospital gown
IV Saline right arm with pole on right side of bed
Medications PCA analgesia in place on left side of the bed
Labs

On chart results

CBC - WNL

PT/INR - WNL

Type and screen

Xray
Other Diagnostics
Chart Records

Intake form

OR report

Anesthesia note

Lab results

Nursing notes

MD notes

Orders Page - PT, OOB, WBAT R LE, OT ADLS for return home

OT and PT initial evaluation

Progression of Events

Manikin Actions Performance Measures Cues/Confederates
0-7 Minutes Initial at 3 minutes
HR 120
Rhythm Sinus
RR 14
O2 Sat 98%
Breath Sounds Clear
B/P 130/80
Temperature 37.8
Bowel Sounds Normal
Mental Status A&O x 4

Tone: anxious, cooperative, but having pain and not wanting to get out of bed

Script: Moans in pain, "No move, pain, no move, pain... rest, rest , please"...(in French) la douleur, la douleur, le repos (repeat)...

  1. Maintains professional behavior in verbal and nonverbal communication in all interactions
  2. Introduces self to patient, family, team members
  3. Sanitizes hands prior to patient contact
  4. Confirms patient identity by verbalizing name and checking wrist band
  5. Checks patient chart for PT orders (OOB, PT, WB Status)
  6. Conducts screening examination to ensure patient clear for participation in PT (VS, ROM, Pain, skin inspection
  7. Moves all lines to 1 side of the bed for safe patient transfer
  8. Realizes patient speaks limited English and asks daughter to translate
8-15 Minutes Initial During Transfer
HR 120 135
Rhythm Sinus Sinus
RR 14 18
O2 Sat 98% 98%
Breath Sounds Clear Clear
B/P 130/80 140/80
Temperature 37.8 37.8
Bowel Sounds Normal Normal
Mental Status A&O x 4 A&O x 4

Tone: Same

Script: moans in pain, "No move, pain, no move, pain... rest, rest , please" (repeat)...(in French) la douleur, la douleur, le repos

  1. Sets up wheelchair and ensures locks on both chair and bed prior to transfer
  2. Moves bedside table and any other furniture for safe transfer.
  3. PT and OT identify patient not safe for discharge to home due to limited mobility
  4. SW enters the room after several minutes to begin discharge plans
  5. PT and OT respond appropriately to questions regarding discharge disposition to daughter
  6. PT and OT appropriately utilize daughter to translate to patient
  7. PT and OT attempt to sit patient at EOB

If/Then Chart

IF Cardiac Respiratory Diagnostic Other
1 PT /OT does not recognize pt not stable for discharge home Daughter starts commenting that she doesn't think her mom will be safe alone at home and asking PT for advice
2 SW enters room and PT/OT do not recognize patient not stable for DC SW insists on a DC plan with team

Integrated Debriefing Guide

Threads Performance Measures/Discussion Points Debriefing Prompt
Opening

Someone give us a quick summary of what was going on with this patient.

What went well?

What didn't go so well?

Understand clinical presentation

Conducts patient interview/history

Conducts screening examination to ensure patient clear for participation in PT (VS, ROM, Pain, skin inspection

What signs and symptoms could we expect for this type of patient?
Identify contributing factors PT/OT identify that culture may be playing a role in patient compliance to rehabilitation

Describe some contributing risk factors we should consider....

How does this patient's culture affect this encounter?

Recognize a change in patient status* PT identifies patient not safe for discharge to home

Looks/sounds like things are changing - what is concerning at this point?

How do we involve the daughter and patient in the plan?

Identify correct intervention / treatment Checks patient chart for PT orders (OOB, PT, WB Status)

What are some standards of care for this type of patient?

What other options for care would be reasonable?

Understand cultural implications

PT/OT determine that patient speaks limited English and looks for interpretation from the daughter

PT/OT determine that patients lack of participation is not just pain related after checking on medication administration

Is it appropriate to use the patient's daughter to interpret? What is the best method for interpretation with the daughter?

What thoughts do we have about how this patient's beliefs may impact outcomes?

How do we best address their beliefs?

Assessment* Conducts screening examination to ensure patient clear for participation in PT (VS, ROM, Pain, skin inspection

Thoughts about types of specific assessments that are important for this patient....

What are priorities for this patient?

Infection Control Sanitizes hands prior to patient contact What infection control practices would we need to consider?
Medication Administration* Identify the pain medication schedule and timing of the PT visit. What medications could be considered? In what order should they be given? How?
Patient Safety

Moves all lines to 1 side of the bed for safe patient transfer

Sets up wheelchair and ensures locks on both chair and bed prior to transfer

Talk about some concerns and options on how we could keep this patient safe...
Documentation What information would we want to document? What are strategies for doing that during a crisis?
Communication *

Introduces self to patient, family, team members

OT/PT realize patient does not speak English, asks the daughter to interpret

What additional information would we like to have had from PT 1?

As a newcomer to the patient situation, what information would be helpful? Lets practice giving an SBAR about this patient...

What are some strategies for handling patient who do not speak English? What are our choices for communication?

Situational Awareness*

PT identifies patient not safe for discharge to home

PT/ OT discuss possibilities for patient

Discuss some strategies to prevent us from becoming task focused...

What resources could be accessed for help?

Decision Making Prioritization*

PT /OT identifies patient not safe for discharge to home

PT/OT responds appropriately to questions regarding discharge disposition to both family and team members

How were decisions made?
Leadership* PT responds appropriately to questions regarding discharge disposition to both family and team members How were roles delegated? How was leadership established? What actions did the leader take to ensure situational awareness?
Professional Behavior* Maintains professional behavior in verbal and nonverbal communication in all interactions

How were we coming across?

What are some strategies for managing difficult interactions?

Closing

What would we do differently next time?

Does anyone have any additional questions or comments?

* = typical event to stop/review with video replay

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