By Kathy Spozio

Gaining Respect and Recognition for you Peer Visitation Program

There are many approaches to developing a successful visitation program--somewhat like the old adage--there's more than one way to skin a cat. Well, maybe that is no longer a politically correct statement, but the idea behind the cliché can be appropriately applied to "growing" a peer visitation program--just ask Liz Zemke, RN, Amputee Coalition Regional Representative (Region K), and below-knee amputee.

In response to a Communicator staff request to share information for the Peer Visitation Corner, Liz has contributed a few success tidbits that I believe have value for everyone involved with or planning a peer visitation program. But, before we consider Liz's comments, let me provide some history on the seven-year seasoned program with which Liz is associated; the Central California Amputee Education and Support Group (CCAESG) Peer Visitation Program.

In the November/December, 2000, issue of inMotion magazine, author Zahra Maghani penned the following excerpt about Liz and the CCAESG in an article titled "Different Strokes." 

Zemke, a nurse case-manager, used her professional knowledge of the health care system to convince various area hospitals to collaborate with CCAESG's peer visitation program. This was no easy task.

The first hospital Zemke approached rejected her overtures contending that it didn't perform enough amputation surgeries each year to warrant a formal alliance with CCAESG. Rather than taking their word for it, Zemke asked the hospital to back up its claim with actual numbers. Tabulation of the statistical incidence of amputation surgeries revealed that the hospital was averaging as many as two or three amputation surgeries each week. "Of course, then the hospital's CEO jumped at the chance to get CCAESG's pre- and post-amputation support services for its annual load of 120 amputee patients," Zemke said.

Encouraged by the creation of the first alliance, Liz approached various other area hospitals with a proposal to formally collaborate with CCAESG. "How could they turn us down?" Zemke asks. "This was a win-win situation--their patients would benefit from this free service and the hospital's reputation for quality patient services would soar."

Now, whenever an area hospital patient is about to undergo amputation surgery, the hospital's patient services department notifies CCAESG's peer visitor program coordinator. Depending on the circumstances and kind of amputation, a peer visitor is selected to visit with the patient. "Seeing someone who has a similar amputation but is active and doing well in life can bring so much hope to the new amputee," Zemke notes.

Because first impressions matter so much, the program coordinator usually arranges for a peer visitor close in age to the new amputee. "A teenager who has just lost his leg might find it easier to communicate with a peer visitor who is closer to his age than someone much older," Zemke notes. With this concern in mind, CCAESG's Peer Visitation Program has recruited peer visitors of various ages, including teens.

To appropriately address the needs and concerns of the new amputee, the program coordinator must respect the emotional limitations of the amputee peer visitors. Because some peer visitors find it difficult to visit with people who have lost a limb because of complications from diabetes and other peer visitors have a hard time counseling trauma amputees, the peer visitor program coordinator takes a great deal of care in matching up new amputees with the "right" peer visitor. "It is really not in the patient's best interest to have a peer visitor who finds the circumstances of the patient's amputation, say cancer, depressing. That peer visitor is not going to be able to offer much support or hope to the new amputee," Zemke stresses.

The care, thoughtfulness, and hard work that has gone into the CCAESG peer visitation program has earned it and its partner hospitals accolades from the Joint Commission on Accreditation of Healthcare Organizations and other reviewing bodies. Zemke points out that, although a formal study on the program's impact on new amputee recovery rates has not yet been done, she believes that the program and support group activities make a significant contribution to the amputees' post-amputation adjustment and general sense of well-being.

Zemke's insights on the needs of new amputees stem from her personal experience. Five (now seven) years ago, when her right leg was amputated below the knee, there was no amputee peer visitor program in place to reach out to for comfort and direction. "It would have made all the difference in my recovery if I had had the kind of support, understanding and information that only amputees can provide to each other," she says.

Along the journey of the past years, Liz has developed a few techniques that have served the CCAESG program particularly well. 

• Utilizing the hospitals' publications to list the peer visitation program and contact information is an avenue for recognition for the program and helps to get the word out. It also is a method of ensuring that there is a routine, dependable method of free advertising.
• Liz meets with and develops a relationship with the hospitals' community resource coordinator, who can tap into the surgery schedule daily, and identify every amputation that is scheduled. The CCEASG then gets a call and a follow up fax with pertinent information from the community resource office. 
• Liz recommends that only one coordinator per site works out the best. She suggests that more than one causes too much work for the hospital.
• All of the hospitals provide the CCAESG with volunteer badges and the peer visitor hours are reported to the volunteer office, sometimes using a faxed form for reporting purposes. 
• Two of the hospitals the CCAESG works with have developed a small brochure to introduce the program and one has developed a big informational book for amputees. Liz uses the big booklets when she visits university students in PT programs and Psychology of Disabilities classrooms.
• Liz liaises with the Case Management Society of America that is comprised of mostly nurses and social workers who coordinate medical care for ill or injured persons. The CCEASG group attended one of their regular meetings to observe a fitting and fabrication demonstration by a prosthetist on an amputee and a discussion of L code billing.

The CCAESG program is good example of how a peer visitation program can grow with time, organization, persistence, and dedication. With the assistance of a few CCAESG volunteers, Liz visits five to ten new amputees per week and also contacts the same number by email, telephone, and regular mail. And, all indications show that the program is growing by leaps and bounds. 

Thanks Liz for sharing some of your success stories. Hopefully, other peer visitation programs will benefit from your proven techniques, and aspiring program coordinators will be encouraged by your results.

Back to Table of Contents

Peer Visitation Retraining Clarification

In a Peer Visitation Corner article published in the February, 2002, edition of the Communicator entitled "Peer Visitation Training Program Gets New Look," I reported on the necessity to "retrain individuals who are currently on the trainer roles (emphasis added), along with anyone else not previously trained." This statement seems to have created some confusion regarding exactly who needs to be trained again. One reader asked if it would be necessary to retrain all peer visitors now on the role call.

I apologize for the confusion that may have occurred and would like to emphasize that my article referred to the retraining of current and future trainers only.

To further clarify this, Pat Isenberg, Amputee Coalition's new COO and training coordinator, was contacted. She explained that Amputee Coalition "will not require that trained and experienced peer visitors be retrained. Obviously, since the material is new, they may want to be, or they may feel that they need a refresher course. We have more than 600 peer visitors in our database; but are unsure how many of these are active." Pat continues, "What I hope we will be able to do at future National Conferences is provide sessions for seasoned peer visitors to deal with more advanced issues. And, I hope some of them will be interested in becoming certified trainers. As we proceed through certification of trainers, I plan to have additional training sessions at National Conferences to enhance the skills of certified trainers (so, each year we would certify new trainers and provide continuing education for those certified previously)."

Sounds to me like the NPN's Peer Visitation Program is a work in progress with many exciting improvements to come in the months and years ahead. And that can only mean bigger and better things ahead for amputees, their families and friends, and the professionals who serve them.

Back to Table of Contents

2002 Peer Visitation Training Schedule

May 11 Pittsburgh, PA; HEALTHSOUTH Harmarville

July 22 Anaheim, CA; Amputee Coalition National Conference 

Back to Table of Contents

Peer Visitation Q and A Forum

Dear Kathy,

My question concerns home visits. What do you do when you find out, once you've arrived at the amputee's home, that due to tension between family members and/or a stressful situation involving an issue that a peer visitor isn't supposed to address, you find yourself unable to conduct a "normal" visit?

Richard

Dear Richard,

Your question correctly suggests that there can potentially be a number of situations that must be resolved before a "normal" visit is possible. Let's look at some of these individually, together with some of the options open to a visitor. Incidentally, as you will recognize, several of these same situations could also occur during a hospital visit. 

The situations to which I am referring involve safety issues, comfort level issues, and inappropriate questions, including combinations of these.

Safety Issues - In general, any situation that causes a visitor to be concerned about his or her personal safety must be dealt with immediately and affirmatively by terminating the visit and leaving the venue. These could involve such things as potentially violent displays of temper, out-of-control arguing among family members, inappropriate or threatening advances by anyone present toward the visitor, evidence of uncontrolled drunkenness or drug use, etc. Fortunately, these kinds of situations are rare, but the visitor must still be prepared to deal with them. 

Visitors should always remember that 1) their duty to protect themselves transcends any duty they might feel they have toward the visitee, and 2) that their own level of discomfort is the barometer that should tell them when to excuse themselves as politely as possible and leave the home. In other words, you don't have to be able to prove the threat exists; simply feeling the threat is enough to justify taking your leave. The most recent Amputee Coalition guidelines, found in the new peer visitor training manual, support you in this. They state: "Terminate the visit if anything about the setting or behavior of anyone in the home makes you feel unsafe or uncomfortable."

Should this happen, reporting the terminated visit to the peer visitation coordinator or referral source would be an important, logical, and necessary next step. Should this occur during a hospital visit, it should also be reported to the charge nurse or social worker.

Comfort Level Issues - There are many possible situations that might make a visitor uncomfortable but which would not normally warrant termination of the visit. In general, these are the kinds of things that the visitor is usually able to control or motivate others present to bring under control. They might include distractions such as from a television or children running noisily through the room, or a family member or other third party who interferes with your conversation with the amputee. 

Most distractions can be reduced one way or another; for example, the visitor might ask that the television be turned off or that the children play elsewhere. Or one can suggest moving to a different room.

In the case of family members who interrupt or dominate the conversation, it's okay to explain diplomatically that you are there to speak privately with the amputee. It would also be appropriate, at your option, to suggest meeting separately or at another time with the family or other support individuals.

Naturally, if the visitor's discomfort level becomes sufficiently extreme, if the distractions or interruptions can't be controlled, or if anyone's behavior becomes too much of a problem, even though the visitor might not have personal safety concerns, he or she can still decide to terminate the visit.

A different kind of comfort level issue involves questions from the visitee that are entirely appropriate but that embarrass the visitor or offend the visitor's sensibilities sufficiently that he or she would be reluctant to answer. An example might be a question concerning the potential for continued sexual relations after amputation. In dealing with these, the visitor should admit to being uncomfortable with responding and then offer to help find another visitor or professional person who would be more comfortable with the subject matter.

Inappropriate Questions - One category of questions that are inappropriate for a visitor to answer involve subjects outside the visitor's purview, such as medical questions or questions about the competence of a particular prosthetist. Equally inappropriate are personal questions, such as "Could you arrange for your prosthetist to contact me?" "Would you be interested in dating me?" etc.

Obviously, the visitor should not answer inappropriate questions and the amputee should be told why. Care should be taken, however, to differentiate these kinds of questions from questions that are simply beyond the visitor's competence to answer. In these cases, explaining that you have no knowledge of the subject matter or a simple "I don't know but I'll find out" should suffice, provided that you actually do get back with an answer.

To summarize:

Rule No. 1 is protect yourself at all times and terminate any visit you feel jeopardizes your personal safety;

Rule No. 2 is attempt to control distractions, interruptions, or other inappropriate behaviors but terminate any visit during which these cannot be controlled;

Rule No. 3 is do not answer inappropriate questions; and

Rule No. 4 is that you have the option of not answering questions that you find too embarrassing or discomforting

If other support group leaders or peer visitation coordinators have information, advice and/or questions to share, please forward them by email directly to Kathy Spozio at mermaid@usachoice.net.