Use peers to locate, educate patients
Lay home visitors’ improve patient relations
A nurse drives up to a run-down house in a new car. She is neatly dressed, highly educated, and of a different ethnic and socioeconomic background than the people in the house. When she enters the home, she tries to assess her patients and offer advice. But the family inside is defensive. Why should they listen to this woman who is telling them to spend money on things they cannot afford?
Sue Chapman, RN, BSN, MAHCA, director of maternal-child health at the Visiting Nurse Association of Greater Philadelphia, knew that lower-income women patients were not responding well to her nurses. They didn’t participate in maternal-child programs both prenatal and well-baby. The nurses didn’t understand the community in which these women lived, and the women didn’t want to listen to nurses who could not understand the obstacles they faced in everyday life.
The answer: a new employee called a "lay home visitor." Trained by the VNA, these women came from the communities they would later serve. They all had at least a high school diploma or GED and received a month of intensive training on newborn and prenatal care programs, how to find resources in the community, nutrition, budgeting, and communication.
The results have been phenomenal, says Chapman, who developed and runs the program. The VNA now has 14 lay home visitors encouraging greater participation in the various health care initiatives and prevention programs. The latest to benefit is the asthma outreach program. (See related story, p. 15.)
The asthma program includes patients who have been to the hospital more than once in the last year. They are referred by the hospital, a physician, or social services. But they are not all always willing to participate in the program. The challenge, in most cases, was to find the patients or their parents in order to encourage participation.
"The lay home visitors know how to ask family and former neighbors for help in locating someone. They know the neighborhoods and are more trusted than a social worker," Chapman says. Once found, the patients respond better to people from their own community who share some of their life experiences. Indeed, Chapman says, many of these women are either asthma sufferers themselves, or have family members who are.
The visitors’ role is limited. They never give medical advice, says Chapman, but can always access a nurse through cell phones or beepers. For the asthma program, the visitors’ role is to find the patient, reinforce the teaching of the nurse, and act as a go-between. "If a patient has a question, she is more likely to ask the visitor than to ask the nurse. The visitor can find the answer for the patient."
A success from the start
The program, which started four years ago, has not changed over the years. But Chapman says lessons have been learned. For example, the lay home visitors have changed their own lives by adopting the budgeting lessons they give to patients in the infant programs.
The lay home staff also grew to know more about resources in the community than the VNA staff who trained them on the subject when they were hired. They became experts at telling patients where to go for help and further information.
The professional staff also have learned from the visitors, Chapman says. "One nutritionist told patients to go to a particular store to buy a specific brand of formula. But that store doesn’t exist in the neighborhood, and the women involved couldn’t afford that formula." The visitors asked the nutritionist to determine which off-brand could best be equated with the name brand.
Staff turnover has been remarkably low, says Chapman, adding that the program is a way to serve the patient community and the community as a whole. "These are women we have put to work, who are now going back to school, taking care of their families, earning good incomes, and getting benefits. I hope we can find the resources to expand it."
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content