The Mended Hearts, Inc. & Mended Little Hearts

Visiting Trainer’s Guide

It’s great to be alive —and to help

others!

Little hearts hold big hopes.

About Mended Hearts and Mended Little Hearts If you would like to learn more about Mended Hearts, Mended Little Hearts, becoming an accredited visitor, or beginning a visitor training program in your area or hospital, please visit www.mendedhearts.org or email info@mendedhearts.org.

Mended Hearts national toll-free phone: 1-888-HEART-99

A Note About Copyright Copying this information without permission from The Mended Hearts, Inc. is illegal and unethical. No part of this video or these training materials may be reproduced without the permission of The Mended Hearts, Inc. ©2011

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A Note to Visiting Trainers

This DVD is intended as one tool in an interactive accredited visitor training session. It is not intended to be used as a stand-alone training tool. The full training session should take about four hours. Please see the suggested agenda for more information about conducting a full training session to accredit visitors.

This DVD is divided into segments and is designed to be stopped and started again, allowing discussion and interaction after each segment. The following are the individual sections of this DVD and their contents:

Welcome—This segment welcomes accredited visiting trainees to the program and briefly explains what the DVD contains. There is a separate Welcome segment for Cath Lab visitor training.

Introduction—Dr. Jeff Marshall talks of the value of the Mended Hearts visiting program to patients and their families. In addition, Dr. Harken, founder of The Mended Hearts, Inc., talks about how the organization and the accredited visiting program began. It also includes some general information about Mended Hearts and its program, Mended Little Hearts.

What Makes a Good Visitor—This segment contains general information about the characteristics of a good visitor such as having a positive attitude, active listening, using discretion, and sticking to appropriate topics.

Listening Skills—Listening is the most important visiting skill. In this segment, active listening is explained. This segment includes information on active listening techniques and barriers to active listening.

Do’s and Don’ts—There are ten things a good accredited visitor should do and should not do. This segment briefly explains these twenty do’s and don’ts so that all visitors know what is acceptable and what is not.

Visiting Overview—This segment briefly explains each step in visiting using the acronym SUPPORTS. This segment serves as an introduction to the Model Visit.

Model Mended Hearts Visit—This segment contains a video of a model visit with a real Mended Hearts visitor, a patient and a caregiver. The model visit isn’t intended to be a “perfect” visit, but to give good examples of steps to visiting heart patients.

Introduction to Accredited Visitor Training

Model Mended Little Hearts Visit—This segment contains a video of a model visit with a real Mended Little Hearts visitor and a parent of a child with a heart defect. The model visit isn’t intended to be a “perfect” visit, but to give good examples of steps to visiting parents and caregivers of children with congenital heart defects.

Privacy Considerations—Respecting patient and family privacy is vitally important to all successful visiting programs. This segment discusses some privacy issues, including the Health Insurance Portability and Accountability Act (HIPAA) and how it impacts Mended Hearts and Mended Little Hearts.

Hospital Considerations—This segment contains information about what to consider when working with hospitals such as following hospital procedures, particularly sign-in or check-in procedures, following rules, patient privacy, and things hospitals may provide to Mended Hearts and Mended Little Hearts visitors.

Program Objectives

At the end of this accredited visitor training program, participants should:

1. Understand the background and benefits of the Mended Hearts and Mended Little Hearts visiting programs.

2. Be able to identify visiting protocol. 3. Know what skills and behaviors are necessary to be an accredited visitor. 4. Understand good listening skills and barriers to listening. 5. Be able to identify ten things accredited visitors should do and ten things

accredited visitors should not do. 6. Understand the steps to effective visiting and demonstrate a “model” visit. 7. Know what privacy issues affect Mended Hearts and Mended Little Hearts,

including how HIPAA impacts our visitors.

Trainer Preparation

Before the training program, you will want to gather information on your hospital’s procedures and have them for your visitors ahead of time. You will want to determine:

• Days of the week visits can be made • Parking for visitors • Sign-in and sign out procedures • Where to go and who to contact when visiting • Where to obtain materials given to patients i.e., Patient Information Packs,

Family Information Packs, Care Packages, heart pillows, etc.

• How and where to record the visits

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Checklist of supplies and equipment

n Trainer’s Guide

n Agenda—one for each participant

n Visitor Training DVD

n Accredited Visitor Handbook—one for each participant

n Hospital Procedures for your hospital(s)

n DVD player

n Projector

n Screen

n Flip charts with pens

n Mended Hearts and/or Mended Little Hearts Fact Sheets (optional)

n Wallet cards—one for each participant

n Confidentiality statement—one for each participant

n Visiting Scenarios on notecards (optional)

n Assessment—one for each participant (copy from this guide)

n Evaluation Form—one for each participant (copy from this guide)

Room Set-Up

Also, in advance, you will want to confirm room availability for the training. Suggested room set-up for this training is tables of four. This allows for group discussion and interaction.

Sample Agenda

(Training will take about 4 hours)

1. Introductions and welcome segment of DVD (15 minutes)

2. About the training program and your local visiting program (15 minutes)

3. Introduction (DVD) (3 minutes)

4. Visiting patients or families—protocol with exercise (12 minutes)

5. What makes a good visitor? (DVD) (5 minutes)

6. Listening skills (DVD)—practice active listening (45 minutes)

7. Do’s and don’ts (DVD)—with discussion (15 minutes)

8. Break (15 minutes)

9. Visiting overview (DVD) (5 minutes)

10. Model visit (DVD—either Mended Hearts, Mended Little

Hearts or both) (10 minutes)

11. Role playing (45 minutes)

12. Privacy considerations—(DVD) with discussion (15 minutes)

13. Visiting scenarios—group discussion (30 minutes)

14. Hospital considerations (DVD) (5 minutes)

15. Assessment (10 minutes)

16. Closing (collect confidentiality forms/present wallet cards) (15 minutes)

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Introduce Yourself

Below is a suggested script to introduce yourself and the visitor training session. Copy in bold is strongly encouraged.

Welcome to your first Accredited Visitors training program. My name is ,

and I am the current Visiting Trainer.

Thank you for agreeing to be an Accredited Visitor. You are the core of the Mended

Hearts and/or Mended Little Hearts program. You can be an integral part of a patient

or family’s healing because of your experience—you have been there. The cardiologists

and surgeons can explain in great detail every aspect of the procedure, but you, as a

patient, parent or caregiver, can give hope and inspiration by showing that one can lead

a productive life after going through the experience of undergoing surgery or other heart

procedures or having a child who has. You can also best relate to what the patient and

family are experiencing.

The rewards are not all one-way though, because as an Accredited Visitor, you can receive

tremendous joy from your visits. As an Accredited Visitor, you will have the opportunity

to see the sparkle return to the eyes of the patient or family member. By making visits, you

will know the true meaning behind our goals of “giving back and helping others” and

“helping the littlest heart patients of all.”

Your Handbook includes an agenda and various handouts that will be used during

today’s training program.

All trainees must be sure to complete ALL parts of the training. This includes

conducting visits that are observed by an experienced Accredited Visitor.

Also, trainees must attend the entire session(s). If you need to leave early for

some reason, you MUST meet individually with the Visiting Trainer to

determine if you can be accredited and/or how you will complete your

training.

Introduce Participants

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You are all welcome to ask questions as we go through each of today’s lessons. If your

question pertains to a subject we will get to later in the day, I will ask you to hold your

question until later.

Show the DVD segment entitled, “Welcome” at this point.

Describe What to Expect

• Go through the agenda with participants and discuss when breaks will occur. • Review housekeeping issues such as where restrooms, water fountains and exits are. • Give general information about your local visiting program and hospital that

you have gathered before the training.

Playing the DVD

Show the DVD segment entitled, “Introduction” to give background about the Mended Hearts visiting program and the Mended Little Hearts program. If you

have Mended Hearts and/or Mended Little Hearts Fact Sheets, you may want to pass them out at this time.

Participant Introductions EXERCISE

After introducing yourself and reviewing information about the training program and your local visiting program, have the participants introduce themselves. One way to do this is to pair them up and have them introduce one another to the group. Ask them to tell their name and why they want to be an accredited visitor. You might also ask them to tell what skills they have that they feel will make them a good accredited visitor.

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Visiting Patients and Families

Review Visiting Protocol with participants. The following is Visiting Protocol for Mended Hearts and Mended Little Hearts:

General Protocol

• Wear badges, vests, or other clothing and items that designate you as an accredited visitor at all times. (This may vary by location.)

• Distribute ONLY approved Mended Hearts or Mended Little Hearts material.

• Always invite the patient, parent or family members to a support group meeting.

Mended Hearts Visiting Protocol

Who is visited?

• Patients with heart disease and caregivers.

Who can visit?

• Members in good standing of Mended Hearts who are Accredited Visitors. • All Accredited Visitors must attend annual re-accreditation training. • Must be a heart patient. Caregivers may visit family members and caregivers if

accompanied by a heart patient. • Newly Accredited Visitors who have attended training. New visitors should be

accompanied by an experienced Accredited Visitor until comfortable. These new visitors are evaluated during this time so they can receive the feedback they need to become the best Accredited Visitors possible.

Introduction to Visiting

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Mended Little Hearts Visiting Protocol

Who is visited?

• Parents, caregivers, and family members of children with heart defects.

Who can visit?

• Members in good standing of Mended Little Hearts who are Accredited Visitors. • All Accredited Visitors must attend annual re-accreditation training. • Must either be a parent or caregiver of a child with a heart defect or an adult

who was treated for a congenital heart defect as a child. No children may visit. Grandparents of children with heart defects may only visit other grandparents.

• Newly Accredited Visitors who have attended training. New visitors should be accompanied by an experienced Accredited Visitor until comfortable. These new visitors are evaluated during this time so they can receive the feedback they need to become the best Accredited Visitors possible.

Patient Perspective EXERCISE

Ask participants to think back to how they felt when they were diagnosed with heart disease or their child was diagnosed with a heart defect. Then, have them remember when they had heart surgery or a heart procedure or when their child had heart surgery or a heart procedure and how they felt at that time. Have participants report to the whole group or discuss in small groups and then report to the whole group. This exercise can set the stage for a good visitor training because participants remember more clearly the patient or parent’s perspective.

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What Makes a Good Visitor?

Show the DVD segment entitled, “What makes a good visitor?” Ask if there are any questions.

Listening Skills

Listening skills are the most important skills for accredited visitors. This part of the training should include practice exercises and discussion of active listening skills, barriers to listening, and non-verbal communication.

Emphasize the importance of good listening skills. Then, show the DVD segment entitled, “Listening Skills.” After the video segment, conduct the practice exercises on Active Listening Skills below (Exercises 1 & 2). Then, you could choose

another exercise from the list if time allows. Refer to the Accredited Visitor Handbook for detailed information on this topic.

For discussion, you can give this list of questions people can ask themselves when listening to others and have participants talk about whether they notice themselves doing these things, or not:

• Do I have an agenda? • Do I want to control the conversation? • Have I asked questions, where appropriate? • Am I sharing too much of my story? • Am I present with the person talking rather than somewhere else? This question

is vitally important. It is hard to do when so many things are going on in our lives, but we must be present with people we are visiting.

Keys to Being a Good Visitor

EXERCISE

Listening Exercises

Following are a few listening exercises. It is highly suggested to conduct the two Active Listening Skills exercises (Exercises 1 & 2) so participants can practice active listening. Then, add another exercise if time permits.

1. Active Listening Skills—Paraphrasing. Put participants in pairs sitting face-to-face. Ask them to think back to the earlier question about how they felt when they were diagnosed with heart disease or their child was diagnosed with a heart defect. Have one person in the pair be the Speaker and briefly tell his or her partner (Listener) how he or she felt. The Listener should actively listen and then paraphrase (repeat in his or her own words) what the Speaker said. Then, have the Listener ask the Speaker if he or she paraphrased correctly. After they practice, have them switch roles.

2. Active Listening Skills—Reflecting (best done after paraphrasing exercise)— Put participants in pairs facing each other. The Speaker will briefly (in a small paragraph) tell the Listener about his or her hospital or heart procedure experience. The Listener should observe non-verbal signals (tone, body language, mood, etc.) as well as listen to what the Speaker is saying. The Listener should think about the Speaker’s message and reflect it back to him or her, including reflecting the Speaker’s mood and feelings. (Ex. “You seem very sad about that experience,” or “It seems like that was very scary for you.”) The Listener then asks the Speaker if he or she heard correctly and truly understood the Speaker’s mood and feelings. After they practice, have them switch roles.

3. Name Game for Listening—Have participants sit in a circle. One person starts by using an adjective starting with the same letter of his or her name and then saying his or her name (ex. Jolly Joyce, Brave Ben, etc.). The next person repeats what the first person said, and then adds his or her own. Go around the circle until you get back to the first person. This allows people to learn each other’s names and practice listening at the same time.

4. Barriers to Effective Listening—Have participants discuss the barriers to effective listening mentioned in the DVD segment and then come up with additional barriers to effective listening. For each barrier, ask participants to come up with at least one solution. Ex. For interrupting, a solution might be to pause briefly before replying. Below are common barriers to active listening.

Interrupting This is probably one of the biggest barriers to active listening. Be sure the patient or family member is done talking before you begin.

Comparing Comparing yourself to the patient or family member or comparing your situation to theirs. It is often hard not to think about whose situation is worse, whose doctor is better, who is more knowledgeable, etc.

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Planning Being preoccupied with what you are going to say before the person has finished speaking.

Filtering Hearing only certain topics and tuning out others.

Judging Prejudging a statement as “stupid,” “nuts,” “immature,” “hostile,” etc.

Daydreaming Allowing your mind to wander and not being fully present with the patient or the family.

Debating Considering every conversation as a personal challenge or affront and looking for ways to argue with the patient or the family member.

Being Right Believing you have all of the answers and don’t need to listen.

Placating Automatically agreeing with all of the speaker’s comments without actually listening. (You’re right…, Of course…, I agree…, Really)

Mind Reading Trying to figure out what the speaker is thinking and feeling.

Remembering Dwelling on your own personal experiences instead of listening to the patient or family member.

5. Non-verbal Communication—Have participants sit in pairs. Give all participants the following script:

A: Have you seen my book? I can’t remember where I put it. B: Which one? A: The murder mystery. The one you borrowed. B: Is this it? A: No. It’s the one you borrowed. B. I did not! A: Maybe it’s under the chair. Can you look? B: OK--just give me a minute. A: How long are you going to be? B: Geez, why so impatient? I hate when you get bossy. A: Forget it. I’ll find it myself.

B: Wait—I found it!

Give the partner who will play Person B a secret emotional distraction like “in a rush,” “bored,” “angry,” “guilty,” “tired,” “overwhelmed,” etc. and have him or her act that out when stating Person B’s lines. After they finish their lines, have Person A guess what emotion Person B was feeling. The group can then discuss non-verbal communication that might be present when visiting. They can also discuss differences in non-verbal communication for people of different cultures.

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Do’s and Don’ts

Show the DVD segment entitled, “Do’s and Don’ts.” After showing the segment, ask if there are questions. Many of these will be shown in the model visit. Refer to the Accredited Visitor Handbook for detailed information on do’s and don’ts.

More exercises can be found at:

http://www.razvandobre.com/10-Exercises-to-Improve-Listening-Skills-and- Become-an-Active-Listener.html

http://www.in-themoment.com/workshop2.asp

http://homeworktips.about.com/od/mindandbody/a/nonverbal.htm

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Visiting Overview

Show DVD segment entitled “Visiting Overview.” This serves as an introduction to the Model Visit. After this segment, go directly to the Model Visit segment

and show the model visit—either Mended Hearts, Mended Little Hearts, or both, as appropriate.

Model Visit

Show the DVD segment with the Model Visit for Mended Hearts, Mended Little Hearts, or both. After the Model Visit, ask participants how the visitors did or

did not follow the visiting do’s and don’ts. Also, go back through the steps for visiting and ask for questions.

The following are the steps for model visits shown in the video segment.

S Sign in or check in

U Use discretion

P Ask Permission to visit and to approach

P Be Positive and encouraging

O Open a conversation

R Respond to questions

T Thank the patient or parent

S Sign out or check out

You may comment, again that procedures for checking in at the hospital (in some places visitors don’t need to check in) vary from hospital to hospital. Here, it would be helpful to review the procedures at your hospital(s) again.

Also, for Mended Hearts Visitors, reinforce that all visitors should leave a response card with patients visited so that Mended Hearts captures patient information and can connect patients with chapters.

Putting Theory Into Practice

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The Importance of Follow Up

Following up with patients and families is vitally important for Mended Hearts and Mended Little Hearts. Patients and families need to know that Accredited Visitors care about the patient or child’s recovery and that there are resources and support available to them. Discuss with participants different ways to follow up after a visit.

Role Playing

After showing the model visits, it is helpful for participants to role play what they observed. If possible, group people in threes or fours. Have one participant play the patient, parent or family member; one play the accredited visitor; and one or two provide feedback on what was done well and what could be improved. Have people switch roles so that all participants have the opportunity to play the role of accredited visitor.

Ask participants to be as realistic as possible. Some participants will feel awkward or self-conscious when role-playing. Assure them that it is okay to make mistakes during the training, and that is why you are practicing before actually visiting.

After role-playing, have participants tell the whole group what they learned by role- playing, what they feel went well, and what they could improve. Also, be sure to ask whether they have any questions or concerns.

EXERCISE

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Privacy Considerations

Show the DVD segment entitled, “Privacy Considerations.” Ask for questions. Refer to the Accredited Visitor Handbook for detailed information on privacy

considerations and frequently asked questions.

Common Issues

There are some situations that commonly occur during visits where the visitor may have difficulty determining a correct course of action. When these situations are discussed during training, the visitor is not caught off-guard during a visit.

Other

Considerations

EXERCISE

Visiting Scenarios

Divide the participants into groups of three or four. Give each group of participants one or two of the following scenarios to discuss. (You may want to write them on index cards ahead of time and pass them out to the groups.) Have the participants come up with as many ways to handle the situation presented in the scenario as possible. Have the individual groups report their solutions to the entire group of participants.

• Will You Pray? What do you do when a patient, parent or caregiver asks you lead a prayer or pray with them? • Possible Answers:

• Tell him or her Mended Hearts and/or Mended Little Hearts are not affiliated with any particular religion, but you would be glad to find the hospital chaplain.

• Tell them that you will be sure to pray for them at home.

• Do NOT lead a prayer (see do’s and don’ts) at any time when visiting.

• The Sound of Silence. What do you do when a patient, parent or caregiver who you are visiting gives you one-word answers or barely speaks to you? • Possible Answers:

• Tell him or her briefly about your experience and ask if they have any questions about their experience that you might be able to answer.

• Ask if you should come back at another time. • Ask them a question unrelated to their hospital situation to start them

talking on a lighter subject. • Do NOT go on about your own experience or keep talking when the

patient or parent clearly doesn’t want to talk or visit.

• Oh No! Not That Doctor! What do you do when a patient, parent or caregiver asks you about his or her doctor or the child’s doctor when you don’t feel that doctor is a good one or have had a bad experience with him or her? • Possible Answers:

• Tell him or her that every person has their favorite doctor and assure him or her that the doctor will give the best care possible.

• Tell him or her that their doctor will provide very good care. • If you know of someone who had a good experience with that doctor,

refer to that situation. • Do NOT speak badly about a patient’s care or medical personnel caring for

the patient at any time—whether visiting or not.

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• Give Me A Kiss. What do you do when a patient, parent or caregiver goes to

give you a hug or to make physical contact with you? • Possible Answers:

• Tell the patient or parent that, although you are very healthy, you don’t want to take any chances.

• In some cases, a physical contact may be appropriate so long as you clean your hands before and after contact, such as if the patient or parent puts a hand out for a handshake.

• Do NOT initiate physical contact with a patient, parent or caregiver.

• This Is A Bad Time. What do you do when you walk into a room, after knocking and being told to come in, when a patient or child is exposed or unclothed? • Possible Answers:

• Quickly state that you thought you heard approval to enter and that you will come back at another time.

• If no one has seen you, leave quickly and quietly. • Do NOT stay in the room with an unclothed patient or child even if

approval is indicated.

• How Much Is Too Much? How much information about patients is appropriate for visiting records and how much is too much? • Correct Answer: Only state as much information as needed to record

the visit. Do NOT comment on the patient or parent’s attitude, attire or demeanor. That type of information may impact the next visitor and his or her attitude toward the patient or parent.

Hospital Considerations

Show the DVD segment entitled, “Hospital Considerations.” Ask if there are any questions.

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Visitor Training Assessment

Please complete the following assessment after completing the Accredited Visitor Training Program.

True False

1. There are rules for Accredited Visitors so that they do not need

to comply with hospital rules as well.

2. Accredited Visitors should always ask for permission before entering a hospital room.

3. When visiting a patient or family member, the Accredited Visitor should do most of the talking.

4. Accredited Visitors should invite patients and families to a Mended Hearts or Mended Little Heart meeting and be sure to follow up

with the patient and/or family to see how they are doing.

5. Accredited Visitors should provide patients and families with only approved Mended Hearts and Mended Little Hearts materials.

6. Accredited Visitors may give medical advice and answer questions about medical care if they know the answer.

7. If a patient or family member does not want to talk, the Accredited Visitor should keep asking questions.

8. Active listening involves paraphrasing, which is repeating what the patient or family member said in your own words, reflecting

mood and feelings.

9. Accredited Visitors may share patient information with close friends and other Accredited Visitors only.

10. Accredited Visitors should share their honest opinions about medical professionals treating the patient, even if they are negative.

Answers key on reverse 21

Concluding the Session

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Answer Key

1. False. All visitors should comply with hospital rules and Mended Hearts rules. In all cases, hospital rules must be followed.

2. True. Always ask for permission before entering a hospital room.

3. False. When visiting, the Accredited Visitor should listen more than he or she speaks. Listening is the most important visiting skill.

4. True. Patients and family members should be invited to a meeting. In addition, visitors should ALWAYS follow up with the patient and/or family member to see how they are doing and continue the relationship.

5. True. Only approved Mended Hearts and Mended Little Hearts materials should be given to patients and families.

6. False. Accredited Visitors should not give medical advice. Refer patients or family members to medical professionals for medical questions even if you know the answer.

7. False. If the patient or family member does not want to talk, tell him or her you can come back at a better time or simply leave information with him or her.

8. True. Active listening is a vitally important visiting skill and involves paraphrasing what the patient or family member said and reflecting mood and feelings.

9. False. Accredited Visitors should share only necessary information with other Accredited Visitors—not with friends, family members or others. Patient information should be kept private.

10. False. Accredited Visitors should ALWAYS be positive about medical care and medical professionals.

Closing

End the training program by thanking the participants for attending and giving them your contact information in case they have questions later. Have participants fill out an evaluation form and the confidentiality statement before they leave and hand it to you. As participants turn in their confidentiality and evaluation forms, be sure to provide their Accredited Visitor wallet card, signed by you, the Accredited Visiting Trainer. Keep confidentiality statements in your chapter’s files.

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Mended Hearts and Mended Little

Hearts Confidentiality Statement

Mended Hearts and Mended Little Hearts honor patient confidentiality requirements. We recognize the fact that patient medical information is confidential and protected by law.

The Mended Hearts, Inc. National Office does not maintain a patient database. For three months, local groups, with the consent of the patients, parents and/or caregivers, are allowed to keep the patient or parent’s name, address, telephone number and email address for the purpose of follow-up visits and/or newsletter distribution.

Exchange of visiting information between chapter or group members or officers must be conducted in a confidential setting.

ACCREDITED VISITORS ARE NOT ALLOWED TO RETAIN PATIENT HEALTH

INFORMATION OR RECORDS. The patient’s, child’s, parent’s and/or caregiver’s name, address or telephone number is not to be distributed to any other organization or used in any manner not initially revealed to the patient or parent.

I have read, understand and agree to abide by the terms of this Agreement.

Accredited Visitor’s Signature:

Printed Name:

Date:

Chapter Number or Group Name:

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Evaluation Form

Excellent Very Good Average Poor

Overall, this training was: n n n n

The training DVD was: n n n n

The training materials were: n n n n

The trainer was: n n n n

The most important thing I learned during this training was:

I would like more information about:

A suggestion for future visitor trainings is:

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NOTES

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www.mendedhearts.org

www.mendedlittlehearts.org

info@mendedhearts.org

Phone: 1-888-HEART-99