Research Shows the Power of Peers
Shepherd Center’s peer support program helps boost confidence, ease the transition home and lower hospital readmissions.
People with spinal cord injuries (SCI) and their families often feel unprepared to return home and deal with the many challenges related to accepting and living with such injuries.
At Shepherd Center, educating patients has always been a priority, especially as it relates to helping them recognize and guard against skin, bladder and bowel issues – the leading causes of readmissions among people with SCI. Until recently, clinicians have been at the helm of patient education. But it seems there might be a more powerful messenger – peers who, like newly injured patients, have faced a life-changing injury and the realities that accompany it.
With grants from the Patient-Centered Outcomes Research Institute (PCORI) and the Robert W. Woodruff Foundation, Shepherd Center has developed, implemented and is now evaluating the effectiveness of efforts that engage peers throughout the continuum of care. Shepherd Center is the first rehabilitation hospital to integrate such a multi-tiered peer support program for people with SCI.
“It’s really based on the concept that people learn better from someone they feel is like them and who has ‘been there, done that,’” says Julie Gassaway, RN, MS, director of health and wellness research at Shepherd Center and the PCORI research initiative.
Shepherd Center’s peer mentoring efforts focus on building patients’ self-efficacy – the belief that they have the know-how and skills to do the things required to manage their condition. Interventions to promote self-efficacy include one-to-one peer mentoring, peer-directed patient education and patient portal for use post-discharge.
“The goal for people with SCI when they leave the hospital is to be able to self-manage conditions that are associated with their injury,” Gassaway says. “They need to know how to recognize early signs of a problem and take the necessary steps to prevent it or minimize the severity.”
Peer mentors work with nurse educators to teach patients about skin issues, bowel and bladder management, prevention of urinary tract infections, high blood pressure, blood clots, spasms, infection control and more.
Peer mentors also assist with patients’ psychosocial adjustment.
“Seeing peers model how to live successful and happy lives while managing all the associated issues that come with a SCI plus using a wheelchair, that’s pretty powerful for our patients,” says Minna Hong, manager, Peer Support Program.
To date, research shows Shepherd’s patient-centered, peer-led education initiatives are more effectively engaging patients. For example, people in peer-led self-care education classes showed significantly more signs of being positively engaged compared with those participating in the standard, lecture-style classes. In turn, they are more prepared to recognize and take steps to manage problems.
“We are giving patients the confidence to problem solve and care for their health needs, whether it be bowel, bladder or skin issues, and the belief that they can go back to some of the activities they used to do – of course, within their new normal,” says Pete Anziano, instructional designer and peer support coordinator.
In addition to being available when requested by patients, peers have become thoughtfully integrated throughout Shepherd Center. Clinicians have embraced the contributions of peer mentors in the rehabilitation process.
“It’s become part of the organizational culture,” Hong says. “We are fortunate that Shepherd Center supports this kind of innovation.”
“We already see improvements in self-efficacy, much higher levels of engagement in the education classes with patients asking more questions and participating in discussions, and it’s clear that it’s making an impact on hospital readmissions, too,” says Mike Jones, Ph.D., vice president of research and technology at Shepherd Center.
The Shepherd team is still collecting and analyzing data and determining how these strategies can be replicated elsewhere. For more information about Shepherd Center’s peer support program, please contact Julie Gassaway at 404-350-7637 or Minna Hong, peer support program manager, at 404-350-7373.
Written by Amanda Crowe, MA, MPH
Photos by Louie Favorite and Gary Meek
Shepherd Center, located in Atlanta, Georgia, is a private, not-for-profit hospital specializing in medical treatment, research and rehabilitation for people with spinal cord injury, brain injury, multiple sclerosis, spine and chronic pain, and other neuromuscular conditions. Founded in 1975, Shepherd Center is ranked by U.S. News & World Report among the top 10 rehabilitation hospitals in the nation. In its more than four decades, Shepherd Center has grown from a six-bed rehabilitation unit to a world-renowned, 152-bed hospital that treats more than 743 inpatients, 277 day program patients and more than 7,161 outpatients each year in more than 46,000 visits.