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MODULE FIVE
Role of the Peer Support
Visitor - Part 2
Training Manual for NSW Health Services
EnableNSW
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Establishing an Amputee Peer Support Visiting Service - Training Manual for NSW Health Services
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Outline of module
Objectives
By the end of the module, participants will have:
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identified at least two implications of “difference” for communication
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examined some of the cultural differences that they may encounter in their roles as Peer
Support Visitors and suggested appropriate responses to culturally diverse behaviours
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identified how their own attitudes and assumptions impact on their expectations of clients.
Time
105 minutes
Resources
Data projector, PowerPoint slides, handouts.
Program
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Dealing with difference.
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When the family is there
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Reactions
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Sensitivity to sadness and depression
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When to refer
PowerPoint slides
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Differences
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Discrimination
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Direct and indirect discrimination
Handouts
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Differences activity sheet
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Handling difficult emotions in others
Exercise sheets
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Dealing with difficult issues
There will be many different circumstances in which the Peer Support Visitor may find themselves.
Adequate preparation for the majority of situations will give the Peer Support Visitor the skills to
approach each new client with confidence.
Module 5 - Role of the Peer Support Visitor Part 2
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Dealing with difference
Briefly discuss the meaning of the word difference. The Macquarie Dictionary gives an example as,
“the degree in which one person or thing differs from another”.
Exercise:
Spot the difference
Differences
Discuss with participants. They may have used different words to mean the same things.
Assure participants that differences are very acceptable. What sort of world would it be if everyone
was exactly the same?
Explain that differences can lead to some difficulties with communication. That is why in Australia
most people speak one language for common communication, English. What are some of the
difficulties in communication that differences can give rise to? And how could these situations lead
to mis-communication in Australian contexts?
For instance:
Religious differences – among many Muslim groups, men and women must not touch each other.
Cultural differences – in some Aboriginal communities men and women do not look directly at a
person of higher authority.
Use of colloquial language – in Australia people invited to a casual meal are sometimes asked to
“bring a plate”.
Ask the group to give other examples. Emphasise that we must be aware of differences that can
lead to mis-communication and misunderstanding between Peer Support Visitors and clients. 4
Establishing an Amputee Peer Support Visiting Service - Training Manual for NSW Health Services
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The role of the volunteer visitor
Australia is a multicultural society, with many different peoples, races, cultures, beliefs and lifestyles. The volunteer role is to support the client, and to do this well, one cannot be judgmental. This means that one often needs to learn more about, and be sensitive to, lifestyles and family
structures, which differ from one’s own.
Exercise:
What’s the difference?
Discrimination:
Direct and Indirect
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Discussion questions
When does difference become discrimination?
What does discrimination mean?
Discuss this definition and ask for examples from participants. Bring out the element of unfairness
that each example shows.
Highlight the point that we can inadvertently discriminate against another by applying the same
conditions to him/her as to everyone else – this can sometimes unfairly disadvantage a person. This is indirect discrimination.
How might a Peer Support Visitor indirectly discriminate against a client without even realising it?
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When the family is there
While the family plays a significant part in the rehabilitation of the amputee, it is important to let the
amputee take charge of his/her own needs regarding life without a limb.
The Peer Support Visitor should at all times answer questions honestly and keep referring back to
the patient regarding any issues he/she would like addressed.
If the Peer Support Visitor feels the family is beginning to take over the visit, then in the nicest
possible way, remind them that while they have concerns regarding their loved one it is important for
the patient to talk and ask questions.
Maybe the family could provide a list of questions and issues, which they could then discuss at a
subsequent visit or perhaps through telephone contact later at a mutually convenient time.
Module 5 - Role of the Peer Support Visitor Part 2
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Reactions – yours and theirs
The Macquarie Dictionary defines reaction as an action in response to some influence or event, or
an action caused by the resistance to another action.
These reactions can be of a positive or negative nature. It is important to recognise that any reaction
may not be of a personal nature but the amputee may be responding to the circumstances that
they find themselves in. Alternatively the Peer Support Visitor needs to be aware of his/her own
responses and the effect that they may have on the client.
Many Peer Support Visitors have found that the experience has been quite positive. Many clients
acknowledge that seeing the Peer Support Visitor walk through the door instilled hope that they too
will live a normal life.
Exercise:
Dealing with difficult issues
This exercise will help the participants to understand that the reactions may be of a non-personal
nature and give them some strategies to deal with adverse reactions.
Dealing with difficult issues
Exercise:
How would you react?
If we respond appropriately to difficult emotions that may arise from the client due to grief, such as
anger, guilt or hopelessness, we can help to bring the emotions to a level at which the issue can be
dealt with more constructively.
This approach has been developed by the Conflict Resolution Network.
Explain the framework:
Try the following if a difficult situation arises. Listen and say nothing for the moment. Give the other
person room to discharge emotions. Respect the other person’s communication of feelings.
Check your own reactions and how you may be feeling.
Ask yourself what you are picking up from the communication. Separate feelings from content.
Strain out what is valid and let at least some abuse pass you by
Reflect both feelings and content
“Let me check with you if….”
Is what you are saying…….”
What are the other person’s needs and concerns? Explore what is behind the words being used.
Ask questions to shift the focus from anger to exploring the issues.
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Establishing an Amputee Peer Support Visiting Service - Training Manual for NSW Health Services
Handout:
Handling difficult emotions in others.
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How to be sensitive to sadness and depression
It is natural to be sad after the loss of a limb. A Peer Support Visitor is there to support the new
amputee. It is important to offer a comforting visit, but your role is not as a counsellor so seek help if
you think you are not able to deal with some issues raised.
At times there may be physical symptoms that come from the deep sadness or depression:
• persistent sadness, anxiety or empty moods
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feelings of hopelessness or pessimism
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loss of pleasure
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problems with sleep
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eating disturbances
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fatigue
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irritability
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difficulty concentrating, remembering or making decisions
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inappropriate feelings of guilt
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thoughts of death or suicide.
The Peer Support Visitor may be sensitive to these feelings and possibly have experienced some of
the physical symptoms. Allowing the person to express their thoughts and feelings may assist them
to accept these feelings.
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When to refer
If at any time the Peer Support Visitor does not feel qualified to discuss a topic, they can offer to
ask a professional counsellor to visit. “I think I understand what you are saying, but I am not the
right person to help you. Would you like me to ask for some help to arrange a visit by a trained
counsellor? or May I tell your nurse that you are worried?”
Module 5 - Role of the Peer Support Visitor Part 2
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Activities
Spot the difference
Handout:
Differences activity sheet
(complete by listing what makes us different)
Ask the participants to think of ways in which people are different and to complete the blank sheet. Ask them to think of families, friends, neighbours, magazines, TV stories. They might like to work in
pairs, groups or individually.
There are 28 spaces on the sheet for differences. How many spaces can they fill? Allow time for
them to fill in. How many have they reached? Ten or more?
Differences activity sheet – Full
Explain that these are some areas of ‘difference’.
What’s the difference?
Imagine your client is from one of the following cultures. How might their outlook on the loss
of a limb differ from yours? Participants might like to work in small groups or pairs to research
this for day two of the course, or you might provide relevant pamphlets/information /materials/
resources - including the experiences of participants - to complete the activity, in class, on Day One. Participants should be encouraged to share their findings with the whole group.
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Indigenous
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Vietnamese
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Buddhist
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Hindu
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Greek
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Italian
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American
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English
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Chinese
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Any others…(particularly those of relevance to a specific region, local area or suburb).
Establishing an Amputee Peer Support Visiting Service - Training Manual for NSW Health Services
Dealing with difficult issues
Exercise sheet:
Dealing with difficult issues
Using your skills, express these statements as a client might. Discuss with participants the possible
reasons for these statements and some appropriate responses.
How would you react?
Pose the following questions to the group. If appropriate, you might ask participants to complete
the exercise individually, then to share their responses/reaction with the whole group. Ensure key
learning points are drawn out during the discussion.
If these situations arose during a visit to a client, how would you react?
1. A client, who has previously requested a second visit, reacts angrily when you arrive
and suggests that you should “get a life” of your own instead of “meddling” in the lives of
others. Would you:
Get angry in return?
Feel awful?
Feel embarrassed and worried that this is how you appear to others?
Think the client might be right?
Recognise the pain and fear behind the anger and try not to take it personally?
2. You are visiting a client while some of his/her family members are present. The client’s
brother-in-law is abrupt and distant with you. Would you:
Wonder what you’ve said or done to upset him?
Avoid him when you can?
Ignore him?
Assume that this is his way of coping and has little to do with you personally?
Speak with him to see if there’s anything you can do to improve the situation?
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Appendix A: PowerPoint slides, handouts and exercise sheets
Module 5 - Role of the Peer Support Visitor Part 2
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Differences
Age
Gender
Shape
Health
Experiences
Education
Culture
Legal Status
Colour
Intelligence
Religion
Values
Race
Height
Ethnicity
Language
Appearance
Employment
Politics
Disability
Social Group
Home Suburb
Economic Status
Sexual
Orientation
Support Base
Personality
Mental Health
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Establishing an Amputee Peer Support Visiting Service - Training Manual for NSW Health Services
Differences activity sheet
Module 5 - Role of the Peer Support Visitor Part 2
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Discrimination
Treating someone unfairly because they belong to a particular group.
Judging the person on the basis of pre-conceptions about the group to
which he/she belongs, rather than on what he/she is like personally.
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Establishing an Amputee Peer Support Visiting Service - Training Manual for NSW Health Services
Direct discrimination
means treating a person less favourably than another would be treated, in similar circumstances.
E.g. To refuse to accept someone’s enrolment in a training
program because of a disability.
Indirect discrimination:
exists where there is a condition or requirement imposed which may be the same for everyone but excludes or disadvantages an individual.
E.g. Insisting that everyone completes a test in the same time
frame, even though one student has dyslexia.
Module 5 - Role of the Peer Support Visitor Part 2
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Exercise
Dealing with difficult issues
Express the questions or statements as a client might. Discuss with participants the possible
reasons for these statements and some appropriate responses.
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Possible reason
Questions
(these may be covered by the
facilitator to generate discussion)
Why is God punishing me?
Fault or blame
I don’t feel like talking today
Withdrawal – hiding
My family will be relieved when I die
Pity – guilt trips
I just want to die
Escape – depression
Please stay a little longer
Isolation, loneliness, fear
I’m so helpless,
I can’t do anything any more
Anger, fear, helplessness
I’m too tired to keep trying
Apathy, resignation
I want my life back like it used to be
Anger, progress, if only
My husband/wife won’t
touch me any more
Sexual fears, abandonment
You know, I find you very attractive
Transference, bravado, I’m okay
Establishing an Amputee Peer Support Visiting Service - Training Manual for NSW Health Services
Handout:
Handling difficult emotions in others
Will you react or respond?
If we respond appropriately to difficult emotions that may arise from the client due to grief, such as
anger, guilt, or hopelessness, we can help to bring the emotions to a level at which the issue can be
dealt with more constructively.
Try the following:
Receive
Listen and say nothing for the moment.
Give the other person room to discharge emotions. Respect the
other person’s communication of feelings.
Notice
Observe your own reactions.
Centre
Tune into your self. Breathe deeply.
Listen again
Ask yourself what you are picking up from the communication.
Separate feelings from content. Strain out what is valid and let at
least some anger pass you by.
Reflect back
Reflect both feelings and content
“Let me check with you if….”
Is what you are saying…….”
Clarify and explore
What are the other person’s needs and concerns? Explore what is
behind the words being used. Ask questions to shift the focus from
anger to exploring the issues.
Repeat the cycle
Ensure that both feelings and facts are mutually understood.
Move
Acknowledge needs and concerns.
Consider the next step e.g. develop options, take time out.
Acknowledgment: Conflict Resolution Network
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