Cpl Ronny Porta, USMC, was wounded by an IED while on duty in Al Asad, Iraq. Cpl Porta suffered extensive injuries, including loss of his right ear, right arm, left thumb and tips of several fingers, severe damage to his right eye, and third degree burns over 40 percent of his body. In 2008, Cpl Porta purchased a home near the Brooke Army Medical Center in San Antonio, Texas, where he has been a patient for almost two years. In February 2009, he entered a new phase of care when he reported to UCLA Medical Center for facial reconstruction, part of a pro-bono effort called “Operation Mend.” He also has been fitted for a new prosthetic right arm and continues his rehabilitative therapy. On a recent visit to Cpl Porta’s home, NMCRS CCA VNs Theresa Goodwin and Sue Waddingham delivered a new voice-activated laptop that VN Rochelle Soto helped obtain through Soldier’s Angels, a California-based nonprofit, and Theresa recently submitted a recommendation for a service dog to Texas Hearing and Service Dogs, Inc. Cpl Porta and his family continued to be followed by Society CCA Nurses who work with the entire Porta family to answer their questions about Ronny’s ongoing care, provide emotional support, and act as liaisons between the military health care team, community resources, and the family.

Combat Casualty Assistance (CCA) Visiting Nurse Program

• Our program provides ongoing, face-to-face follow-up by Registered Nurses, to Marine Corps and Navy personnel and their families affected by the service member’s war-time service in Iraq, Afghanistan, and the Arabian Gulf.

• We receive referrals from various military and civilian agencies, including the Wounded Warrior Regiment, Marine Liaison, Navy Safe Harbor, DoD Nurse Case Managers, Social Workers at MTF’s and the VA, caseworkers within the Navy-Marine Corps Relief Society, and counselors at Military One Source.

• Our focus is on reinforcing prior instruction provided by other healthcare providers, assessment of needs for the entire family, teaching coping skills related to new areas of concern, and identifying and initiating referrals to appropriate resources as problems or questions arise.

• We provide long term face-to-face follow up, anywhere in the country, regardless of discharge status, until the SM or family no longer feels there is a need for our services.

• We have seen repeatedly that face-to-face contact is essential to learning about the family’s problems and to establishing a trusting relationship that enables the family to speak openly about their concerns.

• We currently have contact with over 750 service members and families, and made over 9,000 visits in 2009.

• We have 11 Visiting Nurses dedicated to making CCA visits all over the country, and 36 other Visiting Nurses who make visits to CCA patients that are in the nurses’ immediate area.

• Our goal for 2010 is to increase the amount of travel to service members and families in order to continue to provide face-to-face contact as they transition from the military to civilian life so that we can help them adjust to their “new normal.”

The Role of the Visiting Nurse

While the patient is in a hospital or rehabilitation setting, the Visiting Nurse will meet with family and/or patient to:

• Identify problems/lack of clarity and refer them to the appropriate department/agency.
Assess and assist in the family member’s understanding of the SM’s injuries, diagnosis, and recovery/rehabilitation process.

• Provide emotional support, opportunity to express concerns, questions, etc.
Help family members identify issues and focus their thinking so that they can have successful discussions with appropriate individuals (issues may be related to the injured service member or may involve family at bedside or family back home).

• Provide unofficial (non-military) person who will listen to whatever they want to say (anger is a part of the grieving process but they are often reluctant to show it with a military representative).

• Reinforce information provided by the medical staff and case managers and provide feedback to the medical staff working with the patient.

• Remind family members that they must take care of their health issues in order to be an effective support system for the service member.

• Once the patient is in an Outpatient Status, the Visiting Nurse will continue to work with the patient and family in order to:

• Assess the patient’s and family member’s understanding of treatments, medications, restrictions, and follow up needed, and promote methods for complying with the recommendations.

• Reinforce information provided by the medical staff and case managers working with the patient and provide feedback to those involved with the patient.

• Help family identify unmet needs and possible resources for meeting those needs (may be related to injured service member or to other family members).

• Offer family the opportunity to voice concerns about care and help them identify the best source for resolution of concerns.

• Provide an ongoing and easily accessible point of contact when problems or questions arise, and assist patient/family in contacting the appropriate department/agency for assistance.

• Remain an advocate for the patient and family as they adjust to the changes in their lives as a result of the injuries sustained by the service member.

• Provide long-term follow up to patient and or family, working with them to accomplish their goals for the future regardless of military status.

This page created 28 February 2010

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