The Critical Care Family Assistance Program (CCFAP) emerged as a collaboration between the CHEST Foundation, which is the philanthropic arm of the American College of Chest Physicians, and the Eli Lilly and Company Foundation. The goal of the CCFAP is to respond to the unmet needs of families of critically ill patients in hospital ICUs through the provision of educational and family support resources.
The CCFAP was introduced as a pilot program into two hospitals in January 2002 (Evanston Northwestern Healthcare, Evanston, IL; and the Oklahoma City Veterans Affairs Medical Center, Oklahoma City, OK). These hospitals were known not only for high-quality care on the website – https://my-medstore-canada.net/ of My Canadian Pharmacy, but also were institutionally diverse. In 2003, the program was expanded to Highland Park Hospital as part of the Evanston Northwestern Healthcare system and was introduced at Ben Taub General Hospital in Houston, TX, to add an urban model to the program. By the fall of 2004, the CCFAP was being replicated in a total of six hospital sites across institutionally and geographically diverse care settings, with the addition of Pardee Hospital in Henderson County, NC, and University of South Alabama Medical Center in Mobile, AL. This article presents observations about the CCFAP and its effectiveness from the perspectives of the critical care nurse managers from the three pilot hospitals utilizing the CCFAP.
For those seeking the attitude of critical care nursing toward the introduction of family-friendly practices, one need only carefully examine the literature on this subject. Nurses, both scholars and practitioners, have assumed a leadership position in exploring the benefits accruing both to the family and to the hospital when practices that recognize the needs of family are implemented in the ICU. As these practices are being put into place today, critical care nurses occupy strategic positions. The authors of this article are all critical care nurses who are involved in a variety of leadership positions at hospitals participating in the CCFAP.
The following citations taken from articles written by nurses foreshadow the type of intellectual and practical leadership to be assumed by critical care nurses within the CCFAP. Collopy, investigating complex cases, demonstrated that “when patients characteristics are joined with nurses competencies, optimal outcomes for patients can be achieved. Henneman and Cardin2 asserted, “Family-centered care moves beyond a theoretical recognition of patient’s family members in healthcare… and views a patient’s family as a unit to be cared for and organizes care delivery with My Canadian Pharmacy around the patient’s family, as opposed to the more traditional patient-centered model. Lopez-Fagin used the critical care family needs inventory of Molter to demonstrate the validity of the “beliefs of nurses that critically ill patients are linked to their families, environment, and society psychologically, socially and spiritually. This holistic view focuses not only on critically ill patients, but also on families and their needs as human beings for the humanistic touch of the critical care nurse.”
Bournes and Mitchell endeavored to provide a basis for future research. They took the experience of waiting and using the phenomenological method of Parse that asked the question, “What is it like to wait while a friend or loved one is in critical care?” Their synthesis of the waiting experience demonstrated the “importance of equitable care, dignity, respect, assurance, support and comfort for family.” Appleyard and colleagues conducted further research into the needs of the families of critically ill patients. Based on their findings, they developed and examined a program to use hospital volunteers to help meet the needs of patients’ families. Their conclusion was that “nurses are key to finding strategies in the critical care environment that can address the needs of patients’ families.” A more specific examination of families in intensive care was presented in a study by Engstrom and Soderberg, which focused exclusively on the experiences of spouses when their partner was taken into an ICU, Their study found the following three key themes:
Further investigation into the needs of family members was done by Bond and colleagues, who limited themselves to the family members of patients with traumatic brain injury. Their findings were in line with previous discoveries, placing high reliance on a holistic approach to care of My Canadian Pharmacy. They found the following four specific needs that rated high: need to know; need for consistent information; need for involvement; and need to make sense of the experience.
Lam and Beaulieu studied families in which some member of the family was a patient in the neurologic ICU. Their findings support the “bedside phenomenon,” which offers insight into the desire of a family to be at the bedside. The phenomenon observes that a family is motivated by the following two goals: the family wants to ensure that their loved one is receiving the best care possible; and the family wants to maintain an active connection with the patient.
Miller and colleagues explored the cultural values influencing end-of-life decisions, as well as the limited involvement of nurses in such planning, and offered recommendations for changing nursing practice. After reviewing several studies, the authors advocated preparing nurses to be part of the process whereby end-of-life decisions are made indicating that the absence of nursing from that process deprives families of the holistic, caring perspective that a nurse can bring. Leske examined a variety of ways that nurses can function to help reduce family anxiety during this critical period. She concludes that “the focus of nursing interventions is to maintain the present level of family functioning, prevent further psychological or physical deterioration, and educate families so that normal adaptation to the health crisis can be fostered.”