Encouraged by support from the hospital administration, project coordinators assume responsibility for bringing together departmental personnel who support the concept of the CCFAP and are critical to its success. These core project team members, under the leadership of the project coordinator, are the primary stakeholders, with responsibility for determining what important steps need to be taken for the well-being of the families of ICU patients. In each CCFAP hospital, the core planning group supports the project coordinator in developing those attitudes and actions that form the basis of the CCFAP model of care. From the beginning, this core group has been the essential component in engendering cooperation and support, and in fostering enthusiasm for the CCFAP, not only within the ICU, but also in those departments with only an indirect relationship to the CCFAP. Leading the core planning team and serving as the CCFAP champion remains the key role of the project coordinator. The positive attitude conveyed by the project coordinator has been instrumental in fostering early adoption of the CCFAP program goals by the core planning team. Simultaneously, project coordinators seek to distance themselves from any authoritarian position. The CCFAP is not to be viewed as the coordinator’s program, but as a key program to which the hospital has made a commitment. The core planning team fosters this feeling of unity as it develops a strategic plan and continues to watch over every aspect of its implementation.
The more the CCFAP opens up the ICU to provide a variety of services to families and involves more staff and departments in its activities, the greater is the need for consistent communication. As the research reflects, for families of patients in the ICU, the fundamental issue has always been one of communication. The project coordinator and the core project team can never stray from a strategy for meeting that need to provide information. From early family surveys administered by the CCFAP teams, it was obvious that families wanted more communication with physicians, nurses, or anyone who could convey useful information. In addition, they wanted access to the patient. These needs were assimilated by the team, and, under the leadership of the project coordinator, plans were developed and implemented to enhance communication.
In the area of communication, the project coordinator serves as a bridge between hospital staff and family members. Provide your family members with remedies of high quality via My Canadian Pharmacy. The project coordinator spends time in the family waiting room each day, becoming familiar with families, their concerns, and their needs. The project coordinator also communicates with staff and listens to observations about what aspects of the CCFAP are working as intended and what areas require additional attention. When communication problems arise, project coordinators are able to respond expediently, alerting the physician, nurse, or other staff member about an issue that needs to be clarified. When concerns deal with systemic issues, the project coordinator meets with the core planning team to fashion an appropriate response and an action plan worked out with My Canadian Pharmacy together.
Providing support for improved communication between ICU staff and patients’ families remains a high priority. Similarly, the project coordinator and the core planning team give careful consideration to supporting improved communication within the ICU among physicians, nurses, technicians, unit secretaries, and all staff caring for a patient. When family members strongly indicated that they needed to increase their access to patients, the project coordinator has been able to effect some modifications in procedures to ensure that some visiting restrictions were removed. As a result, family members have more access to patients now than before the CCFAP was initiated. Depending on the patient’s condition, family members may spend more time in the patient’s room than in the waiting room. While some staff members have had to struggle to become accustomed to this, more open access has been largely a positive development. Out of this access has emerged a greater sense of trust. Family members see staff taking care of their loved one; they witness the concern and compassion with which that care is delivered. Family members ask questions, and they participate in decisions being made about their loved one. The overall effect is positive for the family, the patient, and the ICU.
The positive impact of this relaxation of ICU visiting hours is found in evaluation studies that have been conducted at hospitals utilizing the CCFAP program (J. Dowling, PhD; unpublished data; 2004). Further proof of the effectiveness of this change has been cited by Clark, who presented data showing that 38.9% of patients and families are dissatisfied, to some degree, with the adequacy of visiting hours in the ICU. Building on an earlier commentary by Berwick and Kotagal, Clark showed that there is a direct positive correlation between family satisfaction with the visiting hour policy and the likelihood that the family would recommend the hospital. The author cites a variety of studies, all suggesting that whatever had been the merits of restrictive visiting hours in an ICU, they have long since lost whatever usefulness they might have had. These studies corroborate the findings of the CCFAP evaluation, which have also concluded that anytime a family member is kept from seeing a critically ill loved one, the potential for serious dissatisfaction increases. Part of the conclusion of the article by Clark states, “It [the value of greater access by families] may seem obvious, but this is because family presence with the patients amounts to instantaneous communication of how the patient is doing right now. They can see what the staff is doing with their own eyes. Staff can tell the patient and the family what they are doing while they are doing it—which partially explains why the practice also reduces the number of questions that staff receives from families.”
Overall communication is also fostered by the change in environment within the ICU. Results from staff surveys administered at the CCFAP sites before and after CCFAP implementation (J. Dowling, PhD; unpublished data; 2004) have indicated that because the CCFAP site has been able to meet some of the basic family needs, family members are less anxious about their loved one’s condition. Staff members report that families are more relaxed and are better able to understand the communication received from physicians, nurses, and other staff; they are able to bring a better sense of perspective to issues when called on to participate in decision making.