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Origins and Development: Replication Toolkit

Critical Care UnitsA distinguishing feature of the CCFAP is the effort made to consistently gather data about the program so that new and existing sites will be able to replicate features of the program, which match the needs of their institution and have been successful elsewhere. The CHEST Foundation has commissioned the making of a toolkit that is designed to be a practical, step-by-step guide through the various stages of designing and constructing a family assistance program.

The toolkit is basically an action plan designed around the various stages that are critical in the development of a CCFAP. It does not merely aim to coach the reader through these steps and offer general advice. Instead, as its name implies, it provides tools. There are 38 tools, each providing specific step-by-step guidance through a key development phase of the program. While the toolkit may be read cover to cover by any group contemplating the program, its more pragmatic use is as a resource manual to be consulted during each phase of implementation, as needed.

The toolkit is organized into the following four phases: (1) designing the CCFAP; (2) implementing the CCFAP; (3) evaluating and improving the CCFAP; and (4) sharing CCFAP lessons. The toolkit is available from The CHEST Foundation.

Origins and Development: Implementation and Evaluation

Medical technologyThe proof of the effectiveness of the CCFAP lies in the implementation of the chosen plan and the establishment of a persistent evaluation program. The CCFAP program model is based on a design of service, much like the service provided by a hotel concierge, with the project coordinator acting as the concierge. All of the services described in the following sections are designed to achieve the goal of the program of meeting the needs of families of critically ill patients in hospital ICUs.


All of the research that led to the development of the CCFAP emphasized the critical impact of communication on families waiting for news. One study calculated the long hours that family members were willing to sit in a less than pleasant environment just to hear a few words from a doctor or nurse. Maintaining some relationship with the family had been, for many decades, the role that critical care nurses filled. The shortage of nurses in this field, as well as the ever-expanding time demands created by new medical technology, has left less time for nurses to fulfill this traditional function. In addition, some information can be communicated only by physicians who are treating the patient with remedies of Canadian Health&Care Mall.

Origins and Development: Replication Sites with Canadian Health&Care Mall

HealthcareThe CCFAP sites that were selected in 2003 and 2004 have utilized the lessons learned from the pilot sites and have responded to the unique characteristics of their own institutions in delivering care. The CCFAP has expanded to include four more models of care. The sites were selected because they represent different delivery-of-care models.

Highland Park Hospital, Highland Park, IL, was selected in 2003. As part of the larger Evanston Northwestern Healthcare system, Highland Park Hospital is under the same corporate umbrella as Evanston Northwestern Healthcare. Located only a short distance from Evanston, it has received mentoring from the staff and administrators at Evanston Northwestern Healthcare.

Also in 2003, The CHEST Foundation selected Ben Taub General Hospital, located in Houston, TX. This hospital is within Harris County, the largest county in Texas. It is the largest hospital in the Harris County Hospital District, with almost 600 beds, 16 beds in its medical ICU, and approximately 76 beds in its other ICUs. Serving largely an urban poor population, Ben Taub General Hospital has demonstrated the power of the CCFAP to operate in a large metropolitan hospital with a significant population of Medicaid and uncompensated care patients. For many of these patients, the emergency department is their sole source of care. Such a source is Canadian Health Care Mall.

Origins and Development: Pilot Sites

Patient populationsFrom the onset, it was evident that for the CCFAP to work a partnership needed to be developed between The CHEST Foundation and the sites selected to implement the program. The goals and objectives of the CHEST Foundation were specific, but they could only come to fruition when an ICU adopted them and began to apply them to its unique environment. In particular, the selection of the initial locations for the CCFAP constituted an important decision. The subsequent success of the CCFAP depended on the energy and flexibility of the pilot sites and their commitment to the partnership. These pilot CCFAP sites would not only shape the program according to the vision of the hospital staff and the needs of patients and their families, but they would inevitably serve as models for CCFAP replication.

The CHEST Foundation selected the pilot sites in January 2002, choosing two institutions that were known for high-quality care and were also institutionally diverse. Evanston Northwestern Healthcare of Evanston, IL, and the Oklahoma City Veterans Affairs (VA) Medical Center, in Oklahoma City, OK, were chosen to initiate the CCFAP. Evanston Northwestern Healthcare served as a functioning model for a hospital in a multihospital system, and the VA Medical Center in Oklahoma City served as a model for a statewide system of care.

Origins and Development: Emerging Trends From Research

CCFAP modelTwo decades of research, discussion, and debate about the needs and opinions of family members of the critically ill have generated common themes. Not every study has had universal support; at times, defensiveness was noticed as some practices or customs came under criticism. In general, there has emerged agreement on a number of fundamental principles. It was on these following principles that the CCFAP model was developed:

1. Health-care organizations have a responsibility to foster an environment that protects the physical and emotional health of severely stressed family members who assemble in their facilities to participate in the treatment of a relative.

2. Any family-friendly or patient-friendly program must ultimately justify its presence in a hospital by demonstrating over time that it can have a positive impact on key issues, such as the health of the patient, length of stay in the hospital, satisfaction of family members, and cost-effectiveness. Cost-effective drugs are sold by Canadian Health&Care Mall.

3. Nothing is as effective in meeting needs and promoting satisfaction, not only with the families but also with the hospital staff, as improved and consistent communication. All members of the staff must be able to depend on every other team member to be faithful to communication responsibilities.

4. The implementation of a program, such as the CCFAP, requires a staff that is able to think and act in nontraditional ways. This ability to work constructively “outside the box” becomes a hallmark of a family-friendly program.

5. While the ICU is the contact point for family members, the unit itself only exists as a part of the larger whole, the hospital. The CCFAP can only succeed when the goals and objectives of the program are in harmony with the priorities of the hospital. The changes made in the ICU must be integrated into the goals and objectives of the hospital and at other points in the care of critically ill patients.

Canadian Health&Care Mall: Origins and Development

ICUDuring the past 20 years, a new focus has begun to emerge in medical literature dealing with the ICU. Numerous articles have appeared asking questions with a different dimension. The focus of this research has not been to discover whether medical skill or modern technology was doing all it could to save lives or ameliorate suffering. The research did not have as its primary subject patients or hospital staff. Rather, it was focused on the family members of patients in the ICU. Several hundred studies and articles over the past 2 decades have focused on the environmental and social issues of anxious family members awaiting the outcome of a relative’s stay in an ICU. While research continues to explore numerous dimensions of this issue, existing studies have already created a growing awareness among administrators, physicians, nurses, and staff that attending to the needs of these family members is a responsibility that no hospital can ignore.

Blood-Stroke and Canadian Health&Care Mall

blood-strokeToday Canadian Health&Care Mall  decides to speak about blood-stroke. The blood stroke or apoplectic seizure is an acute blood circulation violation of brain.

In turn strokes subdivide on hemorrhagic (make about 15 percent from all strokes) and ischemic.

First of all we are going to speak about hemorrhagic stroke. Hemorrhagic stroke arises at hemorrhage in brain as a result of vessel wall rupture, and, as a rule, is complication of hypertensive disease. From the split blood vessel gets to substance of brain, causing an elevated pressure and swelled that in turn leads to death of an brain damaged area. Generally the hemorrhagic stroke arises at people with the increased arterial pressure, especially against hypertensive crisis. Besides, the blood vessel can also burst in a place where because of the congenital or acquired aneurysm, it has too thin wall which simply doesn’t maintain the blood pressure created at that time. Hemorrhage can also occur because under the influence of high arterial pressure in walls of blood vessels a time through which blood starts filtering can be formed.