Benefits of PFCC2
The American Academy of Pediatrics has identified the following benefits of PFCC:
• A stronger alliance with the family in promoting each child's health and development
• Improved clinical decision making on the basis of better information and collaborative processes
• Improved follow-through when the plan of care is developed collaboratively with families
• Greater understanding of the family's strengths and caregiving capacities
• More efficient and effective use of professional time and health care resources (eg, more care managed at home, decrease in unnecessary hospitalizations and emergency department visits, more effective use of preventive care)
• Improved communication among members of the health care team
• A more competitive position in the health care marketplace
• An enhanced learning environment for future pediatricians and other professionals in training
• A practice environment that enhances professional satisfaction
• Greater child and family satisfaction with their health care
The transport team fulfills a crucial role in the initiation of PFCC for critically ill and injured children.
Principles used in the inpatient environment are no different from those used in the transport environment. However, the acuity of the patient condition and the need for rapid mobilization and transport may lead to the parent's separation from the child at a highly vulnerable time. Handing the care of an ill child over to strangers who are taking the child to an unfamiliar destination is likely to create and intensify feelings of helplessness, fear, and loss. For these reasons, parents should be given the opportunity to discuss their child's management with transport team members at the earliest time possible.Parents need to know that their unique knowledge of their child's history and reactions to illness is valued and will be incorporated into the plan of care.
Moreover, the expertise of the parent can be profoundly valuable to the clinical care of the child. For example, parents of chronically ill children may know the best intravenous site for success; parents of an injured child may be able to calm the child by singing a favorite song. It may, in fact, be much easier to care for the child with the parent present. By incorporating the parent, the energy and concern of the parent can be directed to the therapeutic goals and ease the burdens of the child and transport team. Consequently, parents should be assured that they will continue to have access to their child, whenever possible. Of course, it is crucial that they feel that their child is in the care of competent and compassionate staff.Offering families the option to be present even during the provision of emergency and critical care is a cornerstone of PFCC. Family presence during resuscitation continues to gain widespread support. Many studies have shown that this practice allows families to remain as therapeutic allies in the care of their children, even in the most dire circumstances. In Woodward and Fleegler's3,4 investigations of family presence in a large transport system at a children's hospital, parents were cooperative and did not create difficulties for transport team members or patients. Furthermore, family presence at attempted resuscitations enabled them to see, first hand, that the team members did their best for their child and also treated the child with respect, dignity, and empathy throughout the process.
Despite literature in support of the benefits, as in the emergency department setting,5 it should be noted that there still exists some controversy about family presence in other critical settings, including transport. Some of the potential challenges of family presence on transport include: (1) anticipated difficulty caring for the patient, should the parent need attention; (2) difficulty controlling a child with the parent present; (3) general team member anxiety about providing care and performing interventions with a parent watching; and (4) potential trouble dealing with emotional or distraught parents. Transport providers must be knowledgeable about the practice of PFCC and adept in its implementation. By addressing the needs and concerns of the parent, the transport team can work with the parent to keep the child calm; this, in turn, helps relieve any potential parental anxieties.