Transforming Care at the Bedside (TCAB): Enhancing Direct Care and Value-added Care

dearmon v., roussel l., buckner e.b., mulekar m., pomrenke b., salas s., mosley a., brown s. & Brown A. (2013) Journal of Nursing Management  21 , 668–678 Transforming Care at the Bedside: enhancing direct care and value-added care Aim The purpose of this study was to examine the effectiveness of a Transforming Care at the Bedside initiative from a unit perspective. Background Improving patient outcomes and nurses’ work environments are the goals of Transforming Care at the Bedside. Transforming Care at the Bedside creates programs of change originating at the point of care and directly promoting engagement of nurses to transform work processes and quality of care on medical–surgical units. Methods This descriptive comparative study draws on multiple data sources from two nursing units: a Transforming Care at the Bedside unit where staff tested, adopted and implemented improvement ideas, and a control unit where staff continued traditional practices. Change theory provided the framework for the study. Results Direct care and value-added care increased on Transforming Care at the Bedside unit compared with the control unit. Transforming Care at the Bedside unit decreased in incidental overtime. Nurses reported that the process challenged old ways of thinking and increased nursing innovations. Hourly rounding, bedside reporting and the use of pain boards were seen as positive innovations. Conclusions Evidence supported the value-added dimension of the Transforming Care at the Bedside process at the unit level. Implications for nursing management Nurses recognized the significance of their input into processes of change. Transformational leadership and frontline projects provide a vehicle for innovation through application of human capital.