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


Valorie Dearmon
USA College of Nursing
5721 USA Dr N RM 4068
AL 36688-0002


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.