RESUMO
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.
Assuntos
Cuidados de Enfermagem/organização & administração , Avaliação de Processos e Resultados em Cuidados de Saúde , Assistência ao Paciente/normas , Telefone Celular/economia , Pesquisa em Enfermagem Clínica , Redução de Custos , Humanos , Modelos Organizacionais , Cuidados de Enfermagem/normas , Cultura Organizacional , Medição da Dor , Assistência ao Paciente/economia , Assistência ao Paciente/métodos , Satisfação do PacienteRESUMO
BACKGROUND: How do nurses commit to effecting change, the kind of change that will transform both care received and the caregiver? This was the mission of Transforming Care at the Bedside, the 2003 initiative sponsored by the Robert Wood Johnson Foundation and the Institute of Healthcare Improvement. OBSERVATIONS AND OBJECTIVES: This analysis reflects processes and context of unit change through Transforming Care at the Bedside. Organizational leadership includes engagement in change. SUBJECTS AND METHODS: Descriptions of change process were solicited from stakeholder interviews and focus groups to evaluate and make recommendations for the future. RESULTS AND CONCLUSIONS: Stakeholders recognized that "Change can be good!" Reflection and strategic evaluation strengthen planning for sustainability supporting staff engagement and transformational leadership in an academic health science setting.