Dearmon Valorie, Roussel Linda, Buckner Ellen B, Mulekar Madhuri, Pomrenke Becky, Salas Sheri, Mosley Aimee, Brown Stephanie, Brown Ann
USA College of Nursing, Mobile, AL 36688-0002, USA.
J Nurs Manag. 2013 May;21(4):668-78. doi: 10.1111/j.1365-2834.2012.01412.x. Epub 2012 Aug 9.
The purpose of this study was to examine the effectiveness of a Transforming Care at the Bedside initiative from a unit perspective.
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.
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.
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.
Evidence supported the value-added dimension of the Transforming Care at the Bedside process at the unit level.
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.
本研究旨在从科室层面考察“床边护理变革”倡议的有效性。
改善患者预后和护士的工作环境是“床边护理变革”的目标。“床边护理变革”创建了起源于护理点的变革项目，直接促进护士参与变革，以转变内科-外科科室的工作流程和护理质量。
这项描述性比较研究利用了来自两个护理科室的多个数据源：一个是“床边护理变革”科室，该科室的工作人员测试、采用并实施改进想法；另一个是对照科室，该科室的工作人员继续采用传统做法。变革理论为该研究提供了框架。
与对照科室相比，“床边护理变革”科室的直接护理和增值护理有所增加。“床边护理变革”科室的非必要加班时间减少。护士们表示，这一过程挑战了旧有的思维方式，增加了护理创新。定时巡视、床边报告和疼痛看板的使用被视为积极的创新举措。
证据支持了科室层面“床边护理变革”过程的增值维度。
护士认识到他们对变革过程投入的重要性。变革型领导和一线项目为通过应用人力资本进行创新提供了一种途径。
