AJN, American Journal of Nursing:
Laurie Lewis is a freelance medical writer in New York City.
The TCAB approach is visible to and appreciated by patients.
Vernon and Leah Henderson were volunteers at Cedars-Sinai Medical Center in Los Angeles when the Transforming Care at the Bedside (TCAB) initiative began on the very unit where they served. They became involved in TCAB at the hospital from the beginning.
Figure. Vernon and L...Image Tools
Much of their work with TCAB involved conducting prechange and postchange surveys. For the prechange surveys, they would go to patients' rooms and talk to them about the possibility of the change. Later, they would do postchange surveys to get patients' feedback. Patients and families on the TCAB unit said they appreciated being asked for their opinions.
One of the many TCAB changes tested on the unit was the creation of a discharge lounge where patients could wait for their families. This idea came about because families often arrived later than anticipated to take a patient home, so her or his room would not be available for a new patient. In prechange surveys, most patients gave positive feedback when they realized that another patient would be able to have a room sooner. Interestingly, once the discharge lounge came to fruition, family members started arriving on time to take patients home. Although created to solve a bed availability problem, the discharge lounge turned out to be an impetus for the family to arrive on time to pick up the discharged patient.
Before he and Leah became volunteers, Vernon had been a patient at Cedars-Sinai for six weeks. During this time, Leah had one major frustration. "The team would come in every day and discuss his status and test results. I would be sitting [next to Vernon], but it was as if I was invisible," she recalled. A TCAB innovation changed that for other patients and families. Now interdisciplinary teams, which include the off-going and the on-coming nurses as well as physicians, meet each morning in the patient's room to discuss events that happened during the night. The patient and family participate in the conversation. In the Hendersons' opinion, the improved communication among caregivers, patients, and family members is one of the greatest benefits of TCAB. "This has lowered the stress level for the patient and the family. I've noticed a more relaxed atmosphere on the unit," Leah said.
After six years as volunteers, the Hendersons moved to Oregon. But while they were in Los Angeles, Vernon was the patient representative on Cedars-Sinai's TCAB committee. He also was the patient representative on the TCAB National Advisory Committee. From these perspectives, he has a good understanding of the value of TCAB. As he explained, "TCAB almost entirely involves nurses and support staff at the working level. The impetus comes from the bottom up; it isn't mandated and imposed from the top. It basically is the nursing staff saying, 'If we can make changes and they prove to be effective, it will be better for us as well as for the patients.' With the TCAB process, nurses are able to make rapid changes and test them. The attitude of the staff has become even better than it was, and it already was great. The nurses feel empowered. It's a win–win situation for everyone."
© 2009 Lippincott Williams & Wilkins, Inc.