Enhancing Nursing Care in Rural Public Hospital Network Through Utilizing Transforming Care at Bedside Framework

Sunday, 30 July 2017: 3:30 PM

Salah-Addin H. Aqtash, PhD
College of Health Sciences, School of Nursing, Walden University, Minneapolis, MN, USA


To discuss the experience of a Rural Public Hospitals Network (RPHN) in the United Arab Emirates (UAE) in successfully implementing the Transforming Care at the Bedside (TCAB) framework and the impact of this implementation on improving patient outcomes.


Transforming Care at the Bedside was established as an innovative approach by the Robert Wood Johnson Foundation (RWJF) in collaboration with the Institute for Healthcare Improvement (IHI) to improve the delivery of care as well as work environment in hospitals through empowering front-line nursing staff. The program utilized bottom up approach by allowing front line nurses to develop and implement ideas of change compared to the traditional top down approaches. The TCAB framework has four essential domains including safe and reliable care, vitality and teamwork, patient centered care and value added care process.


One of the most important challenges that faced the senior leadership of the RPHN in the UAE was dealing with the growing and continuing expectations of patients and their families. Consequently, a core responsibility for the nursing leadership in this network was to constantly explore innovative ways and means to ensure the delivery of nursing care that meet or exceed the expectations of patients. Given the popularity the TCAB gained in improving nursing care in many hospitals, the nursing leadership in this RPHN made an executive decision to utilize this framework to guide a quality improvement project focusing on improving the provided care. The leadership has established a TCAB taskforce team chaired by a nurse manager with significant quality experience to work on the implementation and provided the team with all needed resources to help them succeed. After surveying frontline staff and conducting the introductory sessions in the targeted units, the team identified issues related to two domains in the TCAB framework including patient centered care and vitality and team work. The team then initiated the necessary corrective measures through utilizing the PDCA cycle.


The implementation of this innovative framework helped the nursing leadership in identifying some of the gaps in the provided care and consequently developing the necessary action plans to amend them. As a result of the action plans, significant changes have been noted in patients’ feedback. We conclude that the RPHN nursing executive team was successful in utilizing this framework in empowering front line nurses to improve the quality and safety of care as well as improve patients’ positive outcomes.