Transforming Care at the Bedside

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Transforming Care at the Bedside:
Adhering to the Ethical Principles of Patient Autonomy, Beneficence, and Nonmaleficence The Nursing Role

Abstract
This paper explores several published articles following the national program, Transforming care at the Bedside (TCAB), developed by the Robert Wood Johnson Foundation (RWJF) and the Institute for Healthcare Improvement (IHI); and how it supports the ethical principles of patient autonomy, beneficence, and nonmaleficence in patients, especially amongst the geriatric population. By describing and focusing on three main points of the TCAB, safe and reliable care, patient-centered care, and value-added care and their relative goals and high leverages; this will show how they benefit the nurse’s care at the bedside as well as improving involvement from the patients. This paper examines the use of the TCAB model with several sources supporting the information presented.

Transforming Care at the Bedside:
Adhering to the Ethical Principles of Patient Autonomy, Beneficence, and Nonmaleficence The Nursing Role

As nurses, making decisions on an everyday basis requires the use of ethical principles. Adhering to the American Nurses Association (ANA) code of ethics is a part of our professional duty. It is for this reason, a nurse led initiative, Transforming Care at the Bedside (TCAB) came about to develop and improve patient care. The TCAB was developed by the Robert Wood Johnson Foundation (RWJF) and the Institute for Healthcare Improvement (IHI), to improve care and the experiences on medical surgical units for patients and their family members; as well as improving teamwork, nursing retention and satisfaction (Lavizzo-Mourey & Berwick, 2009). The philosophy of TCAB involves all healthcare team leaders, but gives the power to bedside nurses to develop ideas and solutions for change to benefit the patient in accordance to the ANA code of ethics by addressing the patient’s autonomy, beneficence, and nonmaleficence. The TCAB model promotes the ANA code of ethics Provision 2, “the nurse’s primary commitment is to the patient, whether an individual, family, group or community” and Provision 3 “the nurse promotes, advocates for, and strives to protect the health, safety, and rights of patient” (American Nurses Association, 2011) in all goals and high leverage changes presented. The four main ideas of TCAB, safe and reliable care, patient-centered care, value-added care, and vitality and teamwork, are all implemented to assist in redesigning patient care and work environments for medical surgical units (Lavizzo-Mourey & Berwick, 2009). All four ideas are important to the TCAB framework, but only the first three will be explored to show how TCAB is positively influencing patient autonomy, beneficence, and nonmaleficence with its framework of principles and processes, especially for the geriatric population.

In order to discuss the how the TCAB model effects the ethical principles of patient autonomy, beneficence, and nonmaleficence, one must know the definitions of these terms. Patient autonomy, as defined by the ANA (2011), is the patient’s right to make decisions freely and independently regarding their healthcare. In order to further assist patients in making these important decisions, nurses play a vital role in educating them about their concerns regarding their conditions, providing resources, and advocating for the patient when needed. The nurse’s role in patient autonomy is also intertwined with the ethical principles of beneficence and nonmaleficence. Beneficence is defined as the actions that promote the well being of others; nonmaleficence is referred to as the “do no harm” principle (American Nurses Association, 2011). Providing care for patients by promoting their safety, health and well being, is priority for nurses. Applying these ethical principles in every day care assists in providing quality care to all patients, but especially...
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