Page 127 - Encyclopedia of Nursing Research

94 n CoST AnALYSIS oF nURSInG CARE

(Doering, Cross, vredevoe, Martinez-Maza, &
Cowan, 2007). Cost analysis oF
C Several studies have explored the effect nursing Care
of relaxation techniques for CABG patients
post surgery. Investigators found improve-
ment in emotional well-being, state and Cost analysis of nursing care reflects a body
trait anxiety, daily activities, several social of administrative studies that focus on quan-
parameters, and QoL (Dehdari, Heidarnia, tifying nursing costs needed to deliver care to
Ramezankhani, Sadeghian, & Ghofranipour, individual clients or aggregates in a variety
2009; Trzcieniecka-Green & Steptoe, 1996). of settings, using a variety of practice models
Data are also accumulating about the and analysis tools. All cost analysis is based
efficacy of selective serotonin reuptake inhib- on assumptions that must be examined and
itors (SSRI) on the treatment of depression in made explicit when reporting findings.
patients with cardiovascular disease. In one Much of the research on cost analysis of
study (Xiong et al., 2006), SSRI use before nursing care has focused on “costing out”
CABG was associated with a higher risk of nursing services for the purpose of measur-
postoperative rehospitalization and long- ing productivity, comparing costs of various
term mortality. Investigators noted that the nursing delivery models, charging individ-
explanation for the adverse effects could be ual patients for true nursing costs, and relat-
due to incompletely treated depression, SSRI ing nursing costs to other cost models, most
use, or another complex mechanism. Another notably diagnostic-related group categories.
study (Kim et al., 2009) found that the preop- The need and the motivation for these cost-
erative use of SSRIs did not increase the risk ing efforts have evolved with the economic
of bleeding or in-hospital mortality. underpinnings of the health care system, as
Evidences that depression and anxiety have the methodologies and setting focuses.
have prognostic importance in determining Cost analysis of nursing care focuses
CABG surgery outcomes support the devel- on justifying the cost-effectiveness of pro-
opment of pre- and postoperative nursing fessional practice models, evaluating rede-
assessment strategies to identify patients at sign efforts, and monitoring and controlling
risk for adverse events. nurses can play piv- nursing costs within an ever-tightening,
otal roles in identifying patients who need cost- conscious health care environment.
further evaluation, providing education Within the context of rising capitation pen-
about the effects of depression and anxiety etration, cost analysis is essential to accurate
on CABG surgery outcomes, and develop- capitation bidding and financial viability of
ing and evaluating interventions aimed at the parent organization. As “best practices”
ameliorating the effects of these risk factors benchmarking pushes the envelope of com-
on postoperative morbidity and mortality. petitive bidding, demonstrating cost-effective
The challenge for intervention research is to nursing practice becomes essential to secur-
address anxiety and depression rather than ing managed care contracts. Cost analysis
either in isolation and to assess and treat research is a type of nursing administrative
these both pre- and postoperatively. Clearly, research that evaluates aspects of the deliv-
there is a need for large, randomized trials of ery of nursing care.
both antidepressants and psychosocial inter- Cost analysis studies have been relevant
ventions after CABG surgery to determine to decision making by nursing administrators
their efficacy with treatment of anxiety and in selecting delivery models, treatment pro-
depression. tocols, and justifying budgets, but such stud-
Susan H. McCrone ies may become central to the survival of the