COST-EFFECTIVENESS AND QUALITY OF CARE PROVIDED BY CLINICAL NURSE SPECIALISTS

Effects of a nurse-led cognitive-behavior therapy on fatigue and quality of life of patients with breast cancer undergoing radiotherapy: an exploratory study

BACKGROUND

Radiotherapy can have multiple adverse effects, including patient complaints of persistent fatigue and low quality of life. Cognitive-behavior therapy (CBT) has alleviated fatigue and improved QOL of cancer patients; however, little is known about the effects of nurse-led CBT on breast cancer patients undergoing radiotherapy.

OBJECTIVE

The purpose of this study was to analyze the effects of a nurse-led CBT program on fatigue and QOL of patients with breast cancer undergoing radiotherapy.

METHODS

This study was performed using a quasi-experimental pretest/posttest design, with a nonequivalent control group. The participants were patients with breast cancer (N = 71: experimental group = 35, control group = 36) undergoing radiotherapy at P University Hospital in Korea. The experimental group received a 6-week intervention program that included cognitive restructuring, education about the disease and medical treatment, relaxation therapy, and rehabilitation exercise.

RESULTS

After the 6-week intervention, the level of fatigue increased in patients in both groups. However, the increase in the experimental group was lower than that in the control group. Quality of life of the experimental group was significantly higher than that of the control group.

CONCLUSIONS

The nurse-led CBT seemed to control fatigue level and improve QOL. Therefore, the use of nurse-led CBT for patients with breast cancer undergoing radiotherapy must be promoted.

IMPLICATIONS FOR PRACTICE

Active involvement of experienced nurses in the counseling program should be considered. In addition, further research must be conducted into the implementation of the nurse-led cognitive-behavioral intervention to a broader spectrum of patients.

Advanced Practice Registered Nurse supply in a small state: trends to inform policy

This study is a contribution to the small existing pool of state level research on Advanced Practice Registered Nurse (APRN) workforce supply. Data from four biennial surveys of Vermont APRNs from 2003, 2005, 2007, and 2009 (n = 1,538) were analyzed to produce descriptive statistics of one small state's APRN demographic, educational, employment, job satisfaction, intention to leave, and practice-setting characteristics. Survey results were then used to identify patterns or trends that existed in the data. There was a marked shift in the employment settings and a decrease time worked as an APRN, despite an aging APRN workforce. There was an increase in the aggregate education level of APRNs; however, the percentage educated at the doctoral level remained flat at 2%. Overall, APRNs were a satisfied segment of the health workforce; however, those intending to leave for dissatisfaction voiced more concern about job stress and less concern about salary and benefits over time. Implications for workforce planning and public policy are discussed.

National survey of psychiatric mental health advanced practice nursing: development, process, and finding

A survey was sent to all Psychiatric Mental Health (PMH) Advanced Practice Registered Nurses (APRNs) who had a registered e-mail address with the American Nurses Credentialing Center, resulting in 1,899 usable surveys. The practice of two groups of APRNs was examined and contrasted: those certified to treat children and adolescents and PMH-APRNs certified only to treat adults. Our findings raise concerns about the numbers of PMH-APRNs treating children. Considering the national demand for mental health professionals prepared to treat children, the specialty must move to increase the number of qualified APRN child providers.

The cost and cost-effectiveness of nursing services in health care

This article examines the literature on cost-effectiveness in nursing, and considers the relationship between this literature and decision-making in health care systems. Researchers have attempted to examine costs and benefits of nurse staffing and nursing interventions for decades. There are strong literatures for some topics, such as advanced practice nursing, clinical practices, occupational health nursing, and workplace training. However, there are gaps in the literature on the cost-effectiveness of nurse staffing patterns, the use of agency personnel, and changes in organizational structure. A review of 6 major health care management textbooks finds few references to cost-effectiveness analysis, suggesting that health care leaders have little education regarding how to conduct or evaluate economic studies. The agenda for nursing research on cost-effectiveness is daunting. Research must be based on large, representative samples; provide clear, compelling results; discuss the importance of both costs and benefits in decision-making; and be published in highly-visible journals.

The effectiveness of advanced practice registered nurses as psychotherapists

This article explores the effectiveness of advanced practice registered nurses as psychotherapists. Psychiatric/mental health (PMH) clinical nurse specialists (CNSs) possess the training, skills, and abilities necessary to provide effective psychotherapy. A case study is examined involving a client with obsessive-compulsive disorder who underwent psychotherapy by a PMH CNS graduate student. Evidence is presented that CNSs follow evidence-based procedures with effective outcomes.

HIV/AIDS challenges the normative model of healthcare delivery in Canada

With advances in therapeutics, effective therapy for human immunodeficiency virus (HIV) has shifted the focus of HIV care from an acute illness to a chronic disease requiring the services of several disciplines in a primary care setting. This article describes a collaborative model in the delivery of HIV care for HIV-infected individuals who remain fragile, both physically and psychosocially.

Benefits of a Nurse-Psychiatrist Collaborative Practice in an Anxiety Disorders Unit

1 Only one out of four people receives the appropriate therapy for anxiety disorders, despite available and effective treatments. 2 Nurse-doctors collaborative practice is a working relationship with a sharing of responsibilities of the treatment program within the realm of respective roles. 3 Using an evidence-based care approach allowed the care providers to continually monitor, assess and revise the treatment program which proved to be cost effective and time efficient, yet provided premium patient care.

Advanced Practice Psychiatric-Mental Health Nursing in a Community-Based Nurse-Managed Primary Care Program

In the evolving health care environment, advanced practice opportunities for psychiatric-mental health nurses may lie in managed care models of community oriented primary health care. As providers, care managers, health promoters and educators, and client advocates with family systems expertise, psychiatric-mental health advanced practice specialists are a necessary component of all primary health care. This article describes the development of a community-based primary care practice that integrates physical and mental health care on the same site.

Integrated Primary Health Care: Opportunities for Psychiatric-Mental Health Nurses in a Reforming Health Care System

As changes in our health care system evolve, making the transition to greater parity of mental and physical health is paramount to move health care in the direction of prevention and health promotion. Although parity is the goal, the most feasible path to reaching it may lie in relinking mental health to physical health in managed care models of primary health care. This article identifies emerging directions in the mental health field and points to new opportunities for advancing the practice of psychiatric-mental health nurses.

Managed care challenges and opportunities for cardiovascular advanced practice nurses

The aggressive changes in the health-care system are mandating revolutionary new approaches in patient-care delivery. Cardiovascular care, in particular, is under scrutiny due to its high cost and wide variation in outcome. The need to comprehensively coordinate cardiac surgical care and aggressively manage complex cases has resulted in growing interest in using cardiovascular advanced practice nurses (APNs) to ensure high-quality, yet cost-effective patient care. The unique skills of the cardiovascular APN as practitioner, consultant, educator, researcher, and change agent ensure optimal outcomes for patients and their families as well the staff, physicians, and the hospital's bottom line.

Nursing care models increase care quality while reducing costs

Unique models of care delivery, such as the Nursing Care Partnership model for practice used at the Denver Nursing Project in Human Caring, have demonstrated a reduction in inpatient admissions, mean length of stay, and total charges. This descriptive study identified and described clients' (N = 75) perceptions of care and explored the cost-effectiveness of this model. Findings suggest nursing care partnerships play a key role in reducing healthcare costs by providing services in a more cost-efficient setting and by having an impact on client utilization of services. Savings in potential hospital costs were estimated at $1,590,384 for 1993.

Clinical outcomes and satisfaction of patients of clinical nurse specialists in psychiatric-mental health nursing

Survey research was conducted to examine clinical outcomes and satisfaction of patients of psychiatric mental health clinical nurse specialists (CNSs). Patients who had terminated from outpatient psychotherapy with 6 CNSs in 1993 were mailed a questionnaire (N = 223). Follow-ups by mail yielded a response rate of 45% (n = 100). The questionnaires included the Profile of Mood States-Short Form ([POMS-SF]; McNair, Lorr, & Droppleman, 1992). Quality of Life Function ([QOL]; Lehman, 1991), and Patient Satisfaction Scale (Baradell, 1994). Paired difference t-tests were used to evaluate clinical outcomes. Percentages were used to report satisfaction, and Pearson correlations were used to examine the relationship between clinical outcomes and patient satisfaction. The mean age for respondents was 37 years; 82% were female. Diagnoses included depression (46%), adjustment disorders (34%), anxiety (10%), and other (10%). Patients reported significant improvement in all clinical symptoms: anxiety, depression, anger, confusion, fatigue and vigor. Patients reported significant improvement in all domains of QOL: family, social, and job. Patients reported a very high level of satisfaction with the care provided. The more clinical improvement the patients reported, the more satisfied they were with the care provided. If nurses are to be included in a reformed health care delivery system in the future, additional research is essential.

Help Wanted A Quality Needs Assessment Creates a Position for a Psychiatric Clinical Nurse Specialist

1. A survey needs assessment demonstrated that nurses in hospital practice need and want a PCNS for support with conflict resolution, difficult personnel and families, stress reduction, education, death and dying, and support groups. 2. Nurses (69%) who were considering leaving their positions wanted a PCNS to talk with them about their decisions. They felt a PCNS could provide insights they had overlooked. Nurses felt that they needed a PCNS on site or on call to be there for them to improve their practice. 3. Creating a position for a PCNS to be a consultant and liaison for nurses is a cost effective way to increase retention of excellent nurses, improve quality of care, job satisfaction, increased productivity, and reduced costs.