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Nurse-Sensitive Outcomes Across the Breast Cancer
Care Trajectory
Norma Christman, Ph.D., Principal Investigator;
Carol
Ireson, Ph.D. (College of Public Health);
Kay Ross, J. Ingala, M. Kay Price (Central Baptist
Hospital), Co-Investigators
Funded by a University of Kentucky Medical
Center Research Grant
(2001-2002)
Abstract
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Much of cancer care has shifted to outpatient and home
settings, increasing the need for, and the importance of,
documenting the effects of nursing care on patient outcomes.
Documenting these effects requires measures with known
sensitivity to disease and treatment variations, to the
effects of co-morbidity, and to variations in nursing care.
Donabedian's health care evaluation model incorporating the
AAN Expert Panel consensus statement on outcomes sensitive
to nursing care provides the overall study framework.
Andersen's model of treatment related morbidity and recovery
is used to situate the evaluation model within the context
of cancer care.
The proposed study will examine
the effects of selected nursing care structure and process
measures on nurse-sensitive outcomes across primary and
adjuvant breast cancer care. The aims are to: (a) examine
the sensitivity of the outcome measures to stage of disease,
extent of treatment, age co-morbidity, and expected
treatment related effects; (b) describe the nursing
interventions; and (c) examine the effects of nursing care
process and structure variables on patient outcomes.
A longitudinal prospective design
will be used to measure functional, physical, psychological,
and social outcomes, as well as selected cost outcomes, in a
sample of at least 50 women newly diagnosed with breast
cancer. Process and structure indicators will include:
nursing intervention descriptions, R.N. availability,
R.N.-to-patient ratio, R.N. education mix, and use of specific
guidelines, protocols, education materials by care setting,
e.g., inpatient surgical unit, outpatient surgery,
outpatient oncology clinic, radiation therapy.
The Sickness Impact Profile home
management, recreation/pastimes, and social interaction
subscales, and the Profile of Mood States anxiety
depression, anger and fatigue subscales will be used to
measure the functional, social, psychological, and physical
outcomes respectively. Cost outcomes will include
out-of-pocket costs and unscheduled care visits obtained
using a modification of the Birenbaum Cost Interview
Schedule. These measures will be obtained preoperatively,
postoperatively, and during the first and last weeks of
radiation and chemotherapy. The number of times outcomes are
measured will necessarily vary by the need for and extent of
adjuvant treatment. Structure and process data will be
obtained by interviewing and observing selected members of
the nursing staff in each care setting. Content analysis and
a variety of parametric and nonparametric statistical
techniques will be used to address the specific aims.
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