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Economic evaluation of nursing practices: a review of literature
Umeå University, Faculty of Medicine, Department of Nursing.
Sektionen för hälsa, Blekinge Tekniska Högskola.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.ORCID iD: 0000-0002-1633-2179
Umeå University, Faculty of Medicine, Department of Nursing.
2009 (English)In: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 56, no 1, 13-20 p.Article in journal (Refereed) Published
Abstract [en]

Background: The importance of cost-effectiveness of nursing practices and its influence on prioritizations has been discussed in literature. It is, however, unclear to what extent health economic analysis has been used in the area of nursing.

Aim: The aim of this paper was to investigate how studies of nursing practices apply economic evaluations.

Methods: A literature review was conducted that included studies through August 2007. The search was performed using Medline, CINAHL, PsycINFO, Econlit, DARE, HTA, NHS EED, Cochrane reviews, and clinical trials with a search term connected to nursing and health economics. Protocols were used in the screening procedure and the result is reported in a descriptive form.

Results: The search identified 115 studies published between1984 and august 2007. Studies were found in the following nursing practices: provision of support and treatment (n=17); assessing suffering/wellbeing (n=1); preventing or treating ill health (n=53); and organization of individual care (n=44). In 22% of all studies, the authors explicitly presented the health economic method used. In 25% of all studies, the perspective of the economic analysis was explicitly stated and there were a large variability in cost considered in the analysis. In 82 studies, the authors reported cost-effective intervention.

Conclusions: Although economic evaluation of nursing practice has increased, it is still a rather small area. According to the items elucidated in this study, further methodological improvement is needed to evaluate the economics of nursing.

Place, publisher, year, edition, pages
Geneva: The Council , 2009. Vol. 56, no 1, 13-20 p.
Keyword [en]
Healthcare economics and organization, nursing outcome assessment, review
National Category
Nursing
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:umu:diva-27002DOI: 10.1111/j.1466-7657.2008.00672.xOAI: oai:DiVA.org:umu-27002DiVA: diva2:275604
Available from: 2009-11-06 Created: 2009-11-06 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Magmassage vid förstoppning: upplevelser, effekter och kostnadseffektivitet
Open this publication in new window or tab >>Magmassage vid förstoppning: upplevelser, effekter och kostnadseffektivitet
2009 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis evaluates experiences, effects, and costs of abdominal massage for people with constipation. The thesis comprises four papers: Paper I is a literature review of health economic analysis of nursing practice. Paper II and III is a prospective randomized controlled trial that evaluates abdominal massage in terms of effects and costs. Paper IV uses a qualitative approach to illuminate the experiences of receiving abdominal massage. Paper II and III included 60 participants who were constipated in accordance with Rome II criteria. Paper IV included nine participants.

Paper I investigated the application of economic evaluation in studies of nursing practice. Systematic database searches were performed and gave nearly 600 papers that were screened and 115 studies were relevant according to stipulated inclusion criteria. The result showed that there was a trend of increased publications from the year 2000. Few studies reported the health economic methods used and the perspective of the economic analysis. There was a large variability in number of included cost items. Because the methodological weaknesses in many studies, it was difficult to use some studies as ground for discussion of resource distribution.

Paper II investigates the effects of abdominal massage on gastrointestinal function and laxative intake on persons with constipation. The questionnaire Gastrointestinal Symptom Rating Scale (GSRS) was used and data were analyzed using multiple linear regression. The results showed that after eight weeks of abdominal massage the intervention group experienced significantly fewer gastrointestinal symptoms and had significantly more bowel evacuation compared with the control group. There were no differences in laxative intake.

Paper III evaluated the change in health-related quality of life (HRQoL) for people with constipation when receiving abdominal massage and estimates the cost-effectiveness of two alternative implementation scenarios: 1) abdominal massage given by enrolled nurses in a department; and 2) participants giving themselves abdominal massage after receiving training in self-massage. Both scenarios imply that all participants received abdominal massage for eight weeks and those who found the treatment effective continued to receive treatment for eight more weeks. EQ-5D was used to assess HRQoL and for calculating QALY. The intervention group had after eight weeks of abdominal massage significantly higher HRQoL assessed with EQ-5D VAS compared with the control group. No significant differences were assessed with the EQ-5D index. Abdominal massage is initially expensive, but for those who respond favourably abdominal massage can be a cost-effective long-term treatment.

Paper IV examines the experiences of receiving abdominal massage when having constipation. Four themes were formulated: being on one’s guard, becoming embraced by safe hands, feeling touch to body and mind, and being in a fragile state. Receiving abdominal massage was described as comfortable and lead to decreased problems with constipation. The improvement was described as easily disturbed and it was associated with demands to continue massage to maintain the new state.

Conclusion: Abdominal massage is a pleasant treatment that provides significantly fewer gastrointestinal symptoms and increased health-related quality of life. As a long- term treatment, abdominal massage can be a cost-effective treatment.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2009. 80 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1297
Keyword
nursing care, nursing evaluation research, constipation, massage, abdominal massage, life experiences, sign and symptoms digestive, quality of life, QALY, health care economics and organization, omvårdnad, omvårdnadsforskning, förstoppning, massage, magmassage, upplevelser, gastrointestinala symtom, livskvalitet, QALY, kostnadseffektivitet
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-27014 (URN)978-91-7264-886-9 (ISBN)
Public defence
2009-12-04, Aulan,, Vårdvetarhuset, Umeå universitet, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-11-16 Created: 2009-11-06 Last updated: 2011-04-08Bibliographically approved

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