Discuss in 250 words how you would evaluate the clinical effectiveness and the cost-effectiveness of strategies designed to limit costs. Provide examples of nursing sensitive patient outcomes.
Kearney-Nunnery, R. (2012). Advancing Your Career: Concepts of Professional Nursing. (5th., ed.). Philadelphia, PA: F.A. Davis Company. Chapter 16
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The three most significant impacts of cost-limiting strategies will be effects upon patient outcome, effects upon nursing staff, and effects upon patient perception.
Patient perception is important because even if the patient is receiving the same clinical care with the same outcome, their perception may interpret a lower quality of care, affecting long-term recovery as well as the patient's mental health and the reputation of the clinic in the community. For example, if fewer nurses or less time per nurse is involved in the care of a patient, this may result in a perception of lower quality regardless of whether the patient outcome is comparable or identical to the outcome with greater nursing attention. This can be evaluated psychologically and via patient interviews and long-term followup.
Staff effects will involve whether and how the staff perceive their jobs are more or less difficult following implementation. An important point to identify is the line between functionality and satisfaction; what is the boundary between effective but perhaps uncomfortable cost-saving measures, and those which actually impair functionality? Which costs are in fact essential? This can be mediated by involving the nursing staff in the cost-saving process and incorporating their advice, as well as forming a contract or plan under which the measures will be enacted.
Regarding patient outcome, presumably the greatest concern in a cost-cutting environment is the degradation of outcome. If this is immediately apparent, it should require very little evaluation; it will be self-evident. If immediate detrimental effects are not obvious, they may reveal themselves through long-term data and observation. It is important that this data is arranged in such a way that will make correlation-causation relationships obvious; for example, if nursing staff is cut, the data must be contextualized to isolate this factor as the cause of a change in outcomes.
Nursing-sensitive patient outcomes cite falling as one typical example. Falling is, presumably, more likely in the event that a nurse is not present to physically assist the patient in moving. An increase in falls will presumably lead to an increase in patient complications and dissatisfaction, negatively impacting outcome. This may lead to cost-saving measures preferring not to affect the ability of nurses to provide this type of care at the same rate as before their implementation.
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