SELF-CARE, UTILIZATION, COST, QUALITY AND HEALTH STATUS OUTCOMES OF A PSYCHOBEHAVIORAL NURSING INTERVENTION: WOMEN EXPERIENCING TREATMENT FOR BREAST CANCER.

Description

The purposes of this study were: (1) development of the psychobehavioral nursing intervention (PBNI) effectiveness model, an integrated theoretical model of nursing intervention effectiveness that conceptualizes the effects of nursing interventions on client, health care, and sociopolitical system levels; and (2) initial testing of the nursing intervention outcomes model (NIOM), a middle range theory derived from the PBNI effectiveness model that conceptualizes the effects of psychobehavioral nursing interventions on behavioral status and health status outcomes at the three system levels. Outcomes studied were global self-care practice, illness self-care practice, and client morbidity at the client system level, utilization and aggregate morbidity at the health care system level, and cost of care, quality of care, and life quality at the sociopolitical system level. Contextual factors linked to effects at the three system levels were also studied. Data from the Self-Help Intervention Project (SHIP), an experimental, randomized block, repeated measures design study of women undergoing adjuvant medical therapy for treatment of breast cancer, were analyzed using hierarchical multiple regression techniques to test predicted outcomes relationships at three points in time. A volunteer nonprobability sample of 315 subjects were randomly assigned to one of four treatment cells of a six week nursing intervention designed to promote self-help and uncertainty management. Study results provide a global look at relationships between a set of politically sensitive nursing intervention outcomes that confirms the appropriateness of the theoretical basis from which the NIOM was derived, the psychobehavioral nursing intervention effectiveness model with roots in systems, field, epidemiology, economics, and treatment theories. Study results also confirm the presence of complex, multidimensional relationships between nursing interventions and behavioral and health status outcomes at three system levels. Recommendations to increase theoretical and design sensitivity of nursing intervention outcomes studies include enhanced specification and operationalization of outcome concepts, continued delineation of intervening mechanisms, consideration of feedback loops in modeling intervention outcome processes, and development of cross-level studies.

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