Discussion
This study identified the types and amounts of nursing
interventions delivered to the patients with a THR
and demonstrated a way to examine cost-effectiveness
of a large number of hospital nursing interventions
without actual cost information per nursing intervention.
Few previous studies have been able to examine
costs from this perspective.
As elderly persons were the main subjects of this
study, it was reasonable to find that most patients had
comorbidities on admission and had on average five
comorbidities. Advanced age and comorbid diseases
have been associated with an increased risk of complications
(McDonald & Huo 2008, Shebubakar et al.
2009, SooHoo et al. 2010), and comorbid conditions
might be more important than age (Grant et al.
2009). This study also found that patients who had an
additional comorbidity were likely to have more complications
(standardized coefficient = 0.27).
Comorbidity also significantly affected the dose of
nursing interventions. Patients who had more comorbid
conditions were more likely to receive Blood
Draw, IM/SQ Administration, Core Unit Care and
Incentive Spirometry. Blood Draw includes nursing
activities of glucose monitoring, arterial blood gases
monitoring as well as drawing blood from central/
arterial lines. Incentive Spirometry includes spirometer
measurements as well as teaching breathing exercises
using an incentive spirometer after the surgery. This
study used the number rather than the types of comorbidities
owing to diverse comorbidities in the sample
of patients. Further study is needed to articulate the
relationship between specific comorbidities and nursing
interventions to decrease the risk of complications.
For example, patients with diabetes might need more
frequent Blood Draws. Patients who smoke or patients
with lung diseases might need more use of an incentive
spirometer as they are at risk of having airway or
breathing problems after the surgery. This area needs
further exploration in future studies.