A methodological study of the development of a home health care patient assessment instrument


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The purpose of the study was to apply the methodological research process to the development of a valid and reliable instrument which would be used by registered nurses during the initial assessment of patients admitted to a home health care agency for services. The methodological research design was applied to the processes of instrument development and validity and reliability estimation. Eight nurses employed by the study agency volunteered to participate in a series of meetings during which they discussed their experiences and observations regarding patient assessment. As a result of the meetings, two pages of the four-page assessment tool previously used by the agency were modified. The new instrument included additional items related to assessment of psychosocial and caregiver issues as well as revisions in terminology and response formats. Information is presented regarding professional experience and educational preparation of the study agency nurses who volunteered to participate. Content validity was established by an expert panel of 13 nursing professionals who rated each of the draft instrument's 15 sections as "good", "fair", or "poor". The overall mean "good" rating of .89 surpassed the expected overall mean "good" rating of .80. A number of revisions suggested by the panel were included in the new instrument. Data regarding professional experience and educational preparation of the expert panel are presented. During the latter half of the study, the study agency began the process of merging with a hospital-based home care agency. As a result of difficulties encountered during the merger process, proposed plans for determining inter rater reliability were terminated. Involving agency nurses in a collaborative process to develop a patient assessment instrument provided a number of benefits to the nurses and to the practice of nursing. Study agency nurses had the opportunity to question established practice and to participate in a process which balanced clinical practice with nursing research. Nurses' involvement promoted potential acceptance of the instrument by agency nurses. Further research must acknowledge the fast-paced changes taking place in the health care market. More studies are needed which include nurses and which examine the content and process of patient assessment. The validity and reliability of assessment instruments must be clearly supported by multiple estimation methodologies.