Describing the Essentials of Magnetism and Quality in Home Health

by Mensik, Jennifer.

The purpose of this descriptive study was to determine what Home Health nurses perceived to be the Essentials of Magnetism (EOM), the degree to which the EOM exists within each Home Health agency, and whether there was a relationship between quality Home Health agencies and their scores on the EOM. Home Health agencies were determined to be high or low quality agencies based on their published Home Health Compare results as obtained on the Medicare.gov website. The system research organizing model (SROM) was used as an organizing framework for this study. There is a plethora of research within the acute care setting establishing relationships between organizational attributes and quality outcomes. There is a lack of research in the Home Health setting exploring those same variables. The Nursing Work Index Revised (NWI-R) has been used in acute care research relating organizational attributes to quality patient outcomes. This instrument has also been utilized in the Home Health setting, but there have been no published psychometric analyses to confirm generalizability to this setting. Furthermore, research with this instrument has shown it to be unreliable in the acute care setting. The development and utilization of the EOM in the acute care setting provides a foundation for studies in other settings. Research in this study was conducted with two different sets of Registered Nurses in two different phases. The first phase of RNs (N = 106) determined whatHome Health nurses perceived to be the EOM from the 37-item Dimensions of Magnetism (DOM) instrument developed by Kramer and Schmalenberg (McClure and Hinshaw, 2002). The top 10 EOM attributes were obtained by tabulation of the number of respondents to each 14 question. The results showed that 7 of the top 8 EOM items chosen by the Home Health nurses were the same EOM items chosen by acute care nurses in previous studies. A test retest of the top 10 items revealed a high level of reliability (Spearman-Brown correlation of .77). Phase Two RNs (N = 125) determined the degree to which the EOM existed in each Home Health agency and whether there was a significant difference between high and low quality agencies. Home Health RNs from each agency were given the new 10item EOM instrument and were asked to rank each of the items based on the degree of its presence in their current work environment. The scale had a range of 1 to 4 with one being strongly agree and four being strongly disagree. The results showed that low quality agencies had a lower and better mean score (M = 1.40, SD = .34) than did higher quality agencies (M = 1.67, SD = .48). An independent sample t-test was significant t (110.91) = -3.63, p = .00, which is counter to the literature. While the results were not as expected, the high reliability of the instrument suggests that it is a reliable measure of attributes perceived by RNs that allow them to provide quality patient care. Several issues identified with the outcome variables such as time sensitivity and validity may provide some explanation of the results. As well, the outcome variables may not be nursing sensitive as it is a measure of multiple disciplines impact on patient care. While the American Academy of Nursing (2004) has suggested utilization of standardized outcomes in research, these results suggest the need to develop nursing sensitive outcomes in the Home Health setting. 15