With the impressive resurgence of home health care, driven by demographic, economic, and competitive pressures, comes the necessity of identifying and examining the roles and role behaviors of health professionals and clients. More importantly, because uniform and comprehensive standards and norms have not been established for the quality of care being provided in the home, there is an urgency to identify and interpret the values, norms, expectations, and behaviors deemed important to quality care.

The purpose of this exploratory study was to identify the similarities and dissimilarities between nurses in the role of focal actor, and clients and administrators occupying complementary roles to the nurse, and their perceptions of what nursing behaviors represent quality care. Using an investigator-designed, integrated instrument (Quality of Care Indices (QCI)), both qualitative and quantitative data were gathered. Content validity was determined by conducting a pilot study of taped interviews with an "expert" sample of persons in the client, nurse and administrator roles. An overall alpha coefficient of.88 was estimated for the QCI, by using Cronbach's alpha. The final study was conducted by taping interviews using a non-randomized sample of 30 post-discharged clients and 30 nurses and administrators.

Using the techniques of content analysis to analyze the qualitative data for recurrent themes, meanings and frequencies of responses, and cluster analysis to identify clusters within the quantitative data, 8 major dimensions of quality emerged. In order of importance to clients they included: Management of Interpersonal Relationships; Accountability; Competency; Assessment; Case Management; Information Source; Economic Considerations; and Client Satisfaction. Similarities and differences occurred between the groups as the scope and level of concern for the quality of care varied according the actor's cultural beliefs and prior socialization.

Considering the significant position home health care has in today's health care delivery system, this study has significant consequences for all participants in this situation--clients, providers, educators, and policy makers. Systems must be designed to accommodate the various definitions of quality. The indicators of quality defined in this investigation will provide the foundation for the delineation of measurable standards and criteria to be used in nursing care. (Abstract shortened with permission of author.).