Who's Remembering to Buy the Eggs? The Meaning, Measurement, and Implications of Invisible Family Load.

Although much is known of the observable physical tasks associated with household management and child rearing, there is scant understanding of the less visible tasks that are just as critical. Grounding our research in the extant literature, the broader lay discussion, as well as our own qualitative research, we define, conceptualize, and operationalize this construct, which we label as "invisible family load." Using a mixed method, five-study approach, we offer a comprehensive, multidimensional definition and provide a nine-item, empirically validated scale to measure its component parts-managerial, cognitive, and emotional family load. In addition, we investigate gender differences and find, as expected, that women report higher levels of each dimension. We also examine the implications of invisible family load for employee health, well-being, and job attitudes, as well as family-to-work spillover. Although we substantiated some significant negative consequences, contrary to the popular view that consequences of invisible family load are uniformly negative, our results show some potential benefits. Even after accounting for conscientiousness and neuroticism, managerial family load related to greater family-work enrichment, and cognitive family load related to greater family satisfaction and job performance. Yet, emotional family load had uniformly negative potential consequences including greater family-to-work conflict, sleep problems, family and job exhaustion, and lower life and family satisfaction. Our research sets the stage for scholars to forge a path forward to enhance understanding of this phenomenon and its implications for individuals, their families, and the organizations for which they work. Supplementary Information: The online version contains supplementary material available at 10.1007/s10869-023-09887-7.

Can incivility be informative? Client incivility as a signal for provider creativity.

Workplace incivility is generally viewed as a deleterious interpersonal stressor. Yet, alternative theories suggest that incivility may have instrumental implications for some targets. Applying signaling theory, we study client-provider relationships in a health care context to unpack linkages between incivility enacted by organizational outsiders and work creativity responses by employee targets. We argue that providers leverage information from client incivility to provide more creative care over time. In Study 1 (N = 186), results suggest that clients may use incivility to signal perceptions of poor treatment quality to providers. In Study 2 (N = 416), results from topic modeling of qualitative data show that providers observe client incivility and believe it can contain valuable information about client satisfaction. In Study 3 (N = 503), providers reported their experiences of client incivility and creativity (incremental and radical) in client care over five waves of data to capture the incubation time that providers may need to reflect on instances of incivility. Employing trait-state-occasion modeling, our findings show that episodic (i.e., higher than normal) client incivility had positive lagged relationships with incremental and radical provider creativity, suggesting that time is needed for providers to process the information contained in the client incivility signal and creatively modify treatment plans. Theoretical and practical implications for workplace incivility and creativity are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Examining supervisor undermining through the job-demands resources framework.

INTRODUCTION: Supervisor undermining has recently gained increasing attention due to its negative effects on employee health and well-being. In the healthcare context, negative supervisor behaviors have been linked to unfavorable individual and organizational outcomes as well as medical errors and patient mortality. Our study, therefore, examines the influence that supervisor undermining behavior has on employee engagement and performance within a standard job stress framework. METHODS: Our sample consisted of occupational therapists, a health professions group who is growing in demand and importance in the U.S. and has unique job demands. Using an observational, cross-sectional study design, a convenience sample of 521 occupational therapists completed an online survey. A series of independent t-test and multiple-groups path analytic modeling was used. RESULTS: Participants who had a supervisor perceived as engaging in undermining behaviors reported lower levels of resources, higher levels of demands, less motivation, and more overload than those who did not perceive supervisor undermining. These participants were also less engaged and reported lower levels of performance. CONCLUSION: Our results shed further light on the importance of supervisory behaviors specifically in a healthcare setting and the need for organizations to create an environment that promotes positive and productive workplace behaviors.

The Hospital Readmissions Reduction Program's Impact on Readmissions From Skilled Nursing Facilities.

EXECUTIVE SUMMARY: Hospital readmissions have long served as an indicator of patient recovery and the effectiveness of care. The present study examines the Hospital Readmissions Reduction Program's (HRRP's) impact on hospital readmissions from skilled nursing facilities (SNFs) and the characteristics of SNFs that were predictive of lower readmission rates. Adjusted 30-day readmission rates among 14,666 SNFs in the United States from 2011 through 2015 were examined using linear regression with generalized estimating equations to determine the relationship of the HRRP mandate to readmission rates from SNFs. Findings indicate a significant downward trend in adjusted 30-day readmission rates over time, decreasing 1.4% from 2011 to 2015. Furthermore, lower readmission rates were associated with SNF characteristics including location in a hospital facility, rural designation, higher registered nurse-to-nurse ratios, and not-for-profit status. We found a substantial decrease in SNF-related readmissions associated with HRRP, which may limit the impact of the Protecting Access to Medicare Act. Policy-makers may consider these systemic and structural differences before drafting future legislation targeting hospital readmission from SNFs. In addition, acute care facility operators who do not have an SNF may consider adding one to their facility and/or consider partnering with SNFs to ensure that high-quality programs in these SNFs are in place to reduce 30-day readmissions to the acute care facilities.

Barriers to electronic cigarette use.

OBJECTIVE: Recent studies suggest that electronic cigarettes (e-cigarettes) may be a better alternative to traditional smoking cessation therapies for cigarette smokers. This study explores the barriers traditional smokers face when switching to e-cigarettes. DESIGN AND SAMPLE: A convenience sample of adult male and female tobacco and/or e-cigarette smokers (n = 446) were recruited through an online survey. MEASUREMENTS: The survey included questions used to determine the barriers a smoker may experience in regards to their use of e-cigarettes, as well as the characteristics regarding their use of tobacco and/or e-cigarettes. RESULTS: The majority (74%) of tobacco smokers who tried e-cigarettes did not perceive e-cigarettes to be an effective replacement for tobacco cigarettes, and 69% indicated the initial cost and health concerns as reasons to not continue using e-cigarettes. Both current e-cigarette users and those who discontinued use of e-cigarettes noted health or lack of information on side effects as a concern. The majority of e-cigarette users indicated that it took more than a week to settle on a proper dose. We found that for each additional cigarette smoked per day individuals were 4.0% (p = .001) more likely to use e-cigarettes. CONCLUSION: This exploratory study informs future cessation trials involving e-cigarettes about the barriers users face. Given that individuals who smoke a greater number of tobacco cigarettes are more likely to try e-cigarettes, greater attention to nicotine dosing is necessary.

The Impact of Patient Navigation on Diabetes.

EXECUTIVE SUMMARY: Diabetes is a growing concern in the United States as it is associated with increasing rates of mortality and morbidity, in addition to rising healthcare costs. It is the seventh-leading cause of death in the U.S. From 1980 through 2014, the number of Americans diagnosed with diabetes increased fourfold (from 5.5 million to 22 million). Consequently, costs associated with diabetes have soared to an estimated $245 billion, representing an average annual cost of approximately $13,700 per patient with diabetes. Moreover, approximately 28%, or 8.1 million people, with diabetes are undiagnosed. Type 2 diabetes accounts for 90-95% of all cases and can be managed with appropriate lifestyle interventions. Many patients need assistance understanding and managing their disease. However, effective management is difficult for individuals and their healthcare providers. Physicians typically do not have the time or resources to address these patient factors that may influence health outcomes for people with diabetes: adherence to treatment regimen, beliefs, attitudes, culture, understanding of the disease, language ability and health literacy, socioeconomic status, comorbidities, and social support. Behavior modification poses many challenges. In this study, the authors evaluate the impact of a patient navigation program developed by Pack Health, Birmingham, Alabama, to address these challenges. The patient navigation program motivates and educates patients and supports them in changing behavior to help them manage their diabetes effectively. The authors found that patients enrolled in the patient navigation program had greater understanding of diabetes after the program and, on average, their hemoglobin A1c level decreased by 1%.

Exploring Organizational Smoking Policies and Employee Vaping Behavior.

OBJECTIVES: Cigarette consumption has become global threat to both smokers and organizations. However, little is known about organizational smoking and vaping policies, and their influence to employees' smoking and vaping behavior. METHODS: We collected data from 456 employed smokers, vapers, and/or dual users. Smoking and/or vaping behavior, along with perceived organizational smoking/vaping policies were examined. RESULTS: Vapers reported perceiving more stringent smoking policy, while vapers who reported having workplace vaping policies perceived having generally more stringent vaping policy. Most smokers and vapers are well informed about smoking policy; however, a considerable portion of them do not have a good understanding about organizational vaping policy. CONCLUSIONS: Organizations should not consider smoking and vaping to be the same when setting policy. Employers should ensure that organizational vaping policies are present and clear to all employees.

Travel Distance to Cancer Treatment Facilities in the Deep South.

EXECUTIVE SUMMARY: Despite ongoing efforts to improve rural healthcare, the health problems facing rural communities persist. The lack of healthcare providers and infrastructure in rural areas has been linked to a number of negative consequences. Among the elderly rural population, the lack of proximal access presents greater barriers because many elderly people are further limited in their ability to travel and pay for services. In the Deep South specifically, rural residents experience limited access to care and overall poor health outcomes. With cancer in particular, the Deep South has been dubbed the "cancer belt," faring far worse in prevalence and mortality rates than other areas of the country. The present study examines the average travel distance for rural elderly patients residing in the Deep South who are receiving treatment for prostate, breast, or colorectal cancer. We analyzed Medicare claims data of beneficiaries residing in the five Deep South states who had received a primary diagnosis of prostate, breast, or colorectal cancer, with a service date ranging from January 1, 2011, through December 31, 2014. The findings reveal that rural Medicare beneficiaries in the Deep South travel significantly greater distances than do their urban counterparts. In addition, travel distances to prostate cancer treatment facilities are significantly greater than those to breast or colorectal cancer treatment facilities. With cancer incidence predicted to increase, the need to reduce travel distances to treatment is vital in efforts to curb the mortality rate in the Deep South.

A Multi-Functional View of Moral Disengagement: Exploring the Effects of Learning the Consequences.

This paper takes us beyond the unethical act and explores the use of moral disengagement as a multi-stage, multi-functional regulatory, and coping mechanism that not only allows individuals to engage in unethical behavior, but also manage the negative emotions (i.e., guilt and shame) from learning the consequences of such behavior. A resource-based lens is applied to the moral disengagement process, suggesting that individuals not only morally disengage prior to committing an unethical act in order to conserve their own resources, but also morally disengage as a coping mechanism to reduce emotional duress upon learning of the consequences of their actions, which we describe as post-moral disengagement. These assertions are tested using a scenario-based laboratory study consisting of 182 respondents. Findings indicate that individuals will morally disengage in order to commit an unethical act, will experience negative emotions from having learned of the consequences, and then will engage in post-moral disengagement as a coping mechanism. In addition, the findings suggest that guilt and shame relate differently to moral disengagement.

Psychological entitlement and abusive supervision: political skill as a self-regulatory mechanism.

BACKGROUND: Abusive supervision in the workplace is steadily increasing. Such behavior has been linked to a host of negative individual and organizational consequences. In a health care environment particularly, such behavior can have detrimental effects. PURPOSES: This study advances self-regulation theory by framing the entitlement-abusive supervision relationship in terms of a motive to obtain resources via a behavior that is not socially sanctioned. Furthermore, we argue that political skill serves as a self-regulating mechanism that reduces the motivation to secure personal resources through abusive behavior. METHODOLOGY/APPROACH: Our hypotheses were tested using a sample of nurses and their supervisors who were asked to complete a survey. A final sample of 132 supervisor-subordinate dyads was obtained. FINDINGS: Analysis suggests that supervisors high in psychological entitlement are more likely to be perceived by their subordinates as abusive. Political skill, however, moderated this relationship by serving as a regulatory mechanism that thwarts entitled supervisors from engaging in abusive behaviors. PRACTICE IMPLICATIONS: Our findings underscore the common concern that entitlement and abuse can be harmful for organizations. Entitled supervisors who are high in political skill may recognize that engaging in less aggressive influence behaviors may be more effective in achieving self-serving motives. Consequently, health care organizations need to be proactive in order to reduce entitlement and prevent abusive behaviors in the workplace.

Evaluating survey quality in health services research: a decision framework for assessing nonresponse bias.

OBJECTIVE: To address the issue of nonresponse as problematic and offer appropriate strategies for assessing nonresponse bias. STUDY DESIGN: A review of current strategies used to assess the quality of survey data and the challenges associated with these strategies is provided along with appropriate post-data collection techniques that researchers should consider. PRINCIPAL FINDINGS: Response rates are an incomplete assessment of survey data quality, and quick reactions to response rate should be avoided. Based on a five-question decision making framework, we offer potential ways to assess nonresponse bias, along with a description of the advantages and disadvantages to each. CONCLUSIONS: It is important that the quality of survey data be considered to assess the relative contribution to the literature of a given study. Authors and funding agencies should consider the potential effects of nonresponse bias both before and after survey administration and report the results of assessments of nonresponse bias in addition to response rates.

Impact of the economic downturn on nursing schools.

The challenges posed by the economic downturn on baccalaureate nursing schools in the southeast as it relates to their perceptions of changes in the number of applicants, acceptance rates, employer recruitment efforts, and student clinical and job placement were explored. Responses from deans and program directors indicated nursing schools are experiencing negative effects of the economic downturn in the form of graduates having difficulty finding employment, decreased recruitment efforts from prospective employers, difficulty locating clinical placements for students, and no change in faculty applicants despite an increase in undergraduate student applicants as well as graduate student applicants. These multiple factors combined could signal the death knell for programs that are ill-prepared to deal with such a crisis. Programs need to be aggressive in their efforts to draw health care recruiters as well as qualified faculty applicants to their campuses. Nursing schools must be able to clearly show why their graduates are superior to other programs' graduates when competing for both highly qualified faculty applicants and prospective student employers.

Examining human resources' efforts to develop a culturally competent workforce.

The increasing diversification of the nation's population poses significant challenges in providing care that meets the needs of culturally diverse patients. Human resource management plays a vital role in developing a more culturally competent workforce. This exploratory study examines current efforts by human resource directors (HRDs) in Alabama's general hospitals to recruit more diverse candidates, train staff, and make language access resources available. A questionnaire was developed based on the Office of Minority Health's Culturally and Linguistically Appropriate Services standards. The HRDs of the 101 Alabama general hospitals served as the study's target population. A sample of 61 responses, or 60.4% of the population, was obtained. The findings indicate that most HRDs are focusing their efforts on recruiting racially/ethnically diverse candidates and training clerical and nursing staff to care for culturally and linguistically diverse patients. Less effort is being focused on recruiting candidates who speak a different language, and only 44.3% have a trained interpreter on the staff. The HRDs who indicated that they work closely with organizations that provide support to diverse groups were more likely to recruit diverse employees and have racially/ethnically and linguistically diverse individuals in leadership positions. It is crucial that health care organizations take the necessary steps to diversify their workforce to broaden access, improve the quality and equity of care, and capture a greater market share.

Perceptions of school nurses on the challenges of service provision to ESL students.

The number of English-as-as second-language (ESL) students in public schools across the country is rising creating unique challenges for school health services with the introduction of new cultures and languages. This study describes the perceptions of school nurses in Alabama schools regarding the challenges they face when communicating with ESL students and their parents. The population consists of school nurses in Alabama public schools. The obtained sample of 1,429 responses is presented and discussed. Urban school nurses were more likely to have access to an interpreter, yet they were more likely to rely on an ESL student to act as a translator when speaking to his/her parents. Kindergarten through elementary school nurses were more likely to witness an increase in ESL students and encounter difficulty communicating with these students and their parents. School nurses have a unique opportunity to engage parents of ESL students in the health of their child, thus it is vital that they be provided with cultural facts and encouraged to use interpreter services to lessen language barriers.

Organizational factors associated with the use of information systems in nursing homes.

PURPOSE: The use of information systems (ISs) in nursing homes is gradually increasing, yet little is known about the factors that promote the use of these systems. Using resource dependency theory as the conceptual framework, this study examines how chain membership, ownership status, and innovativeness are associated with ISs use in nursing homes. DESIGN AND METHODS: We analyzed the results of the 2004 National Nursing Home Survey. The sampling process consisted of a stratified probability design. A total of 1,174 nursing homes participated in the survey. RESULTS: The results of the regression analysis revealed that facilities that were members of a chain were significantly more likely to use all types of ISs and ISs for administrative tasks than were nonchain facilities. In addition, nonprofit nursing homes were significantly more likely to use administrative systems. IMPLICATIONS: The demand for nursing home services is expected to increase substantially with the aging baby boomers. The use of ISs may assist nursing homes to improve service delivery by collecting and analyzing service, finance, and administrative data that are necessary to achieve operational efficiencies. Membership in a multifacility chain may both increase the need for network-wide communication and provide resources promoting use.

Registered nurses' perceptions of cultural and linguistic hospital resources.

As the patient population continues to diversify, the need to provide care that is culturally and linguistically appropriate is intensifying. This study describes the perceptions of registered nurses (RNs) in Alabama hospitals regarding the training and resources available for providing culturally and linguistically appropriate care. The population consists of all RNs working in Alabama hospitals. A sample of 1976 RNs was obtained using an online survey. The findings indicate that although some resources and training are currently provided to nurses, the majority of respondents still lack sufficient resources and training to provide culturally and linguistically appropriate care. The lack of uniformity in resources and training makes it difficult to ensure that all healthcare providers are receiving the same information. However, hospitals do have the flexibility to tailor training to areas that are specific to their population needs.

Organizational characteristics associated with cultural and linguistic service provision within Alabama hospitals.

Like several states in the Southeast, Alabama is in the nascent stages of an increase in the population of foreign-born individuals for whom English is a second language. These individuals are also culturally different from the traditional southern population. Given the impact of culture and language on a person's service utilization, the introduction of new cultures may pose significant challenges for Alabama's health care providers if they are not prepared. The purpose of this project is to examine the organizational characteristics associated with the provision of culturally and linguistically appropriate services by Alabama hospitals. The data for the project come from a survey of all medical/surgical hospitals (N = 101). Fifty-nine surveys were returned, giving us a 58% response rate. The data were analyzed using correlations, analysis of variance, and logistic regression. Approximately 47% of the sample hospitals reported having a staff interpreter. Furthermore, hospitals that had staff interpreters did seem to be more aware of their community, which was reflected in their mission statements. In addition, directors who viewed their role as fulfilling the strategic plan accepted the task of providing staff interpreters. Thus, several hospitals in Alabama seemed to be ready to meet the cultural and language needs of their markets.

Cultural and linguistic competence in healthcare: the case of Alabama general hospitals.

As the nation's foreign-born population continues to increase, the importance of understanding cultural, ethnic, and religious differences to combat racial/ethnic disparities in access to and utilization of healthcare services intensifies. In Alabama, specifically, the shifting migration patterns and the growth of the foreign-born population have altered the state's demographics, introducing new cultures and languages to this traditionally biracial state. Because Alabama general hospitals are not immune to the widespread cost, access, and quality paradox that plagues every healthcare organization, they too must consider the value of cultural and linguistic competence in providing high-quality, cost-effective care. This exploratory study examined the awareness of and preparedness for the diversifying patient population of general medical and surgical hospitals in Alabama. Questionnaires were mailed to the chief executive officers of 101 general medical and surgical hospitals. A sample of 53 respondents provided data on the measures and resources that the hospitals currently use to meet cultural and linguistic competence standards. Our findings indicate that, although these hospitals are taking the initial steps to prepare for the diversifying patient population, a great deal needs to be accomplished before they are able to meet the National Standards for Culturally and Linguistically Appropriate Services in Health Care established by the U.S. Department of Health and Human Services's Office of Minority Health.

Implementing cultural and linguistic competence in healthcare management curriculum.

As our nation's population continues to diversify, the need to provide culturally and linguistically appropriate services will intensify. In the healthcare industry, specifically, it is imperative that the services provided are congruent with patients' beliefs and practices in order to avoid fatal and costly errors. Much attention has been given to the role of clinicians in providing appropriate services to racially and ethnically diverse groups to eliminate disparities and lessen barriers to access. The need for cultural and linguistic competence, however, extends beyond clinicians. This paper discusses the need to add cultural and linguistic competencies to the healthcare management curriculum and presents a set of core competencies for healthcare management majors. A core competency model is presented along with discussion suggestions and student activities designed to make the learning process intellectually stimulating and improve student receptivity.