Diane Brannon

Self-Reported Use of Anabolic-Androgenic Steroids by Elite Power Lifters.

In brief: Sixty-one athletes competed in the 1987 National Championship of the US Powerlifting Federation; all were surveyed to obtain information on anabolic-androgenic steroids regarding attitudes, patterns of use, and health effects. Of the 45 who responded to the survey, 15 admitted having used steroids. In a follow-up telephone interview of 20 of the competitors, 11 reported previous steroid use. The reason given most often for using steroids was improved athletic performance; the most common side effects reported were heightened libido, acne, and increased body hair. The small number of admitted users suggests that underreporting took place; this level of use probably represents the lower bound of steroid use among power lifters.

Anabolic Steroid Use: Indications of Habituation among Adolescents.

The use of anabolic steroids (AS) by adolescent males is argued to be more widespread than currently acknowledged. Although the long-term physiological and psychological ramifications of use are not well established, current research and anecdotal information suggest that there is reason for concern. In addition, very little is known about the attitudes and behaviors of these adolescent AS users. While the debate concerning the physiological versus the psychological dependence liability of various drugs continues to evolve, there seems to be a consensus that drug dependence is not a per se phenomenon and that the characteristics of dependence differ in accordance with the drug being used. The following article attempts to identify characteristics of the adolescent male AS user and suggests that AS use does have a dependence potential. The AS user population was found to be significantly different from nonusers in several areas such as self-perceptions of health and strength, interest in controlling AS use, and perceptions of peer AS use. The AS user group was also found to contain several subgroups (heavy users [≥ 5 cycles] versus other users, and those who initiated use prior to age sixteen who reported significantly different attitudes and/or behaviors. These differences suggest that prevention efforts will have to focus on different motivations for AS use.

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.

Quality Improvement in Nursing Care Facilities: Extent, Impetus, and Impact

This study examines the extent, motivation, and per formance implications of formal quality improvement (QI) programs in Pennsylvania nursing care facilities. Responses to a 20-item survey sent to facility adminis trators indicate that continuous quality improve ment/total quality management (CQI/TQM) adopters are more motivated by quality of care and human resource concerns in implementing QI, more satisfied with the results of QI efforts, and more aware of a com petitive environment than are non-adopters. There are few differences between adopters and non-adopters with respect to organizational characteristics or per formance on quality of care measures. Comparison with the results of a study of QI implementation in hospitals reveals some differences in motivation, but similarities in satisfaction with results.

Strategic orientation and TQM: Linking vision to action

Abstract Total Quality Management (TQM) programs have been increasing in popularity in the U.S., in part an organizational response to a turbulent environment. Yet empirical studies on the relationship between organizational strategy and implementation of TQM programs are scarce. This issue grows in importance as managers search for ways to integrate internal practices with strategic objectives. Using the Miles-Snow (1978) typology, we studied the relationship between strategic orientation of home health care organizations and their use of TQM practices. The sample for this study consisted of 361 home health care organizations from all major regions of the U.S. Regression analysis showed that the analyzer orientation significantly predicted commitment to quality improvement, after controlling for structural factors.

A structure-technology contingency analysis of caregiving in nursing facilities.

The purpose of this paper is to describe how the work associated with psychosocial and physical caregiving is structured within nursing facilities. Arguing from a contingency perspective, our central hypothesis is that because the technology underlying physical care is less variable and more interpretable and the process-outcome relationships underlying care processes are better understood than for psychosocial care, work in the physical care domain will be comparatively more mechanistically structured even though work in both domains is performed by the same paraprofessional nurse aide staff. Data for this analysis derive from a survey of unit charge nurses (n = 739) in 308 nursing homes in eight states undertaken as part of a large NIA-funded study of the relationship between nursing home organization and resident outcomes. With the exception of centralization, contingency theory correctly predicts how the work associated with physical and psychosocial care is differentiated.

Organizing for nursing home quality.

This article explores the relationship between job, work group, and organizational design and the quality of nursing home care. Contingency theorists contend that effective organizations develop structures that support the nature of their production processes and complement their environment. Within the same facility, units with differing care requirements should be structured differently to achieve quality outcomes. Efforts to improve quality can be integrated through the practice of total quality management and facilitated by using the Health Care Financing Administration Minimum Data Set.

Strategy, structure and performance in nursing facilities

This study tests the contingency theory proposition that a nursing facilitys strategy moderated by its management structure improves performance. Strategy is modeled in terms of degree of innovation; while structure is modeled as organic versus mechanistic. Payor mix, measured as the proportion of Medicaid residents, is used as an indicator of financial performance. Facilities in eight states comprise the sample (N = 308). The data are analyzed via hierarchical moderated regression analysis. The primary finding is that facilities that are both innovative and have an organic structure are more likely to have a lower proportion of Medicaid residents, an indicator of stronger financial performance.

Managerial implications of corporate board involvement and perceived market competition for quality improvement in nursing homes.

This study examines the relationships among corporate board involvement, total quality management (TQM) adoption, perceived market competition, and the perceived effect of quality improvement (QI) activities for a sample of nursing homes in Pennsylvania. The findings of this study have several implications for healthcare managers interested in maximizing the effectiveness of QI efforts. Board involvement in quality improvement was an important predictor of QI outcomes in the areas of finance, resident care, and human resources. However, TQM adoption had a positive effect on human resources outcomes only. These findings suggest that board involvement in any organized form of QI may be more important than the adoption of a formal TQM program in the nursing home industry. TQMs emphasis on employee empowerment may account for its positive influence on human resources. Perceived competition was associated with better financial outcomes. Low-cost leadership can be a key to survival in more competitive markets, requiring a focus on efficiency and productivity issues in QI efforts. By focusing on process improvement, the facilities may achieve cost reductions that can result in an improved financial position. Facilities perceived to be in more competitive environments were also more likely to adopt TQM. This is consistent with the assertion by resource-dependence theorists that organizations facing competition for resources must be responsive to the needs of resource-providing constituencies.

The joint relationship between organizational design factors and Hr practice factors on direct care workers’ job satisfaction and turnover intent

Background: Human resource (HR) practices, such as training and communication, have been linked to positive employee job commitment and lower turnover intent for direct care workers (DCWs). Not many studies have looked at the combined interaction of HR practices and organizational structure. Purpose: The aim of this study is to examine the relationship between organizational structure (centralization, formalization, and span of control) and HR practices (training, horizontal communication, and vertical communication) on DCW’s job satisfaction and turnover intent. Methodology: Data were collected from 58 long-term care facilities in five states. We used latent class analysis to group facility characteristics into three sets of combinations: “organic,” “mechanistic,” and “minimalist.” We used multivariate regression to test the relationship of each of these groups on DCW’s job satisfaction and turnover intent. Findings: After controlling for state, organizational, and individual covariates, the organic group, which represents decentralized and less formalized structures and high levels of job training and communication, was positively related to job satisfaction and negatively related to intent to leave. On the other hand, the minimalist group, which is characterized by low levels of job-related training and communication, showed no significant differences from the mechanistic group (referent) on job satisfaction and intent to leave. Practice Implications: These findings imply that managers in long-term care facilities may want to consider adopting organic, decentralized structures and HR practices to retain DCWs.