Marilyn V. Whitman

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.

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.

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.

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

As the nations 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 states 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 Servicess Office of Minority Health.

Barriers associated with implementing a campus‐wide smoke‐free policy

Purpose – The purpose of this study is to review the barriers associated with implementing a campus‐wide smoke‐free policy as perceived by the American Cancer Societys Colleges against Cancer (CAC) Program chapter representatives.Design/methodology/approach – Four focus group sessions were conducted at the annual CAC National Leadership Summit in October 2006. A total of 109 participants, or 41.4 percent of the total population of CAC member institutions, attended the focus groups.Findings – All participants identified encountering barriers at some stage of the implementation process. Three major themes emerged when participants were asked to identify what they perceived to be the most significant barriers to successfully implementing a campus‐wide smoke‐free policy: lack of administrative and staff support, student involvement, and resources.Practical implications – With the rising rate of smoking among college students and the release of the 2006 Surgeon Generals report citing the harmful effects of s...

Revisiting the Impostor Phenomenon: How Individuals Cope with Feelings of Being in Over their Heads

The recent economic recession has led many organizations to downsize, or eliminate positions, in an effort to cut labor costs and improve profitability. Survivors may suddenly find themselves over-rewarded, or prematurely promoted, into one or more vacant positions. One negative consequence of over-reward in particular, impostor phenomenon, may present significant challenges at both the individual and organizational level. Thus, the purpose of this chapter is to examine the consequences and coping strategies of survivors who perceive themselves as over-rewarded and under-qualified for a job. Hobfolls Conservation of Resources Theory (COR) serves as this studys framework to explicate the outcomes associated with impostor feelings and how impostors cope with their perceived inadequacy. Specifically, we propose that impostor feelings will be positively related to emotional exhaustion. To deal with the exhaustion, impostors may rely on coping strategies in order to master the additional internal and external demands created by feelings of impostorism. The type of strategy used by impostors to cope with the exhaustion is influenced by the level of perceived social support. That is, impostors who perceive higher levels of support will resort to active coping while those who perceive lower levels of support will resort to avoidant coping. Managerial implications and directions for future research are offered.

Examining the impostor phenomenon and work-family conflict

Purpose – The purpose of this paper is to examine the moderated-mediational relationship between the impostor phenomenon (IP) and work-to-family conflict (WFC). Building on conservation of resources (COR) theory, the authors hypothesize that individuals who experience the IP lack the initial resources needed to meet work demands and, thus, experience emotional exhaustion, which leads to WFC. However, the authors hypothesize that additional resources provided by organizations, such as perceived organizational support (POS), may weaken the negative experiences of imposters. Design/methodology/approach – The authors tested a moderated-mediation model using data from a time-lagged survey study among 92 Midwest community college employees. Regression was used to examine the mediating effects of emotional exhaustion and the moderating effect of POS on the IP to WFC relationship. Findings – Results support the hypothesized model. Emotional exhaustion is a mediating mechanism in the relationship between the IP an...

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

The increasing diversification of the nations 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 Alabamas 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 Healths Culturally and Linguistically Appropriate Services standards. The HRDs of the 101 Alabama general hospitals served as the studys 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.

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.