Every Minute Counts: Using Process Improvement and Performance Feedback to Improve Patient Flow in an Emergency Department

Prolonged emergency department (ED) visits are associated with a number of adverse outcomes for patients as well as lower patient satisfaction scores and increased costs. Several factors that influence the length of ED visits are out of the control of hospital employees, but some opportunities exist to improve performance. For this study, the ED department of a 150-bed hospital in the southeastern United States wanted to improve door-to-discharge time. To do so, a subprocess of door-to-discharge time was targeted, door-to-order. After analyzing the process, the team created standard orders for the 10 most common presenting conditions in the ER with preapproval, allowing nurses to submit the orders without the provider first visiting the patient. Following the process change, daily feedback was added to increase utilization of the preapproved orders. Reductions in door-to-order times and door-to-discharge were observed and patient satisfaction remained stable. Implications for future research in this area are discussed.     

Marriage and separation risks among German cohabiters: Differences between types of cohabiter

We propose a typology of different meanings of cohabitation that combines cohabiters’ intentions to marry with a general attitude toward marriage, using competing risk analyses to examine whether some cohabiters are more prone than others to marry or to separate. Using data (N = 1,258) from four waves of the German Family Panel (PAIRFAM) and a supplementary study (DEMODIFF), we compared eastern and western German cohabiters of the birth cohorts 1971–73 and 1981–83. Western Germans more frequently view cohabitation as a step in the marriage process, whereas eastern Germans more often cohabit as an alternative to marriage. Taking into account marital attitudes reveals that cohabiters without marriage plans differ from those with plans in their relationship careers, and also shows that cohabiters who plan to marry despite holding a less favourable view of marriage are less likely to realize their plans than cohabiters whose intentions and attitudes are more congruent.     

Negative (But Not Positive) Parenting Interacts with Infant Negative Affect to Predict Infant Approach: Evidence of Diathesis‐Stress

Temperament by parenting interactions may reflect that individuals with greater risk are more likely to experience negative outcomes in adverse contexts (diathesis‐stress) or that these individuals are more susceptible to contextual influences in a “for better or for worse” pattern (differential susceptibility). Although such interactions have been identified for a variety of child outcomes, prior research has not examined approach characteristics—excitement and approach toward pleasurable activities—in the first year of life. Therefore, this study investigated whether 6‐month maternal reported infant negative affect—a phenotypic marker of risk/susceptibility—interacted with 8‐month observed parenting behaviors (positive parenting, negative parenting) to predict 12‐month infant behavioral approach. Based on a sample of mothers and their infants (N = 150), results indicated that negative parenting was inversely associated with subsequent approach for infants with high, but not low, levels of negative affect. Similar results did not occur regarding positive parenting. These findings better fit a diathesis‐stress model rather than a differential susceptibility model. Implications and limitations of these findings are discussed.     

Timing of Remarriage Among Divorced and Widowed Parents

Research on timing of parental remarriage is important to understanding consequences of remarriage for children. In this study, survival analyses were conducted predicting timing of parental remarriage from parental loss in a sample of 3,774 offspring whose parents divorced or whose mother or father died during childhood. Transition to remarriage was quicker for parents who divorced compared to those who were widowed, especially for fathers. By examining timing of remarriage from the perspective of parents, and thus children, we identify not only who is more likely to experience parental remarriage, but when remarriage is likely to occur.     

Minority Stress,Emotion Regulation,and the Parenting of Sexual-Minority Youth

ABSTRACT

Despite increasing societal acceptance of sexual-minority individuals, there are still gay, lesbian, and bisexual (GLB) adolescents who experience negative mental health outcomes. Minority stress theory posits that stigma-related stress associated with sexual-minority status drives increased risk among GLB individuals. Furthermore, recent evidence suggests that minority stress impacts emotion regulation (ER), identified as a particularly important risk factor for sexual-minority youth (SMY). Current research has identified some aspects of parenting contribute to GLB youth's mental health. We review the literature in these areas, and also integrate research from the broader developmental field on families and emotion socialization in order to identify the need for studies of parenting that go beyond existing data on parental acceptance and supportiveness of youth's sexual orientation. Limitations of the current literature and directions for future research are discussed, with specific focus on implications for interventions with SMY and their families.     

The effects of under‐skilling on need for recovery,losing employment and retirement intentions among older office workers: A prospective cohort study

Based on a sample of older workers from the Maastricht Cohort Study, the authors investigate the prevalence and dynamics of self‐reported under‐skilling and its effects on workers' need for recovery, their risk of losing employment and their retirement intentions over a two‐year period. They find that being under‐skilled is associated both with higher levels of need for recovery over time and with the risk of losing employment, but not with early retirement intentions. To achieve sustainable employment, they argue, the course of under‐skilling should be monitored throughout workers' careers, enabling timely interventions to avoid its negative consequences.     

Continuity and Change in the Family System Across the Transition from Adolescence to Emerging Adulthood

As adolescents move into emerging adulthood, their social networks shift toward a focus on peers and romantic partners, yet parents and siblings remain important sources of support. The present review takes a family systems approach to integrate the growing body of literature examining longitudinal continuity and change in both positive (e.g., intimacy, support) and negative (e.g., conflict, rivalry) qualities of parent–child and sibling relationships as adolescents transition to emerging adulthood. In general, contact with family members decreases, yet the quality of family relationships appears to improve or, at the very least, stabilize across this transition. These pathways are interpreted within the lens of several prominent theories, and a discussion of the limitations of the current literature and ideas for future research are presented.