Situational strength pertains to the idea that various characteristics of situations have the ability to restrict the expression and, therefore, the criterion-related validity of individual differences. Despite situational strength’s intuitive appeal, however, little information exists regarding its construct space. This review (a) categorizes extant operationalizations into four facets (constraints, consequences, clarity, and consistency), (b) examines the empirical literature on situational strength—relevant hypotheses, and, on the basis of the proposed taxonomy and literature review, (c) provides several avenues for future theoretical and empirical research. It is the authors’ hope that these efforts will encourage additional research and theorizing on this potentially important psychological construct.
Situational strength has long been viewed as a useful way of conceptualizing and predicting person–situation interactions. Some have recently argued, however, that more rigorous empirical tests of its behavioral influence are sorely needed. The current article begins addressing this literature gap by (a) developing the Situational Strength at Work (SSW) scale, (b) examining the ways in which individual differences influence perceptions of situational strength, and (c) testing situational strength’s moderating effects on two types of voluntary work behavior (i.e., organizational citizenship behavior and counterproductive work behavior). Results indicate strong psychometric properties for the SSW (thereby facilitating future organizational research on situational strength), support for theoretically based predictions regarding the role of individual differences in perceptions of situational strength, support for theoretically based moderator effects on organizational citizenship behavior, and the presence of countertheoretical (yet strong and consistent) moderator effects on counterproductive work behavior. Thus, this study makes several contributions to the situational strength literature but also reveals important areas for future theoretical development and empirical research.
Background and Objectives
Antipsychotic medications have been widely used in nursing homes to manage behavioral and psychological symptoms of dementia, despite significantly increased mortality risk. Use grew rapidly during the 2000s, reaching 23.9% of residents by 2011. A national campaign for safer dementia care in U.S. nursing homes was launched in 2012, with public reporting of quality measures, increased regulatory scrutiny, and accompanying state and facility initiatives. By the second quarter of 2019, use had declined by 40.1% to 14.3%. We assessed the impact of state and facility initiatives during the Campaign aimed at encouraging more-judicious prescribing of antipsychotic medications.
Research Design and Methods
Our mixed-methods strategy integrated administrative and clinical data analyses with state and facility case studies.
Results
Results suggest that substantial change in prescribing is achievable through sustained, data-informed quality improvement initiatives integrating educational and regulatory interventions, supported by public quality reporting. Adequate staffing, particularly of registered nurses, is key to support individualized management of symptoms through nonpharmacological strategies. Case study results suggest that state and facility initiatives during the campaign achieved considerable buy-in for the goal of more conservative prescribing, through a social process of normalization. Reporting and reduction of antipsychotic use was not followed by increases in sedative-hypnotic medication use. Rather, sedative-hypnotic use declined in tandem with antipsychotic reduction, suggesting that increased attention to prescribing patterns led to more cautious use of other risky psychotropic medications.
Discussion and Implications
Quality improvement initiatives to change entrenched but problematic clinical practices face many barriers to success, including provider-level inertia; perceptions that alternatives are not available; and family and staff resistance. Nevertheless, systemic change is possible through concerted, collaborative efforts that touch prescribing practices at multiple points; integrate educational and regulatory influences; activate local and state champions for improvement; foster reputational influences through public reporting and benchmarking; and support a social process of normalization of preferred care processes as a best practice that is in the interest of patients.
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