Flexibilidad psicológica y atención plena: analizando su valor añadido sobre los niveles de energía y motivación entre enfermeras procedentes de España y Cuba
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Resumen
La energía y motivación de los profesionales de enfermería son fundamentales para su bienestar, para garantizar la calidad asistencial, así como la permanencia de los trabajadores dentro de las organizaciones con altos niveles de compromiso. El objetivo de este trabajo fue explorar el valor añadido que tenían dos recursos personales del propio trabajador: su flexibilidad psicológica y atención plena, sobre sus niveles de vigor y agotamiento emocional relacionados con el trabajo, así como sobre su vitalidad y fatiga, controlando previamente otras demandas y recursos laborales. En el estudio participaron un total de 171 profesionales de enfermería procedentes de España y 50 profesionales de Cuba (10.9% varones y 86.9% mujeres). Se realizaron análisis descriptivos, correlacionales, contraste de medias y análisis de regresión jerárquica. Los resultados revelaron que la flexibilidad psicológica explicaba una parte significativa de la varianza en las puntuaciones de vigor, vitalidad y fatiga, mientras que la atención plena explicaba de forma significativa una parte de la varianza del agotamiento emocional. Demandas laborales como la ambigüedad de rol y recursos laborales como la autonomía, también mostraron un efecto directo importante. Los resultados se discuten en términos de la importancia de incorporar estas variables en los planes de prevención y promoción de la salud dentro de las organizaciones sanitarias.
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Palabras clave
bienestar, enfermería, energía, flexibilidad psicológica, atención plena, teoría de demandas y recursos laborales
Número
Sección
Artículos originales
Derechos de autor 2017 Summa Psicológica
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Referencias
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Alberts, H. J., Schneider, F., y Martijn, C. (2012). Dealing efficiently with emotions: Acceptance-based coping with negative emotions requires fewer resources than suppression. Cognition & Emotion, 26(5), 863-870. doi: 10.1080/02699931.2011.625402
Allen, T. D., y Kiburz, K. M. (2012). Trait mindfulness and work–family balance among working parents: The mediating effects of vitality and sleep quality. Journal of Vocational Behavior, 80(2), 372-379. doi: 10.1016/j.jvb.2011.09.002
Bakker, A. B., & Demerouti, E. (2013). La teoría de las demandas y los recursos laborales. Revista de Psicología del Trabajo y de las Organizaciones, 29(3), 107-115. doi: 10.5093/tr2013a16
Bakker, A. B., y Sanz-Vergel, A. I. (2013). Weekly work engagement and flourishing: The role of hindrance and challenge job demands. Journal of Vocational Behavior, 83(3), 397-409. doi: 10.1016/j.jvb.2013.06.008
Biron, M., y van Veldhoven, M. (2012). Emotional labour in service work: Psychological flexibility and emotion regulation. Human Relations, 65(10), 1259-1282. doi: 10.1177/0018726712447832
Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., ... y Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230-241. doi: 10.1093/clipsy.bph077
Bond, F. W., Flaxman, P. E., y Bunce, D. (2008). The influence of psychological flexibility on work redesign: mediated moderation of a work reorganization intervention. Journal of Applied Psychology, 93(3), 645-654. doi: 10.1037/0021-9010.93.3.645
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., ... Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4), 676-688. doi: 10.1016/j.beth.2011.03.007
Brown, K. W., y Ryan, R. M. (2003). The benefits of being present: mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822-848. doi: 10.1037/0022-3514.84.4.822
Cohen-Katz, J., Wiley, S. D., Capuano, T., Baker, D. M., y Shapiro, S. (2005). The effects of mindfulness-based stress reduction on nurse stress and burnout, Part II: A quantitative and qualitative study. Holistic Nursing Practice, 19(1), 26-35. doi: 10.1097/00004650-200501000-00008
Cole, M. S., Bruch, H., y Vogel, B. (2012). Energy at work: A measurement validation and linkage to unit effectiveness. Journal of Organizational Behavior, 33(4), 445-467. doi: 10.1002/job.759
Crawford, E. R., LePine, J. A., y Rich, B. L. (2010). Linking job demands and resources to employee engagement and burnout: a theoretical extension and meta-analytic test. Journal of Applied Psychology, 95(5), 834-848. doi: 10.1016/j.brat.2005.10.001
Demerouti, E., Bakker, A. B., Nachreiner, F., y Schaufeli, W. B. (2000). A model of burnout and life satisfaction amongst nurses. Journal of Advanced Nursing, 32(2), 454-464.doi:10.1046/j.1365-2648.2000.01496.x
Demerouti, E., Bakker, A. B., Nachreiner, F., & Schaufeli, W. B. (2001). The job demands-resources model of burnout. Journal of Applied psychology, 86(3), 499-512. doi: 10.1037//0021-9010.86.3.499
Escribà-Agüir, V., Mas Pons, R., y Flores Reus, E. (2001). Validation of the Job Content Questionnaire in hospital nursing staff. Gaceta Sanitaria, 15(2), 142-149. doi: 10.1016/S0213-9111(01)71533-6
Gauthier, T., Meyer, R. M., Grefe, D., y Gold, J. I. (2015). An on-the-job mindfulness-based intervention for pediatric ICU nurses: a pilot. Journal of Pediatric Nursing, 30(2), 402-409. doi: 10.1016/j.pedn.2014.10.005
Glomb, T. M., Duffy, M. K., Bono, J. E., y Yang, T. (2011). Mindfulness at work. En J. Martocchio, H. Liao, y A. Joshi (Eds.), Research in personnel and human resource management (pp. 115–157). doi: 10.1108/S0742-7301(2011)0000030005
González, J. L.G., Moreno-Jiménez, B., Garrosa E. H., y López, A. L. (2005). Spanish version of the Swedish Occupational Fatigue Inventory (SOFI): Factorial replication, reliability and validity. International Journal of Industrial Ergonomics, 35(8), 737-746. doi: 10.1016/j.ergon.2005.02.007
Halbesleben, J. R. (2010). A meta-analysis of work engagement: Relationships with burnout, demands, resources, and consequences. Work engagement: A handbook of essential theory and research, 8, 102-117.
Hayes, S. C., Strosahl, K. D., y Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York, NY, USA: Guilford Press. doi: 10.1016/s0022-3999(97)00019-6
Heinen, M. M., van Achterberg, T., Schwendimann, R., Zander, B., Matthews, A., Kózka, M., ... y Schoonhoven, L. (2013). Nurses’ intention to leave their profession: A cross-sectional observational study in 10 European countries. International Journal of Nursing Studies, 50(2), 174-184.
doi:10.1016/j.ijnurstu.2012.09.019
Hülsheger, U. R., Alberts, H. J., Feinholdt, A., y Lang, J. W. (2013). Benefits of mindfulness at work: The role of mindfulness in emotion regulation, emotional exhaustion, and job satisfaction. Journal of Applied Psychology, 98(2), 310-325. doi: 10.1037/a0031313
Iglesias, M. E., Vallejo, R. B. D. B., y Fuentes, P. S. (2010). The relationship between experiential avoidance and burnout syndrome in critical care nurses: A cross-sectional questionnaire survey. International Journal of Nursing Studies, 47(1), 30-37. doi:10.1016/j.ijnurstu.2009.06.014
Jenaro, C., Flores, N., Orgaz, M. B., y Cruz, M. (2011). Vigour and dedication in nursing professionals: towards a better understanding of work engagement. Journal of Advanced Nursing, 67(4), 865-875. doi: 10.1111/j.1365-2648.2010.05526.x
Kabat-Zinn, J. (1990). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York, NY: Delacorte Press.
Kanste, O. (2011). Work engagement, work commitment and their association with well‐being in health care. Scandinavian Journal of Caring Sciences, 25(4), 754-
761. doi:10.1111/j.1471-6712.2011.00888.x
Karasek, R., Brisson, C., Kawakami, N., Houtman, I., Bongers, P., y Amick, B. (1998). The Job Content Questionnaire (JCQ): An instrument for internationally comparative assessments of psychosocial job characteristics. Journal of Occupational Health Psychology, 3(4), 322-355. doi: 10.1037/1076-8998.3.4.322
Leroy, H., Anseel, F., Dimitrova, N. G., y Sels, L. (2013). Mindfulness, authentic functioning, and work engagement: A growth modeling approach. Journal of Vocational Behavior, 82(3), 238-247. doi: 10.1016/j.jvb.2013.01.012
Lloyd, J., Bond, F. W., y Flaxman, P. E. (2013). The value of psychological flexibility: Examining psychological mechanisms underpinning a cognitive behavioural therapy intervention for burnout. Work & Stress, 27(2), 181-199. doi: 10.1080/02678373.2013.782157
Maclean, K. (2013). ACT at Work: Feasibility study of an acceptance based intervention to promote mental health well-being and work engagement in mental health service staff (Tesis doctoral). University of Glasgow.
McCracken, L. M., y Yang, S. Y. (2008). A contextual cognitive-behavioral analysis of rehabilitation workers' health and well-being: Influences of acceptance, mindfulness, and values-based action. Rehabilitation Psychology, 53(4), 479-485. doi: 10.1037/a0012854
Moreno-Jiménez, B., Galvez Herrer, M., Rodríguez-Carvajal, R., y Garrosa Hernández, E. (2010). Emociones y salud en el trabajo: análisis del constructo" trabajo emocional" y propuesta de evaluación. Revista Latinoamericana de Psicología,
42(1), 63-73.
Moreno-Jiménez, B., Garrosa, E., y Gutiérrez, J. L. G. (2000). The nursing burnout: Development and factorial validation of the CDPE. Archivos Prevención de Riesgos Laborales [Prevention of Workplace Hazards Archives], 3(1), 18-28. Retrieved from http://www.bvsde.ops-ms.org/bvsacd/cd49/burnout_enferm.pdf
Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory. New York: McGraw-Hill.Poghosyan, L., Clarke, S. P., Finlayson, M., y Aiken, L. H. (2010). Nurse burnout and quality of care: Cross-national investigation in six countries. Research in Nursing & Health. 33(4), 288-298. doi:10.1002/nur.20383
Rodriguez-Carvajal, R., Méndez, D.D., Moreno-Jiménez, B., Abarca, A.B., y Van Dierendonck, D. (2010). Vitality and inner resources as relevant components of psychological well-being. Psichothema, 22(1), 63-70. doi: 10.1037/e572992012-471
Ruiz, F. J., Langer Herrera, Á. I., Luciano, C., Cangas, A. J., & Beltrán, I. (2013).Measuring experiential avoidance and psychological inflexibility: the Spanish version of the Acceptance and Action Questionnaire-II. Psicothema, 25(1), 123-129. doi: 10.7334/psicothema2011.239
Ruiz, C.O., Rios, F.L., Martin, S.G. (2008). Psychological intervention for profesional burnout in the Palliative Care Unit at Gregorio Marañon University Hospital. Medicina Preventiva, 15(2), 93-97.
Ryan, R. M., y Frederick, C. (1997). On energy, personality, and health: Subjective vitality as a dynamic reflection of well‐being. Journal of Personality, 65(3), 529-565. doi: 10.1111/j.1467-6494.1997.tb00326.x
Schaufeli, W. B., Salanova, M., González-Romá, V., y Bakker, A. B. (2002). The measurement of engagement and burnout: A two sample confirmatory factor analytic approach. Journal of Happiness Studies, 3(1), 71-92. doi: 10.1023/a:1015630930326
Simpson, M. R. (2009). Engagement at work: A review of the literature. International Journal of Nursing Studies, 46(7), 1012-1024. doi: 10.1016/j.ijnurstu.2008.05.003
Soler, J., Tejedor, R., Feliu-Sol, A., Pascual, J. C., Cebolla, A., Soriano, J., ... Pérez, V. (2012a). Propiedades psicométricas de la versión española de la escala Mindful Attention Awareness Scale (MAAS). Actas Españolas de Psiquiatría, 40(1), 19-26. Recuperado de http://repositori.uji.es/xmlui/bitstream/handle/10234/67740/53388.pdf?sequence=1&isAllowed=y
Xanthopoulou, D., Bakker, A. B., Demerouti, E., & Schaufeli, W. B. (2007). The role of personal resources in the job demands-resources model. International Journal of Stress Management, 14(2), 121-141. doi: 10.1037/1072-5245.14.2.121
Zohar, D., Tzischinski, O., y Epstein, R. (2003). Effects of energy availability on immediate and delayed emotional reactions to work events. Journal of Applied Psychology, 88(6), 1082-1093. doi: 10.1037/0021-9010.88.6.1082
Alberts, H. J., Schneider, F., y Martijn, C. (2012). Dealing efficiently with emotions: Acceptance-based coping with negative emotions requires fewer resources than suppression. Cognition & Emotion, 26(5), 863-870. doi: 10.1080/02699931.2011.625402
Allen, T. D., y Kiburz, K. M. (2012). Trait mindfulness and work–family balance among working parents: The mediating effects of vitality and sleep quality. Journal of Vocational Behavior, 80(2), 372-379. doi: 10.1016/j.jvb.2011.09.002
Bakker, A. B., & Demerouti, E. (2013). La teoría de las demandas y los recursos laborales. Revista de Psicología del Trabajo y de las Organizaciones, 29(3), 107-115. doi: 10.5093/tr2013a16
Bakker, A. B., y Sanz-Vergel, A. I. (2013). Weekly work engagement and flourishing: The role of hindrance and challenge job demands. Journal of Vocational Behavior, 83(3), 397-409. doi: 10.1016/j.jvb.2013.06.008
Biron, M., y van Veldhoven, M. (2012). Emotional labour in service work: Psychological flexibility and emotion regulation. Human Relations, 65(10), 1259-1282. doi: 10.1177/0018726712447832
Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., ... y Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230-241. doi: 10.1093/clipsy.bph077
Bond, F. W., Flaxman, P. E., y Bunce, D. (2008). The influence of psychological flexibility on work redesign: mediated moderation of a work reorganization intervention. Journal of Applied Psychology, 93(3), 645-654. doi: 10.1037/0021-9010.93.3.645
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., ... Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4), 676-688. doi: 10.1016/j.beth.2011.03.007
Brown, K. W., y Ryan, R. M. (2003). The benefits of being present: mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822-848. doi: 10.1037/0022-3514.84.4.822
Cohen-Katz, J., Wiley, S. D., Capuano, T., Baker, D. M., y Shapiro, S. (2005). The effects of mindfulness-based stress reduction on nurse stress and burnout, Part II: A quantitative and qualitative study. Holistic Nursing Practice, 19(1), 26-35. doi: 10.1097/00004650-200501000-00008
Cole, M. S., Bruch, H., y Vogel, B. (2012). Energy at work: A measurement validation and linkage to unit effectiveness. Journal of Organizational Behavior, 33(4), 445-467. doi: 10.1002/job.759
Crawford, E. R., LePine, J. A., y Rich, B. L. (2010). Linking job demands and resources to employee engagement and burnout: a theoretical extension and meta-analytic test. Journal of Applied Psychology, 95(5), 834-848. doi: 10.1016/j.brat.2005.10.001
Demerouti, E., Bakker, A. B., Nachreiner, F., y Schaufeli, W. B. (2000). A model of burnout and life satisfaction amongst nurses. Journal of Advanced Nursing, 32(2), 454-464.doi:10.1046/j.1365-2648.2000.01496.x
Demerouti, E., Bakker, A. B., Nachreiner, F., & Schaufeli, W. B. (2001). The job demands-resources model of burnout. Journal of Applied psychology, 86(3), 499-512. doi: 10.1037//0021-9010.86.3.499
Escribà-Agüir, V., Mas Pons, R., y Flores Reus, E. (2001). Validation of the Job Content Questionnaire in hospital nursing staff. Gaceta Sanitaria, 15(2), 142-149. doi: 10.1016/S0213-9111(01)71533-6
Gauthier, T., Meyer, R. M., Grefe, D., y Gold, J. I. (2015). An on-the-job mindfulness-based intervention for pediatric ICU nurses: a pilot. Journal of Pediatric Nursing, 30(2), 402-409. doi: 10.1016/j.pedn.2014.10.005
Glomb, T. M., Duffy, M. K., Bono, J. E., y Yang, T. (2011). Mindfulness at work. En J. Martocchio, H. Liao, y A. Joshi (Eds.), Research in personnel and human resource management (pp. 115–157). doi: 10.1108/S0742-7301(2011)0000030005
González, J. L.G., Moreno-Jiménez, B., Garrosa E. H., y López, A. L. (2005). Spanish version of the Swedish Occupational Fatigue Inventory (SOFI): Factorial replication, reliability and validity. International Journal of Industrial Ergonomics, 35(8), 737-746. doi: 10.1016/j.ergon.2005.02.007
Halbesleben, J. R. (2010). A meta-analysis of work engagement: Relationships with burnout, demands, resources, and consequences. Work engagement: A handbook of essential theory and research, 8, 102-117.
Hayes, S. C., Strosahl, K. D., y Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York, NY, USA: Guilford Press. doi: 10.1016/s0022-3999(97)00019-6
Heinen, M. M., van Achterberg, T., Schwendimann, R., Zander, B., Matthews, A., Kózka, M., ... y Schoonhoven, L. (2013). Nurses’ intention to leave their profession: A cross-sectional observational study in 10 European countries. International Journal of Nursing Studies, 50(2), 174-184.
doi:10.1016/j.ijnurstu.2012.09.019
Hülsheger, U. R., Alberts, H. J., Feinholdt, A., y Lang, J. W. (2013). Benefits of mindfulness at work: The role of mindfulness in emotion regulation, emotional exhaustion, and job satisfaction. Journal of Applied Psychology, 98(2), 310-325. doi: 10.1037/a0031313
Iglesias, M. E., Vallejo, R. B. D. B., y Fuentes, P. S. (2010). The relationship between experiential avoidance and burnout syndrome in critical care nurses: A cross-sectional questionnaire survey. International Journal of Nursing Studies, 47(1), 30-37. doi:10.1016/j.ijnurstu.2009.06.014
Jenaro, C., Flores, N., Orgaz, M. B., y Cruz, M. (2011). Vigour and dedication in nursing professionals: towards a better understanding of work engagement. Journal of Advanced Nursing, 67(4), 865-875. doi: 10.1111/j.1365-2648.2010.05526.x
Kabat-Zinn, J. (1990). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York, NY: Delacorte Press.
Kanste, O. (2011). Work engagement, work commitment and their association with well‐being in health care. Scandinavian Journal of Caring Sciences, 25(4), 754-
761. doi:10.1111/j.1471-6712.2011.00888.x
Karasek, R., Brisson, C., Kawakami, N., Houtman, I., Bongers, P., y Amick, B. (1998). The Job Content Questionnaire (JCQ): An instrument for internationally comparative assessments of psychosocial job characteristics. Journal of Occupational Health Psychology, 3(4), 322-355. doi: 10.1037/1076-8998.3.4.322
Leroy, H., Anseel, F., Dimitrova, N. G., y Sels, L. (2013). Mindfulness, authentic functioning, and work engagement: A growth modeling approach. Journal of Vocational Behavior, 82(3), 238-247. doi: 10.1016/j.jvb.2013.01.012
Lloyd, J., Bond, F. W., y Flaxman, P. E. (2013). The value of psychological flexibility: Examining psychological mechanisms underpinning a cognitive behavioural therapy intervention for burnout. Work & Stress, 27(2), 181-199. doi: 10.1080/02678373.2013.782157
Maclean, K. (2013). ACT at Work: Feasibility study of an acceptance based intervention to promote mental health well-being and work engagement in mental health service staff (Tesis doctoral). University of Glasgow.
McCracken, L. M., y Yang, S. Y. (2008). A contextual cognitive-behavioral analysis of rehabilitation workers' health and well-being: Influences of acceptance, mindfulness, and values-based action. Rehabilitation Psychology, 53(4), 479-485. doi: 10.1037/a0012854
Moreno-Jiménez, B., Galvez Herrer, M., Rodríguez-Carvajal, R., y Garrosa Hernández, E. (2010). Emociones y salud en el trabajo: análisis del constructo" trabajo emocional" y propuesta de evaluación. Revista Latinoamericana de Psicología,
42(1), 63-73.
Moreno-Jiménez, B., Garrosa, E., y Gutiérrez, J. L. G. (2000). The nursing burnout: Development and factorial validation of the CDPE. Archivos Prevención de Riesgos Laborales [Prevention of Workplace Hazards Archives], 3(1), 18-28. Retrieved from http://www.bvsde.ops-ms.org/bvsacd/cd49/burnout_enferm.pdf
Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory. New York: McGraw-Hill.Poghosyan, L., Clarke, S. P., Finlayson, M., y Aiken, L. H. (2010). Nurse burnout and quality of care: Cross-national investigation in six countries. Research in Nursing & Health. 33(4), 288-298. doi:10.1002/nur.20383
Rodriguez-Carvajal, R., Méndez, D.D., Moreno-Jiménez, B., Abarca, A.B., y Van Dierendonck, D. (2010). Vitality and inner resources as relevant components of psychological well-being. Psichothema, 22(1), 63-70. doi: 10.1037/e572992012-471
Ruiz, F. J., Langer Herrera, Á. I., Luciano, C., Cangas, A. J., & Beltrán, I. (2013).Measuring experiential avoidance and psychological inflexibility: the Spanish version of the Acceptance and Action Questionnaire-II. Psicothema, 25(1), 123-129. doi: 10.7334/psicothema2011.239
Ruiz, C.O., Rios, F.L., Martin, S.G. (2008). Psychological intervention for profesional burnout in the Palliative Care Unit at Gregorio Marañon University Hospital. Medicina Preventiva, 15(2), 93-97.
Ryan, R. M., y Frederick, C. (1997). On energy, personality, and health: Subjective vitality as a dynamic reflection of well‐being. Journal of Personality, 65(3), 529-565. doi: 10.1111/j.1467-6494.1997.tb00326.x
Schaufeli, W. B., Salanova, M., González-Romá, V., y Bakker, A. B. (2002). The measurement of engagement and burnout: A two sample confirmatory factor analytic approach. Journal of Happiness Studies, 3(1), 71-92. doi: 10.1023/a:1015630930326
Simpson, M. R. (2009). Engagement at work: A review of the literature. International Journal of Nursing Studies, 46(7), 1012-1024. doi: 10.1016/j.ijnurstu.2008.05.003
Soler, J., Tejedor, R., Feliu-Sol, A., Pascual, J. C., Cebolla, A., Soriano, J., ... Pérez, V. (2012a). Propiedades psicométricas de la versión española de la escala Mindful Attention Awareness Scale (MAAS). Actas Españolas de Psiquiatría, 40(1), 19-26. Recuperado de http://repositori.uji.es/xmlui/bitstream/handle/10234/67740/53388.pdf?sequence=1&isAllowed=y
Xanthopoulou, D., Bakker, A. B., Demerouti, E., & Schaufeli, W. B. (2007). The role of personal resources in the job demands-resources model. International Journal of Stress Management, 14(2), 121-141. doi: 10.1037/1072-5245.14.2.121
Zohar, D., Tzischinski, O., y Epstein, R. (2003). Effects of energy availability on immediate and delayed emotional reactions to work events. Journal of Applied Psychology, 88(6), 1082-1093. doi: 10.1037/0021-9010.88.6.1082