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Managed care poses numerous opportunities and challenges for today's health care organizations and their employees. This article investigates the ways that hospital nurses develop and make sense of their professional roles and organizational environments in a changing and often uncertain managed care setting. The case study approach used in this research combined qualitative methodologies to gain a rich, detailed, and contextual understanding of nurses' work roles and organizational experiences. After an analysis of interviews with 24 nurses and observations of nurses' communicative activities on one inpatient unit, the complexity of sensemaking and role development in a managed care environment is considered. Conclusions are then drawn regarding the theoretical and pragmatic implications of nurses' communicative processes, as they attempted to develop and understand their roles in a changing organizational context.  相似文献   
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The poor reading achievement of African-American children in urban schools is well established. African-American children from low-income homes may be at particular risk for reading difficulties, although middle-income children often fare poorly as well. Intervention efforts have focused on children in kindergarten through fifth grade. This article suggests that prevention efforts must begin prior to kindergarten entry. Several key variables that may influence young children's performance, including poverty, general oral language skills, dialectal variations, home literacy practices, standardized testing bias, and teacher expectations, are explored. Future directions for research addressing emergent literacy in African-American children are discussed throughout.  相似文献   
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This article first looks at the relationship between museums and art galleries and their potential audiences and, in particular, the under-represented sector of young visitors. It examines the main findings from the limited research available on young visitors, and goes on to discuss theories delineating the differences between the cultures, identities and values of culture consumers and culture providers. The second part of the article looks at what specific museums have done towards being more inclusive in their appeal, and then reports the findings of a survey of young people in relation to New Zealand's Auckland Art Gallery. The survey found that young people's ideas of what constitutes modern, relevant art do not match standard art criteria, and that most exhibitions and marketing methods do not mesh with their worldview. The article concludes by using data from the survey to suggest ways of engaging more young people with public art galleries.  相似文献   
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In 2001, the Regenstrief Institute for Health Care and the Indiana University School of Medicine (IUSM) began an IAIMS planning effort to create a vision and a tactical plan for the first Integrated Advanced Information Management Systems (IAIMS) implementation to cross a large area and include unaffiliated institutions. A number of elements made this planning effort unique. Among these elements were the existence of a network infrastructure that supported the Indianapolis Network for Patient Care, the existence of a mature medical informatics program at the Regenstrief Institute, and the existence of a wide-area knowledge network fostered by the IUSM libraries. However, the leadership for a strong information technology role in the IUSM that could promote collaboration in support of education and research across the diverse Indianapolis hospital systems had been lacking. By bringing together various groups, each with a commitment to improve health care quality and public health across the Indianapolis metropolitan area, regardless of individual institutional affiliation, the strategic directions for I3-Indianapolis IAIMS Initiative have been defined and the foundations for a third generation IAIMS construct have been laid in Indianapolis, Indiana.  相似文献   
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This single-case meta-analysis is the first to provide a quantitative synthesis of the published literature on mathematics word problem-solving intervention studies for English learners with learning disabilities and mathematics difficulties. A total of ten single-subject studies were included for analysis. The current study investigated the magnitude of the effect of mathematics interventions targeting the improvement of students’ mathematics word problem-solving performance, and analyzed variables that moderated this effect. Results indicate a moderate overall effect size of 0.81 (95% CI [0.71, 0.90]) on word problem-solving performance for English learners with learning disabilities and mathematics difficulties. Moderator variables such as the implementer of the interventions, instructional focus, and word problem-solving content significantly moderated the mathematics intervention effects.  相似文献   
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