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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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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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The purpose of this ecological study was to examine the impact of a library credit course on graduation rates and GPA using pre-existing records. Over 20?years of aggregate institutional data were analyzed to evaluate the course's impact on first-time-full-time, white, and black students. Results were mixed: students who took the course were less likely to graduate than their peers who did not take the course but enjoyed slightly higher GPAs at graduation. It was discovered that students taking the course are not representative of the overall student body and struggle academically. Implications for revisions to the library credit course are discussed.  相似文献   
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This article presents early results of a research project designed to further our understanding of how to ensure that small scholar‐led journals can survive and thrive in a global open access knowledge commons. This phase of the research focuses on generation of ideas through interviews and focus groups with 15 participants involved in producing small scholar‐led journals that either are or would like to become open access. Although a couple of journals reported that they could survive in an open access future based on existing resources, most were concerned about survival and none expressed confidence that they could thrive in an open‐access future. These journals are far more diverse than one might imagine. Comparing the costs of article production from one journal with another might not make sense. A number of avenues for further research are discussed.  相似文献   
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