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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 aim of the present study is to access communication style in the Malaysian workplace through the development and validation of a communication scale appropriate to the Malaysian workplace. The analysis involved data from 200 state development employees, and construct and criterion-related validation using data from 510 employees, representing three organizations in Malaysia. The results provided support for the use of language (pekerti) and communication and interaction (bicara) as crucial communication dimensions for the Malaysian workplace, which are identified from the item-generation procedure.  相似文献   
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The purpose of this study was to intervene in the process of the Halliwick Method (swimming), in order to improve the method, or some of its aspects, for a sample of 14 individuals with Downs syndrome (aged six to 21 years), using both an individualized educational setting approach and a differentiation of the elements of the Halliwick Method. The pre-intervention phase included medical examination, IQ, measurement of the behaviour according to the Rutter Scale and a Test of Physical Performance for each subject. Next, the subjects were assigned to seven pairs of case studies, where each individual following a Halliwick Methods swimming programme was paired with an individual following a modified swimming programme based on the same method, on physical health variables, IQ, behaviour and motor abilities. The duration of each swimming programme was 24 weeks for each individual, at a frequency of once per week, for 40 minutes. In the light of the findings of this study, further recommendations for the improvement of Halliwick Method procedures were made, common factors that affected the performance of each individual were identified and their relation with performance was explored.  相似文献   
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