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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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Web sites are increasingly used by academic libraries to promote key services and collections to teaching faculty. This study analyzes the content, location, language, and technological features of fifty-four academic library Web pages designed especially for faculty to expose patterns in the development of these pages.  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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Within the school of thought known as Critical Thinking, identifying or finding missing assumptions is viewed as one of the principal thinking skills. Within the new subject in schools and colleges, usually called Critical Thinking, the skill of finding missing assumptions is similarly prominent, as it is in that subject's public examinations. In this article we examine how school‐ and college‐focused texts explain and teach ‘this very important skill’. The same texts also deal with the nature of assumptions, validity and the role of stated reasons in arguments, and the way these matters are tackled will also be examined in our inquiry. In addition we explore what respected contributors to the critical thinking movement have had to say about some of these issues.  相似文献   
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