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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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The issue of format duplication in academic library collections is increasingly complicated and perplexing in an environment of static or dwindling resources, soaring user expectations, dynamic access models, and inconsistent and changing publisher and vendor pricing structures. The problem is further complicated for libraries serving a university with multiple campus locations. This paper surveys recent investigative projects and highlights the work of a Duplicate Formats Task Force at Pennsylvania State University charged with determining the extent and nature of format duplication at that institution.  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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Interdisciplinary research is frequently viewed as an important component of the research landscape through its innovative ability to integrate knowledge from different areas. However, support for interdisciplinary research is often strategic rhetoric, with policy-makers and universities frequently adopting practices that favour disciplinary performance. We argue that disciplinary and interdisciplinary research are complementary, and we develop a simple framework that demonstrates this for a semi-permanent interdisciplinary research field. We argue that the presence of communicating infrastructures fosters communication and integration between disciplines and the interdisciplinary research field to generate innovative knowledge. We apply this to the experience of economic history in Australia in the second half of the twentieth century to demonstrate the life cycle of a semi-permanent interdisciplinary research field.  相似文献   
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