Determinants of resource development strategies in nonprofit organizations: An analysis of children, youth and family services

This study is an exploratory analysis of an operational measure for resource development strategies, and an exploratory analysis of internal organizational contingencies influencing choices of these strategies in charitable nonprofit organizations. The study provides conceptual guidance for advancing understanding about resource development in the nonprofit sector. The statistical findings are, however, inconclusive without further rigorous examination. A three category typology based on organization technology is initially presented to define the strategies. Three dimensions of internal organizational contingencies explored represent organization identity, professional staff, and boards of directors. Based on relevant literature and key informant interviews, an original survey was administered by mail to a national sample of nonprofit organizations. The survey collected data on indicators of the proposed strategy types and selected contingencies. Factor analysis extracted two of the initial categories in the typology. The Building Resource Development Infrastructure Strategy encompasses information technology, personnel, legal structures, and policies facilitating fund development. The Building Resource Development Infrastructure Strategy encompasses the mission, service niche, and type of service delivery forming the basis for seeking financial support. Linear regressions with each strategy type as the dependent variable identified distinct and common contingencies which may partly explain choices of strategies. Discriminant analysis suggests the potential predictive accuracy of the contingencies. Follow-up case studies with survey respondents provide additional criteria for operationalizing future measures of resource development strategies, and support and expand the analysis on contingencies. The typology offers a beginning framework for defining alternative approaches to resource development, and for exploring organization capacity specific to each approach. Contingencies that may be integral components of organization capacity are funding, leadership frame, background and experience, staff and volunteer effort, board member support, and relationships in the external environment. Based on these findings, management questions are offered for nonprofit organization stakeholders to consider in planning for resource development. Lessons learned in designing and conducting this study are also provided to enhance future related research. ^

Teams leading teams: Examining the role of leadership in multi-team systems

A major challenge of modern teams lies in the coordination of the efforts not just of individuals within a team, but also of teams whose efforts are ultimately entwined with those of other teams. Despite this fact, much of the research on work teams fails to consider the external dependencies that exist in organizational teams and instead focuses on internal or within team processes. Multi-Team Systems Theory is used as a theoretical framework for understanding teams-of-teams organizational forms (Multi-Team Systems; MTS's); and leadership teams are proposed as one remedy that enable MTS members to dedicate needed resources to intra-team activities while ensuring effective synchronization of between-team activities. Two functions of leader teams were identified: strategy development and coordination facilitation; and a model was developed delineating the effects of the two leader roles on multi-team cognitions, processes, and performance.^ Three hundred eighty-four undergraduate psychology and business students participated in a laboratory simulation that modeled an MTS; each MTS was comprised of three, two-member teams each performing distinct but interdependent components of an F-22 battle simulation task. Two roles of leader teams supported in the literature were manipulated through training in a 2 (strategy training vs. control) x 2 (coordination training vs. control) design. Multivariate analysis of variance (MANOVA) and mediated regression analysis were used to test the study's hypotheses. ^ Results indicate that both training manipulations produced differences in the effectiveness of the intended form of leader behavior. The enhanced leader strategy training resulted in more accurate (but not more similar) MTS mental models, better inter-team coordination, and higher levels of multi-team (but not component team) performance. Moreover, mental model accuracy fully mediated the relationship between leader strategy and inter-team coordination; and inter-team coordination fully mediated the effect of leader strategy on multi-team performance. Leader coordination training led to better inter-team coordination, but not to higher levels of either team or multi-team performance. Mediated Input-Process-Output (I-P-O) relationships were not supported with leader coordination; rather, leader coordination facilitation and inter-team coordination uniquely contributed to component team and multi-team level performance. The implications of these findings and future research directions are also discussed. ^

The role of a Christian church in the career development of its congregants

The purpose of this study was to examine the role of a Christian church in the career development of its congregants. Contemporary theorists in the 21st century view career development as the totality of an individual's life, and the literature revealed that 85% of Americans claim the practice of Christianity as a major life role. Therefore, an understanding of the church's role in the lives of its congregants is essential when conceptualizing career development theories. Traditional and contemporary theories formed the framework for this examination, which was guided by four research questions: How do congregants of a local church view its contribution to their career development; how do church leaders characterize the potential of the church for making a contribution to the career development of congregants; how useful are church sermon concepts to the career development of congregants; how do church programs and activities contribute to the career development of congregants? A Christian church in South Florida was the study's site, as it was identified as a church which focused on career development. Basic interpretive qualitative inquiry was used to collect and analyze three data sources: interviews, sermon recordings, and church documents. Twenty-four participants were interviewed using two interview guides to elicit perspectives of 15 congregants and 9 church leaders. The interviews and 13 sermon recordings were transcribed and analyzed. Church documents were categorized and analyzed for evidence of career development programs and activities. The findings revealed that the church played the following role in the participants' life career development: empowerment, guidance for life, learning and development, safety and support, and servant-leadership. As a result of their church participation, and through the learning and development from programs and activities, participants developed an awareness of their identity, purpose, and meaning for their lives. These constructs supported their interactions within the environments of home, work, school, and community. This holistic perspective revealed that an integration of traditional and contemporary career development theories was necessary to conceptualize the role of this Christian church in the career development of its congregants.

The career development of Black female chief nurse executives

This qualitative study was designed to explore the career development of Black female chief nurse executives. Although a small proportion of Black female nurses have achieved positions at the nurse executive level, there remains a paucity of Black female nurse executives in this crucial position which raised the question of what factors contributed to this lack of advancement, but, more important, what factors have contributed to the success of the few who have achieved such level of success in healthcare organizations. The purpose of the study was to explore the career paths of Black female chief nurse executives with a view of understanding the factors which both facilitate and hinder the career development of these leaders in healthcare organizations. The guiding research question was, How do Black female nurse executives in this sample describe their career development? The participants in this study were Black female chief nurse executives located throughout the United States who, for the most part, were raised in segregation with a strong family foundation. To collect data, semistructured telephone interviews were conducted with 10 Black female chief nurse executives throughout the United States. The transcripts from the interviews were transcribed, coded, and analyzed. Using Super’s (1990, 1996), and Gottfredson’s (1981, 1996, 2002, 2005) career development theories and critical race theory (Crenshaw, 1995; Delgado, 2000) as the theoretical framework, the researcher found that the participants’ career development was influenced by (a) strong support system, (b) guidance, (c) influence of diversity, and (d) servant leadership. The findings help us understand the factors that have contributed to their successes as Black chief nurse executives. With the increasingly diverse population and concurrent increasing diversity in nursing and concerns about healthcare disparities, it is imperative that organizations attract, hire, develop, retain, and advance qualified Black nurses. Future studies addressing not only the career development of Black nurses but nurses in general might be informed by the present study’s findings. Recommendations are offered for nursing practice, education, and organizational policy.

Developing a leadership identity: A case study exploring a select group of Hispanic women at a Hispanic serving institution

Leadership is a socially constructed concept shaped by the context, values and experiences of society (Klenke, 1996); the historical context of gender and ethnicity in society affects views about leadership and who merits a leadership role. Therefore, developing an understanding of Hispanic women students’ leadership identity development is critical in broadening how we define leadership and develop leadership education. The purpose of this qualitative case study was to explore and describe the leadership identity development of a select group of women leaders at a Hispanic Serving Institution (HSI) in the southeast. A psychosocial approach to the study was utilized. In-depth interviews and focus groups were conducted with 11 self-identified Hispanic women students of sophomore, junior or senior standing with varying degrees of involvement in leadership activities at Florida International University. Participants were asked questions related to four topics; (a) leadership, (b) gender, (c) ethnic identity, and (d) influences that contributed to their understanding of self as leader. Five topics emerged from the data presented by the participants’: (a) encouraging relationships, (b) meaningful experiences, (c) self development, (d) the role of gender, and (e) impact of ethnicity. These themes contributed to the leadership identity development of the participants. Findings indicate that leadership identity development for Hispanic women college students at this HSI is complex. The concept of leadership identity development presented in the literature was challenged as findings indicate that the participants’ experiences living and attending a school in a majority-minority city influenced their development of a leadership identity. The data indicate that leadership is not gender or ethnicity neutral as differences exist in expectations of men and women in leadership roles. Gender expectations posed particular challenges for these women student leaders. The prescriptive nature of stage-based models was problematic as findings indicated leadership identity development a complicated and continuing process influenced strongly by relationships and experiences. This study enhanced knowledge of the ways that Hispanic women students become leaders and the influences that shape their leadership experiences which can assist higher education professionals in developing leadership programs and courses that address gender, multiculturalism and awareness of self as leader.

The role of community college faculty in teaching and learning for sustainable development

The purpose of this study was to explore the attitudes, beliefs, and practices of community college professors regarding education for sustainable development (ESD). In-depth interviews with 14 professors from different disciplines were conducted. The participants taught at Miami Dade College, Florida, a Talloires Declaration signatory since 2006, and all had attended Green Studies professional development workshops. Written documents such as assignments and samples of student work were used for triangulation. The annual report of the college’s Earth Ethics Institute and its Web site served as additional sources. The interviews were recorded, transcribed, and analyzed for common themes. The Talloires Declaration’s 10-point action plan and the key characteristics of ESD (UN DESD, 2006) served as the conceptual framework. The study found that the professors considered ESD an essential issue. The majority discussed the economic and social aspects of ESD; however, the environmental aspect was mentioned most frequently. The professors’ conceptualizations of ESD were influenced by their experiences and evidenced by the metaphors they used. Although their engagement with ESD differed, the professors expressed optimism toward ESD related teaching and learning. They regarded ESD as compatible with their subjects, and most had already been infusing sustainability into their courses or planned to do so. Additionally, the participants’ teaching practices reflected many of the characteristics of ESD. Even though the professors considered ESD challenging, they believed that they could make contributions to the college’s effort. The metaphor of “Planting a Seed” was frequently used to describe this holistic approach. The study also found that many professors regarded interpersonal relationships and communication significant factors for the advancement of ESD. The participants described several challenges to integrating ESD at their college. These related to time constraints, density of curriculum, institutional size and fragmentation, dearth of administrative support and incentives, students’ lack of academic preparation and sustainability awareness, students’ inability to focus on ESD because of personal, social, or economic circumstances, and professors’ frustration about a divisive atmosphere as a result of their engagement with sustainability. Despite these obstacles, the professors believed that ESD could be successfully woven into the community college experience.

Human Resource Development Practices in U.S. Enterprises in Russia: A Literature Review

This study investigated human resource development (HRD) in Russian enterprises, U.S. firms in Russia, or U.S.-Russian joint ventures. Thirty-three articles were selected through a database search and examined using content analysis. Emerging themes included workers’ knowledge and skills, training practices, organizational involvement, responsibility, and communication, and leadership styles.

A study of the relationship between employee virtuality and technology deviance as mediated by leadership and employee perceptions

Recent studies found that organizations have been investing significant capital in developing teams and employees in geographic areas where labor and resources are considerably cheaper. Furthermore, organizations are moving core operational activities such as research and development and back-office processes to globally distributed teams. ^ However, several factors that are inherent to these virtual teams can have a negative impact on employee perceptions and engagement; specifically, the physical and temporal differences between employees and their supervisors, the lack of meaningful social interaction intrinsic to working relationships, and cultural biases that can be fostered when close, daily interactions is not there to help bridge the dissimilarity. ^ When strategies are not in place to mitigate these deficiencies, it can cause virtual employees to disengage emotionally and intellectually from the organization, or lead them to feel justified in working against the best interest of the company. ^ Past research indicates that although deviant behavior in the workplace is not new, transgressions committed by employees have been increasing significantly every year. Beyond the focus of why employees are motivated to act against the organization, to what extent do the recent changes to the organization’s structure influence this type of behavior through their actions at the macro (organizational) and micro level (leadership). ^ In addition, there is a related phenomenon that has aided the transformation of the workplace—namely, the ubiquity of technology. In the context of workplace deviance, established research has documented an increasing trend of employees utilizing company technology as a medium and amplifier when harming the organization. It is important to understand whether technology has facilitated or hindered workplace deviance by virtue of the technology itself (as a means), and as part of the new employee roles created by the evolving technology (i.e., virtual employees). Therefore, it is important to identify how individual attitudes and behaviors can be affected by an employee’s degree of virtuality. ^ This study will add to the understanding of how social interaction and physical proximity, leadership and other perception factors contribute to the changes organizations are experiencing as their structure evolves and adapts to compete in the new global environment. ^

The relationships between elementary school principals' emotional intelligence, leadership style and school culture

The role of the principal in school settings and the principal's perceived effect on student achievement have frequently been considered vital factors in school reform. The relationships between emotional intelligence, leadership style and school culture have been widely studied. The literature reveals agreement among scholars regarding the principal's vital role in developing and fostering a positive school culture. The purpose of this study was to explore the relationships between elementary school principals' emotional intelligence, leadership style and school culture. ^ The researcher implemented a non-experimental ex post facto research design to investigate four specific research hypotheses. Utilizing the Qualtrics Survey Software, 57 elementary school principals within a large urban school district in southeast Florida completed the Emotional Quotient Inventory (EQ-i), and 850 of their faculty members completed the Multifactor Leadership Questionnaire (MLQ Form 5X). Faculty responses to the school district's School Climate Survey retrieved from the district's web site were used as the measure of school culture. ^ Linear regression analyses revealed significant positive associations between emotional intelligence and the following leadership measures: Idealized Influence-Attributes (β = .23, p = < .05), Idealized Influence-Behaviors (β = .34, p = < .01), Inspirational Motivation (β = .39, p = < .01) and Contingent Reward (β = .33, p = < .01). Hierarchical regression analyses revealed positive associations between school culture and both transformational and transactional leadership measures, and negative associations between school culture and passive-avoidant leadership measures. Significant positive associations were found between school culture and the principals' emotional intelligence over and above leadership style. Hierarchical linear regressions to test the statistical hypothesis developed to account for alternative explanations revealed significant associations between leadership style and school culture over and above school grade. ^ These results suggest that emotional intelligence merits consideration in the development of leadership theory. Practical implications include suggestions that principals employ both transformational and transactional leadership strategies, and focus on developing their level of emotional intelligence. The associations between emotional intelligence, transformational leadership, Contingent Reward and school culture found in this study validate the role of the principal as the leader of school reform.^

Students and Universities: Leading the Future of Development- Lecture by Rajiv Shah, USAID

Lecture held at School of International and Public Affairs Ballroom by college of Arts and Sciences and co-sponsored by Division of Research. Since being sworn in in 2007,Shah had managed US Government's response to 2010 Port-Au-Prince earthquake, co-chaired State Department's first review of American diplomacy, and spearheads Obama's Landmark "Feed the Future" food security initiative. Part of Ruth K. and Shepard Broad Distinguished Lecture Series

A Study of the Relationship between Employee Virtuality and Technology Deviance as Mediated by Leadership and Employee Perceptions

Recent studies found that organizations have been investing significant capital in developing teams and employees in geographic areas where labor and resources are considerably cheaper. Furthermore, organizations are moving core operational activities such as research and development and back-office processes to globally distributed teams. However, several factors that are inherent to these virtual teams can have a negative impact on employee perceptions and engagement; specifically, the physical and temporal differences between employees and their supervisors, the lack of meaningful social interaction intrinsic to working relationships, and cultural biases that can be fostered when close, daily interactions is not there to help bridge the dissimilarity. When strategies are not in place to mitigate these deficiencies, it can cause virtual employees to disengage emotionally and intellectually from the organization, or lead them to feel justified in working against the best interest of the company. Past research indicates that although deviant behavior in the workplace is not new, transgressions committed by employees have been increasing significantly every year. Beyond the focus of why employees are motivated to act against the organization, to what extent do the recent changes to the organization’s structure influence this type of behavior through their actions at the macro (organizational) and micro level (leadership). In addition, there is a related phenomenon that has aided the transformation of the workplace – namely, the ubiquity of technology. In the context of workplace deviance, established research has documented an increasing trend of employees utilizing company technology as a medium and amplifier when harming the organization. It is important to understand whether technology has facilitated or hindered workplace deviance by virtue of the technology itself (as a means), and as part of the new employee roles created by the evolving technology (i.e, virtual employees). Therefore, it is important to identify how individual attitudes and behaviors can be affected by an employee’s degree of virtuality. This study will add to the understanding of how social interaction and physical proximity, leadership and other perception factors contribute to the changes organizations are experiencing as their structure evolves and adapts to compete in the new global environment.

The influence of a peer mentor program for international students on domestic peer mentors and their intercultural development

In this study, a mixed method approach was used to examine the experience of 43 domestic peer mentors who participated in a peer mentoring program for international students offered at Memorial University of Newfoundland, St. John’s, Canada. The study aimed to answer the following questions: 1) does participating in a mentorship program for international students result in change in the intercultural development for domestic peer mentors as measured by the Intercultural Development Inventory (IDI)? 2) what were the experiences of domestic peer mentors participating in a peer mentoring program for international students? Following the Developmental Model of Intercultural Sensitivity (Bennett, 1998) as a guide, this study used the scores from the Intercultural Development Inventory (IDI) to gain an understanding of the influence of the program. The scores obtained pre and post mentorship experiences were compared and a significant difference was found. Reflections from 120 monthly reports and seven individual semi-structured interviews were also conducted to gain a deeper understanding of the mentorship experience and the influence it had on the mentors’ intercultural development. The benefits of intercultural peer mentoring on student development of skills such as leadership, communication and empathy are also discussed. The study echoes previous research that calls for an increased amount of facilitated intercultural program within university campuses. The study also advocates for further implementation of programs that provide opportunities for intercultural learning between domestic and international students in order for intercultural development to improve in higher educational settings.

Leading from the Edge: Marginal Leadership at Cultural Crossroads

If a church reflects its larger community, it will have more dynamic interactions among different people. Current U.S. communities consist of very diverse people who have different socioeconomic and cultural backgrounds. Since the mid 20th century, various immigrant communities who have dissimilar cultural, religious, and linguistic traditions have accelerated the need of change in American churches. The drastic cultural change has demanded churches to equip their lay and clergy leaders with multicultural competencies for effective ministries.

My thesis explores imaginative leadership in cultural crossroads. Emphasizing the leadership imagination of cross-cultural ministry, I approach it in biblical, theological, and missional perspectives. In this dynamic cultural milieu, the study topic may help the church renew its ecclesial purpose by seeing cross-cultural ministry as a creative opportunity to reach out to more diverse people of God. I begin with a conceptual framework for cross-cultural ministry and cultural intelligence. Then I explain why cross-cultural ministry is significant and how it enhances the spirit of Christ Jesus. As I develop the thesis, I discuss leadership challenge and development in the cross-cultural ministry context. This thesis may contribute to equipping lay and clergy leaders by overcoming the homogeneous ‘in-group’ mindset in the church.

The primary focus is on developing marginal leadership of church in the post-Christendom era. Church leaders must creatively hold the tension between the current church context and Christian faith resources and seek a hopeful resolution as a third way through integrative thought process. While conventional leadership emphasizes a better choice out of the given options, marginal leadership takes time for integrative thought process to seek a new direction for the future. Conventional leaders take the center with their power, status, and prestige, but marginal leaders position themselves on the edge. Leading from the edge is a distinctive cross-cultural leadership and is based on the servant leadership of Jesus Christ who put himself as a servant for the marginalized. By serving and relating to others on the margin, this imaginative leadership may make appropriate changes desired in today’s American churches.

In addition to academic research, I looked into the realities of cross-cultural leadership in the local churches through congregational studies. I speculated that church leadership involves both laity and clergy and that it can be enhanced. All Christians are called to serve the Lord according to their gifts, and it is crucial for lay and clergy persons to develop their leadership character and skills. In particular, as humans are contextualized with their own cultures, church leaders often confront great challenges in cross-cultural or multicultural situations. Through critical thoughts and imaginative leadership strategies, however, they can overcome intrinsic human prejudice and obstacles.

Through the thesis project, I have reached four significant conclusions. First, cultural intelligence is an essential leadership capacity for all church leaders. As the church consists of more diverse cultural people today, its leaders need to have cultural competencies. In particular, cross-cultural leaders must be equipped with cultural intelligence. Cross-cultural ministry is not a simple byproduct of social change, but a creative strategy to open a door to bring God’s reconciliation among diverse people. Accordingly, church leaders are to be well prepared to effectively cope with the challenges of cultural interactions. Second, both lay and clergy leaders’ imaginative leadership is crucial for leading the congregation. While conventional leadership puts an emphasis on selecting a better choice based on the principle of opportunity cost, imaginative leaders critically consider the present church situations and Christian faith values together in integrative thoughts and pursue a third way as the congregation’s future hope. Third, cross-cultural leadership has a unique characteristic of leading from the edge and promotes God’s justice and peaceable relationships among different people. By leading the congregation from the edge, church leaders may experience the heart of Christ Jesus who became the friend of the marginalized. Fourth, the ‘homogeneous unit principle’ theory has its limit for today’s complex ‘inter-group’ community context. The church must be a welcoming and embracing faith community for all people. Cross-cultural ministry may become an entrance door for a more peaceable and reconciling life among different people. By building solidarity with others, the church may experience a kingdom reality.

This thesis focuses on the mission of the church and marginal leadership of church leaders in ever-changing cultural crossroads. The church becomes a hope in the broken and apathetic world, and Christians are called to build relationships inside and beyond the church. It is significant for church leaders to be faithfully present on the margin and relate to diverse people. By consistently positioning themselves on the margin, they can build relationships with new and diverse people and shape a faithful life pattern for others.

In Whose Image: The Emergence, Development, and Challenge of African-American Evangelicalism

The current era of American Christianity marks the transition from a Western, white-dominated U.S. Evangelicalism to an ethnically diverse demographic for evangelicalism. Despite this increasing diversity, U.S. Evangelicalism has demonstrated a stubborn inability to address the entrenched assumption of white supremacy. The 1970s witnessed the rise in prominence of Evangelicalism in the United States. At the same time, the era witnessed a burgeoning movement of African-American evangelicals, who often experienced marginalization from the larger movement. What factors prevented the integration between two seemingly theologically compatible movements? How do these factors impact the challenge of integration and reconciliation in the changing demographic reality of early twenty-first Evangelicalism?

The question is examined through the unpacking of the diseased theological imagination rooted in U.S. Evangelicalism. The theological categories of Creation, Anthropology, Christology, Soteriology, and Ecclesiology are discussed to determine specific deficiencies that lead to assumptions of white supremacy. The larger history of U.S. Evangelicalism and the larger story of the African-American church are explored to provide a context for the unique expression of African-American evangelicalism in the last third of the twentieth century. Through the use of primary sources — personal interviews, archival documents, writings by principals, and private collection documents — the specific history of African-American evangelicals in the 1960s and 1970s is described. The stories of the National Black Evangelical Association, Tom Skinner, John Perkins, and Circle Church provide historical snapshots that illuminate the relationship between the larger U.S. Evangelical movement and African-American evangelicals.

Various attempts at integration and shared leadership were made in the 1970s as African-American evangelicals engaged with white Evangelical institutions. However, the failure of these attempts point to the challenges to diversity for U.S. Evangelicalism and the failure of the Evangelical theological imagination. The diseased theological imagination of U.S. Evangelical Christianity prevented engagement with the needed challenge of African American evangelicalism, resulting in dysfunctional racial dynamics evident in twenty-first century Evangelical Christianity. The historical problem of situating African American evangelicals reveals the theological problem of white supremacy in U.S. Evangelicalism.

The Career Development of Black Female Chief Nurse Executives

This qualitative study was designed to explore the career development of Black female chief nurse executives. Although a small proportion of Black female nurses have achieved positions at the nurse executive level, there remains a paucity of Black female nurse executives in this crucial position which raised the question of what factors contributed to this lack of advancement, but, more important, what factors have contributed to the success of the few who have achieved such level of success in healthcare organizations. The purpose of the study was to explore the career paths of Black female chief nurse executives with a view of understanding the factors which both facilitate and hinder the career development of these leaders in healthcare organizations. The guiding research question was, How do Black female nurse executives in this sample describe their career development? The participants in this study were Black female chief nurse executives located throughout the United States who, for the most part, were raised in segregation with a strong family foundation. To collect data, semistructured telephone interviews were conducted with 10 Black female chief nurse executives throughout the United States. The transcripts from the interviews were transcribed, coded, and analyzed. Using Super’s (1990, 1996), and Gottfredson’s (1981, 1996, 2002, 2005) career development theories and critical race theory (Crenshaw, 1995; Delgado, 2000) as the theoretical framework, the researcher found that the participants’ career development was influenced by (a) strong support system, (b) guidance, (c) influence of diversity, and (d) servant leadership. The findings help us understand the factors that have contributed to their successes as Black chief nurse executives. With the increasingly diverse population and concurrent increasing diversity in nursing and concerns about healthcare disparities, it is imperative that organizations attract, hire, develop, retain, and advance qualified Black nurses. Future studies addressing not only the career development of Black nurses but nurses in general might be informed by the present study’s findings. Recommendations are offered for nursing practice, education, and organizational policy.