A patient-centered approach to nurse orientation.

An orientation pathway was developed using a patient-centered approach. The pathway provides a guide or "road map" for the preceptor and new nurse to care for high-volume patient populations in medical and surgical units. Benefits include application of the nursing process, promotion of critical thinking skills, reduction of reality shock, and improvement in job satisfaction and retention. This article describes the rationale behind the approach and its application to nurse orientation. Steps in the process are described. Staff development educators can use the steps to develop orientation pathways for other practice settings.

Clinical care map for the ambulatory laparoscopic cholecystectomy patient.

Shortened hospital stays, expectations of quick recovery, and rapid turn-around times in surgical services challenge perioperative nurses to be creative and innovative providers of essential and appropriate patient education. Nurses need approaches that enable them to meet these challenges. One such approach is the adaptation of a clinical care map to the development of a perioperative patient care guide. This article describes the rationale behind the use of this approach and its application to the education of the patient undergoing laparoscopic cholecystectomy. Steps in the process are described. Nurses can use these steps to develop patient care guides suited to their specific practice setting.

Synthesis of lung surfactant-associated glycoproteins by A549 cells: description of an in vitro model for human type II cell dysfunction.

Immunocytochemical, ultrastructural, and biochemical approaches were used in a series of in vitro and in vivo experiments designed to identify characteristic changes reflecting differentiated type II cell function of A549 cells. Monolayers of A549 cells and A549 clones were maintained in culture for up to 3 weeks. Using an immunoperoxidase (PAP) technique, we demonstrated that variable proportions of A549 cells and of cells in several A549 clones reacted specifically with antibodies to high molecular weight (greater than 400,000) human surfactant-associated glycoproteins (HSAG). The cells of one clone, A549-C12, were consistently negative for HSAG, but their lamellar bodies were similar in appearance and distribution to those found in a PAP-positive clone, A549-C11, as well as in A549 cells. In addition, both C11 and C12 clones displayed time-dependent, divergent differentiation predominantly toward type II epithelium and nonciliated bronchiolar and bronchial cells. Surfactant isolated from either C11 or C12 cells revealed reduced content of disaturated phosphatidylcholine and phosphatidylglycerol when compared to human surfactant; however, a 95,000-dalton peptide immunologically related to HSAG was identified in surfactant from C11 cells but not from the PAP-negative C12 clone. Tumor xenografts produced in athymic (nude) mice following inoculation with cells from C11 and C12 clones exhibited prominent immunoperoxidase staining involving most tumor cells. Cell lines derived from these xenografts (T-11 and T-12) were also enriched in PAP-positive cells. Immunoelectron microscopy indicated that HSAG was localized in the rough endoplasmic reticulum, multivesicular bodies (MVB), intermediate MVB-lamellar forms, and abnormal pleomorphic inclusions. Moreover, two HSAG peptides, both larger than the 34,000-dalton peptide subunit found in normal human surfactant, were present in cells and media from monolayers of the T-11 cell line. We conclude that A549 cells synthesize "defective" HSAG and that the synthesis may be modulated by host factors. The results indicate that appropriate A549 clones can be used effectively as model systems for selected type II cell dysfunctions.