BACKGROUND: This article describes how nurse educators at The Hospital for Sick Children, Toronto, have used Benner's findings as a framework to direct the advancement of professional development programs, specifically preceptorship, orientation, and central education programs. METHOD: Narrative methodology was introduced as a key educational strategy to capture the complexity of pediatric clinical practice and enhance learning experiences. RESULTS: The shift in content and structure of the education programs from a structured behavioral teaching-learning framework to the use of narrative methodology has enhanced learning, professional development and clinical practice. CONCLUSION: Participant evaluations of these programs suggest a high level of satisfaction with the use of narrative methodology. Evaluative measures focusing on the relationship between narrative methodology, professional development, and client outcomes is needed. This evaluative approach that measures outcomes is imperative to future directions in program planning.

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Identification of a subpopulation of reactive large granular mononuclear cells in allogeneic heart transplantation.

This study is designed to test the hypothesis that specific morphologic attributes of peripheral blood mononuclear cells, measurable by flow cytometry, are correlated with the timing and the intensity of allograft injury during the development of heart rejection. A pig model of major histocompatibility complex-mismatched heterotopic heart transplantation with (n = 5) and without (n = 5) cyclosporine administration was monitored serially be telemetered electrocardiography and endomyocardial biopsies. Flow cytometric analysis of peripheral blood mononuclear cells revealed the emergence of a discrete subpopulation of peripheral blood mononuclear cells (7.8% +/- 1.0% and 8.5% +/- 0.9% before transplantation to 16.5% +/- 1.3% and 19.4% +/- 3.0% after transplantation in the untreated and the cyclosporine-treated groups, respectively, p < 0.05), exhibiting characteristic changes in forward and 90-degree light scatter, indicative of increased cell size and granularity, and possibly representing monocytes or large granular lymphocytes. Lymphocyte cell surface-marker studies indicated that 62% of these cells are DH59B+ (monocyte/granulocyte). Because intracellular free calcium is an important second messenger in lymphocyte activation we measured intracellular free calcium by flow cytometry using fluo-3. This subpopulation of cells was found to have similar intracellular free calcium when compared to normal-sized lymphocytes (104 +/- 7 nmol/L versus 101 +/- 5 nmol/L, respectively). We conclude that this lymphocyte subset detected by flow cytometry represents specifically reactive cells that are associated with incipient allograft rejection.

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Organizational career development: an overview.

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