The Nurse’s Role in Preparing Patients for Stem Cell Transplantation | Aplastic Anemia and MDS International Foundation

The Nurse’s Role in Preparing Patients for Stem Cell Transplantation

(excerpted from Thomas’ Hematopoietic Stem Cell Transplantation, 5th Edition)

The first interface many patients have with an HCT transplant program occurs at the time they come for a second opinion. Often patients make a consultation appointment to compare a particular program with other centers they are considering. These patients meet with a transplant physician to review their options, a financial counselor, and a nurse. The nurse’s role is to assist the patient with this decision by explaining the logistics of the program, including the usual length of stay on the inpatient unit and how much of the transplant process will be managed on an outpatient basis. Many patients are interested in the nursing services at the program they are considering and ask questions about the nurse-to-patient ratio. The responsibilities of the patient’s caregiver are reviewed as well. At that time, many families are concerned with the logistics of relocating and incorporating this intense therapy into their lives. These patients present with a myriad of questions, and the nurse must be versatile in meeting the patients’ and families’ informational needs. Nurses often are also responsible for giving information regarding the transplant program to physicians and nurses from the referring center as well as to third-party payers.

Prework-up/prior to patient’s arrival at transplant center

Assessment

Understanding of the overall transplant process and time commitment

Current symptoms from previous therapies or disease

Current coping ability

Current pain

Current blood product requirements

Sedation preference for procedures

Teaching

Length of time for work-up, mobilization, and transplant process

Role of caregiver

Care coordination

Confirm family/Friend plan for caregiving.

Contact referring physician’s office to obtain report

Confirm financial clearance

Confirm housing plan

Carrying out the medical care plan

Maintain working knowledge of proposed transplant plan for patient

Work-up

Once a patient has met initial screening and has decided to undergo HCT at a specific center, the nurse’s primary responsibility becomes education. The patient must understand the specifics of the rigorous evaluation. The coordination and timing of care during this phase is especially critical if the patient has an unrelated donor. The completion of work-up and the initiation of conditioning must start on an exact date to allow HSC infusion on the planned date of HSC procurement. The generosity of the volunteer donors must be respected and accommodated.

Assessment

Patient’s current fears and concerns

Barriers to learning

Current pain

Knowledge of disease status

Knowledge of transplant process

Knowledge of patient’s rights and responsibilities when participating in medical research

Usual coping strategies

Level of fatigue and usual sleep patterns

Patient’s experience in other health-care environments

Identified caregiver(s)’ commitment

Identified caregiver(s)’ barriers to learning

Allergies

Current medications and knowledge of purpose

Adherance in taking medications

Culture for presence of antibiotic resistant organisms

Current central venous access

History of central venous access

Teaching

Logistics for working with home infusion companies and administration of home infusions.

Clinic logistics, including how to access care after hours

Importance of having a caregiver during various phases of the transplant process

Purpose of procedures, laboratory tests, and scans required for work-up

Overall transplant process

Usual complications of transplant

Central venous catheter preoperative teaching

Care coordination

Assess ability to adhere to work-up schedule

Confirm financial clearance for transplant

Social work assessment

Nutrition assessment

Carrying out the medical care plan

Maintain working knowledge of proposed transplant plan for patient

Ensure all work-up studies are obtained in a timely manner

Preconditioning

The nurse plays an important role in the informed consent process, supporting the medical staff’s explanations and plans to ensure, as much as possible, that the patient is making an informed decision regarding HCT.

Donor preparation

Donors have been called the “forgotten patients” of transplant. The HCT recipient, appropriately, is the center of focus for the transplant team. However, donors also have concerns about their own health and the procedures they will undergo. It is ideal for donors to have a primary nurse with whom they can establish a relationship and who can prepare them for the hematopoietic cell collection and monitor them throughout the procedure.  The Foundation for the Accreditation of Cellular Therapy (FACT) has also determined that the donor must be cared for by a different physician than the transplant recipient.