(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 |
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Understanding of the overall transplant process and time commitment |
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Current symptoms from previous therapies or disease |
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Current coping ability |
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Current pain |
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Current blood product requirements |
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Sedation preference for procedures |
Teaching |
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Length of time for work-up, mobilization, and transplant process |
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Role of caregiver |
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Care coordination |
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Confirm family/Friend plan for caregiving. |
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Contact referring physician’s office to obtain report |
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Confirm financial clearance |
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Confirm housing plan |
Carrying out the medical care plan |
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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 |
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Patient’s current fears and concerns |
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Barriers to learning |
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Current pain |
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Knowledge of disease status |
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Knowledge of transplant process |
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Knowledge of patient’s rights and responsibilities when participating in medical research |
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Usual coping strategies |
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Level of fatigue and usual sleep patterns |
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Patient’s experience in other health-care environments |
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Identified caregiver(s)’ commitment |
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Identified caregiver(s)’ barriers to learning |
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Allergies |
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Current medications and knowledge of purpose |
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Adherance in taking medications |
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Culture for presence of antibiotic resistant organisms |
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Current central venous access |
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History of central venous access |
Teaching |
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Logistics for working with home infusion companies and administration of home infusions. |
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Clinic logistics, including how to access care after hours |
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Importance of having a caregiver during various phases of the transplant process |
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Purpose of procedures, laboratory tests, and scans required for work-up |
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Overall transplant process |
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Usual complications of transplant |
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Central venous catheter preoperative teaching |
Care coordination |
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Assess ability to adhere to work-up schedule |
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Confirm financial clearance for transplant |
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Social work assessment |
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Nutrition assessment |
Carrying out the medical care plan |
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Maintain working knowledge of proposed transplant plan for patient |
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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.