Bone Marrow Transplant Nurses Research Articles

The Phenotype of a Bone Marrow Transplant Nurse: Survival of the Fittest

There is a need for proficient nursing practice in specialized critical care settings, such as a pediatric Bone Marrow Transplant (BMT) Unit. The staffing crisis continues to be problematic for areas around the country. Nursing tenure has been positively correlated with improving patient outcomes and confidence in giving care, so efforts must be made to retain pediatric BMT nurses. The purpose of this study was to investigate factors of resilience and how it pertains to the retention of pediatric BMT nurses through 1) Understanding current BMT nursing turnover and trend why nurses are leaving; 2) Measure resilience throughout BMT nursing cohort, covering all tenure of nurses; and 3) Interview senior nurses within the cohort to identify themes relating to retention and resilience using grounded theory methodology. This research was carried out in the Bone Marrow Transplant (BMT) Unit at Cincinnati Children's Hospital Medical Center (CCHMC). The study spanned from 2014 to 2019, during which researchers gathered extensive data to evaluate the turnover risk among BMT nurses. A detailed follow-up was conducted in 2019 to further assess this risk. To measure resilience levels, a group of 115 nurses in the unit completed the Connor Davidson Resilience Scale (CD-RISC). Additionally, in-depth interviews were conducted with nine senior nurses in the cohort, continuing until theoretical saturation was reached, ensuring a comprehensive understanding of the factors influencing nurse turnover in the unit. Researchers looked retrospectively at nursing turnover from 2014-2019. Investigators determined the risk of new nurses leaving was between 22 and 24 months (HR 0.025). Further, follow-up was conducted for data points between 2019-present time, which showed a drastic change in the hazard rate curvature. However, the risk remained relatively the same at 22-24 months (HR 0.03). There was no statistical significance found between CD-RISC results and age (p=0.465), gender (p=0.725), working experience (p=0.15), or education (p=0.14). Through a constant comparative process, several themes were identified as positive, negative, and ambiguous contributions to the retention of nurses. The risk of nurses leaving after two years decreases significantly; therefore, we determined that a nurse with a commitment to pediatric BMT occurs with two years' experience. Although our initial hypothesis was that senior nurses had greater resilience than less tenured nurses, there was no statistical significance as the effect of resilience is small. However, we identified several additional factors pertinent to the pediatric BMT field which may be associated with nursing retention.

A Physical Activity Mobile Game for Hematopoietic Stem Cell Transplant Patients: App Design, Development, and Evaluation.

Physical activity mobile apps may encourage patients with cancer to increase exercise uptake, consequently decreasing cancer-related fatigue. While many fitness apps are currently available for download, most are not suitable for patients with cancer due to the unique barriers these patients face, such as fatigue, pain, and nausea. The aim of this study is to design, develop, and perform alpha testing of a physical activity mobile health game for hematopoietic stem cell transplant (HSCT) patients. The ultimate future goal of this project is to motivate HSCT patients to increase physical activity and provide them with a safe and fun way to exercise. A mobile health game called Walking Warrior was designed as a puzzle game where tiles are moved and matched. Walking Warrior interfaces with an open-source step counter and communicates with a central online MySQL database to record game play and walking performance. The game came to fruition after following an iterative process model with several prototypes. Game developers and bone marrow transplant nurses were recruited to perform an expert usability evaluation of the Walking Warrior prototype by completing a heuristic questionnaire and providing qualitative suggestions for improvement. Experts also made qualitative recommendations for improvements on speed, movement of tiles, appearance, and accuracy of the step counter. We recruited 5 additional usability evaluators who searched for and compared 4 open-source step counter programs, then qualitatively compared them for accuracy, robustness, cheat proofing, ease of use, and battery drain issues. Patient recruitment is planned at a later stage in this project. This paper only describes software design, development, and evaluation, rather than behavioral evaluation (ie, impact on physical activity), which is the long-term goal of this project. Internal consistency and the instrument's reliability evaluation results from 1 clinical expert and 4 technical experts were deemed excellent (Cronbach α=.933). A hierarchical cluster analysis of the questionnaire item responses for similarity/dissimilarity among the experts indicated that the two expert groups were not clustered into two separate groups in the dendrogram. This indicates that the item responses were not affected by profession. Factor analyses indicate that responses from the 40-item questionnaire were classified into five primary factors. The associated descriptive statistics for each of these categories were as follows (on a scale of 1 to 5): clarity and ease (median 4; mean 3.7, SD 0.45), appropriateness (median 4; mean 3.7, SD 0.49), game quality (median 3.5; mean 3.3, SD 0.42), motivation to walk (median 3; mean 3.1, SD 0.58), and mental effort (median 3.5; mean 3.1, SD 1.27). The evaluation from experts and clinicians provided qualitative information to further improve game design and development. Findings from the expert usability evaluation suggest the game's assets of clarity, ease of use, appropriateness, quality, motivation to walk, and mental effort were all favorable. This mobile game could ultimately help patients increase physical activity as an aid to recovery.

550 - Creating a Patient-Centered Case Study: Using the Patient Experience to Create a Tool to Educate Bone Marrow Transplant Nurses

550 - Creating a Patient-Centered Case Study: Using the Patient Experience to Create a Tool to Educate Bone Marrow Transplant Nurses

The Practices and Meanings of Care for Nurses Working on a Pediatric Bone Marrow Transplant Unit.

Bone marrow transplant (BMT) units are stressful work environments with high staff burnout, anxiety, and turnover. A qualitative study was undertaken to better understand care for nurses within the context of their clinical practice on a pediatric BMT unit. Understanding care practices for BMT nurses will allow us to design interventions and provide appropriate support for this subspecialty of nurses. Focus groups were held with 24 nurses as key participants, and 2 focus groups with general participants: unit management (N = 2) and caregivers of inpatients (N = 7). Data were analyzed using a thematic analysis. Data were transcribed verbatim and coded to consensus by members of the research team. Five themes emerged from the data: ( a) experiencing stressful situations that impede care, ( b) growing and developing personally and professionally, ( c) providing trustworthy and respectful care, ( d) acquiring meaningful coping skills, and ( e) sharing with others versus isolation. Stress management, professional development, and interdisciplinary communication were areas that emerged for potential intervention.

Emotional Overdrive: How to Pump the Brakes on Compassion Fatigue in Bone Marrow Transplant Nurses

The unique and long-standing relationships that bone marrow transplant (BMT) nurses develop with their patients and their families make end-of-life (EOL) care increasingly difficult and stressful for the nurse. Through continued exposure to suffering and pain, many BMT nurses experience compassion fatigue (CF) which can manifest as physical, emotional and spiritual distress. If left unaddressed, CF can eventually lead to burnout and BMT nurses leaving the field. In order to combat CF, literature shows that a variety of interventions including formal debriefing sessions, EOL and grief education programs as well as holistic and spiritual interventions have shown to be effective in reducing burnout and alleviating grief-related stress in BMT nurses. Prior to introducing any interventions, a needs-assessment survey was conducted on our 28-bed hematology/oncology & BMT unit. Forty-two staff members were surveyed and asked about their level of emotional fatigue and if they thought they would benefit from grief support programs. Overwhelmingly the response was “yes” (41 out of 42), so an initial roll out of four interventions were initiated: Condolence cards to be sent out and signed by staff members to families of patients who passed away on the unit Formal debriefing session led by a psychiatrist Group guided meditation and individual Reiki sessions led by an integrative health RN Remembrance/prayer box that staff members could write notes/thoughts/prayers in Initial feedback from RNs was positive, many saying they found “closure”, particularly with the sending out of condolence cards. A six-month post-intervention survey to be conducted in October. Compassion fatigue is not exclusive to field of hematology/transplantation. With no formal compassion fatigue program in place at our institution, we believe that this program could be implemented hospital-wide and serve as a template for other units to help their staff with this ongoing problem.

Empowered Bedside Bone Marrow Transplant Nurses: The Key to Patient Satisfaction

s / Biol Blood Marrow Transplant 20 (2014) S286eS296 S296 survival outcomes. Larger pediatric studies may be warranted to examine this clinical question. TRANSPLANT NURSING ADMINISTRATION

Utilizing QI Tools to Decrease Line Contaminiations

A trend of nursing errors has been identified in our Bone Marrow Transplant (BMT) patients in whom central lines were contaminated by incorrect administration of tacrolimus or cyclosporine. These drugs have the potential for significant drug absorption when given through plastic administration tubing. Once the drug has been administered through a central venous catheter (CVC) lumen, drug monitoring levels cannot be obtained through that lumen due to risk for falsely high levels. When initiating IV tacrolimus or cyclosporine therapy, the nurse is responsible for identifying which lumen will be utilized for drug administration and which lumen will be utilized for drug level monitoring. If the drug is inadvertently administered in all available lumens, drug level monitoring must be obtained peripherally. These nursing errors resulted in significant patient harm, as patients required painful venipuncture procedures for ongoing drug level monitoring, rather than comparatively painless lab draws through a CVC. A review of the event reporting system identified 5 patients who were harmed by incorrect administration of tacrolimus or cyclosporine between 01/01/1211 and 3/31/12. This baseline data revealed a rate of 0.24 line contaminations per 100 IV doses of tacrolimus or cyclosporine administered (0.24/100). All of these errors were the result of contamination of the central venous catheter due to administering drug through all available lumens, rather than identifying a single lumen for administration and another single lumen for drug level monitoring. In response to this trend, a team was developed to plan and implement a Quality Improvement (QI) project addressing the process for administration and drug monitoring for patients receiving these drugs by implementing the Institute for Healthcare Improvement (IHI) model for QI. The IHI model utilizes the Plan-Do-Study-Act process in which a series of small tests of change are implanted to achieve desired results. The team established the standard nursing practice as administration of tacrolimus or cyclosporine through the white lumen of the tunneled CVC and lab draws for drug monitoring through the red lumen of the tunneled CVC. BMT nurses were informed of the new standard practice during twice daily safety huddles. Nurses were instructed to remember the standard as “red for blood” meaning to draw from the red lumen. Since implantation of this standard practice there have been zero reported line contaminations.

Meaning in Bone Marrow Transplant Nurses’ Work

When a clinical culture emphasizes cure, as in bone marrow transplantation (BMT) services, BMT nurses commonly experience enormous stress when patients are suffering or dying. In this context, it is unclear what meanings BMT nurses experience in their work and how they find meaning and sustain hope, given conflicting responsibilities to patients. This study aimed to explore BMT nurses' experiences of meaning and hope and the effects of a meaning-centered intervention (MCI) on these experiences using qualitative methodology. Fourteen BMT nurses engaged in a 5-session MCI, with 7 members each participating in 2 groups. Semistructured qualitative interviews were conducted at 1 month before and after the intervention. Interpretive phenomenology guided data analysis. The BMT nurses in the Princess Margaret Hospital experienced meaning in their involvement with their patients' suffering. The MCI seemed to inspire participants to engage more with patients and their suffering. Three subthemes reflected this influence: (a) greater awareness of boundaries between their personal and professional involvement, (b) enhanced empathy from an awareness of a shared mortality, and (c) elevated hope when nurses linked patients' suffering with meaning. This study confirms that patients' suffering constitutes nurses' search for meaning and hope in their work. The MCI offers a way in which to actively support nurses in this process. Nurses can learn to be more responsive to patients' suffering beyond limits of cure. A minimal intervention, such as the MCI, supports BMT nurses in finding positive personal meaning and purpose in their otherwise highly stressful work culture.

Perspective of Bone Marrow Transplant Nurses in the United States (US) and Europe (EU) of Unmet Educational Needs

Experienced oncology nurses working in the field of BMT are often faced with challenges of staying abreast on current nursing, medical and scientific advances. Targeted education programs are one way of addressing educational needs of nurses, thus improving patient care. A voluntary written survey was distributed to a sample of oncology nurses participating in a BMT expert panel meeting organized in EU (n = 10) and the US (n = 16). The purpose was to determine educational activities that address unmet needs of BMT nurses and their patients.

A multi-disciplinary ‘outcome’ round to decrease stress and burnout among Bone Marrow Transplant nurses and to promote disscussion and education; one year on

A multi-disciplinary ‘outcome’ round to decrease stress and burnout among Bone Marrow Transplant nurses and to promote disscussion and education; one year on

Evaluation of burnout and job satisfaction in marrow transplant nurses.

The study examined incidence of burnout syndrome, psychopathology, and job satisfaction in bone marrow transplant nurses, in relation to existence of an informal psychosocial support programme for staff needs. Forty nurses participated in the study completing four standardised measures related to burnout, anxiety, depression, satisfaction with aspects of their job, and social support. Results indicated that burnout among these nurses was low, and high personal accomplishment from working with marrow transplant patients was the response of the majority. Job satisfaction was also found to be high, with outpatient nurses scoring significantly higher than inpatient nurses in most aspects of job satisfaction. One out of four subjects presented with the psychic manifestations of the anxiety neurosis, suggesting the stressfullness of the marrow transplant environment, which requires a high degree of responsibility and advanced nursing skills. Social support was not found to influence burnout, psychopathology, or job satisfaction. Presence of depression, low personal accomplishment, and dissatisfaction with pay were the variables predicting high emotional exhaustion, one of the main components of burnout. These results were suggestive of less burned out and more satisfied nurses compared to marrow transplant nurses working in environments with no formal or informal staff support programmes. This highlights the need for development of support services for the nursing staff, allowing them to ventilate their feelings, discuss issues of concern to them and seek professional support where necessary.

Work related stresses of pediatric bone marrow transplant nurses.

The annual conference of the Association of Pediatric Oncology Nurses, entitled Caring: The Foundation of Pediatric Oncology Nursing, was held October 12-14, 1988, in Denver, Colorado. Our thanks to Jory Goldmann, the National Program Chairperson, and Mary Jo Cleaveland, the Local Program Chairperson, and her committee for their hospitality and a very informative meeting. The following are abstracts of some of the clinical, education, and research presentations from this meeting.

Busy year ahead for leukaemia and bone marrow transplant nurses forum.

The year ahead promises to be one of renewed activity for members of the RCN Leukaemia and Bone Marrow Transplant Nurses Forum.