Youth and Pet Survivors: Exploring the Experiences of Pediatric Oncology and Bone Marrow Transplant Patients in a Virtual Animal-Assisted Therapy Pen Pal Program.

Introduction: YAPS™ (Youth and Pet Survivors™) is a form of virtual animal-assisted therapy (AAT), a pen pal program designed for children and adolescents with cancer and/or having a bone marrow transplant (BMT) to engage in virtual visits with a dog or a cat (who has also been treated for cancer or serious medical illness) through letter writing and pictures. The purpose of this qualitative descriptive study was to explore the experiences of YAPS participants over time and to explore how virtual AAT may be an additional or alternative intervention to the traditional form of AAT, which involves live visits with animals, primarily dogs. Method: Open-ended, face-to-face interviews were conducted throughout the participants' involvement with their animal pen pal. Interviews were digitally recorded. Data were analyzed using a content analysis method. Results: Fifteen children and adolescents, aged 7 to 16 years, participated. Three main themes and five subthemes were found, including connection, shared experience, and friendship. Themes suggested that a virtual AAT letter writing program can provide a source of fun and a way to process the cancer experience with a dog or cat pen pal who has also faced cancer or serious medical treatment. Discussion: Interventions that promote well-being for pediatric oncology and BMT patients are needed, and virtual AAT seems to be one such intervention suited for those who have an affinity for animals and enjoy letter writing. The findings of this study also presented an exciting and intriguing gap for further research in virtual AAT.

Covid-19 containment measures adopted in bone marrow transplantation service.

OBJECTIVE: To describe the experience of nursing, in adopting containment measures, in the care of patients undergoing hematopoietic stem cell transplantation to avoid COVID-19. METHODS: Experience report. RESULTS: Containment measures involve those recommended by major health organizations, such as hand hygiene, social isolation, identification and monitoring of suspected or confirmed cases; and also the local measures implemented in the health service, such as the reduction in the number of hospitalizations for transplantation, clinical screening of outpatients entering the service, monitoring of respiratory signs and symptoms, the allocation of specific isolation rooms for those suspected of the disease and testing of symptomatic patients. Final considerations: The nurse is responsible for the challenge of planning nursing care to prevent the spread of coronavirus in a high-risk population and to implement measures based on available evidence, periodically updated.

Programa de intervenção de enfermagem na vacinação dos doentes submetidos a transplante de células progenitoras da hematopoiese / Nursing intervention program on the vaccination of patients undergoing hematopoietic stem cell transplant

The vaccination project for patients undergoing Hematopoietic Stem Cell Trans-plant (HSCT) arose because they lose the immunization provided by vaccines administered prior to transplantation and are extremely vulnerable to infection. This program began in 2012, was based on the organization of the post-HSCT vaccination schedule in nursing consultations aimed at providing the patient with vaccination and verifying compliance with the National Vaccination Plan. The aim of this article is to evaluate the results of the implementation of the vaccination project of patients undergoing hematopoietic stem cell transplant. The method used was a retrospective quantitative analysis of the application of the project methodology, through the defined outcome quality indicator - vaccination rate of patients undergoing HSCT with the National Vaccination Plan. From 2017 to 2018, the number of telephone contacts made in the scope of vaccination was defined as a process quality indicator and the content analyzed. We covered a population of 348 people, 229 patients undergoing allogeneic HSCT and 119 autologous. We achieved vaccination rates of 100. By implementing improvement strategies over the years we have been able to improve project effectiveness and vaccination for a larger number of patients.The project plays an important role in the area of public health and rehabilitation of patients undergoing HSCT as it allows the patient to be linked to the caregiver community, which contributes to a greater connection and proximity of the person to the health unit. enabling them to better integrate into everyday life in the various dimensions of the person

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Covid-19 containment measures adopted in bone marrow transplantation service / Medidas de contención a la COVID-19 adoptadas en el Servicio de Trasplante de Médula Ósea / Medidas de contenção à COVID-19 adotadas em serviço de transplante de medula óssea

ABSTRACT Objective: To describe the experience of nursing, in adopting containment measures, in the care of patients undergoing hematopoietic stem cell transplantation to avoid COVID-19. Methods: Experience report. Results: Containment measures involve those recommended by major health organizations, such as hand hygiene, social isolation, identification and monitoring of suspected or confirmed cases; and also the local measures implemented in the health service, such as the reduction in the number of hospitalizations for transplantation, clinical screening of outpatients entering the service, monitoring of respiratory signs and symptoms, the allocation of specific isolation rooms for those suspected of the disease and testing of symptomatic patients. Final considerations: The nurse is responsible for the challenge of planning nursing care to prevent the spread of coronavirus in a high-risk population and to implement measures based on available evidence, periodically updated.

RESUMEN Objetivo: Describir la experiencia de la enfermería, en la adopción de medidas de contención, en la atención de pacientes sometidos al trasplante de células madre hematopoyéticas para evitar la COVID-19. Métodos: Relato de experiencia. Resultados: Las medidas de contención envuelven aquellas recomendadas por las principales organizaciones de salud, como la higiene de manos, aislamiento social, identificación y monitoreo de casos sospechosos o confirmados; y aún las medidas locales implementadas en el servicio de salud, como la reducción en el número de internamientos para el trasplante, selección clínica de pacientes ambulatorios que adentran el servicio, monitoreo de señales y síntomas respiratorios, destinación de cuartos de aislamiento específicos para los sospechosos de la enfermedad y análisis de pacientes sintomáticos. Consideraciones finales: Compete al enfermero el desafío de planear el cuidado de enfermería para la prevención de la diseminación del coronavirus en población de alto riesgo y para la implementación de medidas pautadas en las evidencias disponibles, periódicamente actualizadas.

RESUMO Objetivo: Descrever a experiência da enfermagem, na adoção de medidas de contenção, no atendimento de pacientes submetidos ao transplante de células-tronco hematopoiéticas para evitar a COVID-19. Métodos: Relato de experiência. Resultados: As medidas de contenção envolvem aquelas recomendadas pelas principais organizações de saúde, como a higiene de mãos, isolamento social, identificação e monitoramento de casos suspeitos ou confirmados; e ainda as medidas locais implementadas no serviço de saúde, como a redução no número de internações para o transplante, triagem clínica de pacientes ambulatoriais que adentram o serviço, monitoramento de sinais e sintomas respiratórios, destinação de quartos de isolamento específicos para os suspeitos da doença e testagem de pacientes sintomáticos. Considerações finais: Compete ao enfermeiro o desafio de planejar o cuidado de enfermagem para a prevenção da disseminação do coronavírus em população de alto risco e para a implementação de medidas pautadas nas evidências disponíveis, periodicamente atualizadas.

Enhancing Advance Care Planning Conversations by Nurses in a Bone Marrow Transplantation Unit.

OBJECTIVES: To describe the impact of advance care planning (ACP) education on nurses' confidence in ACP knowledge and practice and to identify barriers to facilitate ACP conversation in a bone marrow transplantation unit. SAMPLE & SETTING: 60 nurses working in the bone marrow transplant unit at Oregon Health and Science University, an academic medical center. METHODS & VARIABLES: The aim of this quality improvement project was to increase ACP conversations by nurses. The authors used a single-group pre-/post-test design to assess the effectiveness of a 30-minute educational intervention in changing nurses' confidence and practice. Group interviews were conducted to identify barriers to ACP. RESULTS: The educational intervention increased nurses' confidence in knowledge about ACP. The number of nurses who discussed ACP with patients also increased, but it was not statistically significant. Lack of time, inefficient workflow, and concerns about questioning providers' understanding of patient preferences were identified as barriers for nurses engaging in and documenting ACP conversations. IMPLICATIONS FOR NURSING: In addition to appropriate education, strategies that help tailor ACP practice to fit into nurse workflow and promote collaboration with other healthcare team members are needed to change nurses' ACP practice.

Blood and Marrow Transplantation RN Fellowship: Design, Outcomes, and Facilitating Transition to Practice.

Recruiting and retaining blood and marrow transplantation (BMT) nurses remains challenging. In accordance with the Institute of Medicine recommendation to establish programs to prepare nurses for transition to specialty practice areas, a BMT fellowship program was designed and implemented at a large academic medical center. The yearlong fellowship program consists of monthly class sessions, observation experiences, case study presentations, and evidence-based project development. Outcomes related to retention, certification, and scholarship are presented.

How Can a Personal Connection Build Confidence in Your Graduate Nursing Journey?

I wrapped my bright yellow stethoscope around my neck, pockets heavy with essential nursing tools and my clipboard clenched in my right hand. It was my first shift off orientation on the bone marrow transplantation unit at a teaching hospital in North Carolina. As I listened to the change-of-shift report, I felt my nerves on edge. I repeated "be the best nurse you can be" over and over in my head as I did my best to keep calm on that first day. That is what I remember from the first day and now, a few months later, I can reflect on what I learned and what "be the best nurse you can be" means to me.

Nursing challenges caring for bone marrow transplantation patients with graft versus host disease.

Nursing care of blood and marrow transplantation (BMT) patients is complicated. Nursing considerations of BMT patients with GVHD require an additional set of skills and knowledge that include side effects, both expected and less common, assessment skills, treatment administration, both standard and novel, and acute or intensive care. Nursing care of BMT patients with skin GVHD will be determined by the degree of skin alteration with distinct decisions made about hygiene, both topical and systemic treatment, infection prevention, relief of discomfort, functional ability (ADL) and body image alteration. The nurse needs to have knowledge about assessment criteria for acute and chronic (NIH) assessment with special attention to skin (presence of rash, texture, mobility), joint mobility, mouth care, dressings, and skin care products. Nursing consideration of gastrointestinal GVHD includes importance of accurate intake and output, obtaining culture, fluid and electrolyte imbalance, nutrition, treatment, and skin care. Complication of GVHD treatment, namely effects of steroids require experts from many disciplines to provide comprehensive care. Caring and advocating for GVHD patients may include preparing for outcomes that are undesirable and impact the patient's quality of life and mortality. BMT survivorship programs are a major source of patient education about chronic GVHD for patients after treatment. Caring for BMT patients, especially those experiencing GVHD, takes a knowledgeable, committed, and caring team of healthcare providers. Workshops like this are vital in providing information and networking to keep providers around the region and globe engaged in this critical work.

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.

Model of transpersonal caring in nursing home care according to Favero and Lacerda: case report. / Modelo de cuidado transpessoal de enfermagem domiciliar de Favero e Lacerda: relato de caso.

OBJECTIVE: The aim of this paper is to report the experiences of applying a model of transpersonal caring in nursing home care according to Favero and Lacerda to adult patients after hematopoietic stem cell transplantation. METHOD: This is a case report on the application of this model to an outpatient monitored by a bone marrow transplant service. In addition to the initial outpatient contact, the patient received home care visits in October 2014. Data were recorded in the field diary and analysed according to the Care Model and Clinical Caritas Process. RESULTS: The provided care served as support to meet basic human needs, and strengthen the belief system. It also promoted the necessary emotional care to cope with the treatment and professional maturity in the caring relationship. CONCLUSION: The experience description revealed that the model can support the application of the Theory of Human Caring in home care and the use of care models in practice, professional training, and research development.

Effects of Making Art and Listening to Music on Symptoms Related to Blood and Marrow Transplantation.

PURPOSE/OBJECTIVES: To understand the benefits of making art and listening to music and whether those activities may be beneficial for reducing symptoms associated with blood and marrow transplantation. 
. DESIGN: A randomized, three-group, pre-/post-pilot design.
. SETTING: Outpatient Blood and Marrow Transplant Clinic at the University of Kansas Cancer Center in Kansas City.
. SAMPLE: 39 adults aged from 22-74 years receiving blood and marrow transplantations.
. METHODS: Participants were randomly assigned to one of three groups. MAIN RESEARCH VARIABLES: Therapy-related symptoms, state anxiety, and physiologic distress.
. FINDINGS: Of the 39 participants, 14 were randomized to the control group, 14 to the art group, and 11 to the diversional music group. No significant differences in age, gender, ethnicity, or diagnosis existed between groups. No statistical differences were found between groups on all measures following the intervention. 
. CONCLUSIONS: Although the results of the current study did not indicate significant differences, healthcare professionals may still consider creative therapies as a viable option for patients within hospital or outpatient clinics because they do not require specialty training or costly resources, and they may be an enjoyable activity to occupy time for patients and caregivers.
. IMPLICATIONS FOR NURSING: Art making and music listening are safe and desirable for patients undergoing blood and marrow transplantation in an outpatient clinic. Nurses might consider partnering with therapists to offer these creative therapies as diversion during treatment.

Increasing Activities of Daily Living Is as Easy as 1-2-3.

BACKGROUND: Human flora are the most common cause of bacteremia in immunocompromised patients. Activities of daily living (ADL), including oral care and daily chlorhexidine gluconate bathing, can lower the risk of infection. METHODS: To address ADL compliance in our pediatric oncology and bone marrow transplant patients, we adopted the ADL 1-2-3 initiative: daily chlorhexidine gluconate bath and linen change, at least 2 activities per day, and oral care 3 times per day. Using the Model for Improvement we created a standardized ADL process that involved all providers. Interventions included addressing ADL 1-2-3 compliance during rounds, establishing accountability in care delivery, an oral care order set and algorithm, daily text message reminders, and physician intervention with noncompliant and high-risk patients. RESULTS: With our interventions, we increased our median compliance with the all-or-none ADL 1-2-3 initiative from 25% to 66% in 90 days. We have sustained our median compliance to 75% sixteen months after implementation. The greatest impact on compliance was seen with text message reminders to staff to complete and document the ADL 1-2-3 components, designated roles and responsibilities, and physician discussion with noncompliant and high-risk patients. DISCUSSION: Oral care algorithm and order set, daily text message reminders, and physician intervention with noncompliant and high-risk patients has improved our compliance. Units where compliance with ADL participation is low can benefit from incorporating elements from this ADL 1-2-3 initiative.

Modelo de cuidado transpessoal de enfermagem domiciliar de Favero e Lacerda: relato de caso / Modelo de cuidado transpersonal de enfermería domiciliar de Favero y Lacerda: informe clínico / Model of transpersonal caring in nursing home care according to Favero and Lacerda: case report

RESUMO Objetivo Relatar a experiência da aplicação do Modelo de Cuidado Transpessoal de Enfermagem Domiciliar de Favero e Lacerda a paciente adulta pós-transplante de células-tronco hematopoéticas. Método Relato de caso da aplicação deste Modelo a paciente em acompanhamento ambulatorial em Serviço de Transplante de Medula Óssea. Além do contato inicial em ambulatório, foram feitos três encontros domiciliares em outubro/2014. As informações foram registradas em diário de campo e analisadas, considerando o Modelo de Cuidado e o Processo Clinical Caritas. Resultados O cuidado atuou como suporte ao atendimento das necessidades humanas básicas, fortalecimento do sistema de crenças, promoção do cuidado emocional para enfrentamento do tratamento e amadurecimento profissional na relação de cuidar. Conclusão A descrição da experiência permite inferir a contribuição do Modelo para a aplicação da Teoria do Cuidado Humano no cuidado domiciliar e a utilização de modelos de cuidado na prática assistencial, formação profissional e desenvolvimento de pesquisas.

RESUMEN Objetivo informar la experiencia de la aplicación del Modelo de Cuidado Transpersonal de Enfermería Domiciliar de Favero y Lacerda a una paciente adulta postrasplante de células madre hematopoyéticas. Método informe clínico de la aplicación de este Modelo a una paciente en acompañamiento ambulatorio en Servicio de Trasplante de Médula Ósea. Además del contacto inicial en ambulatorio, hubo tres encuentros domiciliares en octubre/2014. Las informaciones fueron registradas en diario de campo y analizadas considerando el Modelo de Cuidado y el Proceso Clinical Caritas. Resultados el cuidado actuó como soporte a la atención de las necesidades humanas básicas, fortalecimiento del sistema de creencias, promoción del cuidado emocional para afrontar el tratamiento y madurez profesional en la relación de cuidado. Conclusión la descripción de la experiencia permite deducir la contribución del Modelo para la aplicación de la Teoría del Cuidado Humano en el cuidado domiciliar y la utilización de modelos de cuidado en la práctica asistencial, en la formación profesional y en el desarrollo de estudios.

ABSTRACT Objective The aim of this paper is to report the experiences of applying a model of transpersonal caring in nursing home care according to Favero and Lacerda to adult patients after hematopoietic stem cell transplantation. Method This is a case report on the application of this model to an outpatient monitored by a bone marrow transplant service. In addition to the initial outpatient contact, the patient received home care visits in October 2014. Data were recorded in the field diary and analysed according to the Care Model and Clinical Caritas Process. Results The provided care served as support to meet basic human needs, and strengthen the belief system. It also promoted the necessary emotional care to cope with the treatment and professional maturity in the caring relationship. Conclusion The experience description revealed that the model can support the application of the Theory of Human Caring in home care and the use of care models in practice, professional training, and research development.

Humanização da assistência em transplante de medula óssea: a percepção da equipe de enfermagem / Humanization of care in bone marrow transplantation: the perception of the nursing team / Humanización de la asistencia en transplante de médula ósea: la percepción del equipo de enfermería

Objetivo: compreender o significado da humanização em transplante de medula óssea segundo a percepção da equipe de enfermagem. Método: estudo qualitativo. Os dados foram coletados por meio de entrevistas com roteiro semiestruturado realizadas com dez profissionais de enfermagem que trabalham em um serviço de transplante de medula óssea de Minas Gerais e analisados por meio da Técnica de Análise de Conteúdo. Possui aprovação do projeto no Comitê de Ética em Pesquisa, CAAE 0074.0.420.000-11. Resultados: foi possível identificar as seguintes categorias empíricas: << A subjetividade do conceito de Humanização >>; << Caminhos para a Humanização em TMO >>; e << Desafios para a Humanização >>. Conclusão: o conceito de humanização possui diferentes significados. O serviço de enfermagem foi considerado como humanizado devido a algumas atividades citadas. Porém, revelaram-se desafios para o alcance de uma prática humanizadora em transplante de medula óssea.(AU)

Objective: to understand the meaning of humanization in bone marrow transplantation according to the perception of the nursing team. Method: qualitative study. Data were collected through semi-structured interviews conducted with ten nurses working in a bone marrow transplant service of Minas Gerais and analyzed using content analysis technique. The project was approved by the Research Ethics Committee, CAAE 0074.0.420.000-11. Results: it was possible to identify the following empirical categories: << The subjectivity of the concept of humanization >>; << Pathways to humanization in BMT >>; and << Challenges for the Humanization >>. Conclusion: the concept of humanization has different meanings. The nursing service was regarded as humanized due to some activities cited. However, some challenges were identified for achieving a humanizing practice in bone marrow transplantation.(AU)

Objetivo: comprender el significado de la humanización en trasplante de médula ósea según la percepción del equipo de enfermería. Método: estudio cualitativo. Los datos fueron recogidos por medio de entrevistas con guía semi-estructurado realizadas con diez profesionales de enfermería que trabajan en un servicio de trasplante de médula ósea de Minas Gerais y analizados por medio de la Técnica de Análisis de Contenido. Posee aprobación del proyecto en el Comité de Ética en Investigación, CAAE 0074.0.420.000-11. Resultados: fue posible identificar las siguientes categorías empíricas: << La subjetividad del concepto de Humanización >>; << Caminos para la Humanización en TMO >>; y << Desafíos para la Humanización >>. Conclusión: el concepto de humanización posee diferentes significados. El servicio de enfermería fue considerado como humanizado debido a algunas actividades citadas. Sin embargo, se revelaron desafíos para el alcance de una práctica de humanización en trasplante de médula ósea.(AU)

Pain Management for Children during Bone Marrow and Stem Cell Transplantation.

Pain management for children during bone marrow and stem cell transplantation is a significant clinical challenge for the health care team. Pain management strategies vary by institution. This paper reports on the use of a pediatric pain management service and patient- and caregiver-controlled analgesia for children undergoing transplant. This 2-year retrospective chart review examined the pain management practices and outcomes of children undergoing bone marrow and stem cell transplants in a large urban teaching hospital during 2008 and 2009. We concluded that patient- and caregiver-controlled analgesia is a well-tolerated modality for pain control during hospitalization for transplantation at this institution.

Central line practice in Canadian blood and marrow transplant.

More than 800 blood cell and bone marrow transplants are performed annually in Canada to treat fatal cancers and rare blood disorders. Central vascular access is fundamental in blood and marrow transplant nursing to facilitate chemotherapy and blood product infusions. A tunnelled Central Venous Catheter (CVC) is the vascular access device-of-choice in the cell and marrow transplant population. Several practice guidelines direct nursing policy and procedure for CVC management and care. CVC insertion and removal guidelines are increasingly relevant given the widening scope of advanced practice nursing. Unresolved issues are noted among the most heavily cited CVC practice recommendations accessible via the Centers for Disease Control and Prevention (CDC). A descriptive survey based on the CDC guidelines was conducted to identify potential variability in CVC strategies in Canadian blood and marrow transplant nursing. Survey results indicate nationwide differences in catheter site selection, educational strategies, dressing strategies, delegation of dressing changes, and volumes of flushing and locking solutions used to manage catheter patency. Variability in practice coincides with gaps in the evidence identified in practice recommendations. Future studies comparing specific care approaches to device-associated complications are needed to resolve issues and strengthen practice guidelines.