Volume 14, Issue 2, June 2003   
Letter from the Coordinator
Group Aims to Have More SIG-Sponsored Sessions at Next Congress

Mary Burgunder, RN, BSN, MS, OCN®
Pittsburgh, PA

Happy summer to all of you. I hope that everyone who attended Congress in Denver had a good time. Please let me know if you have any ideas or are interested in submitting topics for next year’s sessions. There were two SIG-sponsored sessions at Congress this year, and we would like for that trend to continue or improve. Look for more information about the BMSCT SIG’s accomplishments at Congress in the next newsletter.

This newsletter contains a variety of information. There are abstracts from the tandem BMT meetings held in Keystone, CO, in February and information about next year’s tandem BMT meetings. We have an article on how one institution has approached the small pox vaccine as it relates to the patients for whom we care, and the strategy a community-based program used for staff training. We also have a bio of Vicki Fisher, RN, MSN, CPNP, the new co-editor of the newsletter.

We are always looking for topics and authors, so if you have any suggestions or are willing to author an article for the newsletter, please contact myself, Kris Gaster, RN, MS, CNS, CNP, or Vicki at the e-mail addresses or phone numbers listed at the end of the newsletter. Have a safe and happy summer.


Special Interest Group Newsletter  June 2003

War on Terrorism Impacts HSCT: One Center’s Experience With the Smallpox Threat

Rosemary Ford, RN, BSN, OCN®
Seattle, WA

Most of us have given little thought to smallpox--a plague of the past that had its place in history, just as the vaccine developed to prevent it was a major milestone in medical history. If we think about it at all, it is usually in the context of the role the vaccination played in the evolution of modern vaccines.

Our focus has been on our modern infectious killers--HIV, hepatitis, CMV, RSV, antibiotic resistant bacteria, and fungi. We are used to having to deal with naturally occurring epidemics, such as influenza, West Nile virus, and, most recently, SARS. But now the threat of fellow human beings using smallpox in bio-terrorism is a new concept in disease epidemiology. The war on terrorism is affecting those of us caring for patients with hematopoietic stem cell transplantation (HSCT) as our institutions scramble to prepare emergency response plans under the directives from our various state Departments of Health.

The Seattle Cancer Care Alliance, which provides patient care for the Fred Hutchinson Cancer Research Center’s (FHCRC) HSCT Program, has inpatient units at both the University of Washington Medical Center (UWMC) and Children’s Hospital and Regional Medical Center. These two large medical centers would play a major role in responding to a bio-terrorism attack in the Pacific Northwest. In the state of Washington, only public health workers and local smallpox response team members in hospitals are being vaccinated. This has chiefly affected the Infectious Disease Program and Infection Control staff in the program. The physicians and nurses had to determine whether or not to be vaccinated and therefore not be on the transplant units or clinics for up to 28 days after vaccination (for a review of immunosuppressed individuals and the smallpox vaccine, please refer to the CDC’s Web site: www.bt.cdc.gov/agent/smallpox/vaccination/immune-contra.asp).

All of the FHCRC’s infectious disease physicians opted to NOT be vaccinated so they could continue their clinical work uninterrupted (they do not have responsibility for initial emergency medical response). The Infection Control RN at Children’s did receive the vaccination and has been consulting with the Pediatric HemOnc/HSCT staff by telephone and e-mail. The UWMC’s leadership has decided that the staff members who volunteer to be vaccinated will not be allowed to perform direct patient care until the scab at the vaccination site falls away (21–28 days post vaccination). These staff will report to work at an office site miles from the hospital during this time. They will participate in in-services regarding the plan of care for people exposed to smallpox and also be given projects such as patient chart review and procedure review.

It is hard to not feel indignation and disgust for the time, effort, and cost required for these emergency response efforts. Our best minds are turning away from other priorities to address this artificial crisis. The terrorists’ flagrant disregard for life contrasts with the enormous efforts that are made in HSCT to save patients. I realized shortly after 9/11 that the number of people killed in New York and Washington, DC, was very close to the number of patients who are long-term survivors in the history of FHCRC’s 30 years of transplantation. The reality of terrorism is hard to reconcile with the goals we work toward each day.

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Special Interest Group Newsletter  June 2003

Transplant Nursing Sessions at Tandem BMT Meetings Are a Success

Kim Schmit-Pokorny, RN, MSN, OCN®
LaVista, NE

The Transplant Nursing Sessions coordinated by the Blood and Marrow Stem Cell Transplant (BMSCT) SIG were held in conjunction with the 2003 Tandem BMT Meetings in Keystone, CO, February 1-3. This was the fifth year the ONS BMSCT SIG has partnered with the American Society for Blood and Marrow Transplantation (ASBMT) and the International Bone Marrow Transplant Registry/Autologous Blood and Marrow Transplant Registry (IBMTR/ABMTR) to offer transplant nursing educational sessions. This year, more than 250 transplant nurses attended the sessions! Nurses came from nearly every state in the United States and from abroad, including Canada, Denmark, England, Germany, New Zealand, Scotland, South Korea, and Sweden.

Each morning, invited speakers presented on various topics ranging from chronic graft versus host disease to ethical considerations in HSCT. Podium abstracts and roundtable sessions were held in the afternoons. More than 20 nurses presented poster abstracts in a session held with the physicians on Sunday evening. There were plenty of opportunities to network and socialize during the welcome reception and the breakfast and luncheon symposiums. This year, a detailed syllabus, sponsored by three pharmaceutical companies, was given to each of the attendees. Overall, the evaluations indicated the program, topics, and speakers were excellent! Even though the altitude slowed everyone down, nurses took the opportunity to enjoy the skiing, tubing, ice skating, horse-drawn sleigh rides, and excellent food!

The 2004 Tandem BMT Meetings will be held in Orlando, FL, at the Coronado Springs Resort, February 13–17. Please see the next newsletter for the exact dates of the transplant nursing sessions. Topics for next year include donor selection issues, acute transplant complications, comparison of care settings, novel treatment for transplant recipients, new medications, symptom management, survivor issues, an ethics panel, and new directions in transplant. Online advance registration and abstract (podium and poster presentation) submission will open in August. The abstract deadline is October 20. Roundtable submissions also will be accepted by e-mailing me directly at kschmit@unmc.edu.

Please visit the ASBMT Web site (www.asbmt.org) for additional details regarding the program, registration, housing, and Orlando area events. Please contact me with any questions via e-mail at kschmit@unmc.edu or phone 402-559-4910. I look forward to seeing you in Orlando!

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Special Interest Group Newsletter  June 2003

A Creative Strategy to Develop Transplant Nursing in a New Community Stem Cell Transplant Program

Kris Gaster, RN, MS, CNS, CNP
Sioux Falls, SD

There are numerous challenges in establishing a community-based stem cell transplant program. One of the challenges is the development of education programming and role modeling for nursing staff. Nurses are recognized as a cornerstone to a stem cell transplant program because they have a significant impact on patient and program outcomes. Stem cell transplant programs depend on nurses to be knowledgeable in the care of the transplant recipient; to be capable of critical thinking; to be able to make accurate assessments; to anticipate the patient trajectory; and to effectively communicate vital information to the transplant physician and team, enabling early intervention to maximize patient care and outcomes.

The challenge for a community-based program is that there are limited in-house resources experienced in the nuances of stem cell transplant. Subsequently, a great amount of responsibility for education falls to the transplant physician. However, the transplant physician alone is not able to fully role model the nursing practice that one would hope to achieve despite formal classroom lectures and teaching patient rounds.

This limitation creates a challenge to think “outside the box” for a creative solution. After lengthy discussion at our facility, we decided on the strategy to develop a core group of stem cell transplant staff nurses. It was felt that this core group of nurses could serve as role models for the other existing nursing staff, as well as new nurses, participate in the development of a standard for transplant nursing practice, and create standards of nursing care. An outcome to the discussion was the development of the Bone Marrow Transplant Traveling Scholar Award.

The Bone Marrow Transplant Traveling Scholar Award was designed to provide an all-expense-paid educational opportunity for a RN to shadow an experienced RN in a transplant nursing unit at an established stem cell transplant program for five days. This experienced transplant nurse would serve as a role model in transplant nursing practice, critical thinking, and communication with the transplant team members. When accepting this award, the recipient would agree that upon returning, he or she would implement a change project in nursing practice and provide an education session for the nursing staff on a BMT-related topic. A grant request was made to, and approved by, the hospital Foundation to fund the cost of the program, with the exception of the paid work hours that were funded from the travel and training budget of the unit.

Interested RNs who met the eligibility criteria completed an application that required submission of a written document outlining why they were interested in receiving the award, a list of activities in which they have participated related to the profession of nursing, and two goals they hope to accomplish with this opportunity. They also were required to submit a current curriculum vitae and a letter of recommendation. A selection committee was convened that was comprised of the BMT Medical Director, Director and Manager of the Oncology/Transplant Unit, BMT Coordinator, Professional Practice Director, Foundation Director, Education Director, and President of the Nurse Governing Council. Applications were reviewed, and three candidates were selected. The recipients were acknowledged through newsletters and in-house communications and will complete the shadow experience at Barnes Jewish Hospital in St. Louis, MO.

In community-based transplant programs where in-house resources are limited, one is stretched to seek out creative strategies and create opportunities beyond local walls to enhance the care delivered within those walls. Developing a core group of staff nurses through this program will hopefully achieve the outcome desired; that is, create staff nurses with the confidence to take on a leadership role with their colleagues in creating a strong transplant nursing staff.

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Special Interest Group Newsletter  June 2003

A Parent Support Program for Children Undergoing Stem
Cell Transplantation: The Duke University Pediatric Stem
Cell Program Model

Hungate, J., & Frey, M.A.
Duke University Pediatric Stem Cell Transplant Program
Durham, NC

Presented at the 2003 Tandem BMT Meetings sponsored by ASBMT

The care of a child undergoing a stem cell transplant requires a complex, multidisciplinary team approach to achieve the best possible outcome. Critical to the success of this approach is the role of the parent or caregiver. The road through transplant often is grueling. Parents typically stay with their children for the duration of therapy. Caregiver stress and burnout is a common phenomenon. Financial hardship often adds to the strain and worries. Parental/caregiver support is one element that is often overlooked in the literature.

The Duke Pediatric Stem Cell Transplant Program has implemented a family support program to cultivate a formal relationship between the parent and the healthcare team. Core components of the program include

1. Pre-admission teaching and education related to parental expectations.

2. The development of “The Duke PSCT Parent Handbook,” which includes detailed caregiver education.

3. The Duke PSCT “Best Buddies Program,” which uses carefully selected volunteers that support the family and allow the parent to leave the unit for brief periods of time.

4. A family resource area/lounge on the inpatient unit that provides cooking, bathing, and laundry facilities for caregivers.

5. The Fountain Fund Project, which uses monies obtained from the hospital lobby fountain for parent support projects.

6. The use of community volunteers, such as hair stylists, food vendors, and other support, to reduce emotional stress and minimize extraneous expenses, such as food and parking.

7. Numerous fund-raising activities (e.g., Racing Heroes Auction, Rainbow of Heroes Walk), which can create a discretionary fund used to support parents and caregivers.

8. Weekly psychosocial rounds can identify caregivers and family dynamics that may be high risk.

The goal of this abstract is to illustrate the unique programs used at Duke to support families and caregivers. The implementation of these programs has resulted in high satisfaction scores as well as an indirect reduction in length of stay.

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Special Interest Group Newsletter  June 2003

Care of the Autologous Blood and Marrow Transplant Patient
in a Fast-Paced Clinic With a Multidisciplinary Team Approach

Baughman, E.E., Harris, C., Thornton, T., Rhodes, B., & Neumann, J.
Blood and Marrow Transplantation Center,
UT M.D. Anderson Cancer Center
Houston, TX

Presented at the 2003 Tandem BMT Meetings sponsored by ASBMT

The nursing goal for the Blood and Marrow Transplantation (BMT) Fast Track Clinic is to provide point-of-service care to meet the needs of autologous patients in an efficient manner that fosters quality of care. The Fast Track multidisciplinary team consists of an advanced practice nurse, clinic nurse, clinical pharmacists, phlebotomist, and a scheduling coordinator. This team collaborates to address the various symptoms presented by this population, such as nausea, diarrhea, pain, and fatigue. Fast Track is located within the BMT Clinic, with several exam rooms designated for use. Patients have labs drawn in the morning by the phlebotomist, who facilitates timely return of results. The clinic nurse then performs an initial patient assessment. Once the lab results are available, the team further assesses the patient. Treatments such as electrolyte replacements and IV fluids are administered by ambulatory IV pumps. Infusions that take longer than one hour and blood product transfusions are transitioned to ambulatory clinics capable of longer-term infusions. Post-mobilization patients are transitioned to the apheresis clinic once their CD43+ counts are adequate. BMT physicians evaluate patients once a week until their absolute neutrophil count is stable and they are able to transition off IV fluids. At that time, the patient is “graduated” from Fast Track, down the hallway, back to their physician’s regular clinic. Monthly patient satisfaction surveys and daily comment cards are used to evaluate the patient’s perception of care and the nursing goal of Fact Track. Data such as patient volume, room usage, and types of treatments administered are documented on a daily spreadsheet. These data are reviewed by the Fast Track multidisciplinary team on a monthly basis to monitor trends and implement quality improvements as needed.
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Special Interest Group Newsletter  June 2003

Meet the Co-Editor

Vicki Fisher, RN, MSN, CPNP, is the program manager/nurse practitioner for the Pediatric Blood and Marrow Transplant Program at Rainbow Babies and Children’s Hospital of the university hospitals of Cleveland. She has been a member of ONS for five years and the BMT SIG for two years. She is the chair of the Nursing Strategy Group in the Pediatric Blood and Marrow Transplant Consortium.
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Special Interest Group Newsletter  June 2003

Invest in Yourself and in the Profession of Oncology Nursing by Applying for the Next ONS Leadership Development Institute.

As a nurse, you face more challenges than ever. The nursing shortage, lack of access to care, and advances in treatment all affect how you do your job. The ONS Leadership Development Institute (LDI) is a dynamic, interactive conference that will teach new and creative ways to respond to challenges in the workplace and to take an active role as a leader in your profession. It will help you hone your leadership skills so that you can ensure that oncology nurses remain a driving force in the cancer-care arena.

Apply for this important conference today! As an LDI fellow, you will learn to role model, train, coach, and mentor others. Curricula are presented by faculty representing national leadership experts, veteran LDI fellows, and other nurses skilled in leadership and professional development. LDI’s curriculum will prepare you to serve as a leader in both your personal and professional life, regardless of your practice setting or background. It will provide you with knowledge, behaviors, values, and skills necessary to be an effective leader in the 21st century.

As a fellow, you will acquire practical skills and learn the process of developing project action plans, presentation skills, and other valuable tools. The conference focuses on networking and building professional relations with peers, the public, politicians, and other influential decision-makers. Fellows also learn about managing projects and leading others; explore coaching, counseling, mentoring, and mobilizing others.

For more information, visit ONS Online (www.ons.org) or contact ONS Customer Service toll-free at 886-257-4ONS.

Do not miss out on this opportunity to shape oncology nursing and cancer care!

Contents of story 8 here.
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Special Interest Group Newsletter  June 2003

Blood and Marrow Stem Cell Transplant SIG Officers

Coordinator (2002-2004)
Mary Burgunder, RN, BSN, MS, OCN®
144 Arla Dr.
Pittsburgh, PA 15220-2633
412-276-9288 (H)
412-648-6650 (fax)

Coordinator-Elect (2003-2004)
Rosemary Ford, RN, BSN, OCN®
P.O. Box 19023
Seattle, WA 98109-1023
206-288-2123 (B)
206-288-1223 (fax)


Kris Gaster, RN, MS, CNS, CNP
624 E. Wiswall Place
Sioux Falls, SD 57105-2030
605-335-1039 (H)
605-322-3020 (fax)


Vicki Fisher, RN, MSN, CPNP
3326 W. 100th St.
Cleveland, OH 44111-2853
216-651-0913 (H)
216-844-5431 (fax)

ONS Publishing Division Staff
Lori Wilson, BA
Staff Editor


Know someone who would like to receive a print copy of this newsletter?
To print a copy of this newsletter from your home or office computer, click here or on the printer icon located on the SIG Newsletter front page. Print copies of each online SIG newsletter also are available through the ONS National Office. To have a copy mailed to you or another SIG member, contact Membership/Leadership Administrative Assistant Carol DeMarco at carol@ons.org or 866-257-4ONS, ext. 6230.

ONS Membership/Leadership Team Contact Information
Angie Stengel, Director of Membership/Leadership

Diedrea White, Manager of Member Relations

Carol DeMarco, Membership/Leadership Administrative Assistant

The Oncology Nursing Society (ONS) does not assume responsibility for the opinions expressed and information provided by authors or by Special Interest Groups (SIGs). Acceptance of advertising or corporate support does not indicate or imply endorsement of the company or its products by ONS or the SIG. Web sites listed in the SIG newsletters are provided for information only. Hosts are responsible for their own content and availability.

Oncology Nursing Society
125 Enterprise Dr.
Pittsburgh, PA 15275-1214
ONS Online: www.ons.org

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