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| Volume
18, Issue 3, October 2007 |
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| What's
Inside... Stem
Cell Transplant Complications Pose Challenges in Nursing Care SIG
Members to Present Topic at ONS Congress 2008 Josh
Gottheil Memorial Bone Marrow Transplant Career Development Award
Recognizes Achievements 2008
Blood and Marrow Transplant Tandem Meetings Taking Place in San Diego |
Coordinator's Message Blood and Marrow Transplant Nurses Combine Purpose With Progress  Margaret
Bevans, RN, PhD, AOCN®Bethesda, MD mbevans@comcast.net “The purpose of life is a life of purpose.” Although blood and marrow transplant (BMT) nursing is just one purposeful aspect of your life, ONS, and specifically the Blood and Marrow Stem Cell Transplant (BMSCT) SIG, exists to support and motivate the development of your BMT specialty. The 32nd annual ONS Congress offered the BMSCT SIG the opportunity to act on its purpose. Multiple sessions and activities offered knowledge to enhance the practice of BMT nursing while networking opportunities expanded our resources and friends! In addition to the educational offerings during Congress, the BMSCT SIG had its business meeting. This year’s meeting was filled with celebration, recognition, and fun. Eventually we did settle down to business and reviewed the purpose of the BMSCT SIG, the strategic plan. The major points are outlined below.
In addition, we generated some new ideas for the BMSCT SIG to consider. Topic submission ideas for ONS Congress 2008 were plentiful and yielded seven SIG-sponsored submissions! In addition, more dialogue surfaced about a curriculum specific to BMT nursing. If you are reading this message, you are one of 1,511 SIG members reaching out to enhance your purpose as a BMT nurse. Now it’s time to consider sharing your enthusiasm with colleagues. See my challenge to all BMSCT SIG members on our Virtual Community (http://bloodmarrow.vc.ons.org/). Educate your colleagues about membership, remembering that they can join one SIG free when joining ONS or renewing their membership. In closing,
I want to thank you for your continued efforts to improve the care of
BMT patients and their families. I hope that everyone has a peaceful
fall and wonderful holiday season. All my best to you and your family. |
The
Blood and Marrow Stem Cell Transplant SIG Newsletter is produced
by members of the Blood and Marrow Stem Cell Transplant SIG and ONS staff and is not a peer-reviewed publication. |
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| Special
Interest Group Newsletter October 2007 |
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Kim Schmit-Pokorny, RN, MS, developed and submitted the idea of a basic class on stem cell transplantation (SCT) for the novice blood and marrow transplant (BMT) nurse or nurses who did not work in SCT to the ONS conference planning team. In an instructional session at the 32nd annual ONS Congress, Kim presented a wonderful introduction, which included types of transplants, indications, rationale, and patient/family preparation. I followed up with some of the acute complications, focusing on graft-versus-host disease (GVHD) and infections. For the newsletter, I will highlight a few of my comments. From the day the preparative regimen begins till day +100 post-SCT, the nurse is managing multiple problems simultaneously, including 1) Symptom management—nausea, vomiting, diarrhea, mucositis,
and skin changes The risk factors for infections in SCT recipients includes the underlying disease, preparatory regimen, bone marrow suppression, use of broad-spectrum antibiotics, immunosuppressive medications, presence of central venous catheter, loss of skin and mucosal integrity, GVHD, prior infections, and hospitalization. The types of infections encountered following SCT change over time. 1) In the first month following SCT
GVHD is an immune response of the donor T cells against recipient tissues. Acute GVHD usually occurs prior to day +100 and principally affects the skin, liver, and gastrointestinal tract. The incidence of acute GVHD is 25%-50% of matched sibling donor transplants and higher for partially matched or unrelated donors. Risk factors for acute GVHD include human leukocyte antigen (HLA) disparity, gender mismatch, increasing age, and infections. Each organ system receives a grade of GVHD based on the extent of involvement, and then the score of the three organ systems is combined for an overall grade. Overall grade III and IV acute GVHD is life-threatening, with an overall survival rate of < 20%. Prevention strategies for acute GVHD include HLA matching, T-cell depletion, immunosuppressive medications, and infection prevention. The nursing care of an individual with acute GVHD includes practicing meticulous skin care, performing pain management, monitoring liver function tests, maintaining fluid and electrolyte balance, assessing neurologic status, reducing hepatotoxic medications, providing transfusion support, administering immunosuppressant medications, and providing psychological support for the patient and family. The incidence of chronic GVHD is approximately 35% of HLA-identical sibling transplants and higher in mismatched or unrelated donor transplants. Chronic GVHD occurs greater than 100 days post-SCT and can affect almost any tissue in the body. The most commonly affected tissues are the skin, mouth, eyes, and liver. Poor prognostic features of chronic GVHD include prior acute GVHD, progressive subtype (development of chronic GVHD immediately following acute GVHD), persistent severe thrombocytopenia, lichenoid changes of the skin, elevated bilirubin, and multiorgan disease. Immunosuppressive medications are the mainstay of therapy for chronic GVHD. An important principle in the management of patients with chronic GVHD is the selection of antimicrobial agents for preventing infectious complications while the patient is on immunosuppressive therapy. Nursing care of the individual with chronic GVHD is focused on symptom control, prevention of complications, nutritional support, and monitoring the response to immunosuppressive therapy. Other late complications of SCT include cataracts and hypothyroidism in approximately 20% of patients who receive fractionated total body irradiation as part of the preparative regimen. Infertility is almost universal following the high-dose preparative regimens used in transplant. Additionally, women will experience premature menopause. Both infertility and early menopause are significant sources of emotional distress for individuals who have not completed their childbearing. Fears of secondary malignancies and relapse also remain significant emotional challenges for SCT recipients and their families. Despite the many complications associated with SCT, most transplant recipients report good to excellent quality of life (QOL). Two strategies to improve the QOL of SCT recipients include aggressively managing late effects and helping individuals to develop realistic expectations of life after transplant. Bibliography Andrykowski, M.A. (1994). Psychosocial factors in bone marrow transplantation: A review and recommendations for research. Bone Marrow Transplantation, 13, 357–375. Andrykowski, M.A., Bishop, M.M., Hahn, E.A., Cella, D.F., Beaumont, J.L., Brady, M.J., et al. (2005). Long-term health-related quality of life, growth, and spiritual well-being after hematopoietic stem-cell transplantation. Journal of Clinical Oncology, 23, 599–608. Andrykowski, M.A., Brady, M.J., Greiner, C.B., Altmaier, E.M., Burish, T.G., Antin, J.H., et al. (1995). ‘Returning to normal’ following bone marrow transplantation: Outcomes, expectations and informed consent. Bone Marrow Transplantation, 15, 573–581. Appelbaum, F.R. (1996). The use of bone marrow and peripheral blood stem cell transplantation in the treatment of cancer. CA: A Cancer Journal for Clinicians, 46, 142–164. Broers, S., Kaptein, A.A., Le Cessie, S., Fibbe, W., & Hengeveld, M.W. (2000). Psychological functioning and quality of life following bone marrow transplantation: A 3-year follow-up study. Journal of Psychosomatic Research, 48, 11–21. Brugger, W. (2002). Improving outcomes in transplantation. Seminars in Oncology, 29 (2 Suppl. 6), 23–26. Buchsel, P.C., Leum, E.W., & Randolph, S.R. (1996). Delayed complications of bone marrow transplantation: An update. Oncology Nursing Forum, 23, 1267–1291. Cimprich, B. (1995). Symptom management: Loss of concentration. Seminars in Oncology Nursing, 11, 279–288. Hacker, E.D. (2003). Quantitative measurement of quality of life in adult patients undergoing bone marrow transplant or peripheral blood stem cell transplant: A decade in review. Oncology Nursing Forum, 30, 613–629. Johnson Vickberg, S.M., Duhamel, K.N., Smith, M.Y., Manne, S.L., Winkel, G., Papadopoulos, E.B., et al. (2001). Global meaning and psychological adjustment among survivors of bone marrow transplant. Psycho-Oncology, 10, 29–39. Langer, S., Abrams, J., & Syrjala, K. (2003). Caregiver and Patient marital satisfaction and affect following hematopoietic stem cell transplantation: A prospective, longitudinal investigation. Psycho-Oncology, 12, 239–253. Syrjala, K.L., Langer, S.L., Abrams, J.R., Storer, B., Sanders, J.E., Flowers, M.E., et al. (2004). Recovery and long-term function after hematopoietic cell transplantation for leukemia or lymphoma. JAMA, 291, 2335–2343. Syrjala, K.L., Roth-Roemer, S.L., Abrams, J.R., Scanlan, J.M., Chapko, M.K., Visser, S., et al. (1998). Prevalence and predictors of sexual dysfunction in long-term survivors of marrow transplantation. Journal of Clinical Oncology, 16, 3148–3157. Tierney,
D.K. (2004). Sexuality following hematopoietic cell transplantation.
Clinical Journal of Oncology Nursing, 8, 43–47.
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D.
Kathryn Tierney, RN, PhD |
| Special
Interest Group Newsletter October 2007 |
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SIG Members to Present Topic at ONS Congress 2008 Congratulations to Georgie Cusack and Lenore Rees! Their topic “BMT Population: Understanding and Communicating Acuity to Support Staffing” has been accepted for presentation at the 33rd annual ONS Congress. To attend this session or to submit an abstract for Congress 2008, visit our SIG Web site (http://bloodmarrow.vc.ons.org/). Submission and registration details will be coming soon.
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| Special
Interest Group Newsletter October 2007 |
| Josh Gottheil Memorial Bone Marrow Transplant Career Development Award Recognizes Achievements
The application deadline for the 2008 awards is December 1, 2007. Information about this and other ONS awards can be found at www.ons.org/awards/. The following biographies were provided by the award recipients. Rosemary Ford, BA, BSN, OCN® Rosemary Ford entered nursing school in the mid-1970s with the goal of becoming a public health (PH) RN. This caused angst within her consciousness-raising group in the National Organization for Women, as the women’s rights movement had just exploded across the country. Starting a career in nursing or teaching was not seen as breaking the gender barrier in the workplace. Rosemary, however, knew several PH RNs in Santa Clara County where she lived and was impressed with the positive difference they made in the lives of their patients, the autonomy in their work lives, and the creativity they brought to their jobs. In school, she was bitten by the ICU bug, which was fortunate as this was a time in nursing history where there was a surplus of nursing jobs and PH departments were not hiring new graduates. Rosemary moved to Seattle after graduating and began her nursing career in the county’s burn unit, which the recruiter called “a good stepping stone for ICU nursing.” Fortunately, she had wonderful preceptors and after two years had developed strong ICU skills. She especially enjoyed the long-term relationships she developed with the patients in this unit. At the end of 1978, a couple of the nurses from the burn unit were hired at the newly established Fred Hutchinson Cancer Research Center (FHCRC) Clinical Research Bone Marrow Transplant Unit. She had never considered oncology; however, they encouraged Rosemary to apply, luring her with a better work schedule, not working with surgeons, similar therapies as with burn care (e.g., antibiotics, blood transfusions, fluid and electrolytes), and yes, long-term relationships with patients. Rosemary started on evening shift at FHCRC and immediately felt she had found her niche. Yes, the work schedule was better, and she was able to incorporate the specifics of transplant nursing into her skill set. And the oncologists treated the RNs with respect, not rounding on a patient unless the RN was present (the burn unit surgeons had not allowed the RNs to speak during “teaching rounds”), and seeking out nurses’ assessments and suggestions for patient care. She worked with a team of very dedicated nurses who worked together as they incorporated new therapies (cyclosporine IM, double-lumen Hickman catheters) into their routines. In 1980, Rosemary was asked to consider the position of nursing education and practice coordinator. This was a very difficult decision, as she was very satisfied with her position on evening shift. However, she would be working with one of the nurses she most admired in the chief nursing position, so she applied and accepted the position. For the next 13 years she coordinated the orientations of 108 RNs, chaired the nurse practice committee, and coordinated learning experiences for hundreds of nurses from other centers nationally and internationally who wanted to set up their own transplant units. In 1993, Rosemary agreed to fill in on a temporary basis for the Outpatient Transplant Clinic’s nurse manager, who had resigned. She found committed RNs working in the growing clinic without much structure or continuity with patients. Rosemary started problem solving with the staff on how to reorganize, and two months later was asked to take the position permanently, which she did. She is still in this position, the staff has more than doubled, and patient satisfaction with the clinic runs between 95%-100%. Rosemary has actively supported transplant nursing as a subspecialty for many years. In 1984, Rosemary was on the planning committee of the first transplant nursing conference planned by Seattle transplant RNs. The original goal was to hold a conference for Seattle RNs and open it to other RNs if interested. The committee was overwhelmed by the national and international response of more than 600 RNs! This group planned another five conferences periodically, with the last one in 1998. By 1989, there were many transplant centers in the country and a growing need for nurses in this specialty to organize. Rosemary was asked by the ONS Board to chair the Special Interest Group (SIG) committee with the mission to propose a model for SIGs within ONS. The BMSCT SIG was one of the charter SIGs of ONS. Rosemary is particularly pleased with the SIG’s participation in the tandem transplant annual medical conferences, where she sees the opportunity for education and networking at the expert transplant nurse level being securely met for years to come. Kristen Geraghty, RN, BSN, OCN® Kristen came to the inpatient BMT unit at the University of California, San Diego (USCD) Medical Center’s Thornton Hospital in La Jolla, CA, after obtaining a bachelor of science in nursing degree from the University of Tennessee in 2001. Since coming to UCSD, she has served as the charge nurse on night shift and has trained many new employees and new graduate RNs as a preceptor. She currently is actively involved in implementing a unit-based shared governance model and is serving as the chair of the Standards of Care Committee. Her contributions to the BMT unit and the university include authoring and/or revising standards of care to incorporate evidence-based interventions in the care of the BMT patient, developing a BMT quick-reference manual for the intensive care unit, which was presented at the 2006 Association of California Nurse Leader’s Meeting in San Diego and the 2006 ONS Congress in Boston, and implementing a new graduate RN orientation program specific to BMT. She is currently pursuing her master’s degree in the Adult/Elderly Acute Care Nurse Practitioner Program at San Diego State University. Anna Rodriguez, RN, BSN, OCN® Anna Liza Rodriguez, RN, BSN, OCN®, from Chicago, IL, graduated in 1992 with a bachelor of science in nursing from St. Louis University, Baguio City, Philippines. After graduation she worked in a tertiary maternity hospital in the Philippines, where she practiced for three years as a staff nurse in the labor and delivery, post-partum, maternal, and child units. She was also a clinical instructor in a midwifery program. In 1995, she immigrated to the United States. Here, Anna specialized in many different areas, including geriatrics, medical-surgical, rehabilitation, quality, and utilization review. Within these units she held several positions, including staff nurse, charge nurse, and coordinator. In 2000, Anna discovered her niche in oncology nursing, particularly in stem cell transplantation. Currently, she manages a 30-bed inpatient stem cell transplant/hematology unit at Northwestern Memorial Hospital in Chicago. Her contributions to stem cell transplant nursing include developing a competency-based stem cell transplantation orientation, coauthoring an article on multiple myeloma and implications to nursing that was recently published in the August 2007 Clinical Journal of Oncology Nursing , and, most recently, developing a computer-based training module on graft-versus-host disease. Anna has delivered various lectures and presentations locally: "Hand Hygiene Sustaining our Improvement," "Competency-Based Stem Cell Transplant Orientation for Nurses," "Stem Cell Transplant Basics," "Lymphoma," "Stem Cell Transplant Chemotherapy Regimens," and "Future Directions in Stem Cell Transplantation." She also has presented several poster sessions at national oncology and evidence-based practice conferences. Anna currently is enrolled in graduate studies with concentrations in nursing and healthcare administration, with anticipated graduation in October of 2007. Rebecca Babb, RN, BSN, OCN® Rebecca’s bio has not been included, as it was
recently featured in the newsletter.
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The
Blood and Marrow Stem Cell Transplant (BMSCT) SIG would like to congratulate
the 2007 recipients of the Josh Gottheil Bone Marrow Transplant Career
Development Award: |
| Special
Interest Group Newsletter October 2007 |
| 2008 Blood and Marrow Transplant Tandem Meetings Taking Place in San Diego Rebecca
Babb, RN, BSN, OCN® The 2008 Blood and Marrow Transplant Tandem Meetings, sponsored by the American Society for Blood and Marrow Transplantation (ASBMT) and the Center for International Blood and Marrow Transplant Research, will be held February 13-17, 2008, at the Manchester Grand Hyatt in San Diego, CA. The Transplant Nursing Conference, coordinated by the Blood and Marrow Stem Cell Transplant SIG, will take place February 15-17. Please visit the ASBMT Web site (www.asbmt.org) for additional details regarding the program, registration, and housing. We hope to see you in San Diego!
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| Special
Interest Group Newsletter October 2007 |
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The Blood and Marrow Transplant Program is a unique joint venture between the University of California, San Diego (UCSD) Medical Center and Sharp Memorial Hospital. It is located in the Moores Cancer Center in La Jolla, CA, which is the only National Cancer Institute–designated center in San Diego. Since 1998, the program has performed more than 1,000 autologous, allogeneic, and cord or double cord transplants. Blood and Marrow Transplant Quality Resource Manager Role More than two years ago, as the U.S. Food and Drug Administration’s (FDA’s) Guidance for Industry regarding donor eligibility (21 CFR Part 1271) was in the process of being implemented, our program’s application for the Foundation for the Accreditation of Cellular Therapy (FACT) reinspection was due, and negotiations for a service contract to add Rady Children’s Hospital of San Diego (RCHSD) as the pediatric add-on to our FACT Accreditation were being made. To facilitate the integration of the FDA requirements with our inspection and merger with RCHSD, our program administrator, Nancee Whitson, identified a need for a quality nurse who would oversee compliance with regulatory requirements. A job description for a quality resource manager (QRM) position was developed and posted with the following duties and responsibilities.
At that time, I had been working as a CNIII on the Heme/Onc/BMT inpatient unit for more than 10 years and decided to look for a position in the outpatient setting. After reviewing the description, I applied and was offered the job. As the QRM was a newly formed position, I developed my role without the benefit of a predecessor. With help from members of our Quality Assurance Committee and other staff members from UCSD and RCHSD, policies and standard operating procedures, competencies and training, a quality management plan, audits and tools, PI initiatives, and new/revised forms were developed to comply with regulatory standards and to prepare for site visits. I have and will continue to enjoy my role and the autonomy that comes with it. Just when I think my role will be to maintain compliance, new standards and changes in practice brought about by current research and evidence-based practice recommendations are developed that keep issues related to the provision of quality care for BMT patients ongoing. Please feel free to contact me if you have questions. I would also
like to hear from others with similar roles and about your program’s
quality practices.
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Elaine
Kenniston, BSN, RN, OCN® |
| Special
Interest Group Newsletter October 2007 |
| Editors'
Message Mindi Chouinard, RN, BSN, OCN® Rebecca Babb RN, BSN, OCN® We would love to feature your blood and marrow transplant center in an upcoming newsletter. If you are interested in writing a brief article about your program, please contact us at babbr@cc.nih.gov.
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Members
Encouraged to Submit Articles |
| Special
Interest Group Newsletter October 2007 |
| Spotlight on Excellence
The Blood and Marrow Transplant (BMT) Program at Ohio State University (OSU) James Cancer Hospital and Solove Research Institute offers transplants to adults patients for a wide variety of diseases, including leukemia, amyloidosis, aplastic anemia, lymphoma, multiple myeloma, and other myelodysplastic and myeloproliferative disorders. The program performs autologous transplants and allogeneic transplants with either related or unrelated donors using either peripheral stem cells or marrow and/or T-cell depletion. A myeloablative or reduced-intensity chemotherapy regimen may be used to prepare the patient for transplantation. The BMT program at OSU started in January 1984 with one bed on an interdisciplinary hematology-oncology unit. The first BMT was performed on February 13, 1984. As the program grew along with the inception of the James Cancer Hospital, a new comprehensive cancer center fully dedicated to the care of patients with cancer, the BMT Program expanded to a 12-bed inpatient unit. Over the years, the program has continued to expand to what is now a 24-bed inpatient facility and has performed more than 2,000 transplants. The program’s outpatient clinic provides care to the transplant patient throughout the BMT process. Patients are seen in clinic for consultation, work-up to BMT, and after the transplant. As the care of the BMT recipient becomes more and more complex, the program is looking ahead with the building of a new outpatient clinic expected to open in the spring of 2008. BMT patients at the OSU James Cancer Hospital and Solove Research Institute are cared for by specially trained staff. All nursing staff of the transplant unit and outpatient clinic are educated and trained to provide all aspects of care for the program’s patients. The inpatient BMT unit is able to provide intensive care unit management. All RNs are certified in advanced cardiopulmonary life support, and many are oncology certified nurses who are active in ONS. Clinical research is vital to improve the lives of patients undergoing blood cell transplantation. The OSU BMT Program is involved in several National Institutes of Health (NIH)–supported clinical trials designed to make transplants better tolerated and more successful overall. We are one of a select group of transplant centers involved in the NIH-sponsored Blood and Marrow Transplant Clinical Trials Network and also are a main member of the National Cancer Institute–sponsored Cancer and Leukemia Group B. The BMT Program at OSU James Cancer Hospital and Solove Research Institute has earned international recognition for advancements in treating cancer. The program is accredited by all the major accrediting agencies, including the Foundation for the Accreditation of Cell Therapy. To learn more about the program or to tour the unit, please browse our Web site at www.jamesline.com/patientsandvisitors/tests/treatment/blood_and_marrow_transplant
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Michelle
Wasko, MS, RN |
| Special
Interest Group Newsletter October 2007 |
| The SIGs Virtual Community Keeps You Connected The SIGs Virtual Community was developed to improve communication among SIG leaders and members. Visiting your SIG’s Web page on the Virtual Community keeps you updated about SIG activities by providing you with important information and resources. To navigate to your SIG’s page, visit the SIGs Virtual Community at http://sig.vc.ons.org and select “Find a SIG” from the top navigation. Many features in the SIGs Virtual Community are useful to all members. Below is an outline of the information that can be found on your SIG’s page. From your SIG’s main page, you can subscribe to SIG announcements, calendar events, and the discussion forum. Once you are subscribed to the areas, an e-mail will be sent to you every time an announcement, event, or discussion has been posted. Announcements are added frequently with important information pertaining to your SIG, such as scholarship, leadership, and meeting information. SIG events on the SIG calendar are showcased on the main page for your convenience. Simply click on an event for detailed information. About Us News Discussions ONS National Announcements If you have questions or problems navigating the SIGs Virtual Community, contact me at jshinsky@ons.org.
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Jenny
Shinsky |
| Special
Interest Group Newsletter October 2007 |
| Membership Information SIG Membership Benefits
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| Special
Interest Group Newsletter October 2007 |
| Blood and Marrow Stem Cell Transplant SIG Officers
Know
someone who would like to receive a print copy of this newsletter? To view past newsletters, click here. ONS Membership/Leadership Team Contact Information Angie
Stengel, MS, CAE, Director of Membership/Leadership Diane
Scheuring, MBA, CMP, Manager of Member Services 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
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