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Hematopoietic Stem Cell Transplantation Nursing: A Practice Variation Study

Margaret Bevans
D. Kathryn Tierney
Coleen Bruch
Mary Burgunder
Kathleen Castro
Rosemary Ford
Michelle Miller
Sandra Rome
Kim Schmit-Pokorny
ONF 2009, 36(6), E317-E325 DOI: 10.1188/09.ONF.E317-E325

Purpose/Objectives: To examine practice variation in hematopoietic stem cell transplantation (HSCT) nursing and to identify the gap between recommended standards of practice and actual practice across settings. Additional practices relevant to HSCT nursing also were explored.

Research Approach: Cross-sectional, descriptive survey.

Setting: National and international cancer centers.

Participants: A convenience sample was obtained from the 2006 Oncology Nursing Society Blood and Marrow Stem Cell Transplant Special Interest Group membership list (N = 205). Most participants were women (94%) with a median age of 45 years. The primary role was bedside nurse (46%), with an adult-only population (78%) in an academic (84%), inpatient (68%-88%) center. 39 (94%) U.S. states and 7 (6%) non-U.S. countries were represented.

Methodologic Approach: Survey development was guided by Dillman Mail and Internet survey design. Electronic questionnaires were conducted with Zoomerang™ Market Tools.

Main Research Variables: Infection control practices across bone marrow transplantation settings.

Findings: Descriptive statistics revealed minimal practice variation regarding infection control across transplantation types or conditioning regimens. Practices regarding implementation of restrictions on patients' hygiene, diet, and social interactions varied by phase of transplantation, with the greatest variations occurring during the post-transplantation phase. Sixty-two percent of respondents reported using published guidelines; 72% reported using organization-specific policies.

Conclusions: Although published standards are under consideration, practice variation exists across transplantation centers. Whether the variation is caused by a lack of compliance with published guidelines or by the poor delineation of details for providers to translate the guidelines into practice is not known.

Interpretation: Identifying gaps in the literature and inconsistencies in HSCT practices is an important first step in designing evidence-based projects that can be used to standardize practice and link best practices to improved patient outcomes.

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