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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

hematopoietic stem cell transplantation
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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    References

    Buchsel, P.C., & Kaputsay, P.M. (Eds.). (2005). Stem cell transplantation: A clinical textbook. Pittsburgh, PA: Oncology Nursing Society.
    Buchsel, P.C., Leum, E., & Randolph, S.R. (1997). Nursing care of the blood cell transplant recipient. Seminars in Oncology Nursing, 13(3), 172-183.
    Centers for Disease Control and Prevention, Infectious Diseases Society of America, & American Society of Blood and Marrow Transplantation. (2000). Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. Biology of Blood and Marrow Transplantation, 6(6a), 659-713, 715, 71-727.
    Cohen, M.Z., Ley, C., & Tarzian, A.J. (2001). Isolation in blood and marrow transplantation. Western Journal of Nursing Research, 23(6), 592-609.
    Colombo, A., Solberg, B., Vanderhoeft, E., Ramsay, G., & Schouten, H.C. (2005). Measurement of nursing care time of specific interventions on a hematology-oncology unit related to diagnostic categories. Cancer Nursing, 28(6), 476-480.
    Craig, J.V., & Smyth, R.L. (2002). The evidence-based practice manual for nurses. Edinburgh, NY: Churchill Livingstone.
    Dadd, G., McMinn, P., & Monterosso, L. (2003). Protective isolation in hematopoietic stem cell transplants: A review of the literature and single institution experience. Journal of Pediatric Oncology Nursing, 20(6), 293-300.
    Dekker, A., Bulley, S., Beyene, J., Dupuis, L.L., Doyle, J.J., & Sung, L. (2006). Meta-analysis of randomized controlled trials of prophylactic granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor after autologous and allogeneic stem cell transplantation. Journal of Clinical Oncology, 24(33), 5207-5215.
    Dillman, D.A. (2000). Mail and Internet surveys: The tailored design method (2nd ed.). New York: John Wiley and Sons.
    Einsele, H. (2003). Antigen-specific T cells for the treatment of infections after transplantation. Hematology Journal, 4(1), 10-17.
    Ezzone, S., & Schmit-Pokorny, K. (Eds.). (2007). Blood and marrow stem cell transplantation: Principles, practice, and nursing insights (3rd ed.). Sudbury, MA: Jones and Barlett.
    Fink, R., Thompson, C.J., & Bonnes, D. (2005). Overcoming barriers and promoting the use of research in practice. Journal of Nursing Administration, 35(3), 121-129.
    Ford, R., & Eisenberg, S. (1990). Bone marrow transplant. Recent advances and nursing implications. Nursing Clinics in North America, 25(2), 405-422.
    Gaskill, D., Henderson, A., & Fraser, M. (1997). Exploring the everyday world of the patient in isolation. Oncology Nursing Forum, 24(4), 695-700.
    Grant, M., Cooke, L., Bhatia, S., & Forman, S.J. (2005). Discharge and unscheduled readmissions of adult patients undergoing hematopoietic stem cell transplantation: Implications for developing nursing interventions [Online Exclusive]. Oncology Nursing Forum, 32(1), E1-E8. Retrieved September 23, 2009, from http://ons.metapress.com/content/9542w132k6470kv6/fulltext.pdf http://ons.metapress.com/content/9542w132k6470kv6/fulltext.pdf
    Institute of Medicine and Committee on Quality of Health Care in America. (2001). Crossing the quality of chasm: A new health system for the 21st Century. Washington, DC: National Academy of Sciences.
    Keswick, B.H., Berge, C.A., Bartolo, R.G., & Watson, D.D. (1997). Antimicrobial soaps: Their role in personal hygiene. In R. Aly, K.R. Beutner, & H. Maibach (Eds.), Cutaneous infection and therapy (pp. 49-82). New York: Marcel Dekker.
    Klastersky, J. (1985). Infections in immunocompromised patients. I. Pathogenesis, etiology, and diagnosis. Clinical Therapeutics, 8(1), 90-99.
    Kruger, W.H., Hornung, R.J., Hertenstein, B., Kern, W.V., Kroger, N., & Ljungman, P. (2001). Practices of infectious disease prevention and management during hematopoietic stem cell transplantation: A survey from the European Group for Blood and Marrow Transplantation. Journal of Hematotherapy and Stem Cell Research, 10(1), 895-903.
    Larson, E. (2001). Hygiene of the skin: When is clean too clean? Emerging Infectious Diseases, 7(2), 225-230.
    Larson, E., & Nirenberg, A. (2004). Evidence-based nursing practice to prevent infection in hospitalized neutropenic patients with cancer. Oncology Nursing Forum, 31(4), 717-725.
    Lee, S.J., Eapen, M., Soiffer, R.J., McCarthy, P.L., Loberiza, F.R., Kernan, N.A., et al. (2007). Practice variation in supportive care in hematopoietic cell transplantation. Biology of Blood and Marrow Transplantation, 13(2), 77.
    Li, Y., Wong, T., Chung, J., Guo, Y.P., Hy, J.Y., Guan, Y.T., et al. (2006). In vivo protective performance of N95 respirator and surgical facemask. American Journal of Industrial Medicine, 49(12), 1056-1065.
    Mank, A., & van der Lelie, H. (2003). Is there still an indication for nursing patients with prolonged neutropenia in protective isolation? An evidence-based nursing and medical study of four years experience for nursing patients with neutropenia without isolation. European Journal of Oncology Nursing, 7(1), 17-23.
    Moya, R., Espigado, I., Parody, R., Carmona, M., Marquez, F., & De Blas, J.M. (2006). Evaluation of readmissions in hematopoietic stem cell transplant recipients. Transplantation Proceedings, 38(8), 2591-2592.
    Passweg, J.R., Rowlings, P.A., Atkinson, K.A., Barrett, A.J., Gale, R.P., Gratwohl, A., et al. (1998). Influence of protective isolation on outcome of allogeneic bone marrow transplantation for leukemia. Bone Marrow Transplantation, 21(12), 1231-1238.
    Pavletic, Z.S., Bishop, M.R., Tarantolo, S.R., Martin-Algarra, S., Bierman, P.J., Vose, J.M., et al. (1997). Hematopoietic recovery after allogeneic blood stem cell transplantation compared with bone marrow transplantation in patients with hematologic malignancies. Journal of Clinical Oncology, 15(4), 1608-1616.
    Poe, S.S., Larson, E., McGuire, D., & Krumm, S. (1994). A national survey of infection prevention practices on bone marrow transplant units. Oncology Nursing Forum, 21(8), 1687-1694.
    Polovich, M., White, J.M., & Kelleher, L.O. (Eds.). (2005). Chemotherapy and biotherapy guidelines and recommendations for practice (2nd ed.). Pittsburgh, PA: Oncology Nursing Society.
    Rizzo, J.D., Wingard, J.R., Tichelli, A., Lee, S.J., van Lint, M.T., Burns, L.J., et al. (2006). Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation. Biology of Blood and Marrow Transplantation, 12(2), 138-151.
    Russell, J.A., Chaudhry, A., Booth, K., Brown, C., Woodman, R.C., Valentine, K., et al. (2000). Early outcomes after allogeneic stem cell transplantation for leukemia and myelodysplasia without protective isolation: A 10-year experience. Biology of Blood and Marrow Transplantation, 6(2), 109-114.
    Saito, A.M., Zahrieh, D., Cutler, C., Ho, V.T., Antin, J.H., Soiffer, R.J., et al. (2007). Lower costs associated with hematopoietic cell transplantation using reduced intensity versus high-dose regimens for hematological malignancy. Bone Marrow Transplantation, 40(3), 209-217.
    Sasaki, T., Akaho, R., Sakamaki, H., Akiyama, H., Yoshino, M., Hagiya, K., et al. (2000). Mental disturbances during isolation in bone marrow transplant patients with leukemia. Bone Marrow Transplantation, 25(3), 315-318.
    Siegel, J.D., Rhinehart, E., Jackson, M., & Chiarello, L. (2007). 2007 guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings. Retrieved September 30, 2009, from http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf
    Speers, J., Bernard, H., O'Grady, F., & Shooter, R.A. (1965). Increased dispersal of skin bacteria into the air after shower-baths. Lancet, 1(7383), 478-480.
    Tabbara, I.A., Zimmerman, K., Morgan, C., & Nahleh, Z. (2002). Allogeneic hematopoietic stem cell transplantation: Complications and results. Archives of Internal Medicine, 162(14), 1558-1566.
    West, F., & Mitchell, S.A. (2004). Evidence-based guidelines for the management of neutropenia following outpatient hematopoietic stem cell transplantation. Clinical Journal of Oncology Nursing, 8(6), 601-613.
    Zerbe, M.B., Parkerson, S.G., & Spitzer, T. (1994). Laminar air flow versus reverse isolation: Nurses' assessments of moods, behaviors, and activity levels in patients receiving bone marrow transplants. Oncology Nursing Forum, 21(3), 565-568.
    Zitella, L., Friese, C., Holmes Gobel, B., Woolery-Antill, M., O'Leary, C., Hauser, J., et al. (2008). Prevention of infection: What interventions are effective in preventing infection in people with cancer? Retrieved October 16, 2008, from http://www.ons.org/outcomes/volume1/prevention/pdf/InfectionPEPCard.pdf