Abstracts of the Nurses Group EBMT 2006
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Abstracts of the Nurses Group EBMT 2006 and so decreases levels of anxiety and improves clinical Supportive care outcomes (Audit Commission 1993). Bone Marrow Transplantation (BMT) has been described as a procedure associated with isolation of the patient, prolonged N922 hospitalizations, rapid fluctuations in medical conditions, Nursing aspects in patient-information frequent and often life-threatening infections, and graft-versus- G. Rother, C. Weßler, N. Reebehn host disease (GvHD). UK-SH, Campus Kiel (Kiel,D) It is a complex process with immediate as well as long-term effects, which may permanently impair quality of life and can In addition to the information supplied by physicians there is affect morbidity and mortality. Achieving a level of also a need for explaining the nursing aspects to the patients. understanding of what is involved can be a bewildering Both sides are important to minimize fear, to create an proposition for many patients and their carers, and in itself can atmosphere of confidence and to help the patient complete present obstacles to informed consent and subsequent post- their treatment successfully. transplant expectations. A stay on the BMT-unit is not like any other time in hospital. The Seven Steps is a project which evolved through the need Lots of questions arise before admission and during the stay to meet our patients’ demand for accurate and clear written and patients often are left with a huge amount of uncertainty literature to support and compliment verbal description. The about what to do or not to do. During the preparations at the result is a book, which divides the bone marrow transplant outpatient clinic physicians inform their patients thoroughly journey into 7 clear steps, which provide a high level of detail about the medical side of the transplantation process but they yet with a strong patient focus. cannot give sufficient answers to questions concerning the The Seven Steps has been a multi-phase project nursing aspects of the upcoming admission and the weeks on incorporating a needs assessment, pilot and review of the first the ward. draft. The views, opinions and suggestions of patients, their Information patients get by hearsay or find in literature and carers, medical staff, nursing colleagues and members of the other media like the internet vary widely as concepts of multi-disciplinary team were incorporated at each stage. treatment and nursing still differ a lot from one transplantation Members of relevant professional bodies (EBMT Nurses’ centre to another. Group and RCN Haematology and BMT Nursing Forum) In order to avoid confusion and to enable patients to prepare reviewed the final draft. their stay on the BMT-unit properly some people of the The Seven Steps project is supported by the Leukaemia nursing team of our unit have started to develop a concept of Research Fund who publish and distribute the book. It can be patient-information from a nursing point of view. accessed by anyone seeking information on the subject since This concept consists of: it is free of charge to all users in hard copy, can be 1. Before admission a booklet is handed out to the patient downloaded from the Internet and has been translated into which basically explains the terms which are important during Spanish and Arabic. There is clearly scope for the Seven the stay and gives some general information about the course Steps to be translated into additional languages to facilitate of the day on the ward. more wide scale distribution beyond the United Kingdom. 2. Once a month an informative talk is offered for patients to The Seven Steps book has been widely used since be admitted to the unit within the next weeks. Relatives are publication 4 years ago and circulation is currently in the invited as well and there is a lot of time to answer specific region of 14,000 copies in the United Kingdom. The Seven questions, again about the nursing aspects of the treatment. Steps has filled a void for many patients and in response to 3. On the day of admission a nurse tells the patient the details patient demand; a follow-up book addressing post transplant about his everyday care, nutrition, communication facilities, complications and late effects is currently being developed. isolation procedures, visitor regulations and other things important to nurse and patient. Relatives are encouraged to be present at this conversation and the major content of the N924 talk is left at the patients bed in a written leaflet. Recognising indications for photopheresis in acute and Existing plans: chronic graft-versus-host disease patients 1. To design a brochure with advice and information for the H. Jordan-Graham (1), J. Wade (1), J. Rizzo (1), P. Hari (1), time after discharge. W. Drobyski (1), S. Miels (1), R. Gruling (1), S. Sorensen (2), 2. To continually improve the existing written information and A. Murtaugh (3) to keep it up to date. (1)Medical College of Wisconsin (Milwaukee, USA); (2)M D The poster will present the development and implementation Anderson (Houston, USA); (3)Seattle Cancer Care Alliance of our “Patient-information from a nurses point of view. (Seattle, USA) Extra Corporal Photopheresis (ECP) is currently being used N923 as an effective treatment for patients with Acute (A) and The seven steps and beyond: developing accessible Chronic (C) Graft versus Host Disease (GvHD). Treatment information to meet the patients' needs before, during has been initiated as early as twenty-four hours after and after bone marrow transplantation confirming GvHD to be refractory to steriods. Although, there M. Kenyon is no standard treatment for CGvHD, ECP has been utilized Kings College Hospital (London, UK) as treatment with promising results. Method: Cumulative treatment records for patients with The benefits of good patient information are huge. It increases A/CGvHD that received ECP were retrospectively reviewed. the patient’s feeling of control (Gammon and Mulholland 1996) Indications, frequency and appropriateness of ECP were analyzed. Although, there were indications of improvement in S258 patients with A/CGvHD while receiving ECP, it was difficult to quantify positive or negative changes in the patients' physical Crossing borders - a European assessment. It is important to recognize indications of GvHD approach in the allogeneic blood and marrow transplant population. Presented is a tool to facilitate recognition and follow-up of physical indicators in patients with A/CGvHD. This N926 assessment tool was developed following discussions with Experiences of the EBMT Swiss Nurses Group physicians and nurses in an effort to prospectively quantify the E. Aerts, J. Cvetanovic, C. Pino-Molina, M. Rigiani, C. Langer, response to therapeutic modalities. Additionally, it will assist V. Chapuis, N. Imboden, S. Van den Bosch, G. Kollbrunner on identifying time of response and benefit of ECP. The tool is behalf of the EBMT Swiss Nurses Group being validated prospectively on patients currently undergoing ECP. Once validated, it will be placed in routine use. The Introduction: Already in the early nineteen eighties,nurses met ultimate goal is to develop a tool to assist the clinical in and exchanged ideas with colleagues from different Swiss providing an initial and ongoing assessment both before and SCT-Units. during ECP. This tool, can assist in identifying improvements During the EBMT Congress in Montreux (CH)in 2002 senior or changes in the patient's A/CGvHD status. nurses from the transplant centers in Basel and Zurich Result: ECP can be an adjunctive therapeutic modality in the initiated a local organisation committee. treatment of A/CGvHD. The therapeutic effectiveness of the As the congress took place in Montreux, in the French treatment has been clinically evident. Most therapeutic speaking part of Switzerland, contact was made with the local responses recognized occurred with skin, fascia and muscle centers (Lausanne, Geneva), as well as centers from the GvHD. Providing documentable substantiation of therapeutic German and Italian speaking cantons of Switzerland. treatment is essential in providing effective care. Reporting Following the meeting, we started preparing the formation of a observable therapeutic effectiveness to treatment is also Swiss National Nurses Group. important in providing continuity of care. The Initial and Regular meetings and working liaisons have been established Ongoing physical assessment tool facilitates comprehensive by the teams of the Swiss centers. assessment for following patients with multisystem GvHD on The Swiss Nurses Group on Stem Cell Transplant Care was several immunosuppressive modalities. This tool provides a finally formed on May 11th, 2004. simple clinical document that facilitates characterization of Group meetings take part twice a year and consist on the GvHD at initation of ECP and tracking of response by disease following: manifestation/site. We hope this will provide better long term 1. Looking at the organisation of centers and the exchange of assessment of patients as a supplement to routine abstraction knowledge of clinic charts and dications. 2. A study session /workshop. First goals being exchange of knowledge, expertise and experience, the group was affiliated to the EBMT-NG at the N925 end of 2004. Retrosopective quantification of oral graft-versus-host While new goals were added, the team became more and disease symptoms by questionnaire more a professional working group. J. Gray, F. Clark The Swiss Nurses Group is currently involved in the JACIE Queen Elizabeth Hospital (Birmingham, UK) Accreditation process. The group recognises the importance of the project and is Oral complications after allogeneic stem cell transplantation planning an active cooperation with haematologists in the are increasingly recognised as a significant cause of last post- JACIE process. transplant morbidity. One of the most important causes is Method: chronic graft-versus-host disease and this has been The Swiss Nurses Group has been able to build up a national documented histologically in up to 45% of patients.