Pre-procedure education key for BMT patients
Pre-procedure education key for BMT patients
Information reviewed to ensure retention
Educating bone marrow transplant (BMT) patients can be an intense process due to the pertinent details they need to learn - before the procedure is performed. Patients must know the preparation process for the transplant, what to expect during their inpatient stay, how to prevent infection upon discharge, and what outpatient follow-up visits will be like.
Much of the education lies in preparing the patients for what they can expect, says Susan Hanauer, BSN, nurse clinician at the University of Wisconsin Hospital and Clinics in Madison. The information is covered before the procedure because immediately after the transplant takes place, the patient is too sick to do much learning.
"Patients get very sick, but they must understand that it's part of the transplant process, not part of their disease. When they know what to expect, their anxiety is decreased," explains Hanauer.
Too much information at once
There is so much information, it is difficult for patients to absorb it all, says Leslie Parran, MS, RN, blood and marrow transplant clinical nurse specialist at Fairview-University Medical Center in Minneapolis. That's why it is important to make sure teaching is ongoing. "Too much information in a big chunk is too overwhelming. You can't just hand them a manual. They must constantly be reassured that there will be multiple opportunities to learn," says Parran.
Patients are admitted to the hospital a week before the transplant for conditioning radiation and/or chemotherapy. Recovery time following the procedure is lengthy. The average hospital length of stay for allogenic, or unrelated donor transplant, is 47 days. Additionally, patients can spend a year in recovery before returning to work. For autologous transplant patients, the length of stay is 11 to 18 days and six months off work.
Successful BMT education programs provide teaching across the continuum of care and use a variety of educational methods, says Parran. However, the pre-transplant education builds the foundation. Much of the teaching takes place in preparation for the transplant. Following are several suggestions for creating the pre-transplant educational component for a BMT program:
· Solid information to help patients make a treatment decision.
Physicians provide patient candidates for a BMT at University of Wisconsin Hospital and Clinics in Madison with a pamphlet titled Deciding to Have Your Bone Marrow Transplant. The pamphlet, created by the hospital's education department, is a synopsis of the transplant process, explains Hanauer.
The education department also created a BMT video that physicians can show patients, or it can be viewed by patients in the clinic after they decide to have the transplant. A narrative portion explains the transplant process step-by-step and discusses follow-up procedures. One patient is followed through the entire transplant process, and other patients discuss certain issues, such as how they felt on transplant day. "It's a nice summary, and patients like to know how others who had a bone marrow transplant feel," says Hanauer.
BMT patients at Fairview-University Medical Center come to the hospital for a tour and short lecture to help them decide whether the treatment option is right for them, says Parran.
· Pre-admission teaching to build educational foundation.
Patients who decide to proceed with a transplant attend a group class at Fairview-University Medical Center. They learn about the process and what will be done on an inpatient basis and what part of the treatment takes place in the clinic, says Parran.
Pre-admit counseling offered
During the pre-admission workup, when the patients complete the necessary testing, the nurse coordinator spends a lot of time going over information pertinent to the patient's case. Also, the physician answers the patient's questions during this time.
At University of Utah Hospitals and Clinics in Salt Lake City, patients also attend a class that is taught by a clinical educator. Other disciplines, such as social services and dietary, provide information according to that discipline's expertise. The educator covers the basic information. "The patients need to learn what they will need to do to get through the process and get better," says Robin Phillips, MSN, RNC, nurse manager for bone marrow transplants at the health care facility.
"There is a lot of time upfront spent teaching and a lot of repetition in different formats," says Parran. (For information on documenting the education, see story, at right.) Currently, the hospital is developing a series of videos to aid in the education process, including the workup for BMT, discharge information, and graft vs. host disease. A discharge video is complete and is shown at the patient/family discharge class.
Patients at Fairview-University receive a manual as part of their pre-admission teaching. It is divided into sections that include disease information, discharge articles, medication instructions, nutrition information, graph vs. host disease, contact numbers, a glossary of medical terms, and the patient's workup schedule.
Patients carry the manual with them through the transplant process and make it specific to their own procedure. For example, the medication sheets are specific to each patient's prescriptions, and the dietitian provides brochures specific to a patient's nutritional needs. "There are some generic articles in sections, but the manual is tailored to the patient as time goes on," explains Parran.
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