Nurses: Changing Psychological Deadlines to Lifelines
As soft as sponge, in a bony crunch, form blood cells and fight with infection cells. “The bone marrow” which produces body’s blood cell including red blood cell as oxygen carrier, white blood cells as germi shield commander and platelets as blood clotter. Malfunction of this bone marrow can create a radical change in the meaning of life. The malfunction of this bone marrow produces immature and excessive quantity of the above cells hence creating a malformed cell market in the body.
This can be in the case of aplastic anemia, leukemia or some immune deficiency disease. The immature or defective blood cells interfere with the production of normal blood cells, accumulate in the bloodstream and may invade other tissues. This malfunction in the bone marrow can be cured with three of the modalities: 1) Chemotherapeutic agents, 2) Radiation therapy and 3) Bone marrow transplantation. Large doses of chemotherapy and/or radiation can destroy the abnormal stem cells and abnormal blood cells.
These therapies, however, not only kill the abnormal cells but can destroy normal cells found in the bone marrow and further, can destroy healthy bone marrow too. While bone marrow transplants do not provide 100 percent assurance that the disease will not recur, a transplant can increase the likelihood of a cure or at least prolong the period of disease-free survival for many patients. A bone marrow transplant is a physically, emotionally, and psychologically exhausting procedure for both the patient and family. A patient needs and should seek as much help as possible to cope with the experience.
“Toughing it out” on your own is not the smartest way to cope with the transplant experience. The bone marrow transplant is an unbearable experience. Imagine the symptoms of a severe case of the flu – nausea, vomiting, fever, diarrhea, extreme weakness. Now imagine what it’s like to cope with the symptoms not just for several days, but for several weeks or may be for several months.
During this period the patient will feel very sick and weak. Walking, sitting up in bed for long periods of time, reading books, chatting on the phone, visiting with friends or even watching TV may necessitate more energy than the other patient has to spare. Complications can develop after a bone marrow transplant such as infection, bleeding, graft-versus-host disease, or liver disease, which can create additional discomfort. The pain, however, is usually controllable by medication.
In addition, mouth sores can develop that make eating and swallowing uncomfortable. Temporary mental confusion sometimes occurs and can be quite frightening for the patient who may not realize it’s only temporary. The nursing staff will help the patient deal with these problems. Nurses play a vital role in the care of the patient undergoing bone marrow transplantation.
Responsibilities include supporting patients through the procedure and the recovery phase, by monitoring changes in their condition and administering a range of therapeutic interventions (such as blood products or antibiotics). BMT recipients are usually cared for in protective environments. During the experience of isolation intensive caring relationships are likely to be established between patients, their families and staff whose primary focus will be on achieving disease control or cure. Here the nurse is playing a two way supporter angel between the family and patient.
The motto of the bone marrow transplant nurse is: “with the patient for the patient; a guardian angel in a form of nursing agent”. Moreover, the nurses in BMT are also playing as a counselor and educator for patients and family. Different teaching methods are used and patients are approached toward the new dimension of BMT including side effects, complication, and the care during transplant. Further patients who are suffering with the different side effects are managing by nurse accordingly.
The patients who are on complete bed rest during transplant time have daily sponges and daily health hygiene care by nursing staff. The nursing staff is using all the time using a sterilize technique even for handling minute stuff and is acting as germisheild commander for the bone marrow transplant patients. The psychological and emotional stress is also one of the issues in bone marrow transplant patient. First, patients undergoing transplants are already traumatized by the news that they have a life-threatening disease.
While the nurse offers hope for their recovery at this stage. The long weeks of waiting for the transplanted marrow to en-graft, for blood counts to return to safe levels and for side effects to disappear increase the emotional trauma. Recovery can be like a roller coaster ride: one day a patient may feel much better, only to awake the next day feeling as sick as ever. Here the role of the nurse is to fully support the patient and family and to build a ray of positivity in them. In a nut shell, the nurses are playing a helping hand for bone marrow transplant patients in all aspects of care.
About the Author: Maryam PyarAli is currently working as a Bone Marrow Transplant nurse at Aga Khan University Hospital. She deals with adult and peads poulation for selected group of oncology and hematology patients who require isolation, special care and critical care for bone marrow transplant. She can be reached at [email protected]
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