Provisional practice: the nature of psychosocial bone marrow transplant nursing.
OBJECTIVE
To develop an empirically based description of the key concepts guiding psychosocial nursing practice for the patient undergoing bone marrow transplantation (BMT).


METHODS
Retrospective, descriptive.


METHODS
National Cancer Institute-designated comprehensive cancer center.


METHODS
Medical records of 23 adults (11 males, 12 females; X age = 33 years) who have undergone BMT.


METHODS
All psychosocial-related charting was extracted manually from the subjects' medical records and nursing care plans. Text was analyzed for content, coded, and sorted into 42 categories. The investigators wrote category definitions.


METHODS
All present and past psychosocial problems that had been identified; psychosocial assessment; psychosocial-related admission and discharge teaching; and references to pain and sleep disturbances that included or implied psychosocial overlay.


RESULTS
Thematic categories were present in each of five core concepts: discovering the lived reality, managing the flow, emerging awareness, keeping watch, and behind closed doors. Synthesis of these concepts led to one encompassing concept--the provisional nature of psychosocial BMT nursing practice.


CONCLUSIONS
The results provide empirical evidence that five key concepts exist within psychosocial BMT nursing and can be applied to a new paradigm of nursing care.


CONCLUSIONS
Provisional practice, as a new paradigm, requires further development. The five concepts derived from this study provide a useful framework for delineating significant psychosocial needs of patients and families and for designing tailored nursing therapeutics. The study suggests that preparation for practicing BMT nursing should include education in specific psychosocial strategies, documentation, and coping with the personal implications of practice in this setting. The study raises important issues in psychosocial care requiring further clarification and elucidation. These center around the nature of uncertainty, caring, and social support in BMT.
University of Washington, School of Nursing in Seattle.
G
G
Winters
C
C
Miller
L
L
Maracich
K
K
Compton
M R
MR
Haberman
D000223:Adaptation, Psychological; D000328:Adult; D016026:Bone Marrow Transplantation / Q000451:nursing* / Q000523:psychology*; D002985:Clinical Protocols; D005260:Female; D006694:Holistic Health; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008875:Middle Aged; D016294:Models, Nursing; D009730:Nursing Assessment; D009731:Nursing Audit; D015404:Nursing Methodology Research; D009737:Nursing Records; D010347:Patient Care Planning; D010348:Patient Care Team; D010351:Patient Discharge; D010353:Patient Education as Topic; D012189:Retrospective Studies; D012961:Sociology