title: Trained clinical nurse specialists proficiently obtain bone marrow aspirates and trephine biopsies in a nearly painless procedure--a prospective evaluation study.
abstract: Patients often experience bone marrow examinations (BMEs) as frightening and painful. Varying operators and uncertainty about who will perform the BME worsen their anxiety. In our study, clinical nurse specialists (CNSs) were trained to perform BMEs to ensure continuity and to test the feasibility, patient satisfaction, and biopsy quality. This exploratory evaluation assessed 574 BMEs at our tertiary center between January 2012 and February 2013, 398 BMEs performed by CNS and 176 by physicians. Our aims were to determine whether BMEs by CNS yield results similar to those of physicians, analyzing (1) patient satisfaction with the BME (a) consent and (b) performance, (2) induced pain, and (3) quality of aspirates and length of trephine biopsies. When performed by CNS, 100 % of the patients were satisfied with the consent procedure and 99 % with the BME performance (physicians 99 and 91 %, respectively). The median pain score was low when both CNS and physicians performed the BME, with no or only mild pain in 92 and 76 % of patients, respectively. Bone marrow (BM) aspirates by CNS and physicians were assessed as technically evaluable in ~70 %; moreover, the median length of trephine biopsies was similar when performed by CNS or physicians with 12 and 13 mm, respectively. In conclusion, BMEs conducted by motivated CNS and within a structured training program are feasible and yield equal outcomes compared to physicians. The use of adequate pain management during BMEs by trained and experienced operators results in an extremely rare use of sedatives, low pain scores, and high patient satisfaction.
authors.affiliation: Department of Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Naegele
authors.forename: L
authors.initials: L
authors.lastname: Leppla
authors.forename: C
authors.initials: C
authors.lastname: Kiote-Schmidt
authors.forename: G
authors.initials: G
authors.lastname: Ihorst
authors.forename: A
authors.initials: A
authors.lastname: Rebafka
authors.forename: A
authors.initials: A
authors.lastname: Koller
authors.forename: A M
authors.initials: AM
authors.lastname: May
authors.forename: M
authors.initials: M
authors.lastname: Hasemann
authors.forename: J
authors.initials: J
authors.lastname: Duyster
authors.forename: R
authors.initials: R
authors.lastname: Wäsch
authors.forename: M
authors.initials: M
authors.lastname: Engelhardt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001853:Bone Marrow / Q000473:pathology*; D004509:Education, Nursing, Continuing; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009720:Nurse Clinicians / Q000193:education*; D010146:Pain / Q000517:prevention & control*; D011446:Prospective Studies