Construction of a nursing care protocol for children in post-hematopoietic stem cell transplantation

Rodrigues, Jéssica Alline Pereira; Lacerda, Maria Ribeiro; Galvão, Cristina Maria; Gomes, Ingrid Meireles; Cubas, Marcia Regina; Fernandes, Ana Paula Pereira

doi:10.1590/1983-1447.2022.20210028.en

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Revista Gaúcha de Enfermagem

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Original Article • Rev. Gaúcha Enferm. 43 • 2022 • https://doi.org/10.1590/1983-1447.2022.20210028.en copy

Construction of a nursing care protocol for children in post-hematopoietic stem cell transplantation

Construcción de protocolo de cuidados de enfermería para niños después del trasplante de células tronco hematopoyéticas

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To construct a nursing care protocol for children in post-hematopoietic stem cell transplantation.

Method:

Methodological research carried out from January to September 2019, in three steps: (a) integrative review (nursing care was identified); (b) theoretical structuring and organization of healthcare based on the Theory of Basic Human Needs and on the International Classification for Nursing Practice (supplementing the review data); and (c) development of a protocol in the three previously mentioned stages. Analysis of the understanding of the protocol's items/care was performed by three specialist nurses.

Results:

The care protocol consists of 40 nursing problems and is organized in accordance with the psychobiological, psychosocial, and psycho-spiritual needs of children undergoing transplantation, integrating practical and guidance care.

Conclusion:

The care protocol is an important technology for nursing care to transplanted children, aimed to prevent and manage transplantation complications.

Keywords:
Nursing methodology research; Hematopoietic stem cell transplantation; Nursing diagnosis; Nursing care; Child; Standardized nursing terminology

Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Rua São Manoel, 963 -Campus da Saúde , 90.620-110 - Porto Alegre - RS - Brasil, Fone: (55 51) 3308-5242 / Fax: (55 51) 3308-5436 - Porto Alegre - RS - Brazil
E-mail: revista@enf.ufrgs.br

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[1] Corresponding author:
Jéssica Alline Pereira Rodrigues E-mail: jessica.rodrigues@hc.ufpr.br

Basic Human Needs (TBHN)	Nursing problem	Basic human needs affected	(ICNP®) Code	Nursing Diagnoses (ICNP^®)	Nursing care (literature, ICNP^® and experience of specialist nurses)
PSICHOBIOLOGICAL
Regulation (cell growth and functional development)	Infection (viral, fungal, bacterial)	Regulation (thermal)	10023032	Infection	PRACTICAL CARE • Assess the persistence of fever and notify the physician; • Keep suspected or confirmed cases of respiratory infections in isolation and advise on the use of a mask; • Monitor vital signs, paying attention to temperature and clinical symptoms; • Perform physical examination; Administer antiviral, antifungal and/or antibiotic early, as prescribed by the physician; • Follow the recommended interval between prescribed doses of antivirals, antifungals and antibiotics. GUIDANCE CARE • Advise the caregiver on checking body temperature at home; • Advise the child and caregiver not to maintain contact with other patients if the viral infection is contagious; • Advise the child and caregiver on the importance of following the times of prescribed medications given by mouth; Reinforce the importance of body hygiene care to prevent infection; • Advise on the cleaning of the environment and the absence of contact with carpets, rugs, teddy bears, plants, animals, works; • Advise on the risk of fungal infection due to the use of immunosuppressants; • Reinforce the importance of a neutropenic diet, with cooked foods.

Basic Human Needs (TBHN)	Nursing problem	Basic human needs affected	(ICNP®) Code	Nursing Diagnoses (ICNP^®)	Nursing care (literature, ICNP^® and experience of specialist nurses)
PSICHOSOCIAL
Education for health and learning	Self-care/ Care provided by the caregiver	Gregarious communication, Recreation and leisure, Emotional security, Freedom and participation	10027773 10021788 10001647 10038411 10018410 10037230	Caregiver Stress; Stress due to Change (or Transfer) of the Environment; Social isolation; Mental disorder; Social disorder; Risk of Difficulty with Coping	PRACTICAL CARE • Assess the caregiver's ability to provide care; • Assess the child's and caregiver's psychosocial response to the care plan; • Discuss information from the internet capable of causing distress and/or confusion in the caregiver, not translating the reality of the transplantation process and generalizing the case; • Talk about shifting the role of the family; adjustment after isolation and hospitalization; common emotional responses; offering support; coping with life after treatment; • Offer motivational support; Help alleviate child and caregiver anxiety at the time of transition from different levels of care and locations, providing guidance for care; • Promote support for coping with the treatment to the child and caregiver; • Request support and involve the multidisciplinary team in care, including occupational therapy, psychology, social work; • Refer to psychiatric follow-up, if necessary; • Encourage support groups among caregivers, with monitoring by the multidisciplinary team; • Offer social support options available to patient and caregiver.

Basic Human Needs (TBHN)	Nursing problem	Basic human needs affected	(ICNP®) Code)	Nursing Diagnoses (ICNP^®)	Nursing care (literature, ICNP^® and experience of specialist nurses)
PSYCHOSPIRITUAL
Religiosity or spirituality	Hope	Religiosity or spirituality	10018614 10009105	Risk of Spiritual Condition, Impaired; Risk of Hopelessness	PRACTICAL CARE • Promote hope through words of comfort; • Promote spiritual support, explaining the importance of spirituality in the illness process, respecting individual beliefs; • Present available social support options; • Support beliefs; • Refer to psychological and/or psychiatric follow-up, if necessary.