الفهرس 
Overview of AutologousOnly 14 pages are availabe for public view
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Abstract
B
one marrow transplantation, formerly a highly experimental, rarely used procedure, has become a fairly common and accepted treatment. Bone marrow transplant (BMT) has evolved over the past two decades from an experimental treatment modality to the treatment of choice for certain malignant and non-malignant hematological disorders. BMT is, however, a risky procedure, with attendant side effects and complications. Many of these are serious; some can be life-threatening (Grimm et al., 2017).
A stem cell transplant is a procedure that replaces unhealthy blood- cells with healthy ones. An autologous transplant is a type of stem cell transplant that uses the patients’ own stem cells. These cells are collected in advance and returned at a later stage. They are used to replace stem cells that have been damaged, and then returned to them after they receive high-doses of chemotherapy. In the 1970s, bone marrow transplantation (BMT) was still an experimental procedure. Over the past two decades the BMT has become the treatment of choice for certain malignant and non-malignant hematological disorders. BMT is, however, a risky procedure, with attendant side effects and complications. Many of these are serious; some can be life-threatening (Majhail, 2015).
Autologous bone marrow transplantation involves the use of a patient’s own stem cells. The stem cells are collected from marrow or blood, then frozen. The thawed cells are returned to the patient after he or she has received intensive chemotherapy and/or radiation therapy for his or her disease. The primary purpose of an autologous transplant is to allow the patient to be given high doses of chemotherapy with or without radiation that would otherwise be too toxic to tolerate because the marrow would be severely damaged. Such high doses of treatment can sometimes overcome resistance of the disease to standard doses of chemotherapy. Autologous transplantation requires that an individual has sufficient numbers of healthy stem cells in the marrow or blood (Michelle, 2017).
Having a caregiver at home is a basic requirement to be considered for transplantation. The presence of active and effective caregivers is critical to the success of the transplant process. A caregiver must be available at home to the patient 24 hours a day, 7 days a week after transplant. After discharge, and staying at home, some patients might have experience physical or psychological problems. These ongoing needs must be managed by following up in the hospital by health team and at home by caregiver as family support which is very important (Mittelman, 2016).
The community health nurse should identify and assess needs of the patients and their caregivers beside environmental sanitation to which the patients are exposed. It includes care, isolation, nutrition, hygiene care, sleep pattern, housing, recreation, physical fitness. In addition, advocate and spokes for patients and their caregivers; improving physical environment; promoting multi service programs in services and providing health education to patients and their caregivers. There are many points at which the community health nurse can make a difference in the lives of patients and their caregivers (Grimm et al., 2015).
Aim of the Study
The aim of this study is to evaluate the effect of nursing intervention for caregivers of Post Autologous Bone Marrow Transplantation Patients at home through:
1. Assessing health needs and problems of post autologous bone marrow transplantation patients at home.
2. Assessing caregiver’s knowledge, practices and attitude regarding of post autologous bone marrow transplantation patients at home.
3. Assessing environmental sanitation for post autologous bone marrow transplantation patients at home.
4. Designing and implementing nursing intervention program for the caregivers to care for post autologous bone marrow transplantation patients at home.
5. Evaluating the effect of nursing intervention program on the caregivers’ knowledge, practice and attitude while caring of post autologous bone marrow transplantation patients at home.
Research hypotheses
The nursing intervention program will improve the caregivers’ level of knowledge, practices and attitude in caring of post autologous bone marrow transplantation patients at home.
Subjects and Methods
Research Design:
The present study is a quasi-experimental research design was carried out.
Setting:
This study was conducted in Bone Marrow Transplantation unit at outpatient follow-up clinics in the three biggest hospitals in Egypt for autologous bone marrow transplantation. Sheikh Zayed Specialized Hospital, National oncology institute and Nasser institute.
• Sampling:
The sample included adults patients their aged range between 21-50 years old post autologous bone marrow transplantation who were attending the follow up clinic, the total number of the sample was 143 as follow (43 patients from Sheikh zayed Specialized Hospital, 51 patients from National Oncology Institute, and 49 patients from Nasser Institute) at Autologous Bone Marrow Transplantation unit for 6 months period.
Study tools:
Part I: Demographic data of the study patients and their caregivers: as age, gender, marital status, education, and occupation.
Part II: Assessment of health needs and problems of post autologous bone marrow transplantation patients such as physical assessment, from head to toe using adopted form of (Bickley & Szilagyi, 2015) including weight, height, body mass index, vital signs, lab results, signs of complications.
Part III: Caregivers’ knowledge regarding
• General information about post autologous bone marrow transplantation.
• The procedure such as preparation, duration, following up regiments, investigation, medications and dietary requirements.
• Post transplantation complications such as fever, signs and symptoms of infection, tendency of bleeding.
A. Caregivers’ practices regarding post autologous bone marrow transplantation at home such as patient transfer, Assisting the patient with central line catheter care, meals preparation and diet restrictions, personal hygiene needs, medication administration schedule, and infection control.
B. Caregivers’ attitude regarding post autologous bone marrow transplantation at home such as Feeling overwhelmed, anger, exhausted, Constant worry and fear about the future, Lack of concentration, Irritability, moodiness. etc…….
Second tool
Inventory checklist for reported assessment of home environment. It was adopted by World Bank (2016). It assessed the presence of safe environmental sanitation such as bed rooms, good ventilation, cleanliness and safe waste disposal.
The study revealed that:
• The mean age of the studied patients was (36.8 ± 15.1) years, 53.1% were males.
• The mean age of the studied caregivers was (34.7 ± 16.2) years. 68.5% of the caregivers were females. kin-relation with the patient 26.6% were their wives.
• 76.3% of the total patients had abnormal complete blood count, and 56.6% had abnormal blood chemistry.
• There was statistical significant differences between pre and post implementation of interventional program was satisfactory 27.2%, 87.5%. respectively regarding total caregivers’ knowledge
• There was statistical significant differences between in total caregivers’ practice of post-autologous bone marrow transplantation patients. As pre interventional program practice was adequate 36.4%, had improved post implementation of an interventional program was adequate 89.3%.
• There was statistical significant relation in total caregivers’ attitude toward post-autologous bone marrow transplantation patients at home. As pre interventional program positive attitude was 42.1% and post implementation of an interventional program improved to be 63.7%.
• Total healthy environment was 64.3%, while unhealthy environment was 36.7.9%.
• There was statistical significant relation between pre and post total caregivers’ knowledge and caregivers’ demographic characteristics.
• There was statistically significant relation between pre & post-test of caregivers’ practices and caregiver’ demographic characteristics.
• There was statistically significant relation between pre & post-test of caregivers’ attitude and caregivers’ demographic characteristics.
• There was statistical significant positive correlation between pre & post-test of total caregivers’ knowledge and practices.
• There was statistical significant positive correlation between pre & post-test of total caregivers’ attitude and practices
Recommendations
The findings of this present study, led to the following recommendations based on the research findings:
• There is a need for a written discharge plan include resources manual for the caregivers and the patients.
• The community health nurse should assist in providing program consisting of knowledge, practice and attitude for the patients and their caregivers related to post autologous bone marrow transplantation.
• The caregivers should assure high standard of environmental sanitation and patient safety.
• Health care team should inform the patients and their caregivers about post autologous transplantation needs and most common complications and how to avoid and manage these complications.
• Further research with a larger sample of caregivers from other governorates in Egypt are required in order to have a better understanding the needs of caregivers’ knowledge and practices post autologous bone marrow transplantation patient at home.