FAMI LY CRI SI S I N THE CONTEXT OF BONE MARROW TRANSPLANTATI ON: AN
I NTEGRATI VE REVI EW
1Tat ian a Cam ila Mat su bar a2
Em ilia Cam pos de Car v alho3 Silvia Rit a Mar in da Silva Canini4 Nam ie Ok ino Saw ada5
Ma t su b a r a TC, Ca r v a l h o EC, Ca n i n i SRMS, Sa w a d a NO. Fa m i l y cr i si s i n t h e co n t e x t o f b o n e m a r r o w
t r ansplant at ion: an int egr at iv e r ev iew . Rev Lat ino- am Enfer m agem 2 0 0 7 j ulho- agost o; 1 5 ( 4 ) : 6 6 5 - 7 0 .
This st udy pr esent s an int egr at iv e lit er at ur e r ev iew about t he cr isis ex per ienced by r elat iv es of bone
m ar r ow t r ansplant ( BMT) pat ient s. The sam ple consist ed of 25 publicat ions, one of w hich cam e fr om Lilacs and
2 4 fr om Medlin e. Th e r esu lt s ev iden ced t h at t h er e w er e n o ex per im en t al st u dies an d t h at in t er v en t ion s ar e
aim ed at psy ch ological an d social aspect s. I n t er m s of aspect s of f am ily cr isis in dicat ed in t h e ar t icles, all
pu blicat ion s discu ssed t h e ch ar act er ist ic of t h e ev en t ( diagn osis of t h e disease an d BMT) an d t h e per ceiv ed
t hr eat ; 52% of t he ar t icles m ent ion t he r esour ces offer ed as being r elev ant and 20% m ent ion t hat past cr isis
exper iences influence t he cur r ent cr isis. Under st anding t he elem ent s of fam ily cr isis and ident ifying appr opr iat e
int er v ent ions help nur ses in car e deliv er y t o BMT pat ient s.
DESCRI PTORS: fam ily ; bone m ar r ow t r ansplant at ion; nur sing car e
CRI SI S DE LA FAMI LI A EN EL CON TEXTO DE TRASPLAN TE DE MEDULA ÓSEA: UN A
REVI SI ÓN I NTEGRADA
Est a revisión int egrada de la lit erat ura se t rat a de la crisis vivenciada por los parient es del pacient e con
t rasplant e de m édula ósea ( TMO) . La m uest ra se const it uyó de 25 publicaciones, una de ellas obt enida del Lilacs
y 24 del Medline. Los result ados m ost raron la inexist encia de est udios experim ent ales, y que las int ervenciones
se dirigen a los aspect os psicológicos y sociales. Considerando los aspect os de la crisis fam iliar apunt ados en los
art ículos, se observó que el 100% m encionó la caract eríst ica del event o ( diagnóst ico de la enferm edad y TMO) y
la am enaza per cibida; el 52% cit ó com o r elevant es los r ecur sos ofr ecidos y el 20% indicó que exper iencias de
crisis pasadas influencian la crisis vivenciada. La com prensión de los elem ent os de la crisis fam iliar y la ident ificación
de int er venciones apr opiadas ayudan el enfer m er o en la at ención a par ient es de pacient es som et idos al TMO.
DESCRI PTORES: fam ilia; t r asplant e de m édula ósea; at ención en enfer m er ía
A CRI SE FAMI LI AR N O CON TEXTO DO TRAN SPLAN TE DE MEDULA ÓSSEA ( TMO) : UMA
REVI SÃO I NTEGRATI VA
Tr at a- se de r evisão int egr at iva que abor da a cr ise vivenciada pelo fam iliar do pacient e com t r ansplant e
de m edula óssea ( TMO) . For am selecionados 25 ar t igos, sendo um da Base Lilacs e 24 d Medline. Os r esult ados
apont ar am a inexist ência de est udos exper im ent ais e, t am bém , que as int er venções est ão volt adas aos aspect os
psicológicos e sociais. Con sider an do os aspect os da cr ise f am iliar dest acados n os ar t igos, obser v ou - se qu e
100% deles abor dar am a car act er íst ica do event o ( diagnóst ico da doença e TMO) e a am eaça per cebida; 52%
cit ar am com o r elev an t es os r ecu r sos of er ecid os e 2 0 % m en cion ar am q u e ex p er iên cias d e cr ises p assad as
influenciar am a cr ise vivenciada. A com pr eensão dos elem ent os da cr ise fam iliar e a ident ificação de int er venções
apr opr iadas aux iliam o enfer m eir o na assist ência aos fam iliar es de pacient es subm et idos ao TMO.
DESCRI TORES: fam ília; t r ansplant e de m edula óssea; cuidados de enfer m agem
D isponible e n ca st e lla no/ D isponíve l e m língua por t ugue sa SciELO Br a sil w w w .scie lo.br / r la e 1 Pr oj ect developed by t he r esear ch gr oup Com m unicat ion and Nur sing: t he int er faces, at t he Univer sit y of São Paulo at Ribeir ão Pr et o College of Nur sing,
WHO Collabor at ing Cent r e for Nur sing Resear ch Developm ent , Br azil, accr edit ed by CNPq, par t ially funded by CAPES; 2 RN, Specialist in Hem at ology, Mast er ’s st udent ; 3 RN, Full Professor, e- m ail: ecdcava@usp.br; 4 RN, PhD, Professor, e- m ail: canini@eerp.usp.br; 5 RN, Associat e Professor, e- m ail: sawada@eerp.usp.br.
I NTRODUCTI ON
I
n dicat ion f or bon e m ar r ow t r an splan t at ion ( BMT) has incr eased ov er t he last decades, not onlyf o r h e m a t o l o g i c, b u t a l so a u t o - i m m u n e d i se a se s.
Mor eov er, t h er e ar e st u dies t h at h igh ligh t it s u se in
cell r egener at ion of t he hem at opoiet ic or gan.
BMT i s d e f i n e d a s a p r o ce d u r e i n v o l v i n g
in t r av en ou s in f u sion of st em cells - CD3 4 ( r em ov al
of bone m ar r ow fr om a com pat ible donor, pr ev iously
select ed) - int o a previously condit ioned r ecipient . The
a i m o f t h i s p r o c e d u r e i s t o r e c o n s t i t u t e t h e
hem at opoiet ic organ, w hich has been debilit at ed eit her
by infilt rat ion of leukim ic cells in t he bone m arrow or
b y d i s e a s e s t h a t h a r m a n d c h a n g e b l o o d - c e l l
pr odu ct ion ( 1 ). Th is t h er apeu t ic pr ocedu r e t r igger s a
com pr om ised st at e of m ult iple or gans and t issues, as
w ell as severe im m une depression. This causes higher
pr edisposit ion t o sy st em ic infect ions and effect s due
t o p r e v i o u s t r e a t m e n t s i n v o l v i n g ch e m o t h e r a p y,
radiot herapy, and use of hepat ot oxic and nephr ot oxic
dr ugs. Thus, r ecipient pat ient s need bot h pr ofessional
and fam ily suppor t in or der t o feel secur e t hr oughout
t r eat m en t ph ases.
I n gener al, hospit als w it h BMT unit s allow a
fam ily m em ber t o accom pany t he pat ient t hr oughout
t he pr ocess, fr om adm ission t o dischar ge; hence, t hat
person experiences all of t he phases and com plicat ions
i n v o l v e d i n t h e B M T. I n s u c h c a s e s , a n u r s i n g
professional, along w it h a m ult idisciplinary t eam , m ust
pr ovide assist ance t o bot h t he pat ient and his or her
f am ily.
Th i s s t u d y a i m s t o e n c o u r a g e n u r s i n g
professionals t o ponder t he em ot ional crisis t hat fam ily
m em ber s of BMT pat ient s m ay be exposed t o. I t aim s
t o sy n t h esize t h e k n ow led g e av ailab le in scien t if ic
lit er at ur e concer ning fam ily cr isis fr om 1995 t o 2005.
The fam ily of t he BMT pat ient
BMT com plexit y is capable of pr oducing deep
p sy ch olog ical ef f ect s on p at ien t s, f am ily m em b er s,
an d h ealt h car e p r of ession als. I g n or in g su ch f act or s
a n d si m p l y co n si d e r i n g t h e p r o ce d u r e ’ s t e ch n i ca l
a s p e c t s m a y b r i n g s e r i o u s c o n s e q u e n c e s t o a l l
involved. Thr oughout BMT, t he pat ient and his or her
f a m i l y u n d e r g o c h a n g e s i n t h e i r p s y c h o s o c i a l
st r u ct u r e s. He n ce , n u r si n g p r o f e ssi o n a l s h a v e a n
im por t ant r ole in t his adapt at ion so t hat t he best qualit y
of life m ay be achiev ed. The fam ily is an ally of t he
n u r s i n g t e a m i n t h a t i t p r o v i d e s s e c u r i t y a n d
psychological suppor t t o t he t r ansplant pat ient dur ing
r eadapt at ion of t he BMT pat ient t o his or her r egular
social life( 2).
T h e p r i m a r y s o u r c e s o f s o c i a l s u p p o r t ,
f a m i l i e s h a v e s h o w n c h a n g e s i n t e r m s o f
dem ogr aph ics an d t h e r oles of each elem en t w it h in
t he fam ily nucleus ( 3). Nur sing pr ofessionals m ust t ak e
t he v ar ious fam ily univ er ses int o consider at ion: legal
( b l o o d r e l a t i v e s , a d o p t i v e c h i l d r e n , s p o u s e s ) ;
biological ( t h ose gen et ically r elat ed t o t h e pat ien t
-ch i l d r en , p ar en t s) ; so ci al ( g r o u p s o f cl o se f r i en d s
fr om t h e pat ien t ’s social life) ; psy ch ological ( people
w ho ar e int im at ely im por t ant t o t he pat ient , such as
p e o p l e w h o c o - h a b i t - m o n a s t e r i e s , c o n v e n t s ,
f r at er n i t i es, an d b o ar d i n g h o u ses; an d al t er n at i v e
fam ilies, as in t he case of hom osex uals)( 2). A fam ily
m ay also be f or m ed by people r elat ed by m ar r iage
or blood w h o h av e a r elat ion sh ip t h at f ollow s r u les
t h at ar e specific t o t h em . Su ch r u les det er m in e t h e
fu n ct ion s an d dist r ibu t ion of r oles w it h in t h e gr ou p,
all of w h ich sh ar e t h e sam e sy st em of b elief s an d
loy alt ies( 2 ).
Not alw ays ar e fam ily m em ber s r eady t o deal
w it h t he sit uat ions im posed by BMT. Many t im es t hey
m ay not be pr epar ed, k now how t o ask for help, or
sim p ly st an d b y a lov ed on e. BMT t r eat m en t m ay
exceed t he pat ient ’s or fam ily’s adapt at ion and coping
abilit ies. The t r eat m ent necessit at es t he r est r uct ur ing
of fam ily r out ines. This is caused by fact or s such as
r o l e c h a n g e s a n d t h e s e a r c h f o r f i n a n c i a l a n d
em ot ion al r esou r ces.
Var ious m odels of fam ily cr isis ar e st at ed in
t he lit er at ur e. The m odel chosen for t he pr esent st udy
in dicat es f ou r f act or s in f lu en cin g t h e f am ily ’s abilit y
t o deal w it h and adapt t o a cr isis: char act er ist ic of t he
e v e n t , p e r c e i v e d t h r e a t , e v a l u a t i o n o f f a m i l y
r e s o u r c e s , a n d f o r m e r c r i s i s e x p e r i e n c e( 4 ). Th i s
analy t ic m odel pr ov ides t he basis for ev aluat ing bot h
t he m eaning t hat t he cr isis has t o t he fam ily and t he
fam ily ’s capacit y t o adapt t o t he sit uat ion. Mor eover,
it allow s for t he ident ificat ion of fam ily st r engt hs and
w eak n esses. Th is m ak es possible t h e applicat ion of
nur sing int er v ent ion st r at egies t o t he sit uat ion.
Th e p r esen t st u d y w as d ev elop ed w it h t h e
aim of ob t ain in g k n ow led g e ab ou t t h e f am ily cr isis
p h en om en on . I f t h e BMT p at i en t ’s f am i ly r ecei v es
em ot ional and social suppor t , t he pat ient w ill obt ain,
in addit ion t o know ledge of t he sit uat ion, bet t er car e
RESEARCH OUTLI NE
The pr esent st udy is an int egr at ive lit er at ur e
r eview t hat aim s t o gat her and synt hesize pr e- exist ing
k now ledge about t he pr oposed t hem e ( 5).
I n t e g r a t i v e r e v i e w s , w h e n c r i t i c a l l y
d e v e l o p e d , h a v e t h e sa m e st a n d a r d s o f p r i m a r y
r e s e a r c h i n t e r m s o f c l a r i t y a n d r i g o r. I t i s a n
ap p r op r iat e st r at egy f or sit u at ion s in w h ich st u d ies
covering a part icular subj ect are insufficient for m et
a-analy sis r esear ch t o be conduct ed ( 6).
Th e s t a g e s i n p e r f o r m i n g a n i n t e g r a t i v e
r ev iew ar e: a) iden t if y in g t h e t h em e or qu est ion of
t h e in t eg r at iv e r ev iew : con sist s of d et er m in in g t h e
guiding t hem e of t he r esear ch in a clear and specific
m anner, w it h clinical and t heoret ical reasoning by t he
r esear cher, and t hen choosing t he key w or ds t hat w ill
b e u se d i n t h e l i t e r a t u r e se a r ch ; b ) sa m p l i n g o r
se a r ch i n g t h e l i t e r a t u r e : b e g i n t h e se a r ch i n t h e
select ed dat abases t o obt ain t he st udies t hat w ill be
included and analyzed; st udy select ions m ust be m ade
according t o cert ain crit eria in order t o obt ain int ernal
validit y of t he review , and such crit eria m ust be clearly
a n d c o n c i s e l y s t a t e d i n t h e t e x t ; c ) s t u d y i n g
cat egor izat ion: consist s of defining t he infor m at ion t o
be ext r act ed fr om select ed st udies, using a pr eviously
cr eat ed inst r um ent ; d) ev aluat ing st udies included in
t he int egr at iv e r ev iew : t he select ed st udies m ust be
s u b m i t t e d t o c r i t i c a l e v a l u a t i o n , t a k i n g i n t o
consider at ion t he r esear cher ’s clinical ex per ience; e)
in t er p r et in g r esu lt s: d iscu ss t h e an aly zed d at a an d
com p ar e t o p r e- ex ist en t t h eor et ical k n ow led g e; f )
sy n t h esizin g k n ow led g e ev id en ced in t h e an aly zed
ar t i cl es o r p r esen t at i o n o f t h e i n t eg r at i v e r ev i ew :
sy n t h esis of t h e ev id en ce ob t ain ed in t h e an aly zed
ar t icles, based on a cr it ical m et hod( 5- 6).
The guiding quest ion of t he pr esent st udy is:
how have nur sing pr ofessionals appr oached t he fam ily
cr isis t hem e in BMT?
Th e LI LACS an d Pu b Med d at ab ases w er e
used w hich have broad coverage of scient ific j ournals
in t h e ar ea of h ealt h car e. Con su lt in g su ch a lar g e
b a s e e n s u r e d c o m p l i a n c e w i t h t h e l i t e r a t u r e
r e co m m e n d a t i o n o f se a r ch i n g f o r p u b l i ca t i o n s i n
different sources( 7). The art icles w ere ident ified in t he
j ournal sect ion of t he Cent ral Library of t he Universit y
of São Pau lo - Ribeir ão Pr et o Cam pu s. Ar t icles t h at
w e r e n o t l o ca t e d i n t h i s se ct i o n w e r e r e q u e st e d
t h r o u g h t h e u n i v er si t y ’ s Bi b l i o g r a p h i c Co m m u t i n g
Pr og r am ( COMUT) .
I n c l u s i o n c r i t e r i a f o r t h e a r t i c l e s w e r e :
j our nals had t o be indexed in t he LI LACS and MEDLI NE
d at ab ases; p u b lish ed in eit h er En g lish , Sp an ish , or
Por t uguese; published dur ing t he per iod fr om Januar y
1 9 9 0 t o M a y 2 0 0 5 ; a p p l i e d t o h u m a n b e i n g s
independent of color, et hnic group, or religious beliefs;
u sed t h e descr ipt or s “ bm t ”, “ f am ily ”, “ bon e m ar r ow
t ransplant at ion”, and “ fam ily”, respect ively in t he t hree
lan gu ages; appr oach ed t h e su bj ect of assist an ce t o
t he fam ilies of BMT pat ient s.
Once t he st udy sam ple had been est ablished,
t he next st ep was t o read t he art icles wit h t he aim of
ident ifying relevant dat a in t he dat a collect ion inst rum ent .
Cer t ain m et hodological st eps w er e follow ed t o assur e
higher st udy reliabilit y: ident ificat ion of t he publicat ion;
m et hod used in t he publicat ion; m et hodological problem s
ident ified in t he developm ent of t he invest igat ion; level
of evidence in t he art icles; nursing care st rat egies and
t he m odel of crisis used in t he st udy.
I n order t o analyze t he m et hodology used in
t he st udies, publicat ions were ident ified by t he following
it em s: j our nal nam e, volum e, num ber, page num ber,
year/ m ont h of publicat ion, aut hors, t it le, t ype of st udy,
subj ect s( 8). To analy ze ev idence found in t he ar t icles,
a 6- level classificat ion was done ( 1- evidence obt ained
from m et a- analysis result s of random ized clinical t rials;
2- evidence obt ained in an experim ent al- design st udy;
3 - ev idence obt ained in quasi- ex per im ent al r esear ch;
4 - ev iden ce f r om descr ipt iv e st u dies or a qu alit at iv e
m et hod approach; 5- evidence from case or experience
report s; and 6- evidence collect ed based on t he opinions
of ex p er t s or law m ak er s( 9 - 1 0 ). To id en t if y t h e cr isis
co n ce p t u se d i n t h e st u d i e s, t h e y w e r e a n a l y ze d
follow ing t he fam ily crisis m odel ( 4) : charact erist ic of
ev en t s, p er ceiv ed t h r eat t o f am ily r elat ion sh ip s in
t er m s of t heir st at us and goals, ev aluat ion of fam ily
r e s o u r c e s , a n d p a s t c r i s i s e x p e r i e n c e . N u r s i n g
int ervent ions ident ified wit hin t he t ext were associat ed
w i t h t h e i n t e r v e n t i o n s p r o p o se d b y t h e N u r si n g
I n t e r v e n t i o n Cl a s s i f i c a t i o n ( N I C)( 1 1 ) f o r n u r s i n g
d iag n oses: “ I n t e r r u p t e d f a m i l y p r o ce sse s” an d
“ Co m p r o m i s e d f a m i l y c o p i n g ” . S u c h n u r s i n g
diagn oses w er e ch osen becau se t h ey r epr esen t t h e
st udied fam ily cr isis fr am ew or k .
RESULTS AND DI SCUSSI ON
Th e f in al sam ple w as r each ed af t er in it ially
d a t a b a se . Am o n g t h e se , 7 8 3 st u d i e s w e r e a b o u t
m edical aspect s of BMT and 24 cover ed fam ily cr isis,
t h e t h em e p r op osed f or t h e p r esen t st u d y, t h ou g h
u sin g a dif f er en t t er m . Tw o addit ion al st u dies f r om
Lilacs w er e consider ed, of w hich one w as a m ast er ’s
disser t at ion and w as included in t he sam ple. Thus 24
( 9 6 % ) of t h e an aly zed st u dies w er e ex t r act ed f r om
t he Medline dat abase and one ( 4 % ) fr om t he Lilacs
d at ab ase.
As for t he j our nals’ count r y of or igin, it w as
obser ved t hat 18 ( 72% ) w er e fr om t he Unit ed St at es,
one ( 4% ) fr om Gr eece, one ( 4% ) fr om Canada, one
( 4% ) fr om Poland, and one ( 4% ) fr om Br azil. I t w as
im possible t o det er m ine t he or igins of t hr ee j our nals
( Cl i n i c a l Tr a n s p l a n t , S u p p o r t Ca r e Ca n c e r a n d
Psy chot her Psy chosom ) . The j our nal w it h t he highest
incidence of publicat ion w as Oncology Nur sing For um
( 2 0 % ) , f o l l o w ed b y Can cer Nu r si n g ( 1 2 % ) , So ci al
Science Medicine ( 8 % ) , Canadian Jour nal Psy chiat r y
( 8% ) , and Yale Jour nal Biological Medicine ( 8% ) . The
ot her j our nals had only one publicat ion each.
Regar ding year of publicat ion, st udies show ed
higher incidence in t he year s 1990 ( 16% ) , 1996 ( 20% ) ,
and 1999 ( 16% ) , as show n in Figur e 1:
and r equir es gr eat er at t ent ion fr om r esear cher s. The
l i t er at u r e st at es t h at t h e b est cl i n i cal ev i d en ce i s
obt ained by ex per im ent al clinical st udies, t ak ing int o
c o n s i d e r a t i o n a c c u r a c y, p r e c i s i o n , a n d p r a c t i c a l
applicabilit y( 1 2 ).
As t o t h e e v id e n ce le v e ls( 9 ), m ost st u dies
show lev el four ( 64% ) , follow ed by lev els six ( 28% )
an d f iv e ( 8 % ) . Su ch r esu lt s d em on st r at e t h at t h e
st u d i e s d o n o t i n d i ca t e st r o n g cl i n i ca l e v i d e n ce .
Ne v e r t h e l e ss, t h e e v i d e n ce f o u n d i n t h e st u d i e s
em p h asi zes t h e i m p o r t an ce o f cl ear an d ef f ect i v e
com m unicat ion bet w een fam ily m em ber s, healt hcar e
t eam s, and pat ient s in or der t o m inim ize anxiet y and
d ep r ession . Fact or s w h ich m ay en h an ce em ot ion al
s u p p o r t a r e : c e r t a i n f a m i l y t y p e s w i t h s p e c i f i c
ch ar act er ist ics, f am ily coh esion , f ew con f lict s w it h in
t h e f am ily, cu lt u r al an d in t ellect u al elem en t s, an d
r e l i g i o n . Su p p o r t g r o u p s a n d n e t w o r k s m i n i m i ze
a n x i e t y, a n g u i sh , a n d d e p r e ssi o n e x p e r i e n ce d b y
pat ient s and t heir fam ilies.
Most ar t icles por t r ay t h e im pact of BMT on
pat ien t s an d t h eir f am ilies t ak in g in t o con sider at ion
fact or s t hat gener at e st r ess, depr ession, anguish, and
st r at egies used t o help t hem cope w it h t hat sit uat ion.
Fam ily cr isis w as appr oached by t he aut hor s
w hen t hey highlight ed t he im pact of fact or s such as
d iag n osin g t h e d isease, ch oosin g t r eat m en t ( BMT) ,
com p licat ion s in v olv ed , an d w h ich of t h ese f act or s
in f lu en ced t h e ev er y - d ay liv es of t h e f am ilies. Th e
aut hor s st at e t hat pat ient s as w ell as t heir r elat iv es
m ay develop anguish, depr ession, and anxiet y dur ing
t h e v ar i o u s t r eat m en t p h ases. No n et h el ess, w h en
h ealt h car e pr of ession als com m u n icat e w it h pat ien t s
a n d t h e i r f a m i l i e s i n a c l e a r a n d e f f e c t i v e w a y,
r e s p e c t i n g t h e i r r e l i g i o u s b e l i e f s , s y m p t o m
con sequ en ces can be m in im ized.
A s t o t h e f i n d i n g s a b o u t f a m i l y c r i s i s
analy zed accor ding t o t he select ed m odel, it can be
affirm ed t hat event charact erizat ion ( disease diagnosis
an d BMT) an d per ceiv ed t h r eat ( m ov in g t o an ot h er
cit y, t r eat m ent , separat ion, com plicat ions and changes
in fam ily roles) w ere report ed in all t he art icles. Such
asp ect s ar e r elev an t f or p r op osin g in t er v en t ion s t o
m inim ize consequences br ought about by t he sit uat ion.
St a t e m e n t s a b o u t f a m i l y r e so u r ce s w e r e
ob ser v ed in 5 2 % of t h e ar t icles. Accor d in g t o t h e
st udied aut hor s, r esour ces ( housing in suppor t hom es,
possible help for t r anspor t at ion, food, and m edicat ion)
offered t o t he fam ilies influence result s. The influence
o f f o r m er cr i si s ex p er i en ce, st at ed i n 2 0 % o f t h e
Figur e 1 - St udy dist r ibut ion by y ear of publicat ion
Con cer n in g t h e a u t h o r s o f t h e st u d ie s, it
w as obser v ed t hat 12 st udies ( 48% ) w er e dev eloped
by nur ses, six ( 24% ) by ot her pr ofessionals, and seven
( 28% ) did not specify t heir aut hor s’ pr ofessions. These
findings indicat e t he m ult ifacet ed nat ure of t he t hem e,
w hich is of int erest t o various healt hcare professionals.
Fur t her m or e, it w as obser v ed t hat m ost w er e clinical
ex per t s or pr ofessionals w it h gr aduat e degr ees. The
aut hor s ar e em ploy ed at univ er sit ies, hospit als, and
suppor t ing inst it ut ions.
Regar ding t he r e se a r ch ou t lin e , all analyzed
st udies ar e non- ex per im ent al, of w hich 7 ( 28% ) ar e
ex - p o st - f act o an d 1 9 ( 7 2 % ) ar e d escr i p t i v e ( case
r e p o r t s, e x p e r i e n ce r e p o r t s, l i t e r a t u r e r e v i e w s) .
Th er ef or e, i t w as ob ser v ed t h at t h e p r od u ct i on of
art icles, m ay lead t o eit her posit ive or negat ive coping
in t h e cu r r en t sit u at ion . Th u s, n u r sin g pr ofession als
m u st in t er v en e in sit u at ion s t h at g en er at e an x iet y,
st r ess, and depr ession so t hat a posit iv e solut ion is
a c h i e v e d , w h i c h w o u l d c o n t r i b u t e t o p a t i e n t s ’
t r eat m en t .
All an aly zed ar t icles st at e t h at pat ien t s an d
t heir fam ilies m ust be infor m ed about t he t her apy as
o f t h e m o m e n t o f d i a g n o s i s . Th e a u t h o r s a l s o
em p h asi ze t h e n eed t o ex p l ai n t h e i m p o r t an ce o f
keeping t he pat ient isolat ed during t reat m ent , as w ell
as t o pr ovide addit ional infor m at ion about t he possible
com plicat ions, pr ognosis, and how t r eat m ent w ill de
done. Nur sing pr ofessionals hav e a fundam ent al r ole
in helping fam ily m em ber s adapt t o t he new sit uat ion
and t o deal w it h t he var ious t r eat m ent st ages, as w ell
as t o m in im ize t h e con seq u en ces of st r ess f act or s
due t o t he com plex it y of t r eat m ent( 13).
BMT causes a r upt ur e in fam ily dynam ics w it h
h a r sh ch a n g e s, ca u si n g p a r t i cu l a r l y a d e cl i n e i n
econom ic st at us ( 14)and role changes, and init iat es t he
search for t reat m ent cent ers ( w hich usually are dist ant
f r om t h eir h om e t ow n ) . Su ch sit u at ion s ar e st r ess
g en er at o r s( 1 5 ). Si x t y - f o u r p er cen t o f t h e a n a l y zed
ar t icles defined BMT as a com plex t r eat m ent r equir ing
t h a t n u r si n g p r o f e ssi o n a l s p r o v i d e a ssi st a n ce t o
p a t i en t s a s w el l a s t h ei r f a m i l i es. Si t u a t i o n s t h a t
generat e st r ess, anx iet y, or anguish t ake place as of
t h e m ed ical d iag n osis an d con t in u e t h r ou g h ou t t h e
v ar iou s t r eat m en t st ages; su ch as select in g don or s,
preparing for t ransplant at ion, t he t ransplant at ion it self,
and possible com plicat ions. These difficult ies cont inue
t h r ou gh ou t t h e w h ole pr ocess u n t il disch ar ged fr om
hospit al and forw arded t o out - clinic follow - up. At such
m o m en t s, b o t h em o t i o n al an d so ci al su p p o r t s ar e
r elev an t b ecau se it is t h r ou g h acq u ir ed k n ow led g e
t h at f am ily m em b er s can p osit iv ely cop e w it h t h is
sit u at ion .
B o t h p s y c h o s o c i a l a n d p s y c h o e m o t i o n a l
a sp e ct s i n t e r f e r e w i t h t r e a t m e n t i n a p o si t i v e o r
n e g a t i v e w a y, d e p e n d i n g o n h o w o n e d e a l s w i t h
sit uat ions t hat generat e st ress and anxiet y. Exam ples
of such sit uat ions include: fear of deat h, reduct ion in
financial r esour ces, and w it nessing com plicat ions and
changes in t he pat ient ’s condit ions. The nurse is able
t o evaluat e t he fam ily’s em ot ional st at us( 16) as w ell as
t o develop coping t echniques, t hus helping t hem deal
w it h t he sit uat ion in t he best possible w ay( 17).
Th e a r t i cl e s h i g h l i g h t t h a t t h e p r o p o s e d
in t e r v e n t io n s m u st m eet t h e Nu r sin g I n t er v en t ion
Classif icat ion ( NI C) . Most ar t icles ( 6 4 % ) st at e t h at
e m o t i o n a l s u p p o r t i s r e l e v a n t t o m i n i m i z e t h e
p sy ch olog ical con seq u en ces b r ou g h t ab ou t b y BMT,
an d t h at t h e n u r se h as a f u n d am en t al r ole in t h at
p r o c e s s . Ot h e r p o i n t s t h a t w e r e h i g h l i g h t e d a s
im por t ant t o posit ive coping ar e: fam ily suppor t ( 36% ) ,
financial aid ( 2 4 % ) , suppor t gr oups ( 3 2 % ) , w ay s of
coping ( 40% ) , anxiet y r educt ion ( 28% ) , fam ily pr ocess
m a i n t e n a n c e ( 1 6 % ) , a n d r o l e p e r f o r m a n c e
r eor gan izat ion ( 1 2 % ) .
Accor ding t o 16% of t he ar t icles, it is im por t ant
t o cr eat e explanat or y handout s w it h infor m at ion about
t he t r eat m ent , com plicat ions, r ecom m endat ions, and
su p p o r t i n st i t u t i o n s t h a t o f f e r h o u si n g , f e e d i n g ,
t r a n sp o r t a t i o n , a n d m e d i ca t i o n . Ci t y g u i d e s a n d
schedules for public t r anspor t at ion ar e also r elev ant
an d m ak e it easier f or f am ily m em ber s t o adapt t o
t he new sit uat ion, r educing st r ess.
Ta k i n g t h e r e s u l t s i n t o c o n s i d e r a t i o n , a
synt hesis of t he m ain findings concerning fam ily crisis
in t he BMT cont ex t is pr esent ed:
- t he analyzed ar t icles w er e indexed m ost ly ( 96% ) in
MEDLI NE dat abase, n ot obser v in g dou ble cit at ion of
ar t icles, i.e., in bot h dat abases;
- m ost j our nals ( 72% ) ar e fr om t he Unit ed St at es;
- nur sing pr ofessionals ( 48% ) w er e t hose w ho m ost
published ar t icles about t he pr oposed t hem e;
- m ost aut hors hold clinical expert ise or graduat e t it les,
a n d w o r k a t u n i v e r si t i e s, h o sp i t a l s, a n d su p p o r t
inst it ut ions;
- 7 6 % of t he ar t icles w er e dev eloped by m or e t han
on e au t h or ;
- 36% of t he art icles w ere published in specific nursing
j ou r n als;
- m ost ar t icles r ep or t ed on t h e im p act of BMT on
pat ient s and t heir fam ilies, t ak ing int o consider at ion
fact or s t hat gener at e st r ess, depr ession, anguish, and
t he st r at egies used t o cope w it h t he sit uat ion;
- al l st u d i es p r esen t ed n o n - ex p er i m en t al d esi g n s,
dist r ibut ed int o 7 ( 28% ) ex- post - fact o and 19 ( 72% )
descr ipt iv e ( case r epor t , ex per ience r epor t , lit er at ur e
r e v i e w ) ; cl i n i ca l e v i d e n ce r a n g e d b e t w e e n l e v e l s
4( 64% ) , 5 ( 4% ) , and 6 ( 28% ) ;
- e v i d e n ce f r o m n u r si n g st u d i e s a r e st i l l o f l o w
c o n s i s t e n c y ; t h e f a m i l y c r i s i s t e r m s “ e v e n t
c h a r a c t e r i z a t i o n ” a n d “ p e r c e i v e d t h r e a t ” w e r e
obser v ed in all t he analy zed ar t icles;
- n u r sin g in t er v en t ion s ap p r oach m ain ly em ot ion al
suppor t as r elev ant t o m inim ize t he consequences of
FI NAL CONSI DERATI ONS
I t i s u n d e r s t o o d t h a t t h e f a m i l y c r i s i s
gen er at ed by bon e m ar r ow t r an splan t at ion can lead
fam ily m em ber s t o exper ience anxiet y and depr essive
e p i s o d e s . S u c h f a c t o r s a r e n o h e l p i n p a t i e n t s ’
t r eat m ent and or t o fam ily m em ber s’ coping w it h t he
sit uat ion. Nur sing car e should not focus only on t he
biological aspect s of BMT, Psychosocial aspect s require
n u r si n g i n t e r v e n t i o n s f o r b o t h p a t i e n t s a n d t h e i r
f am ilies, h elp in g t h em cop e w it h an d ad ap t t o t h e
cr isis.
I t i s w o r t h n o t i n g t h a t o n o n e h a n d t h e
b eh a v i o r o f f a m i l y m em b er s m a y i n t er f er e i n t h e
im m unologically com prom ised pat ient ’s condit ions. Yet
on t h e ot h er h an d, det er ior at ion of fam ily st r u ct u r e
o c c u r s c o n c o m i t a n t l y w i t h t h e m o s t s e v e r e
com plicat ion s af t er BMT. I t can n ot be af f ir m ed t h at
in ad eq u at e f am ily cop in g is t h e cau se f or on set or
w or sening of t he pat ient ’s condit ions. This hypot hesis
needs fur t her inv est igat ion, as r ecom m ended by t he
au t h or s.
At t ent ion t o socioeconom ic fact or s, per ceived
t hreat t o fam ily relat ionships and st ruct ure, along w it h
t h e n eed t o clar if y all t h e f act or s in v olv ed in t h is
t h e r a p e u t i c p r o c e d u r e , m e e t t h e c h a r a c t e r i s t i c s
described in t he fam ily crisis m odel used in t his st udy.
Car e t o BMT pat ient s’ fam ilies is a challenge
for t he w hole m ult ipr ofessional t eam . How ev er, w hen
t hese people’s needs are underst ood, one can help t hem
cope effect ively and posit ively wit h t he crisis sit uat ion
brought about by t he t reat m ent , m inim izing em ot ional
consequences such as depression, st ress, and anxiet y.
Fu r t h e r s t u d i e s a r e n e e d e d i n o r d e r t o
evaluat e t he r esponse of fam ily m em ber s t o differ ent
st r at eg ies.
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