Caring Process in Hematopoietic Stem Cell Transplantation: A Grounded Theory Study.

Abstract

Abstract: Introduction: Caring has been an important concept in nursing and clarifying the caring indifferent patients is an important aspect of research in nursing. There are many studies in caring of different patients, but not study conducted in Hematopoietic stem cell transplantation (HSCT) patients about caring concept. HSCT is new, complex, time demanding and invasive procedure and the last resort in the treatment of number of life threatening diseases. HSCT is the most stressful medical procedures because of the associated dangers and risks of complications in physical, psychological, emotional and social domains. The research in caring of HSCT patients is apriority and this study aimed to exploring the process of caring for HSCT patients. Method: The present study was conducted according to grounded theory between 2011 and May2013 in Tehran Shariati hospital, which is also the main HSCT center in Iran. Major source of data collection was in-depth interviews, also observation used as supplementary. Participants in this study included 18 nurses, physicians, 12 HSCT patients, and family members. Sampling was purposeful, and as the study progressed, purposive sampling was superseded by theoretical sampling. Data analysis carried out with method of Strauss and Corbin (2008). Finding: The following four categories were emerged from the data analysis, namely: encountering to patient limbo between life and death attempt to reduce risk of death psychological rebuilding and caring achievements .The four main categories were consisted of13 subcategories. Supporting in order to patient pass the HSCT way with successfully was recognized as the core variable that represents caring for HSCT patients in study setting, and can relate all categories together. The goal of emergent theory named supporting in order to patient pass the HSCT way with successfully is to help patients traverse HSCT with few complications and more successful. Conclusion: Caring for HSCT patients is process that occur in encountering to patient´s limbo between life and death context, via attempt to reduce risk of death and psychological rebuilding as action/reaction strategies, with some consequence to patients and nurses. Strategies used by nurses in caring of HSCT patients performed according to protocol in some aspects, and in other cases without any guidelines. Successfully HSCT and survival of HSCT patients is very important in caring of these patients, and nurses attempt to help HSCT patients pass the HSCT way with successfully. But in this way they encounter to some problems as well as the emotional labor that can affect the quality of care and provision of emotional support to HSCT patients. This aspect need to be modified. Finding and emerged theory of the present study can be used in nursing activities, nurse orientation and education programs and nursing policy.