Nursing Care for Patients in the Step-Down Ward Following Hematopoietic Stem Cell Transplantation
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Abstract
Hematopoietic stem cell transplantation (HSCT) represents a final treatment option for various hematologic malignancies, with the primary goal being complete disease cure or achieving the longest possible remission period. Following HSCT, patients require close monitoring due to exposure to high-dose chemotherapy and immunosuppressive drugs. Hospitalization typically spans an average of 30 days, though this duration varies based on factors such as the patient's age, underlying disease, treatment specifics, source of stem cells, and potential complications. Based on medical statistics from Siriraj Hospital spanning 2013-2020, an average of 63 HSCT procedures are performed annually. Unfortunately, the limited number of available beds results in a waiting period of approximately 6-8 months, leading to longer queues for patients. This prolonged wait time is associated with a higher risk of disease relapse, increased cumulative toxicity from chemotherapy drugs, and a heightened mortality risk. In contrast, some foreign countries offer outpatient care for HSCT patients, which yields similar survival rates to inpatient care but at a lower cost, with increased patient satisfaction and improved quality of life. However, in Thailand and specifically at Siriraj Hospital, only inpatient care for HSCT patients is available due to various constraints, including the challenge of finding potential caregivers for 24-hour monitoring, transfer logistics, and bed availability for emergencies. To address these challenges, Siriraj Hospital has developed a continuous care program for post-HSCT patients within the recovery ward or step-down unit, aiming to reduce the length of stay at the bone marrow transplant unit and expedite HSCT procedures. This article focuses specifically on nursing care for patients after HSCT within the step-down ward, with the goal of equipping nurses with the knowledge and skills necessary to provide safe and effective care for post-HSCT patients.
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