Provisional practice: the nature of psychosocial bone marrow transplant nursing

To develop an empirically based description of the key concepts guiding psychosocial nursing practice for the patient undergoing bone marrow transplantation (BMT).

Retrospective, descriptive.

National Cancer Institute-designated comprehensive cancer center.

Medical records of 23 adults (11 males, 12 females; X age = 33 years) who have undergone BMT.

All psychosocial-related charting was extracted manually from the subjects' medical records and nursing care plans. Text was analyzed for content, coded, and sorted into 42 categories. The investigators wrote category definitions.

All present and past psychosocial problems that had been identified; psychosocial assessment; psychosocial-related admission and discharge teaching; and references to pain and sleep disturbances that included or implied psychosocial overlay.

Thematic categories were present in each of five core concepts: discovering the lived reality, managing the flow, emerging awareness, keeping watch, and behind closed doors. Synthesis of these concepts led to one encompassing concept--the provisional nature of psychosocial BMT nursing practice.

The results provide empirical evidence that five key concepts exist within psychosocial BMT nursing and can be applied to a new paradigm of nursing care.

Provisional practice, as a new paradigm, requires further development. The five concepts derived from this study provide a useful framework for delineating significant psychosocial needs of patients and families and for designing tailored nursing therapeutics. The study suggests that preparation for practicing BMT nursing should include education in specific psychosocial strategies, documentation, and coping with the personal implications of practice in this setting. The study raises important issues in psychosocial care requiring further clarification and elucidation. These center around the nature of uncertainty, caring, and social support in BMT.