Distress and emotional state throughout bone marrow transplantation
Creators: name: Gray, Caroline J.
Publisher: name: University of British Columbia
Year: 2010

description: Bone marrow Transplantation causes a variety of symptoms and emotional states which change throughout the treatment. The purpose of this descriptive correlational, repeated measures study was to describe the type and degree of symptom distress and the emotional states experienced by BMT patients at the time of admission, through the administration of chemotherapy and radiotherapy, bone marrow infusion, waiting for engraftment to 25 days following the infusion of bone marrow. In addition, this study investigated the relationship between symptom distress and emotional states of the BMT patient. The conceptual framework was based on Lazarus and Folkman's (1984) theory of stress, appraisal, and coping. The design involved administering McCorkle and Young's (1978) Symptom Distress Scale, McNair, Lorr, and Droppleman's (1971) Profile of Mood States, and two Data Collection Guides to ten patients at five times during the BMT procedure. A convenience sample of 12 subjects participated in the study. Overall, the participants experienced moderate degrees of symptom distress. Distress related to insomnia and appetite problems caused high levels of distress with moderate amounts of distress reported for distress related to nausea, pain, fatigue, bowel changes, concentration, and outlook. The least amount of distress was associated with appearance, breathing, and coughing problems. Symptom distress changed significantly over time with increased levels during the administration of chemotherapy and radiotherapy, one and seven days post-infusion and decreased to near baseline levels 25 days following the bone marrow infusion in all symptoms except outlook. Outlook distress was high initially and gradually declined over the course of the treatment. Significant changes were shown in nausea existence, appetite, insomnia, bowel, and concentration distress. The levels and changes seemed to reflect the clinical course of the BMT procedure. The participants showed moderate levels of emotional disturbance during the BMT with vigor and fatigue reaching high levels, tension and confusion reaching moderate levels, and depression and anger remaining fairly low. Emotional disturbance changed significantly over the course of the BMT for total emotional state and for all the emotional subscales except depression. The findings indicate that during times of intensive treatment emotional disturbance is greater. Total symptom distress and emotions showed no correlation except one day following bone marrow infusion; however, all six specific emotion components were correlated with at least one of the following distressful symptoms: outlook, pain, appearance, concentration, or fatigue. The findings suggest that symptom distress and emotions are closely linked to clinical events such as medications, blood transfusions, chemotherapy, radiotherapy, infections, nutritional deficits, but were tempered by coping abilities and lack of risk factors for emotional disturbance. Implications from the findings suggest specific times for the nurse to be particularly cognizant of specific symptom distress and emotional states and their patterns during the BMT. In addition, the nurse must be aware that there are complicated and uncomplicated courses for the BMT. The nurse must be adept at assessing the BMT patients for particular symptom distress and emotions when they are most likely to be problematic and to intervene appropriately.