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Nursing Considerations

  • Brienne LearyEmail author
  • Barbara Cuccovia
  • Colleen Nixon
Chapter

Abstract

Care of the critically ill pediatric hematology/oncology/hematopoietic cell transplantation (HCT) patient in the pediatric intensive care unit (PICU) is complex and challenging. This patient population requires significant resource utilization, exceptional nursing and physician expertise, and high-level care coordination. Nevertheless, they represent a disproportionately low number of all PICU admissions, rendering them a high acuity-low frequency patient population. Historically, outcomes for critically ill pediatric hematology/oncology/HCT patients have been poor. Current data suggests marked improvements in short- and long-term survival, thanks to novel treatment regimens and advances in supportive and critical care.

In both the inpatient pediatric hematology/oncology/HCT unit(s) and the PICU, nurses at the bedside and in advanced practice roles are integral members of the care team contributing to this trend. Achieving family-centered care and optimal patient outcomes requires collaboration, communication, and respect of each other’s specialties. A strong interdisciplinary care model that builds operational partnerships while considering institutional variation is essential.

This chapter will focus on describing the multifaceted needs of clinical situations the critically ill hematology/oncology/HCT patient may experience. The challenges of chemotherapy and biotherapy administration in the PICU will also be addressed. Strategies to combat compassion fatigue and staff distress are also explored.

Keywords

Pediatric intensive care Nursing Interdisciplinary Multidisciplinary Collaboration Complexity System(s) Acuity Patient- and family-centered care (PFCC) Chemotherapy biotherapy Oncology Hematology Hematopoietic cell transplant(ation) Complications 

Notes

Acknowledgments

We are grateful to the following individuals for the insight, guidance, and knowledge they shared with us throughout the development of this chapter: Robyn Blacken, Peggy Brill-Conway, Celeste Chandonnet, Janet Duncan, Colleen Gerrity, Steven Sloan, and Lindsay Weir.

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Copyright information

© Springer International Publishing 2019

Authors and Affiliations

  • Brienne Leary
    • 1
    Email author
  • Barbara Cuccovia
    • 2
  • Colleen Nixon
    • 3
  1. 1.Pediatric Medical-Surgical Intensive Care UnitBoston Children’s HospitalBostonUSA
  2. 2.Pediatric Stem Cell Transplant UnitBoston Children’s HospitalBostonUSA
  3. 3.Pediatric Hematology/Oncology UnitBoston Children’s HospitalBostonUSA

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