Foundations of Pediatric Hematopoietic Stem Cell Transplantation: 3^rd Edition Now Available

The primary resource designed explicitly to educate new pediatric hematology/oncology nurses on caring for pediatric transplant patients is now available! The Transplant Foundations course is designed to teach nurse learners how to care for pediatric transplant patients at their institution. The new edition of the course provides both a self-paced independent learning experience and classroom instruction. This course emphasizes the following:

• Core foundational concepts that are required before learning specific institutional practices
• A multi-disciplinary team approach and plan of care
• Providing psychosocial support and education for patients, parents, and family members about what to do/expect during their care.

This course is meant to be paired with classroom training about institutional-specific pediatric transplant practices. Providing these online modules reduces the nurse educator’s preparation time and time in the classroom. The new edition of the course provides both a self-paced independent learning experience and classroom instruction. Each module is available in PowerPoint format with presenter notes allowing nurse educators’ to use the content in the classroom setting. 

Target Audience

This course is written for the following target audiences.

• Novice nurses with limited pediatric clinical experience and no stem cell transplant experience.
• Experienced nurses who don’t have hematology, oncology, bone marrow transplant (BMT), or pediatric experience. These nurses may know about adult stem cell transplants but have not cared for pediatric patients.
• Nurse Practitioners who may have some experience but not extensive transplant experience.

Learn About the Course Objectives

After completing the Transplant Foundations course, the nurse will be able to:

• Identify and define the types and sources of transplants
• Identify indications for transplants and ethical considerations
• Identify the types of conditioning regimens for BMT and their potential adverse effects
• Administer and manage cellular therapy infusions
• Conduct assessments specific to pediatric BMT patients
• Manage symptoms as needed and required (pain, mucositis, nausea, vomiting, skin integrity, etc.)
• Recognize the complications for each type of transplant regardless of donor source or conditioning regimen
  • In the event of an emergency, immediately intervene
  • For non-emergencies, notify/escalate to the appropriate provider, who should intervene
• Describe post-transplantation immune re-constitution and late effects after BMT
• Plan for safe discharge, including home and follow-up care
• Maintain professional boundaries and care for self
• Care for an initial, small cohort, less complicated stem cell patient.

Learn About the Course Modules

Module 1 — Introduction & Overview

Learnong Objectives

Module Instructor: Rita Secola, PhD RN CPON^® NEABC FAAN
By the end of this module, participants will be able to:

1. describe the goals of hematopoietic stem cell transplantation (HSCT)
2. describe the types of HSCT and indications for its use
3. explain the ethical considerations related to HSCT.

Topics Covered — Module Outline

Maximum time to teach: 30-45 minutes, 26 slides

1. HSCT Overview
2. Definitions and Goals
3. Types and Indications
4. HSCT Phases
5. Ethical Considerations
6. Knowledge Check Questions

Module 2 — HSCT Types, Selections, Stem Cell/Cellular Therapy Sources

Module Instructor: Rita Secola, PhD RN CPON^® NEABC FAAN

Learning Objectives

By the end of this module, participants will be able to:

1. describe HSCT donor types and selections
2. define HSCT stem cell sources and collections
3. describe other HSCT cellular therapy.

Topics Covered — Module Outline

Maximum time to teach: 45-60 minutes, 51 slides

1. Donor Types Autologous, Allogeneic
2. Donor Stem Cell Types/Sources
3. Stem Cell Donor Assessment
4. Donor Selections
5. HLA Typing
6. Donor and Patient Selection Factors
7. Stem Cell Collections Mobilization
8. Therapeutic Apheresis
9. Other HSCT Related Cellular Therapy Sources
10. CAR-T Therapy
11. Knowledge Check QUestions

Module 3 — Hematopoietic Stemm Cell Transplant (HSCT) Conditioning Regimens

Module Instructor: Rita Secola, PhD RN CPON^® NEABC FAAN

Learning Objectives

By the end of this module, participants will be able to:

1. describe the principles of HSCT conditioning regimens
2. define types of HSCT conditioning regimens
3. explain patient care and monitoring related to HSCT conditioning regimens.

Topics Covered — Module Outline

Maximum time to teach: 45-60 mins, 30 slides

1. Principles Of HSCT Conditioning Regimens
2. HSCT Regiment Types
   • Ablative /Myeloablative Examples
3. Nonmyeloabaltive/Reduced intensity Examples
4. HSCT Chemotherapy Regimens Types
   • Adverse Effects
5. HSCT Radiation Therapy Adverse Effects
6. HSCT Immunosuppressive Medications
   • Side Effects
   • Nursing Care
7. Conditioning Regimen Related Patient care and Monitoring
8. Meeting the Concerns of Patients and Family
9. Knowledge Check Questions

Module 4 — Administration and Management of Stem Cell Infusions

Module Instructor: Karen Wolownik, MSN RN CPNP CPHON^®

Learning Objectives

By the end of this module, participants will be able to:

1. define the different types of stem cell infusions and the implication for the use of each
2. identify methods of stem cell product manipulation and explain the procs and cons of using each
3. understand implications and ABO incompatibility
4. describe the preparation of the patient and environment and the necessary monitoring for cell therapy infusions
5. identify expected minor and serious adverse events of stem cell infusion and nursing management
6. describe psychosocial considerations in caring for patients undergoing cell therapy infusions.

Topics Covered — Module Outline

Maximum time to teach: 45 mins, 40-50 slides

1. Types of cell therapy infusions
2. Implications of storage and volume
3. Stem Cell Manipulation
4. Administration Considerations
5. Cell Therapy Infusions and Adverse Reactions
6. Psychosocial considerations
7. Patient and Family Education

Module 5 — Recognition and Management of Toxicities

Module Instructor: Misty Evans, DNP APRN CPNP-AC BMTCN^®

Learning Objectives

By the end of this module, participants will be able to:

1. recognize common toxicities following HSCT
2. identify nursing interventions to prevent and manage toxicities following HSCT.

Topics Covered — Module Outline

Maximum time to teach: 1 hour, 52 slides

1. General Introduction
   • Magnified/more severe/earlier onset in the transplant setting
   • Provide appropriate palliative care
   • Educate patients and family
2. Hematopoietic
   • Neutropenia
   • Anemia
   • Thrombocytopenia
3. Metabolic and Endocrine
4. Gastrointestinal
   • Nausea and vomiting
   • Diarrhea
   • Abdominal pain
   • Mucositis
5. Hepatobiliary
   • Transaminitis
   • Hyperbilirubinemia
6. Renal
   • Risk of acute kidney injury
   • Nephrotoxic medications
   • Hemorrhagic cystitis
7. Pulmonary
8. Cardiovascular
   • Hypertension
   • Pericardial effusion
   • Cardiac dysfunction
9. Neurological
   • Medication- related
   • Peripheral neuropathy
   • General encephalopathy
   • Cerebral vascular disease
   • PRES
   • Pain
10. Integumentary
    • Skin
    • Alopecia

Module 6 — Common HSCT Complications

Module Instructor: Karen Wolownik, MSN RN CPNP CPHON^®

Learning Objectives

By the end of this module, participants will be able to:

1. describe the pathophysiology of acute and chronic Graft-Versus-Host Disease (GVHD)
2. recognize the signs and symptoms of acute and chronic GVHD
3. describe and demonstrate an understanding of the staging and grading guidelines for GVHD
4. describe the most common prophylactic and management strategies for acute and chronic GVHD.

Topics Covered — Module Outline

Maximum time to teach: 90 minutes

1. GVHD Pathology, Staging, Treatment
2. Prophylaxis and treatment of Infectious complications
3. Diagnosis, prophylaxis and treatment of Sinusoidal Obstructive Syndrome (SOS)
4. Assessment and management of bleeding complications
5. Assessment and treatment Cytokine Release Syndrome (CRS)
6. Pathology, diagnosis and treatment of Thrombotic Micro Angiopathy (TMA)
7. Diagnosis and Management of Idiopathic Pneumonia Syndrome (IPS)
8. Diagnosis and management of Multi Organ Failure (MOF)

Module 7 — Discharge Planning and Education

Module Instructor: Misty Evans, DNP APRN CPNP-AC BMTCN^®

Learning Objectives

By the end of this module, participants will be able to:

1. determine appropriate discharge criteria following HSCT
2. identify patient and caregiver education needs following HSCT
3. explain ongoing follow-up of the post-transplant patient after the hospital discharge.

Topics Covered — Module Outline

Maximum time to teach: 25 minutes, 19 slides

1. Assessing discharge readiness
2. Discharge planning
3. When/how to seek medical attention
4. Dietary restrictions
5. Medication administration
6. Early follow- up (Discharge through Day 100)
7. Day 100 evaluation
8. Ongoing follow up: Day 100 through One year
9. One year evaluation
10. Annual follow up and survivorship

Module 8 — Immune Reconstitution and Late Effects

Module Instructor: Misty Evans, DNP APRN CPNP-AC BMTCN^®

Learning Objectives

By the end of this module, participants will be able to:

1. describe the late complications of HSCT
2. recognize the risk factors associated with late complications of HSCT
3. identify diagnostic tests to monitor long-term complications of HSCT
4. describe the recommended survivorship follow-up for HSCT survivors.

Topics Covered — Module Outline

Maximum time to teach: 60 minutes, 50 slides

1. Immune system recovery and infectious risks
2. Late complications and risk factors:
   • Pulmonary
   • Cardiovascular
   • Hepatobiliary
   • Renal and GU
   • Skeletal
   • Muscle and connective tissue
   • Endocrine
   • Ocular
   • Oral and dental
   • Neurological and developmental
   • Fertility
   • Psychosocial
   • Sexuality
   • Mucocutaneous
   • Secondary malignancies

Module 9 — Boundaries & Self-Care

Module Instructor: Janice Nuuhiwa, MSN RN NPD-BC CPHON^®

Learning Objectives

By the end of this module, participants will be able to:

1. identify expectations for maintaining professional boundaries when caring for chronic, long-term patients receiving HSCT
2. describe a relationship-based model of care’s essential components
3. define provider well-being within the context of personal and team accountability.

Topics Covered — Module Outline

Maximum time to teach: 45 minutes

1. Relationship-based care model (familiar with, amplified in this context)
   • Self
   • Team
   • Patient
   • Family
2. Therapeutic relationships
   • Uniqueness of Chronic Long-Term Patient Care
   • Boundaries
   • Compassion Fatigue
   • Moral Distress
   • Burnout
3. Provider well-being
   • Individual
     • Self Awareness
     • Self-Care Planning
   • Team
     • Peer Support Programs
     • Organizational Support Programs

Meet the Course Content Developers

Course Reviewers

Caroline Costello, MBA BSN RN CPON^® BMTCN^® NPD-BC

Nursing Education Coordinator

Boston Children’s Hospital

Boston, Massachusetts

Ellen Olson, MS RN CPNP CPHON^® BMTCN^®

Blood and Marrow Transplant Nurse Practitioner

Children’s Healthcare of Atlanta/Aflac Cancer Center & Blood Disorders

Atlanta, Georgia

CNE Contact Hours

Participants that complete the online self-paced version of the course will earn 9 CNE contact hours. All modules have an end-of-module quiz with feedback for correct and incorrect answers. Successful completion of the module quizzes will be required to move forward in the course.

To complete the course and earn CNE contact hours, self-paced participants must pass all module quizzes. Each individual must complete the self-paced version of the course to earn CNE contact hours. CNE contact hours are not provided by APHON for courses taught by nurse educators within the hospital setting.