Caring Process in Hematopoietic Stem Cell Transplantation: A Grounded Theory Study

  • Leila Sayadi 1) Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran 2)Hematology-Oncology and Stem Cell Transplantation Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
  • Vahid Zamanzadeh Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
  • Leila Valizadeh Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
  • Fariba Taleghani Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
Keywords: Hematopoietic stem cell transplantation; Caring; Grounded theory; Supporting




Background: Caring is one of the main concepts in nursing and its modes of delivery in different diseases have been widely studied. Hematopoietic Stem Cell Transplantation (HSCT) is a novel, complex, and time-consuming clinical intervention which is applied as a final medical choice in several life-threatening diseases. The aim of the current study was to explore the process of caring for patients undergoing HSCT.

Materials and Methods: In this article, we present a qualitative research study conducted between 2011 and 2013 in accordance with the procedures of grounded theory methodology. Data were gathered by interviewing and observing health professionals involved in HSCT process, as well as patients and their families. The study participants consisted of 18 HSCT nurses, 2 physicians, 12 patients, and 7 members of patients’ families. The initial sampling in the study was purposeful, followed by theoretical sampling. Data were analyzed using the Corbin & Strauss (2008) method.

Results: Four main categories, reflecting 13 sub-categories, were emerged by analyzing the data: struggling of patients between life and death, trying to reduce the chance of patient’s death, enforcing patients’ spirit and caring achievements. The core variable of study, defined as “supporting patients to go through the HSCT process successfully”, represented the nature and efficiency of care delivered to HSCT patients in the study setting.

Conclusion: HSCT patients enter the caring process in the context of life-and-death limbo. The caring strategy in HSCT patients is aimed at trying to reduce the chance of the patient’s death, as well as enforcing patients’ spirit. The HSCT process affects all areas involved in various ways and has some outcomes. The findings and the theoretical conclusions of this study are potentially valuable in improving nursing practice, designing of educational programs and setting of caring policies. 



1. Jasmine T. Art, Science, or Both? Keeping the Care in Nursing. Nurs Clin North Am. 2009; 44(4):415-21.
2. Spichiger E, Wallhagen MI, Benner P. Nursing as a caring practice from a phenomenological perspective. Scand J Caring Sci. 2005; 19(4):303-9.
3. Leininger MM. Leininger's Theory of Nursing: Cultural Care Diversity and Universality. Nurs Sci Q. 1988; 1(4):152-60.
4. Clarke PN, Watson J, Brewer BB. From Theory to Practice: Caring Science According to Watson and Brewer. Nurs Sci Q. 2009; 22(4):339-45.
5. Watson J. Nursing the Philosophy and Science of Caring. Revised Edition. Colorado: University Press of Colorado; 2008.
6. Hinshaw AS, Feetham S, Shaver JLF. Handbook of clinical nursing research. California: Sage Pubns; 1999.
7. Lea A, Watson R, Deary IJ. Caring in nursing: a multivariate analysis. Journal of Advanced Nursing. J Adv Nurs. 1998; 28(3):662-71.
8. Leininger M. Caring: a central focus of nursing and health care services. Nurs Health Care. 1980; 1(3):135-43, 176.
9. Finfgeld-Connett D. Meta - synthesis of caring in nursing. J Clin Nurs. 2008; 17(2):196-204.
10. Brilowski GA, Wendler MC. An evolutionary concept analysis of caring. J Adv Nurs. 2005; 50(6):641-50.
11. Sumner J. Is caring in nursing an impossible ideal for today's practicing nurse. Nurs Adm Q. 2008; 32(2):92-101.
12. Chiovitti RF. Nurses' meaning of caring with patients in acute psychiatric hospital settings: A grounded theory study. Int J Nurs Stud. 2008; 45(2):203-23.
13. White MF. A Study of Nurse Caring Behaviors Using Q Methodology The State University of New Jersey; 2003. (Doctoral dissertation, Rutgers University).
14. Halligan P. Caring for patients of Islamic denomination: critical care nurses’ experiences in Saudi. J Clin Nurs. 2006; 15(12):1565-73.
15. Vivar CG, Orecilla-Velilla E, Gómara-Arraiza L. [“It's harder”: nurses’ experiences of caring for patients with cancer recurrence]. Enferm Clin. 2009;19(6):314-21
16. Rafii F, Oskouie F, Nikravesh M. Caring behaviors of burn nurses and the related factors. Burns. 2007; 33(3):299-305.
17. Yi M. Nurses' experience of caring for dying patients in hospitals. Taehan Kanho Hakhoe Chi. 2003; 33(5):553-61.
18. Gysels MH, Higginson IJ. Caring for a person in advanced illness and suffering from breathlessness at home: threats and resources. Palliat Support Care. 2009; 7(2):153-62.
19. Liu JE, Mok E, Wong T. Caring in nursing: investigating the meaning of caring from the perspective of cancer patients in Beijing, China. J Clin Nurs. 2006; 15(2):188-96.
20. Dunne K, Sullivan K, Kernohan G. Palliative care for patients with cancer: district nurses’ experiences. J Adv Nurs. 2005; 50(4):372-80.
21. Mohan S, Wilkes LM, Ogunsiji O, et al. Caring for patients with cancer in non-specialist wards: the nurse experience. Eur J Cancer Care (Engl). 2005; 14(3):256-63.
22. Fall-Dickson JM, Rose L, editors. Caring for patients who experience chemotherapy-induced side effects: the meaning for oncology nurses. Oncol Nurs Forum. 1999; 26(5): 901-907.
23. Cant AJ, Galloway A, Jackson G. Practical Hematopoietic Stem Cell Transplantation. Massachusetts: Blackwell Pub. 2007.
24. Ramzi M. Hematopoietic stem cell transplantation in Southern Iran: History, current status and future direction. Iran Red Crescent Med J. 2009; 11(4):364-370.
25. De la Morena MT, Gatti RA. A history of bone marrow transplantation. Hematol Oncol Clin North Am. 2011; 25(1):1-15.
26. Roeland E, Mitchell W, Elia G, et al. Symptom control in stem cell transplantation: a multidisciplinary palliative care team approach. Part 2: Psychosocial Concerns. J Support Oncol. 2010; 8(4):179-83.
27. Appelbaum FR, Forman SJ, Negrin RS, et al. Thomas' Hematopoietic Cell Transplantation: John Wiley & Sons; 2009.
28. Cooke L, Gemmill R, Kravits K, et al. Psychological Issues of Stem Cell Transplant. Semin Oncol Nurs. 2009; 25(2):139-50.
29. Appelbaum FR. Hematopoietic-Cell Transplantation at 50. N Engl J Med. 2007; 357(15):1472-5.
30. Ghavamzadeh A, Alimogaddam K, Jahani M, et al. Stem Cell Transplantation in Iran; 1991 until 2009. Int J Hematol Oncol Stem Cell Res. 2009; 3(1):27-33.
31. Ghavamzadeh A, Alimoghaddam K, Jahani M, et al. Stem Cell Transplantation; Iranian Experience. Arch Iran Med. 2009; 12(1):69-72.
32. Ghavamzadeh A, Alimoghaddam K, Ghaffari F, et al. Twenty Years of Experience on Stem Cell Transplantation in Iran. Iran Red Crescent Med J. 2013; 15(2):93-100.
33. Fliedner MC. Research within the field of blood and marrow transplantation nursing: How can it contribute to higher quality of care? Int J Hematol. 2002; 76 Suppl 2:289-91.
34. Rice RD, Bailey G. Management Issues In Hematopoietic Stem Cell Transplantation. Semin Oncol Nurs. 2009; 25(2):151-8.
35. Cohen MZ, Rozmus CL, Mendoza TR, et al. Symptoms and Quality of Life in Diverse Patients Undergoing Hematopoietic Stem Cell Transplantation. J Pain Symptom Manage. 2012; 44(2):168-80.
36. Sabo BM. Compassionate presence: The meaning of hematopoietic stem cell transplant nursing. Eur J Oncol Nurs. 2011; 15(2):103-11.
37. Leung D, Esplen MJ, Peter E, et al. How haematological cancer nurses experience the threat of patients’ mortality. J Adv Nurs. 2012; 68(10):2175-84.
38. Coolbrandt A, Grypdonck MHF. Keeping courage during stem cell transplantation: A qualitative research. Eur J Oncol Nurs. 2010; 14(3):218-23.
39. Mercês NNA, Erdmann AL. Nursing and hematopoietic stem cell transplantation: scientific production from 1997 to 2007. Acta Paulista de Enfermagem. 2010; 23(2):271-277.
40. Kelly D, Ross S, Gray B, et al. Death, dying and emotional labour: problematic dimensions of the bone marrow transplant nursing role? J Adv Nurs. 2000; 32(4):952-60.
41. Leininger M. Culture Care Theory: A Major Contribution to Advance Transcultural Nursing Knowledge and Practices. J Transcult Nurs. 2002;13(3):189-92;
42. Parsa Yekta Z, Nikbakht Nasrabadi A. Caring: A Concept Analysis. Modares Journal of Medical Sciences (Pathobiology). 2005; 7(2):31-39. [In Persian].
43. Corbin JM, Strauss AL. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Editor: Sage Publications, Incorporated; 2008.
44. McCann TV, Clark E. Grounded theory in nursing research: Part 1--Methodology. Nurse Res. 2003; 11(2):7-18.
45. Phillips P. A deconstruction of caring. J Adv Nurs. 1993; 18(10):1554-8.
46. Chen HY, Boore JR. Using a synthesised technique for grounded theory in nursing research. J Clin Nurs. 2009; 18(16):2251-60.
47. Ghavamzadeh A, Alimogaddam K, Jahani M, et al. Hematopoietic Stem Cell Transplantation in Iran: 1991 through 2010. Int J Hematol Oncol Stem Cell Res. 2010; 4(4):1-9.
48. Wimpenny P, Gass J. Interviewing in phenomenology and grounded theory: is there a difference? J Adv Nurs. 2000; 31(6):1485-92.
49. Turner DW. Qualitative interview design: A practical guide for novice investigators. Qual Rep. 2010; 15(3):754-760.
50. Mulhall A. In the field: notes on observation in qualitative research. J Adv Nurs. 2003; 41(3):306-13.
51. Polit DF, Beck CT. Nursing Research: Generating and Assesing Evidence for Nursing Practice. 9th ed: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2012.
52. Stoltz P, Andersson EP, Willman A. Support in nursing—An evolutionary concept analysis. Int J Nurs Stud. 2007; 44(8):1478-89.
53. Gardner KG. Supportive nursing: a critical review of the literature. J Psychiatr Nurs Ment Health Serv. 1979; 17(10):10-6.
54. Zamanzadeh V, Valizadeh L, Sayadi L, et al. Life in Limbo: Experiences of Iranian Hematopoietic Stem Cell Transplantation Recipient Patients and Nurses in a Qualitative Study. Int J Hematol Oncol Stem Cell Res. 2013; 7(3):25-33.
55. Sayadi L, Jafaraghaee F, Jeddian A, et al. Views of patients undergo hematopoietic stem cell transplantation on their basic needs. Int J Hematol Oncol Stem Cell Res. 2013; 7(2):23-9.
56. Jim HS, Syrjala KL, Rizzo D. Supportive Care of Hematopoietic Cell Transplant Patients. Biol Blood Marrow Transplant. 2012; 18(1 Suppl):S12-6.
57. Sirilla J, Overcash J. Quality of life (QOL), supportive care, and spirituality in hematopoietic stem cell transplant (HSCT) patients. Support Care Cancer. 2013; 21(4):1137-44.
58. Sullivan KM, Meyers J, Petersen FB, et al. Supportive Care of the Marrow Transplant Recipient: The Seattle Experience. Acute Leukemias II .1990; 33:539-45. Springer, Berlin, Heidelberg.
59. Valizadeh L, Zamanzadeh V, Sayadi L, et al. Truth-telling and hematopoietic stem cell transplantation: Iranian nurses’ experiences. Nurs Ethics. 2014; 21(5):518-29.
60. Zamanzadeh V, Valizadeh L, Sayadi L, et al. Emotional labour of caring for hematopoietic stem cell transplantation patients: iranian nurses' experiences. Asian Nurs Res (Korean Soc Nurs Sci). 2013; 7(2):91-7.
61. Chagas-Moreira M, Luzia Leite J, Miranda da Silva M, et al. Nursing Support Strategies in the Care of Cancer Patients: Expectations Found among the Residents of a Brazilian Community. Aquichan. 2010; 10(2):132-145.
62. Vanaki Z, Parsa Yekta Z, Kazemnejad A, et al. Interpretation of support for cancer patients under chemotherapy: a qualitative research. Iran. J. Psychiatry Clin. Psychol. 2003; 9(1):53-61. [In Persian].
63. Mahmoodi h. Caring in Emergency. Tehran: Baghiatallah University of Medical Sciences; 1390.
64. Molazem Z. Designing a nursing care model for general surgery patients Tehran: Tarbiat Modares University; 2010 [In Persian].
How to Cite
Sayadi L, Zamanzadeh V, Valizadeh L, Taleghani F. Caring Process in Hematopoietic Stem Cell Transplantation: A Grounded Theory Study. Int J Hematol Oncol Stem Cell Res. 13(2):83-94.
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