Recipients of bone marrow transplants: making a smooth transition to an ambulatory care setting.

Health care is changing rapidly due in part to Diagnostic Related Groups (DRGs), patients becoming consumer-oriented, and the Acquired Immune Deficiency Syndrome (AIDS) crisis. Patients now spend less time in acute care settings and more time recovering in an ambulatory care environment. Patients undergoing bone marrow transplants have a long, stressful, and expensive course of recovery. Patients who have had transplants are similar to other groups of patients with cancer due to the severe immunosuppression they experience. Discharge teaching is begun once granulocyte counts start to rise, and other medical problems can be monitored easily in an outpatient clinic. Being discharged from the hospital is both exciting and anxiety-provoking for patients and their families. Discharge planning requires a multidisciplinary approach. Nursing care focuses on self-care needs and prevention of infection in the face of impaired immune function. Effective discharge planning incorporates patient care needs and a focus on the patient's successful reentry into the community.