The role of the nurse before, during and after transplant

As part of the MDT, optimal nursing care is central to the stem cell transplant journey, encompassing clinical expertise, patient advocacy, and holistic support. It is likely that specialist transplant nurses will care for patients during the transplant process, but myeloma nurse specialists may also be involved if the transplant centre is at the same hospital as the one where the patient is regularly treated.

In the pre-transplant phase, nurses engage in thorough patient education, ensuring individuals and their families understand the procedure, potential risks, and expected outcomes. Leading coordination of pre-transplant assessments, facilitating stem cell mobilisation and collection, and providing anticipatory guidance to prepare patients physically and emotionally are crucial to ensure informed decision-making and readiness for treatment.

Throughout the transplant and recovery phases, nursing practice is grounded in vigilant clinical monitoring, skilled symptom management, and continuity of care. Nurses are central to managing high-dose chemotherapy side effects, supporting engraftment, and maintaining infection prevention protocols during periods of profound immunosuppression.

Psychological support

HDT and SCT can be frightening, confusing and stressful for patients and their families. It is essential that the doctors, nurses and the transplant team involved provide coordinated information and support to patients and their families during this time. Patients and their families should be given ample time to ask questions and voice their concerns and fears at every stage of the process.

Protective isolation in the immediate period post-transplant can be a lonely experience and patients have different coping mechanisms to deal with it. Some patients describe feeling low for weeks after undergoing a transplant, a symptom commonly associated with ongoing fatigue and a desire to ‘get back to normal’. This highlights the need for ongoing nursing support.

HDT and SCT is a top-loaded procedure during which care is minimised, after an intensive 3 – 6 months when blood counts have normalised. This can be when patients need support the most. Many patients report to ‘not feeling their normal self again’, and after such an intensive few months, can feel isolated. While many experience relief and excitement about returning home, these feelings are frequently accompanied by anxiety and uncertainty. Concerns about coping independently, the success of treatment, and the absence of continuous clinical support can leave patients feeling vulnerable.

This transitional period represents a critical point in the patient’s recovery, and nursing involvement is key to ensuring continuity of care and psychological reassurance.

Nurses play a central role in preparing patients for discharge, including:

• Providing clear, anticipatory guidance about what to expect in the days and weeks ahead
• Reinforcing signs and symptoms that require prompt reporting, such as fever, fatigue, or signs of infection
• Educating patients and families on the importance of infection prevention measures, including hygiene practices, avoiding crowds, and safe food handling
• Ensuring patients know who to contact—and how—should concerns arise after discharge

Beyond information-sharing, nurses are instrumental in managing patient expectations and supporting the emotional transition from hospital-based care to home. This includes recognising and validating patient concerns, providing reassurance, and facilitating access to community or specialist support where appropriate. Effective discharge planning reflects the broader nursing responsibility of integrating intensive and non-intensive phases of care, promoting safety, independence, and confidence as patients adjust to life post-treatment.

Many centres have clinical psychologists attached to the clinical area who can provide specific psychological support. The benefits these professionals provide are that they are not directly associated with the patients’ treatment and are highly skilled in managing complex psychological distress. Nurses should refer patients for specific psychological support if they feel it is appropriate or if patients express a wish for one. You can read more about how nurses can support patients with emotional and psychological changes as a result of treatment in our Myeloma Nurse Guide: Emotional and Psychological changes.