"Let us never consider ourselves finished nurses ... we must be learning all of our lives."
Most evidence-based nursing practice projects begin with a clinical question or observation. But one such project began with a promise to a patient’s husband.
Inspired by their experience of caring for a mother separated from her two young children — and so many other parents and grandparents like her — a team of nurses tackled the question of child visitation and why 12 was the magic age for children to be restricted from inpatient leukemia, lymphoma, myeloma and stem cell transplant units.
They questioned a child visitation policy in place at MD Anderson for many years.
The query originally was posed by the husband of a 34-year-old mother frequently admitted to the hematology units with aggressive B-cell lymphoma. The unit nurses — most of whom are parents — didn’t feel they had substantive answers for the father. They often struggled ethically when critically ill patients requested to see their young children.
After the young mother died, five nurses from the unit set out to fulfill their promise to her husband to review the policy.
Looking for published studies on young children as infection carriers, the team found no evidence that children pose a greater risk to immuno-compromised patients than adults.
They continued their research, meeting with experts from the Department of Infectious Disease, surveying other institutions and informally polling MD Anderson physicians.
With the initial research complete, the team saw the potential for changing the policy.
Change on the horizon?
They presented their research to MD Anderson’s Nursing Practice Congress and a multidisciplinary Professional Action Coordinating Team (PACT) was assigned to further explore the issue and possible policy revisions.
“We knew that evidence-based research was our first recourse for advancing a change in the visitation policy,” says Jane Falk, associate director of clinical nursing, who led the PACT. “As nurses, we support the family throughout the cancer journey. We see the joy that children can bring to a parent or grandparent.”
When the study found no evidence to support child visitation restrictions, the PACT shifted its focus to researching and developing evidence-based policies and guidelines to prevent the spread of infection by visitors, regardless of age.
Guidelines for young visitors
Today, after multiple clinical committees signed off on the policy change, children younger than 12 can visit patients in most areas of the hospital, though some restrictions remain.
As part of the policy, children are screened for colds, coughs or fevers. They also must wash their hands and wear gloves and masks as instructed, be supervised by an adult and remain only in the family member’s room.
“This was my first evidence-based research project, and I want to participate in future projects because of the great experience and impact of what we could do for our patients and their families. We were committed to seeing this project through but, ultimately, the evidence spoke for itself,” says Lisa Comer, clinical nurse.
Comer, Falk and others were the authors of a paper on the new guidelines recently published in the Clinical Journal of Oncology Nursing.