Discussion Response
Respond to 2 separate discussion posts below.
Peer Post 1
1.The topic of unaccompanied migrant children has been highly controversial, as policies on family separation at the border raised concerns for a humanitarian crisis. The American Nurses Association released a statement in 2018, stating their position against the separation of families at the U.S.- Mexico border (American Nurses Association, 2018). Since then, no further response or guidelines have been developed, despite the rise in influx of migrant children since its publication 4 years ago. Similarly, the National Association of Hispanic Nurses released a statement in 2019 (National Association of Hispanic Nurses, 2019), but no further commentary has been published. Both organizations called for a change in policy, but no efforts have been allocated to support this action. The lack of action in both the policy and practice fronts further supports a need for research and practice guidelines in the care of this population.
The American Academy of Pediatrics (AAP) estimates that one in every 4 children in the U.S. live in an immigrant family. This is defined as children who are foreign-born, or who are born in the U.S. but live with at least 1 parent who is foreign-born. Despite no formal guidelines from nursing organizations, the AAP created practice recommendations and guidelines to provide support and education to pediatric primary care providers. Resources include the Immigrant Child Health Toolkit, a tip sheet on how to support the health of immigrant children, and various health webinars focused on the care of immigrant children (American Academy of Pediatrics, 2021). The toolkit includes recommendations in the following domains: clinical care, medical screening and treatment recommendations for newly arrived immigrant children, access to health care and public benefits, immigration status and related concerns; and mental, emotional, and behavioral care (Meneses et al., 2021). While the toolkit was not specifically designed for unaccompanied migrant children, it includes relevant updated information on its prevalence and significance. In addition to recommendations for care, the AAP also warns about the heightened risk of human trafficking among this population.
While it is imperative for pediatric primary care providers to be well-versed on the topic, most migrant children are not connected to a medical home. For this reason, they are more likely to receive health services through emergency departments. Currently, there are no guidelines for the care of unaccompanied migrant children from the Emergency Nurses Association, and this is perhaps a gap in practice that is important to explore. Pediatric emergency nurses must become educated on the challenges faced by unaccompanied migrant children, as thousands of children are being placed in our neighboring communities every month (Office of Refugee Resettlement, 2023). These children are here, and it is our responsibility to care for them.
It is evident that there is great opportunity for improvement in both policy and practice. Nurses and advance practice nurses are at the forefront of health care, and therefore need guidance and education on how to properly identify and care for unaccompanied migrant children, both pre and post-reunification. The first step is awareness and education. The purpose of this evidence-based practice project is to increase awareness and education on the incidence, prevalence, and care of unaccompanied migrant minors among pediatric emergency nurses at a local pediatric emergency department.
References:
American Academy of Pediatrics. (2021). Immigrant child health. https://www.aap.org/en/patient-care/immigrant-child-health/
American Nurses Association. (2018). American Nurses Association calls for an immediate end to immoral and cruel practice of separating children from their families. https://www.nursingworld.org/news/news-releases/2018/separation-of-children-families/Links to an external site.
Meneses, C., Chilton, L., Duffee, J., Joiner, T., Koehler, J., Linton, J., Stauffer, W., Young, J., Yun, K. (2021). Immigrant child health toolkit. American Academy of Pediatrics. https://downloads.aap.org/AAP/PDF/cocp_toolkit_full.pdf?_ga=2.50974304.836415877.1674627750-1248881034.1637248802Links to an external site.
National Association of Hispanic Nurses. (2019). NAHN Family Separation Statement. https://nahnnet.org/policy/NAHN-family-separation-statement
Office of Refugee Resettlement. (2023). Unaccompanied children released to sponsors by county.https://www.acf.hhs.gov/orr/grant-funding/unaccompanied-children-released-sponsors-county
2. Peer Post – Annette Isozaki
The Oncology Nursing Society (ONS) is a professional organization that is involved with the management, treatment, and prevention of oral mucositis in hematopoietic stem cell transplant (HSCT) patients. ONS exists because “Cancer is an epidemic, and the fight against it is being waged every minute of every day in the health systems around the world. Oncology nurses are at the forefront of this battle, delivering care, carrying out clinical trials, and advancing evidence-based research. This is our reason to be” (Oncology Nursing Society, 2023). ONS is involved with several health policies affecting health professions and the nursing education coalition, the nursing community, one voice against cancer, partnerships for effective tobacco control, and the patient’s quality of life coalition. ONS also has grants and scholarships available for certification and conferences, leadership scholarships, professional development awards, and research grants for emerging to mid-career oncology nurse researchers as principal investigators.
Statistics
Oral Mucositis (OM) occurs in approximately 80% of cancer patients undergoing Hematopoietic stem cell transplantation (Brahmer et al., 2018 & Jackson et al., 2015). However, the incidence of severe forms of OM in patients undergoing HSCT can be anywhere from 20-75% depending on the treatment regimen and the patient’s predisposing factors, which may put them at a higher risk for developing OM or more severe OM (Guberti et al., 2022). Oral mucositis can lead to increased infections, diarrhea, gastrointestinal complications, pain, use of opioids, need for nutritional support, interruption of interventions focused on life-saving treatments, decreased quality of life, prolonged hospitalization, and even death (Isozaki & Brant, 2022). OM can also increase the risk of anorexia, dehydration, weight loss, and malnutrition due to increased pain, discomfort, and dysgeusia associated with eating and drinking (Brahmer et al., 2018 & Jackson et al., 2015).
Guidelines on Oral Mucositis
ONS guidelines currently recommend the use of photobiomodulation (PBM) using low-level laser therapy (LLLT) in patients undergoing HSCT as also recommended by the Federal and Drug Administration (FDA) and the Multinational Association of Supportive Care in Cancer (MASCC). PBM is the practice of delivering light therapy to the buccal mucosa, upper and lower lips, ventral tongue, lateral tongue, the floor of the mouth, and soft palate (Adnan et al., 2021). PBM is used to reduce inflammation in the intraoral cavity, prevent the development of oral ulcers, and promote wound healing if ulcerations develop (Lalla et al., 2014).
In my current place of employment, cryotherapy is utilized for the prevention of oral mucositis in HSCT patients receiving high-dose chemotherapy. However, there is currently no guideline or policy that utilizes low-level laser therapy for the prevention of OM in patients undergoing HSCT.
Purpose Statement
New interventions have been identified to help prevent and treat oral mucositis and significantly reduce the adverse reactions associated with lifesaving cancer treatments. This paper will aim to evaluate whether the use of photobiomodulation helps to prevent and treat oral mucositis more effectively than the use of oral cryotherapy alone on an inpatient stem cell transplant unit.
References:
Adnan, A., Yaroslavsky, A. N., Carroll, J. D., Selting, W., Juliano, A. F., London, W. B., Sonis, S. T., Duncan, C. N., & Treister, N. S. (2021). The Path to an Evidence-Based Treatment Protocol for Extraoral Photobiomodulation Therapy for the Prevention of Oral Mucositis. Front Oral Health, 2, 689386. https://doi.org/10.3389/froh.2021.689386Links to an external site.
Brahmer, J.R., Lacchetti, C., Schneider, B.J., Atkins, M.B., Brassil, K.J., Caterino, J.M., … Hallmeyer, S. (2018). Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: American Society of Clinical Oncology Clinical Practice Guideline. Journal of Clinical Oncology, 36, 17141768. https://doi.org/10.1200/JCO.2017.77.6385Links to an external site.
Guberti, M., Botti, S., Fusco, A., Caffarri, C., Cavuto, S., Savoldi, L., Serra, N., Merli, F., Piredda, M., & De Marinis, M. G. (2022). Stem cell transplantation patients receiving a novel oral care protocol for oral mucositis prevention and treatment: patient-reported outcomes and quality of life. Supportive Care in Cancer, 30(7), 6317-6325. https://doi.org/10.1007/s00520-022-07073-8Links to an external site.
Isozaki, A. B., & Brant, J. M. (2022). Clinical Updates in Mucositis-Related Symptom Management. Seminars in Oncology Nursing, 38(1), 151252. https://doi.org/https://doi.org/10.1016/j.soncn.2022.151252Links to an external site.
Jackson, L.K., Johnson, D.B., Sosman, J.A., Murphy, B.A., & Epstein, J.B. (2015). Oral health in oncology: Impact of immunotherapy. Supportive Care in Cancer, 23, 1–3. https://doi.org/10.1007/s00520-014-2434-6Links to an external site.
Lalla, R.V., Bowen, J., Barasch, A., Elting, L, Epstein, J., Keefe, D.M., . . . Mucositis Guidelines Leadership Group of the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology. (2014). MASCC/ISOO evidence based clinical practice guidelines for mucositis secondary to cancer therapy. Cancer, 120, 1453–1461. doi:10.1002/cncr.28592
Oncology Nursing Society. (2023). Our reason to be. ons.org. Retrieved January 24, 2023, from https://www.ons.org/about-ons/our-reason-be?ref=RO
