Application of Evidenced-based Practice Regarding pediatric Patients and Otitis Media 1
Running head: Application of Evidenced -based Practice
Application of Evidence-based Practice
Regarding Pediatric Patients and Otitis Media
Running head: Application of Evidence-based Practice 2
The nursing practice heavily relies on the evidence based clinical information to determine current standards of practice within the nursing scope of practice. A multitude of informational journals and peer reviewed articles are readily available to help guide the decisions placed into practice. The nurse is responsible for recognizing the quality of evidence collected to improve the standard of care patients receive. This paper will investigate four articles regarding the appropriate care and treatment of the pediatric population with otitis media. In addition, an appropriate recommendation for antibiotic therapy will be made based on information gathered during the research. To answer the question of whether a wait-and -see approach is recommended, an initial validation of the information collected must be determined. Four articles will be assessed based on the type of research collected as filtered, unfiltered, or general information. The source will be investigated as inappropriate or appropriate. Lastly, the articles will be classified as primary research evidence, evidence summary, or evidence-based guideline. In addition to the four articles, a study and interview from current patients of the clinic will be discussed. The first article by the American Academy of Pediatrics and American Academy of Family Physicians discusses the diagnosis and management of acute otitis media. This article is a filtered resource as several large studies have been completed on the topic. The article is from a reliable and reputable source and is determined to be appropriate. The type of research is an evidence summary as well as providing evidenced based guidelines for practice. The second article by The Pediatric
Infectious disease Journal provides unfiltered information. The author Dr. Block discusses evidenced collected within studies of her own as well as collected data from Running head: Application of Evidenced-based practice 3
previous studies and as a result the article is mainly primary research. This source would be considered inappropriate for a nurse evaluating a standard practice to recommend. The information presented within the article is too broad and does not recommend a best practice standard. The article is an unfiltered article based on the foundation of a multitude of studies and expert opinion presented. A physician may find this article useful if investigating which pathogen would best respond to a specific antibiotic. The third article is a general informative resource for the clinic to apply evidence based practice. The resource is a filtered article which provides appropriate information relating to general practice. The research is evidence summary as well as evidence-based guideline. This article provides general information regarding pain and treatment of ear problems. This article may by appropriate for the diagnosis of specific ear conditions and treatments however may not be appropriate to determine if a wait-and-see approach is supported. The last article reviewed discusses treatment of otitis media in an era of increasing microbial resistance. This is an unfiltered resource and appropriate for determining if a practice change should be implemented. The type of research is evidence summary and evidence-based guidelines. This article would support an evidenced based approach to support a change of practice within the clinic. Finally, interviews collected from patients who utilize the clinic is unfiltered information and inappropriate to base a clinical change of practice. The type of research is primary research evidence. This information may be helpful for determining the type of culture who utilizes the clinic and how accepting the community may perceive a change in practice. All pieces of information collected has valuable information, however from nursing standards an article should present current evidence based practice standards.
Application of Evidenced-based Practice 4 The evidence presented within one article supports a watchful waiting approach to treating acute ear infections in children. Data is strongly supported with evidenced based practice guiding the appropriate course of treatment as prescribed by physicians. For example, The American Academy of Pediatrics and American Academy of Family Physicians have provided a practice guideline for the diagnosis and treatment of acute otitis media. This article should be considered the gold standard of practice for physicians and presents filtered information. The article clearly provided recommendations based on the presentation of the patient in addition to practice standards. The article is current and is supported by regulatory licensing agencies. Future research goals are also discussed along with current recommendations. This informative practice guideline should be reviewed with additional information to fully support a practice change within the clinic. However, additional current studies would be required to implement a change of practice with more supportive data. Considering multiple resources were obtained to investigate a change in practice, some articles were outdated and referenced studies which may not be applicable to modern practice. In conclusion, research does support a more watchful approach to treating patients; more supportive current data would be required so an informed decision can be made.
To implement a policy change within a clinic, a committee should be established to review current evidence based literature to support a change in practice. A review of current recommendations for practices can be investigated along with a discussion with a larger pediatric medical facility. Having a better understanding of current trends from neighboring establishments can better prepare the facility for a change in practice. Educational information should be prepared for parents to establish a clear understanding of why a practice change has been implemented. Nursing will have a vital role in educating families and possibly reminding practitioners of practice Running head: Application of Evidenced-based practice 5 recommendations. By the nursing staff having the knowledge of best practice, they can advocate a higher quality of care for their patients. Ethical concerns and vulnerable populations should be considered when researching and changing clinical practice guidelines.
The practitioner and nursing staff must assure they are implementing practice changes to improve quality of care for their patients. Well supported and researched standards should only be implemented. The patient population of the clinic should not be uses as a test group or population without prior knowledge or informed consent. During the process of informed consent, all risks must be explained to the patient and family. Patients must be educated by the practitioners and nursing staff regarding the implementation of a new practice. The staff must be aware of credible resources for data collection and applications to practice. Reassurance of protecting patient privacy should be discussed with patients and parents. The nurses must continue to advocate for human rights during the research process by identifying vulnerable populations. These populations may include children, pregnant woman, elderly, and cultural differences. If any language barriers exist, the nursing staff should be prepared to have alternate communication methods. State and federal guidelines must be followed during any research process and advocate for those who cannot advocate for themselves.
Block, S.L. (2008). Causative Pathogens, Antibiotic Resistance and Therapeutic Considerations in Acute Otitis Media. Pediatric Infectious Disease Journal, 15(4), 448-456.
Hay, W.W., Levin, J.J, Sondheimer, & Deterding, R.R. (2006). Current pediatric diagnosis and treatment. Ear, Nose and Throat. (pp. 159-492). Denver, Colorado: Lange.
McCracken, G.H. (1998). Treatment of Acute Otitis Media in an Era of Increasing Microbial Resistance. Pediatric Infectious Disease Journal, 17(6), 576-579.
American Academy of Pediatrics. (2004). Diagnosis and Management of Acute Otitis Media, 113(5), 1451-1465.