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Evidence-Based Practice & Applied Nursing Research Essay

Type of Sources / Appropriateness of Sources / Classification of Sources American Academy of Pediatrics and American Academy of Family Physicians article regarding acute otitis media is a filtered resource. It is an appropriate source for nursing practice because; it establishes clinical guidelines to diagnose and manage AOM. It also establishes guidelines when to treat the signs and symptoms of AOM, watchful waiting, or to treat with an antibiotic. This article is classified as an evidence based guideline because, it reviews multiple research literatures in a systemic manner and provides recommendations of practice. Block’s Causative Pathogens article is an unfiltered resource. It is an appropriate source for nursing practice because it provides the clinician with the most recent and up to date research on the topic. The article is primary research evidence because; its researchers acquired the data first hand.

Kelly’s article regarding Current pediatric diagnosis and treatment is a general information resource. This article is not appropriate for clinician use because it only provides basic general background. It does not guide the clinician in diagnosing and treatment. McCracken’s article in the Pediatric Infectious Disease Journal is an unfiltered resource. It is an appropriate for nursing practice because it supports established guidelines and shows what will happen with continued antibiotic use. This is an evidence summary article because it lists all of the important information and the evidence supporting it. The last source of evidence is interviews with parents. This type of source is considered a general information resource. It is appropriate because, the interviews give firsthand experience of onset and signs and symptoms of AOM.

This source of classifications is none of the listed. “Acute otitis media (AOM) is the most common infection for which antibacterial agents are prescribed for children in the United States. As such, the diagnosis and management of AOM has a significant impact on the health of children, cost of providing care, and overall use of antibacterial agents (AAFP, 2004). Watchful waiting can have many benefits for the children and the provider if used properly. Diagnosing AOM can be tricky. The signs and symptoms can also be related to other illnesses such as an upper respiratory virus. Throwing antibiotics at any illness use to be the course of action. However, now that there is evidence that bacteria have become resistant to some antibiotics, clinicians are testing out other means of treating illnesses. If the child presenting with symptoms of AOM has no underlying conditions and has means to follow up with the doctor if the symptoms progress, watchful waiting is an appropriate approach for treating the child.

According to the research, placebo controlled trials have shown that children have responded well without antibacterial intervention. Giving the opportunity for the illness to resolve without antibacterial intervention not only benefits the child but, the caregivers and the clinician. It benefits the child by not being exposed to antibiotics that are not needed, therefore creating a potential resistance to that antibiotic. It benefits the caregiver by not spending money on a medication their child does not need. Last, it benefits the clinician by preventing resistance to an antibiotic that may be useful in the near future. Watchful waiting is only appropriate if the patient meets the guidelines of uncomplicated AOM, assurance of a follow up if necessary, and access to antibiotics if symptoms progress or worsen. The findings in the AAFP article can be applied in many ways to improve nursing practice in a healthcare setting.

The article provides evidence based guidelines on how to properly diagnose AOM and the typical signs and symptoms. It establishes the three criteria the patient must exhibit for a certain diagnosis of AOM. If the patient does not meet the certain criteria, it guides the clinician to continue to assess the patient for another illness, such as an upper respiratory virus. Proper diagnosis will improve clinician treatment and care of the patient. The article also includes a descriptive chart on how to assess and manage pain associated with AOM. It lists for the clinician the recommended medications, remedies, and agents for the clinician to utilize to manage pain. It also lists the effectiveness and the side effects. This will help improve nursing care by implementing the proper medication and or remedies to the patient with the highest effectiveness and the least amount of side effects.

The article also very clearly identifies when watchful waiting is not appropriate and what antibiotics should be prescribed and the usual dosage. This information is helpful to nursing practice by helping the clinician distinguish what patient is suitable for watchful waiting or antibiotic therapy. Another way the article improves nursing practice is, that the article provides information on how to prevent AOM and reoccurrence. This information can be used to help educate patient’s caregivers on ways to prevent AOM and reoccurrence. Ethical issues always arise when it comes to healthcare, especially when it comes to children. When conducting an evidence based research, there is a high likelihood of exposing the child to potential danger, illness, and adverse reactions. The first ethical issue is; is it even right to subject a child to research if there is a high likelihood of helping other children. That is something for the children’s parents to decide.

However, it is the responsibility of the researchers to fully explain the process, potential side effects, potential danger, and any other concerns to the parents. It also the responsibility of researchers to determine if the parents have the capability to comprehend the information and the risk of the research. Not doing so would be unethical and could tarnish the results of the research. Another major ethical dilemma that comes with involving children in research is that the children do not have the capability of making that decision themselves. Research should be a voluntary thing and not left up to someone else to decide. However, when it comes to children that is not an option. The ethical problem is should the child be subjected to potential harm because of the parents’ willingness to allow it. The needs to be guidelines established prior to the start of the research that regulate the risks that the child might be subjected to. The risk should be very minimal with a very high benefit. Involving children in any type of evidence based research can be very tricky and has the potential of bringing up multiple ethical issues.

It is the researcher’s responsibility to ensure the child is protected, not exposed to unneeded harm, and the caregivers are knowledgeable of the risk factors and are competent enough to make an informed decision. Besides ethical issues, there are other issues that need to be taken into consideration when research involves children. Vulnerable populations, such as low income families, families with different cultural backgrounds, and families with insufficient education can be at risk when it comes to research involving children. For an example, low income families may not have the opportunity to participate in evidence based research because they might not fit certain criteria. In the AAFP research, in order for the child to be a candidate of the watchful waiting, they had to have means of a follow up appointment.

For low income families, coming to the doctor multiple time may not be option. Financially they may not be able to afford, parents may not be able to get time off from work, or have means of transportation for a follow up appointment. These circumstances may subject the child to unneeded antibiotic treatment simply because the patient is unable to follow up with the doctor. Also, families with a cultural difference may not fully understand the benefits or risks of allowing their child to participate in this research.

Without informed consent, the results of the research are tarnished and run the risk of jeopardizing the study. Informed consent when it comes to research involving children is extremely important for validity of a project and prevents any ethical problems. Any research involving children can be extremely tricky and should be held to the highest ethical standards and involve minimal risk to children.

References

American Academy of Pediatrics and American Academy of Family Physicians. (2004.) Clinical practice guideline: Diagnosis and management of acute otitis media. Retrieved from http://aappolicy.aappublications.org/cgi/content/full/pediatrics;113/5/1451 Block, S. L. (1997). Causative pathogens, antibiotic resistance and therapeutic considerations in acute otitis media. Pediatric Infectious Disease Journal, 16, 449–456.

Kelley, P. E., Friedman, N., Johnson, C. (2007). Ear, nose, and throat. In W. W. Hay, M. J. Levin, J. M. Sondheimer, & R. R. Deterding (Eds.), Current pediatric diagnosis and treatment (18th ed., pp. 459–492). New York: Lange Medical Books/McGraw-Hill.

McCracken, G. H. (1998). Treatment of acute otitis media in an era of increasing microbial resistance. Pediatric Infectious Disease Journal, 17, 576–579.


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