Application of Research in Evidence-Based Practice: Its Merits and Drawbacks - Essay Example

? Application of Research in Evidence Based Practice: Its merits and Drawbacks Application of Research in Evidence Based Practice: Its merits and Drawbacks American Academy of Pediatrics and American Academy of Family Physicians. (2004.) Clinical practice guideline: Diagnosis and management of acute otitis media. Retrieved May 17, 2008 from http://aappolicy.aappublications.org/cgi/content/full/pediatrics;113/5/1451 This source of evidence is a thoroughly evaluated resource document because it provides guidelines and recommendations for clinicians to use when providing primary care and management to children with uncomplicated acute otitis media. The document provides guidelines for use in the right diagnosis and the proper treatment of children between ages 2 months to 12 years with symptoms of AOM. The source is just a guideline meant to provide some basis or framework when coming up with clinical conclusions about making correct clinical decisions. The source does not provide full details of evidence and nurses cannot use it as the only source to guide them during management of children with AOM. The source is also an evidence-based guideline compiled by different experts creating a comprehensive report. Even though it lacks the specific research details, it is very helpful since it provides important information for nurses on pain management, observation, antibacterial treatment, and preventive measures. The practical guidelines of the article, supported with adequate reasons, and summaries of findings of the study, makes this article very resourceful and appropriate for this nursing practice situation. Block, S. L. (1997). Causative pathogens, antibiotic resistance, and therapeutic considerations in acute Otitis media. Pediatric Infectious Disease Journal, 16, 449- 456. This source of evidence can be classified as unfiltered resource because its source comes from the research studies of the author. The recommendations and views of the work are typically those of the author and since most of the information in the article particularly in the conclusion part represents views and recommendations of the author, it is certainly un-filtered. The resource nature makes it an evidence summary, because the authors made a summary from existing evidence. The source gives a clear-cut specific evidence of the pathogens that cause Acute Otitis Media (AOM) and the effectiveness of various antibiotics for treatment. Its drawback is that it does not provide a detailed report about other lines of treatment or alternative approach in treating AOM. In such a case, the nurses may miss some important information on treatment therefore; some more important and relevant research findings should be included. The fact that this resource paper is an evidence summary then the details missing makes it to be less helpful to the nurses. It is therefore not a proper guideline for use by the nurses in such a situation. 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. The source of evidence is an incomprehensive resource because it provides research work of the author. The source gives a comprehensive report on various causes of ear infections, antibiotic resistance in the treatment of AOM and the challenges doctors face when looking for alternative treatment choices. The source therefore addresses specific issues, which nurses can find to very resourceful, relevant, and helpful when dealing with a situation at hand. The author’s recommendations and conclusions will be of great help to the nurses too. The resource falls under the category of summary of evidence since the authors used the actual research work of the author to create the summary. Even though the source is quite narrow and specific, the results and conclusions are very relevant and this makes it appropriate for this nursing practice situation. McCracken, G. (1998). Treatment of acute otitis media in an era of increasing microbial resistance. Pediatric Infectious Disease Journal, 17, 576-579. This is an unfiltered resource because it provides information based on research studies of the author. The recommendations, views, and conclusions are those of the author. The resource provides an analysis on causes of ear infections, treatment of infections and information on microbial resistance, based on the author’s research. This also makes this resource a summary of evidence, because the author made a summary from already existing evidence. Information on microbial resistance and causes of ear infections already exists. The analysis provided is significantly beneficial, because it helps the doctors make the right choice of treatment when treating AOMs, particularly in this era of increasing microbial resistance. This makes the resource suitable in nursing practice. Interviews with parents’ results Interviews with parents, who bring their children into the clinic for acute otitis media, will be of great importance to the nurses since they can get first hand information on how and when the infection started. However, the results and conclusions of such interviews cannot provide enough and adequate information to be used in the treatment or management of AOM. Interviews of such a kind will fall under the category of a filtered resource since the nurses are most likely to use prepared questionnaires, which are very specific in questioning the parents. In this case, some parents will come with children who obtained treatment before, some will be first timers, and some will probably have cases of resistance. Gathering of such information is quite tricky because the accuracy factor comes in. Some parents may not give true or accurate information or they might not know how the child feels exactly. These major drawbacks of such interviews affect the process of recording the clinical manifestation of AOM in such children. This type of resource falls under the category of primary research. The major drawbacks mentioned make it less reliable for use by the nurses in such a situation. Clinical Practice Guidelines According to the Clinical Practice guideline recommended by the American Academy of Pediatrics together with other partners, the most appropriate way of managing uncomplicated AOM is watchful waiting. This takes place in the first few days around 48 to 72 hours and it entails observation and pain management by treating the symptoms. The option is recommended to healthy children between six months to two years or older. The evidence provided in the article shows that the option is quite appropriate with listed benefits. The option prevents the likelihood of development of antibacterial resistance. It also considers the economic factor and with the increasing costs of purchasing antibiotics, the parents do not entail any costs (AAP, 2004). The patient therefore recovers with comfort. There is however, some concern by parents of these children that such an option could lead to complications if the initial signs are not treated. In any case, this should not be an issue since research shows that with this option, there is a relative balance of benefit and risk. In the observation of a child without initial antibacterial therapy, it is important that the parent or guardian or any other person providing care to have a ready means of communicating with the clinician to allow monitoring of the child and to make the process of obtaining medication convenient (McCracken, 1998). Application of the Findings in the Nursing Practice The findings are of particular importance considering the benefits that come along with it. If applied in clinical practice some factors such as antibacterial resistance will go down and people who cannot afford the cost of buying medication will get some relief. However, clinicians and parents can end up misusing some practices in this study; for example, the watchful waiting option is suitable for use on children who are specifically healthy with a specified age. If the clinicians and parents are not enlightened about such factors then severity of such cases could manifest. It was crucial to inform the participants that recovery without the use of antibiotics differs depending on the severity of signs (Block, 1997). The factor of over dependence of drugs also comes in. The fact that the society over depends on antibiotics even with the slightest form of illness, it will prove difficult to convince people to adopt some practices such as the watchful waiting. The adoption of such guidelines will require approval from the relevant authority and confidence of the public. The benefits of adopting of such a guideline however, outweigh the risks. If applied in a clinic then nursing is bound to improve. This is because the guideline provides specific definitions and addresses several clinical roles such as pain management, observation, choices of treatment, and preventive measures. The guidance will help provide a framework that will help primary care specialists in AOM management. It will provide a proper guideline in the diagnosis and initial observations. The guideline also provides important information on different lines of treatment and the choice of drugs to use at a specified time of treatment. This will really help clinicians in determining the right choice of drugs and eliminate factors such as antibiotic resistance allergies to certain drugs. The recommendations that the guideline provide are also invaluable and if followed then clinical practice will improve. The recommendations result from observational studies and a thorough assessment of benefit over risk, and this provides a good platform for their use on patients with acute otitis media. The guideline also contains detailed methods and procedures which will help guide clinicians in performing the right procedures, such as otoscopy or tympanostomy. Ethical Issues related with Researching and Changing the Clinical Practice Guidelines Ethical issues normally arise in any form of medical research particularly when the findings reach the stage of application. It is therefore paramount that the clinicians understand that the rights of the patient have come first before using the study on them. The clinicians should have adequate information regarding ethics because such matters could cause legal conflict. Clinicians should understand matters concerning the consent of the patient. Every child should have their rights even if they refuse a certain procedure or practice then they application of force is unfair. In some cases, the parent has to decide for the child and this happens when the child is not in a sound condition to make a sound choice or decision. If the child and the parent want to use medication then the watchful waiting does not apply in such case. Confidentiality is also another factor in ethics and all clinicians should understand that any information pertaining to any patient should remain with held from other people. It should remain strictly confidential. In very painful situations then the patient deserves pain relief without hesitation. The patient’s rights come first and their preferences, values, and personal The sources of evidence that have proved to be appropriate for use by the nurses, are those compiled by a group of individuals to come up with guidelines that help the clinicians. These are the filtered sources and are much more resourceful to the nurses than the unfiltered ones. The interviews are less reliable for use by the nurses in collecting important details for diagnosis of AOM. The clinical practice guideline provides a good source for proper clinical practices and it adoption by clinics will improve nursing practice. 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. (1998). Treatment of acute otitis media in an era of increasing microbial resistance. Pediatric Infectious Disease Journal, 17, 576-579. University of Washington School of Medicine (n.d). Introduction: Case analysis in clinical ethics. Retrieved from http://depts.washington.edu/bioethx/tools/ceintro.html Read More