Evidence Based Nursing. Watchful Waiting - Essay Example

? Evidence Based Nursing American Academy of Pediatrics and American Academy of Family Physicians. (2004 Clinicalpractice guideline: Diagnosis and management of acute otitis media. This is a filtered source besides being an evidence based guideline. It has literature touching on AOM (Acute otitis media) that is based on evidence summary. As such, the recommendations contained in it were gathered on data from peer reviewed articles about otitis media. It is a solid guideline developed specifically for physicians when treating cases and complications emanating from AOM. The adduced evidence in the article is quite relevant to nursing practice owing to the many sources of data that have been used to develop it. In addition, the guidelines were compiled by specialists from different medical fields that are allied to AOM such as infectious diseases and microbiology. Although the steps outlined in the source are many, they are quite simple to follow for any medical practitioner. It completely discourages the automatic prescription of antibiotics for AOM cases. Block, S. L. (1997). Causative Pathogens, Antibiotic Resistance and Therapeutic Considerations in Acute Otitis Media. Pediatric Infectious Disease Journal, 16, 449–456. This article can be classified as a filtered as well as summary of evidence which came about through a symposium that discussed the challenges of antibiotic resistance. In the recent past, there has been an unprecedented increase of antimicrobial resistance to antibiotics which has affects the treatment of AOM. This is because antibiotics have been viewed as the choice of treatment and as such, their prescription has been abused. The evidence summary in the article summarizes way of handling antibiotic resistance and therefore makes it appropriate for nursing practice. Underlying causative microbes of AOM are different and it follows then that before prescription of antibiotics the causative pathogens must be known. Moreover, research has shown that some antibiotics are only effective in particular pathogens which underscore the need for proper diagnosis of causative pathogens. 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 information contained in this source is on ears, nose and throat infections which in different ways are connected to AOM. As such, it is a filtered article which articulates the different pathogens that cause infections in ears, nose and throat. These three parts (ears, nose and throat) are in close proximity and therefore infection in one part can be easily transmitted to other areas. Moreover, the article is also an evidence based guideline due to the information that it avails on diagnosis, treatment and prognosis of infections that are found within those three parts. The information here is detailed, well researched and presented thereby making it appropriate for nursing practice. Much of the information is summarized in a diagram that contains steps to follow when handling cases of AOM. McCracken, G. H. (1998). Treatment of Acute Otitis Media In An Era Of Increasing Microbial Resistance. Pediatric Infectious Disease Journal, 17, 576–579 Just like the previous three articles, this article is both an evidence summary and a filtered source because it articulates the way forward when handling AOM cases. It synthesizes many peer reviewed articles and states that there is no single or clear way of treating cases of AOM. This is because the causative pathogens are different with varying levels of virulence and sometimes antibiotics may be used in combination. It follows then that there is no standard way of handling AOM cases due to factors such as efficacy of antibiotics, causative pathogens and their virulence. The appropriateness of this article to nursing practice is found in its excellent articulation and synthesis of materials on AOM causing pathogens and their eradication. It advances the idea that most of pathogens resistant to antibiotics may be effectively eradicated using regimens of antibiotics. Caution should however be exercised in use of some regimens because they may cause harmful side effects. Interview Results Parents with children suffering from AOM were involved in an interview to gauge their views on management of AOM and whether watchful waiting is appropriate. The sample involved 1256 parents and it took place within a period of two weeks in different pediatrician clinics. An overwhelming 85% of the parents interviewed were against watchful waiting because they were used to automatic antibiotic prescription and they did not like seeing their children suffer needlessly. A further 10% of the respondents were for both watchful waiting and antibiotic prescription on the condition that their children would recover soon. The rest of the parents did not have any particular inclination provided that the physician was competent in handling AOM. Appropriateness of Watchful Waiting in Handling cases AOM in Children Watchful waiting is the best approach to handling cases of AOM in children because of the principles that is based upon and what it aims at achieving. The problem antibiotic resistance has been steadily on the increase and due to oversubscription of antibiotics. This in itself is challenge to treatment of AOM because antibiotics are the only medications that can handle it and its related symptoms. For a long time, treatment of AOM has been through prescription of antibiotics without much consideration. Currently in US, this automatic prescription of antibiotics is being discouraged although the public is not yet persuaded. Not all cases of AOM infections automatically qualify for antibiotics therapy because some dissipate on their own. Another reason for adopting watchful waiting is so that the correct diagnosis and prognosis of AOM infections may be done before treatment is started. When the correct diagnosis is done, then chances of complications arising from AOM are minimized because the correct antibiotics are administered. Most countries in Europe have completed adopted watchful waiting approach for the management of AOM and US should not be an exception. Application of the Article’s findings to improve clinical nursing practice According to the details and guideline outlined the article, it is advisable to conduct diagnosis and prognosis thoroughly to establish the causative pathogens in AOM infections. Going by traditional way of handling AOM, antibiotics prescription have been the preferred therapy but trends are changing. Application of this article is to use watchful waiting which is the new recommended approach whereby symptoms and arising from the infection are treated first. If the infection persists, then antibiotics therapy can be started by administering the correct regimen. Ethical issues that could arise in researching and changing clinical practice guidelines, based on the evidence-based research Research and changing guidelines for clinical practice can have ethical issues such as confidentiality, informed consent and vulnerable population with regards to research in children. Confidentiality revolves around the use of data that is gotten from research because its dissemination should be authorized. Much of clinical research should be kept in secret because it may have private information about the people involved. However, in the case of AOM research, the data should be shared for the good of the public. On the part of informed consent, the issue is that all participants in a clinical research should give their consent without coercion. For children, they cannot do it and therefore it is upon their parents or guardians to give it on their behalf. The other ethical issue of vulnerable population is that children cannot know what is being done to them and their level of immunity to diseases is usually fragile. It follows then that caution should be taken so that other opportunistic infections may not afflict the children in the course of a clinical research (Emanuel, Wendler, & Grady, 2000). References 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 Block, S. L. (1997). Causative Pathogens, Antibiotic Resistance And Therapeutic Considerations in Acute Otitis Media. Pediatric Infectious Disease Journal, 16, 449–456. Emanuel, E. J., Wendler, D., & Grady, C. (2000). What makes clinical research ethical?. JAMA: the journal of the American Medical Association, 283 (20), 2701-2711. 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. (This article is available on e-reserves.) McCracken, G. H. (1998). Treatment of Acute Otitis Media In An Era Of Increasing Microbial Resistance. Pediatric Infectious Disease Journal, 17, 576–579. Read More