Evidence-Based Practice Research Paper

Pages: 10 (3367 words)  ·  Bibliography Sources: ≈ 23  ·  File: .docx  ·  Level: College Senior  ·  Topic: Children

Nursing

Evidence-based Practice

The article Clinical Practice Guideline: Diagnosis and Management of Acute Otitis Media, (2004), is an example of filtered information in the form of an evidence-based guideline. Due to the fact that this guideline provides suggestions to primary care clinicians for the management of children from 2 months through 12 years of age with uncomplicated acute otitis media (AOM) this is definitely appropriate for the nursing situation at hand. This source would be helpful to this group of nurses as they try to determine if watching and waiting is a better approach than immediate administration of antibiotics.

The article by Block (1997), entitled Causative pathogens, antibiotic resistance and therapeutic considerations in acute otitis media, is an example of filtered information in the form of an evidence summary. This particular resource would not be appropriate for this particular situation. Since this article is about the effectiveness of different types of antibiotics and whether one antibiotic is better than another to treat AOM and the issue that the nurses are trying to look at is more focused on the type of treatment this article would not prove to be helpful.

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In the article Ear, nose and throat (2007), by Kelley, Friedman and Johnson, this is an example of filtered information in the form of an evidence-based guideline. This article is contained in the Current Diagnosis and Treatment: Pediatrics, provides recommendations as to how AOM is currently treated within the medical community. This would be an appropriate resource for the group of nurses to use in researching their issue.

Research Paper on Evidence-Based Practice Assignment

The 1998 article Treatment of acute otitis media in an era of increasing microbial resistance, by McCracken is an example of filtered information in the form of an evidence summary. This resource would be very helpful to the group of nurses in researching their issue as it summarizes different studies that have been done in regards to increased resistance among the main AOM pathogens (namely Streptococcus pneumoniae and Haemophilus influenzae) and how this is associated with a dramatic decrease in bacteriologic response to antibiotic treatment, which in turn has an impact on clinical response.

In regards to the resource of the results of the interviews with parents who have brought their children into the clinic for acute otitis media, this would be an example of unfiltered information in the form of none of the identified evidence resources. This would be a good resource for this situation because it addresses the outcomes that are occurring with the patients on a daily basis. This would be a good resource to have to compare to the other resources to see if what is being recommended is actually working or not.

Acute otitis media (AOM) is the most frequent infection for which antibacterial agents are prescribed for children in the United States. The diagnosis and supervision of AOM has a significant impact on the health of children, cost of providing care, and overall use of antibacterial agents. The illness also produces a significant social burden and indirect cost due to time lost from school and work. The projected direct cost of AOM was $1.96 billion in 1995. In addition, the indirect cost was estimated to be $1.02 billion. Throughout 1990 there were almost 25 million visits made to physicians in the United States for otitis media, with 809 antibacterial prescriptions given per 1000 visits, for a total of more than 20 million prescriptions for otitis media-related antibacterials. Even though the total number of office visits for otitis media decreased to 16 million in 2000, the rate of antibacterial prescribing was approximately the same (Diagnosis and treatment of otitis media in children, 2004).

There has recently been a lot of debate as to the necessity for the use of antibacterial agents at the time of diagnosis in children with uncomplicated AOM. While in the United States the use of antibacterial agents in the management of AOM has been routine, in some countries in Europe it is common practice to treat the symptoms of AOM initially and only institute antibacterial therapy if clinical improvement does not take place. For the clinician, the option of a specific antibacterial agent has become a key aspect of management. Concerns about the increasing rates of antibacterial resistance and the growing costs of antibacterial prescriptions have focused the attention of the medical community and the general public on the need for judicious use of antibacterial agents. Greater resistance with many of the pathogens that cause AOM has fueled an increase in the use of broader-spectrum and generally more expensive antibacterial agents (Diagnosis and treatment of otitis media in children, 2004).

According to this article, many episodes of AOM are associated with pain. Although pain is an important part of the illness, clinicians often see otalgia as a peripheral concern not requiring direct consideration. The management of pain, particularly during the first 24 hours of an episode of AOM, should be tackled regardless of the use of antibacterial agents (Diagnosis and treatment of otitis media in children, 2004).

The observation option for AOM consists of deferring antibacterial treatment of selected children for 48 to 72 hours and limiting administration to symptomatic relief. The choice to observe or treat is based on the child's age, diagnostic certainty, and severity of the illness. To watch a child without initial antibacterial therapy, it is important that the parent has a ready means of communicating with the doctor. There must be a system in place that permits reassessment of the child. If necessary, the parent must be able to obtain medication conveniently (Diagnosis and treatment of otitis media in children, 2004).

This option should be limited to otherwise healthy children who are 6 months to 2 years of age with non-severe illness at presentation and an uncertain diagnosis and to children 2 years of age and older without severe symptoms at presentation or with an uncertain diagnosis. In these instances, observation provides an opportunity for the patient to improve without antibacterial treatment. The connection of age younger than 2 years with increased risk of failure of watchful waiting and the concern for serious infection among children younger than 6 months influence the decision for immediate antibacterial therapy. As a result, the panel recommends an age-stratified approach that incorporates these clinical considerations along with the certainty of diagnosis (Diagnosis and treatment of otitis media in children, 2004).

Placebo-controlled tests of AOM over the past 30 years have shown consistently that most children do well, without adverse issues, even without antibacterial therapy. It has been shown that 7 to 20 children have to be treated with antibacterial agents in order for 1 child to benefit from it. By 24 hours, 61% of children have decreased symptoms whether they receive placebo or antibacterial agents. By 7 days, approximately 75% of children have resolution of symptoms. The AHRQ evidence-report meta-analysis showed a 12.3% decrease in the clinical failure rate within 2 to 7 days of diagnosis when ampicillin or amoxicillin was prescribed, compared with initial use of placebo or observation (Diagnosis and treatment of otitis media in children, 2004).

Based upon the evidence that has been presented in this article it appears that watchful waiting is a viable approach to the treatment of Acute Otitis Media for certain children under certain circumstances. As with the treatment for any medical condition, each child would need to be evaluated upon on their arrival to the clinic and the best decision for their treatment made based upon the symptoms that they are presenting at the time.

The evidence that has been presented in this article could help to improve nursing practice in a clinic by allowing the evidence to be available as a guideline for nurses to utilize when educating parents on this type of treatment approach. Typical treatment procedures usually involves a clinical examination is necessary to diagnose acute otitis media. Diagnosis should be made with pneumatic otoscopy. There should be education of parents on measures to prevent the occurrence of otitis media. Children who are at low risk should use a wait-and-see approach to treatment.

If the treatment approach of watchful waiting is chosen then a patients parents would need to be educated on not only why this treatment method is being used but also on what they should be watchful of so that they know when to seek further medical treatment if necessary. Many parents have anxiety regarding this option, but acceptability is increased among those with more education and those who feel included in medical decisions. It is thought that considerable change in both parental and provider views would be needed to make initial observation a widely used alternative for acute otitis media (Finkelstein, Stille, Rifas-Shiman and Goldmann, 2005). This is where nurses would be needed to educate and advocate this treatment plan. Parents are more likely to be accepting and on board if they know all the facts and feel as if they are being included in their child's treatment.

There are numerous ethical issues that must be considered when… [END OF PREVIEW] . . . READ MORE

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