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Nursing research informs the development and implementation of evidence-based practices. Otitis media is no exception to this rule. Recent changes in the nursing guidelines suggest that watchful waiting is a better alternative to the immediate use of antibiotics, once the disease is diagnosed. The fact is that otitis media represents one of the most common reasons why children and adolescents are prescribed antibiotics (Finkelstein, Stille, Rifas-Shiman & Goldmann, 2005). These antibiotics may have devastating consequences for children's health, in case they are misdiagnosed. The current research into the appropriateness of watchful waiting in the context of otitis media is quite voluminous, but future studies are needed to confirm the safety of the watchful waiting procedures and reconsider the reliability and validity of the recent research outcomes.
Reviewing the Sources of Evidence
Nurses cannot make appropriate evidence-based decisions without considering the quality of various evidence sources. These sources are generally classified as general, filtered, or unfiltered.
Classifying the Type of Each Source
American Academy of Pediatrics and American Academy of Family Physicians. This source of information can be classified as filtered. Filtered are the sources, which present appraisals the quality of other studies and provide recommendations for clinical practice (Glover, Izzo, Odato & Wang, 2006). The discussed source presents the results of numerous studies, evaluates their consistency, and brings together to shape practice guidelines. This is why it should be considered as filtered.
Block, S.L. (1997). Like the source developed by the American Academy of Pediatrics, the article by Block (1997) is a filtered resource. The reason why it should be regarded as filtered is because the author reviews everything that has been published on otitis media and its causative agents. According to Block (1997), "streptococcus pneumoniae, Haemopholus influenzae and Moraxella catarrhalis are the most frequently isolated pathogens in patients with acute otitis media" (p.449). In this study, Block (1997) organizes and systematizes the information related to otitis media and its causative agents, thus filtering everything that goes beyond the scope of his study.
Kelley, Friedman and Johnson (2007). This information source can hardly be called "filtered", at least because the authors do not perform any appraisals and do not evaluate the consistency of the earlier findings. They simply present the general knowledge of ear and nose infections, thus presenting their work as a general source.
McCracken (1998). Again, this source is filtered, at least because its goal and findings are based on the analysis of everything that had been written about acute otitis media before McCracken (1998). The discussed study is focused on the analysis of the most popular treatment procedures and reasons why they might have failed; therefore, the researcher had to filter the existing information to choose the data and findings that provide answers to his research questions.
Results from interviews. It is an unfiltered source of information, because it presents primary evidence that requires detailed consideration and evaluation by nurses.
Evidence Appropriateness for Nursing Practice
When nurses are looking for the best solution to a difficult health situation, they are bound to work with more than one source of information and evidence. The appropriateness of sources varies, depending on their quality and reliability. Starting with the American Academy of Pediatrics and American Academy of Family Physicians (2004), it is clear that nurses can readily use this source to explore possible approaches to diagnosing acute otitis media in children and adolescents. The source provides valuable information regarding the appropriateness of various diagnostic procedures, which can serve as guidance for nurses, as they are trying to achieve the best health outcomes for their patients. The source by Block (1997) is equally appropriate, as it informs nurses' practices in situations, when they are trying to choose the best treatment approach. In a similar vein, McCracken (1998) offers an extensive and useful review of various treatment modalities, which can help nurses identify reasons why their treatment approaches fail. However, both these sources have to be treated with caution: the fact is that the author's appraisal of primary evidence may differ from that of nurses. Moreover, both resources were published almost 15 years ago, which may render them as less relevant than the most recent findings. The least appropriate is the source by Kelley et al. (2007), since it is too general to benefit nurses, as they are trying to find the best treatment approach to acute otitis media. Parents' interviews may be confusing, misleading, and take a lot of time to be filtered, although they often become the most appropriate source of information when choosing the best method of treatment for the child.
Classifying Sources of Evidence
The source presented by the American Academy of Pediatrics and the American Academy of Family Physicians (2004) can be used as guideline for practice, which means that it should be classified as evidence-based guideline. The articles by Block (1997) and McCracken (1998) are both classified as primary data collections, since the authors present, systematize, and analyze the primary evidence from other sources. Finally, the general source by Kelley et al. (2007) does not belong to any evidence category noted here. It is not primary research evidence, as the authors do not perform any experiments or trials. It is not a collection of primary data, because Kelley et al. (2007) share the most general knowledge of the disease. It is not evidence-based guideline, because it does not allow making practice decisions. It can only serve as the source of the most common, basic knowledge about the disease. Parents' interviews can be categorized as primary evidence, as they contain the original data shared by parents, who bring their children into the clinic.
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Reviewing the Article
The evidence provided by the American Academy of Pediatrics and American Academy of Family Physicians (2004) confirms the medical appropriateness of watchful waiting for children diagnosed with acute otitis media. The evidence-based guideline provides compelling primary evidence that watchful waiting is safe for children, reduces the need for antibacterial treatment, and reduces the risks of antibacterial side effects (American Academy of Pediatrics & American Academy of Family Physicians, 2004). However, applying these guidelines in practice will not be easy. First, I will have to ensure the presence of relevant, effective, and comprehensive diagnostic guidelines for acute otitis media. According to the American Academy of Pediatrics and American Academy of Family Physicians (2004), proper diagnosis is crucial to the child's safety and health, when watchful observation is a preferable option. In addition, and according to the evidence-based guideline, I will have to ensure that an adult monitors the child closely for 24-72 hours following the diagnosis and can contact the hospital, in case of any complications. I will provide everything needed to establish and maintain a close contact with the parent and schedule a follow-up appointment in 48-72 hours (American Academy of Pediatrics & American Academy of Family Physicians, 2004). I will also need to evaluate the risks and consequences of inappropriate use of antimicrobial agents, in case the child gets worse.
Certainly, the process of researching and changing clinical evidence-based guidelines is not without ethical difficulties. Children are categorized as vulnerable populations, and parents' informed consent is required to avoid any ethical conflicts during research. The most controversial is involving children in the studies, where placebo is used. Placebo research involving children is appropriate, only when the risks of withholding treatment are minimal (Committee on Clinical Research Involving Children, 2004). Based on this premise, it is possible to expect that future studies into watchful waiting as an alternative to antibacterial treatment for acute otitis media will be approved under federal regulations. Still, parents will have to be provided with complete information about the risks and possible outcomes of the future research, while researchers will have to share evidence that the risks to children's health are minimized.
Nurses must spend a great deal of time, trying to select the most appropriate resources for developing and changing evidence-based clinical practices. The most appropriate are filtered primary data collections, which present a systematic review of the earlier research findings on any given topic. However, even despite compelling evidence that watchful waiting is appropriate for treating acute otitis media, future research is needed to confirm its validity. Future researchers will have to be particularly thorough with developing and implementing ethical procedures for the studies involving children.
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