Introduction
The sphere of nursing undergoes several changes, improvements, and evaluations constantly. Many professional researchers offer their own ideas and suggestions on how it is possible to optimize the system and provide patients with appropriate treatment and care. In this article, certain attention is paid to evidence-based research (EBR) in nursing practice, several particular sources of evidence, and ethical issues which may be aroused in nursing practice.
EBR is considered to be a powerful step for many current and future nurses to realize how it is possible to manage various health problems of patients and prove that nursing care corresponds to special standards and expectations (Dickson & Flynn, 2008). For current EBR, four different sources are evaluated as well as personal communications with parents who have brought their children to the clinic to solve the problems caused by acute otitis media.
Evaluation of watchful waiting is another important aspect that has to be taken into consideration in this paper. Some clinical guidelines admit that this kind of attitude to patients is more effective in comparison to immediately beginning treatment. It is not always correct to provide children with some treatment in order to do something.
This is why a particular group of nurses finds the ideas of evidence-based research more appropriate for this practice and try to prove that the chosen methods should properly influence a child’s condition considering such crucial ethical issues like confidentiality, vulnerable population, and informed consent of parents. Evidence-based research in nursing practice is a new tendency that has to support and improved from time to time to help patients be confident in the care provided and in a healthy future for them.
Evaluation of the chosen sources of evidence
The theme of the chosen evidence-based research is children with acute otitis media and the decision to use watchful waiting to provide patients with appropriate treatment or to start treatment with antibiotics immediately. There are five sources of evidence chosen for this project. Each source introduces a separate attitude to the problem of acute otitis media in children; the diversity of suggestions should help to define what kind of treatment is more appropriate in this case and how it is better to implement new ideas into the already established system. The nurses brought sources of evidence of different types for their first meeting.
One online source, two articles from Pediatric Infectious Journal, the chapter from the book by Hay, Levin, Sondheimer, and Deterding, and personal communications with parents are considered to be the sources of evidence for the nursing situation where children with acute otitis media have to be treated.
Classification of sources by information type
The first source under analysis is the American Academy of Pediatrics and the American Academy of Family Physicians from the Clinical Practice Guideline. This source of evidence contains reliable and educative information about treatment to children with acute otitis media (AOM) that is defined as a common infection that is characterized by antibacterial agents (Clinical Practice Guideline, 2004). The authors find it possible to use the already achieved results by other researchers as well as promote new ideas to manage AOM. Taking into consideration the informative side of the article, this article should be identified are one of the filtered resources in this research.
Other two sources are taken from Pediatric Infectious Disease Journal. Block (1997) evaluates the new macrolides as an appropriate alternative to manage AOM among little children and considers the already known facts about Haemophilus and Chlamydia pneumonia in young children. McCracken (1998), in his turn, introduces six factors that play an important role in therapy for AOM. To achieve success in the chosen activity, he had to evaluate the already identified facts and share a new vision of the problem. This is why these two sources should be regarded as filtered sources as well as they have an issue to be analyzed and conclusions which are given in regard to the question posed.
The chapter Kelley, Friedman, and Johnson informs the reader about some basics about AOM and clinical findings with the help of which this disease may be treated. As this source provides detailed background information about AOM, it should be classified as general information source. Finally, the results of personal interviews with parents (Smith, 2010) help to comprehend that sometimes immediate treatment is required, still, it is obligatory to remember about ethical issues which improve the system. As this source provides the most recent information about the disease under consideration and is based on some questions from the interviewer, it is identified as the only unfiltered source of evidence in this research.
Chosen sources and appropriateness for nursing practice
Each of the above-mentioned sources may be appropriate for the nursing practice situation when the decision in defense of watchful waiting or defense of immediate treatment with antibiotics for children with acute otitis media should be made. The chosen sources help to realize that AOM is an infection that has to be treated within a short period of time. Still, there is a burning need to identify the causes of the infection as well as its outcomes on the organism before a particular treatment is prescribed. It is known that AOM may be of severe and non-sever type (Rosenfeld & Bluestone, 2003), this is why it seems to be wrong to provide the same immediate treatment in case it is not always easy to identify the type of the disease.
Clinical Practice Guideline (2004) states that several discussions concerning antibacterial agents during the process of diagnosis take place recently. In spite of the fact that American clinics refer to this routine activity, the representatives from European countries do not trust the effectiveness of various antibacterial agents with the help of which treatment is possible. In the United States of America, 2/3 of all American children suffer from acute otitis media at least one time in their lives during their first year of life, and 80% of children have some problems because of AOM by their 3 years of age (Natal & Chao, 2009).
Such frequency of the disease makes the vast majority of nurses take appropriate care for children and evaluation of the conditions under which the infection may be spread. This is why the work by Kelly, Friedman, and Johnson (2007) where the elements of AOM are discussed is one of the most appropriate information sources with the help of which AOM signs, symptoms, and development are defined.
Personal communication with the Smiths, the parents of the child who is delivered to the clinic because of first symptoms of acute non-sever otitis media, shows that even current technologies and professionalism of the staff cannot serve as powerful evidence of successful treatment. As a rule, parents try to overcome the challenges caused by their children’s health problems and support the idea of watchful waiting to get certain and correct diagnosis. McCracken’s investigations explain how the safety profile of a patient should be considered to the same level the issue of compliance is. Antibiotic selection needs to be supported by practical approach, parental tolerability, and clinical experience (McCracken, 1998). Nurses should take into account that management of pain that is caused by AOM in children is the primary task to be accomplished (Clinical Practice Guideline, 2004; Block, 1997), but still, the decision to treat with antibiotics has to be made only after careful analysis of the case.
Classification of sources according to evidence type
The chosen sources of evidence for this particular research may be classified in accordance with the type of evidence provided. The identification of evidence should help to comprehend what information is more appropriate and reliable for certain evidence-based research. American Academy of Pediatrics and American Academy of Family Physicians is regarded as the evidence-based guideline within the frames of which several problems are identified as well as several types of recommendations are given. The management of AOM requires much time and effort, and this source may become a good guide for nurses to rely on.
The article by McCracken is also considered to be of the evidence-based guideline by means of which the author gives appropriate recommendations as for medicines to be used for children with AOM. Newhouse et al (2007) say that primary evidence is the data that is gathered as a result of contact with patient, this is why any type of personal communication that takes place in the clinic and the chosen for this project communication with Mr. and Mrs. Smith are considered to be primary research evidence because their personal experience, emotions, and knowledge are evaluated. There are no special theoretical approaches and strategies, just what happens around and what needs to be done.
The work by Kelley, Friedman, & Johnson has to be identified as evidence summaries because it provides broad foci on a particular topic of AOM. The article written by Block in the journal is also of evidence summary type with the help of which the author evaluates the already known facts about diseases of little children and provides a treatment that may be used in this situation.
Clinical Practice Guideline with its own position in regard to EBP
Watchful waiting as an appropriate approach for treating children with acute otitis media
Nowadays, in the vast majority of clinics, nurses try to practice as many effective approaches to treat children as possible. The evaluation of the already achieved results shows that much depends on the situation under which a child is treated, this is why it is wrong to make some decisions and be sure of its appropriateness to all situations. To comprehend better how watchful waiting may be used as appropriate means to treat children with acute otitis media, the ideas offered in the article American Academy of Pediatrics and American Academy of Family Physicians by Clinical Practice Guideline have to be taken into consideration.
One of the methods discussed in the article is all about observation without use of some antibacterial agents. One of the most important conditions identified by the authors of the article is that child’s age, the severity of the infection, and diagnostic certainty should be considered before the decision to observe a child watchfully is made (Clinical Practice Guideline, 2004). In this article, the idea of watchful observation is not argued, still, a number of precautionary steps have to be taken. This is why this type of watch could be an appropriate and safe approach for treating children with AOM in case certain means of communication and the system that supports re-evaluation of child’s condition are established accordingly. The last point plays the most important role in the research.
In comparison to other studies as a result of which the use of antibacterial agents in children with AOM is reduced to 20-25% (Mintegi-Raso et al., 2007), the achievements of the Clinic Practice Guideline were not that positive. In fact, due to the increased risk of failure of the chosen watchful waiting, the decision to rely on immediate antibacterial therapy has been made in order to save children’s lives. This is why there is no certain rule that may forbid the use of observations as a good method to treat children successfully; however, at the same time, there is no evidence that may explain the correctness of the chosen approach. This is why it is better to regard the process of watchful observation as an appropriate approach to treat children only after all precautionary measures are taken into account.
The chosen article is a considerable improvement to nursing practice
Nursing practice in the clinic may be improved in a variety of ways. Still, the nurse who is going to suggest some ideas has to be ready to evaluate the situation from all perspectives and have several additional options just in case. The findings of the article under consideration contribute a lot to the sphere of nursing. There are several powerful recommendations with the help of which treatment is possible. Any nurse has to diagnose the patient to identify the signs of the disease and evaluate all symptoms both of which are evident and which are not. Only after this step is taken, the management of pain should be started. If watchful observation is not harmful to the patient, it is possible to try this approach and comprehend what treatment methods are more appropriate. Finally, nursing practice should be based on prescription particular antibacterial agents.
Ethical issues and evidence-based research
Current clinical research studies have to be developed taking into consideration a number of ethical principles. In the project under discussion, several ethical issues could be raised in order to achieve better communication with patients, evaluation of personal activities, and cooperation with other nurses. It is necessary to underline that nursing care is offered to all people including those who are not capable of providing informed consent, who are also called the representatives of vulnerable populations considering the issues of confidentiality and respect.
Confidentiality is an ethical issue that has to be considered by any nurse
For a long period of time, the issue of confidentiality is regarded as an integral part of nursing process. In spite of the fact that significant challenges define the way of how nurses protect patients’ confidentiality, nurses try to maintain confidentiality and help patients achieve the desired care and understanding. The evident-based research under analysis may be considerably changed in case some ethical principles are taken into account. For example, the issue of confidentiality should not be neglected by nurses, still, to comprehend whether children with AOM should be treated immediately or after watchful observation promote breaking some confidential information about the patient.
This is why, in the chosen EBR, the idea to maintain information confidence should be reevaluated. It is also necessary to admit that this case touches upon children’s treatment, this is why the role of parents should be admitted: children are the representatives of vulnerable populations, and it is better to comprehend how they should be treated and how informed consent may be sedated for procedures.
Vulnerable population and informed consent: the issues to be remembered
Nursing is the sphere of life that divides people into special groups; this division provides nurses with a chance to identify the level of treatment and steps which have to be taken. In nursing, a vulnerable group of people may consist of children, people with doubtful capacity to consent, prisoners, and even students. These people are not able to protect their interests, this is why there is another group of people who have to participate in treatment. Children as the representatives of vulnerable populations should be treated in accordance with information offered by their parents or legal guardians.
These people should also be responsible for informed consent, a document that has some legal power and proves parents’ agreement for their child’s treatment or nontreatment. With the help of this document, an informed patient may be involved in decisions concerning his/her health condition.
All nurses have to consider the all above-mentioned ethical issues in their practice. Children who suffer from AOM are in need of appropriate treatment, still, there are several instances that have to be overcome before the final decision concerning activities in regard to a child is made. Still, it is very important to evaluate the situation and the conditions under which a patient is at the moment. There are some cases when immediate activities and treatment are favorable to save a human life; at the same time, these immediate decisions may negatively influence the human condition and lead to some unpleasant results which could hardly be understood by parents or by any other person.
Conclusion
In general, the idea to evaluate the case when children with acute otitis media are required for immediate antibiotic treatment or watchful waiting seems to be powerful from numerous perspectives. On the one hand, such a definite case helps to consider a number of ethical issues like vulnerable population (children are the representatives of such population) and informed consent that has to be presented by children’s parents or guardians. The necessity to maintain confidence is also burning in the chosen evidence-based research. With several informative pieces of literatures, the comparison of two different methods of treatment is evaluated.
As a result of the comparison, it is stated that watchful waiting may become an appropriate approach to treat young children with AOM under specific conditions such as appropriate diagnosis, age identification, and systems that may reevaluate child’s conditions in case it is necessary. Evidence-based research is a unique chance to understand how it is better to succeed in nursing practice, and this paper properly analyzes the approaches which may be used in regard to a particular group of patients under specific conditions.
Reference List
American Academy of Pediatrics and American Academy of Family Physicians. (2004). Clinical practice guideline: Diagnosis and management of acute otitis media. Web.
Block, S. L. (1997). Causative pathogens, antibiotic resistance and therapeutic considerations in acute otitis media. Pediatric Infectious Disease Journal, 16, 449–456.
Dickson, G.L. & Flynn, L. (2008). Nursing policy research: Turning evidence-based research into health policy. New York: Springer.
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. New York: 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.
Mintegi-Raso, S., Benito-Fernando, J, Fuente-Diez, I., Garcia-Gonzalez, S., & Mora-Gonzalez, E. (2007). Antibiotic treatment vs. watchful waiting in non severe acute otitis media: a retrospective study from an emergency department. Italian Journal of Pediatrics, 33, 17-21.
Natal, B & Chao, J. (2009). Otitis media. eMedicine from WebMD. Web.
Newhouse, R.P., Dearholt, S.L., Poe, S.S., White, K.M. (2007). John Hopkins nursing evidence-based practice model and guidelines. Indianapolis, IN: Sigma Theta Tau.
Rosenfeld, R.M. & Bluestone, C.D. Evidence-based otitis media. Hamilton: BC Decker.
Smith, J (2010). Parent of the Child, Private Clinic. Personal Interview.