Posted: June 27th, 2015

_Research Integration

Introduction

Otitis media is a disease that affects the middle ear. This is a condition that is associated with inflammation of the middle ear thereby resulting in an infection. Previous studies have pointed out that use of antibiotics is not a preferable means of treating this condition. The watchful waiting approach has been identified as the best strategy in managing the condition. It has been suggested in the clinical guidelines that watchful waiting is preferable over immediate administration of antibiotics in treating otitis media among children. In a given scenario, nurses in an outpatient clinic decided to make use of the evidence-based research to ascertain the appropriateness of this practice. If the nurses were of the view that they would change the clinical policy guidelines only if they would prove that watchful waiting was the best approach. They were aware of the fact that this policy may draw a lot of concern from the parents who are used to immediate antibiotic treatment to their children. The nurses looked at various sources of evidence. This paper shall provide a critical review of the various sources that the nurses considered in their analysis.

Part A

1. American Academy of Pediatrics and American Academy of Family Physicians. (2004). Clinical practice guideline: Diagnosis and management of acute otitis media. Pediatrics, 113: 1451-1465.

This source can be regarded as a filtered source. The article was filtered by a journal that focuses on pediatric issues. In this respect, the article was accepted to be published in the journal after meeting the set criteria for inclusion. In addition, it can be noted that this source has a comprehensive literature review meaning that it filtered through various sources to come up with certain information. This source is appropriate for the nursing practice situation. This is because the article provides a guideline for the correct diagnosis and initial treatment of a child suffering from acute otitis media (AOM). The diagnostic data in this article can be regarded as essential to the nursing practice. Although this source is appropriate for the discussion, there are chances that it might not reflect the current trend as it is quite old having been published in 2004. This research study can be regarded as an evidence-based guideline (American Academy of Pediatrics and American Academy of Family Physicians, 2004).

2. 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.

It can be noted that this source is a general informational source. This is because the article contains no recommendations for practice. However, the article has a lot of literature review. Nonetheless, the article does not attempt to channel the previous studies undertaken in an effort to come up with some results. This article is suitable for inclusion in the nursing practice situation presented. This is because the article articulates about the vital organs among which is the ear that is affected by the acute otitis media. However, the article is not largely relevant because it provides general information from various studies. This source can be regarded as evidence summary. This is because the article highlights numerous elements that are related to the ear, nose, and the throat. This article is also appropriate considering that it was published relatively recently. Therefore, the article must have captured some of the most recent trends in its analysis (Kelley, Friedman & Johnson, 2007).

3. Block, S.L. (1997). Causative pathogens, antibiotic resistance and therapeutic considerations in acute otitis media. Pediatric Infectious Disease Journal, 16, 449–456.

This source can be regarded as a filtered source. This is because the article must have been filtered before being published in the journal. The publication of the journal is an indication that the article passed the inclusion criteria. Also, it can be noted that this source establishes practical recommendations. This article is appropriate to the nursing practice situation presented. This is because the article analyses the causative pathogens, antibiotic resistance and therapeutic considerations among children suffering from acute otitis media. This article is relevant to the nursing practice especially with respect to the analysis of bacteria resistance to treatment. This article was published in the year 1997 and thus might be too old to reflect the current trends. Nonetheless, it still remains appropriate for the nursing situation presented as it focuses on aspects that rarely changes over time. This evidence source can be classified as primary research evidence due to the fact that it establishes new knowledge on the subject matter (Block, 1997).

4. McCracken, G.H. (1998). Treatment of acute otitis media in an era of increasing microbial resistance. Pediatric Infectious Disease Journal, 17, 576–579.

This source can be considered to be a filtered source. This is because it has been published in a peer reviewed journal which has inclusion criteria. The publication of the article leaves no doubt that the article passed the established inclusion criteria. This article can be regarded as being appropriate for the nursing practice situation presented. This is because the article presents the challenges encountered in the treatment of the acute otitis media in the wake of a growing trend of microbial resistance. This article can be dismissed on the grounds that it is quite old. However, the issues articulated in the article are vital and they do not change easily. This makes the article relevant even in the modern days. The article presented can be said to be primary research evidence. This is because the research study focused on an area that had not been studied in the past (McCracken, 1998).

5. Results from interviews with parents who have brought their children into the clinic for acute otitis media

This source can be considered as unfiltered source. This is because the interviews are not published in any publication, be it peer-reviewed or not. Therefore, the interviews just represent unedited views and opinions of the parents regarding the subject matter. This source of evidence is critical for the nursing practice situation presented. This is because parents are vital stakeholders in respect to the health of their children. Therefore, their views and opinions were necessary for the nursing practice scenario presented. This source of evidence can be classified as primary research evidence as it is composed of raw data. This is because the interviews conducted can lead to new information from the parents.

Part B

Review of: “Clinical practice guideline: Diagnosis and management of acute otitis media”

This article was written by the American Academy of Pediatrics and American Academy of Family Physicians. Experts from these two organizations were convened with the aim of coming up with an effective evidence-based literature review that is associated with the acute otitis media. The authors were tasked with coming up with several recommendations guidelines regarding the treatment of acute otitis media. Essentially, the guidelines provided were aimed to assist in the effective diagnosis and treatment of children suffering from the acute otitis media.

In addition, the guideline presents an explicit definition to the acute otitis media. These guidelines address various aspects including pain management, initial observation, and antibacterial management among other aspects related to acute otitis media. In this research article, there were critical decisions that were made. These decisions were arrived at basing on a logical grading of the quality of evidence and strength of approvals. The clinical practice guideline presented cannot be regarded as the only way in the management of acute otitis media among children. However, it can be regarded as part of the various means to aid the primary care clinicians through the provision of a framework for decision-making.

This study made various recommendations regarding the clinical practice guideline in the diagnosis and management of acute otitis media. In the first recommendation, it was asserted that the clinician needs to confirm various aspects related to the acute otitis media before offering an effective diagnosis. Some of the aspects that should be confirmed include identification of symptoms for middle-ear effusion, historical background of the acute onset, and the evaluation regarding the availability of signs in respect to the middle-ear inflammation. The second recommendation asserts that the management of the acute otitis media must include the assessment of pain. The clinicians are advised to treat pain if it is present among the patients. The third recommendation asserts that observation that is not followed with the administration of anti-bacterial agents can be used for special category of children. This can be affected by various elements including age and illness severity among others. In the event a clinician decides to administer anti-bacteria agents, amoxicillin is the best prescription in most instances.

In the fourth recommendation, it was noted that there can be failure by a patient to respond to the management option taken in two to three days. In this regard, there is a need for reassessment of the patient aimed at confirming the acute otitis media and rule out the possibility of other factors causing the illness. After the acute otitis media has been confirmed among the patient that was initially subjected to observation, the clinician has to administer the anti-bacteria treatment. If the patient was initially on anti-bacteria agent, there is a need for the clinician to change the agent being used in the treatment. In the fifth recommendation, it was noted that clinicians should champion for the prevention of the acute otitis media through reduction for the risk factors associated with this condition. The sixth recommendation held that there was no enough evidence that supported the use of complementary or alternative medicine for the treatment of acute otitis media.

Watchful waiting is an approach that has been suggested in the treatment of acute otitis media. This approach helps the clinician to have enough time to diagnose and thus offer the appropriate treatment. Therefore, it can be noted that watchful waiting is acceptable in treating children suffering from the acute otitis media. This aspect has been well-articulated in the research study by the American Academy of Pediatrics and American Academy of Family Physicians. This is an aspect that has been supported by other research studies. In the article by the American Academy of Pediatrics and American Academy of Family Physicians, it has been stipulated that watchful approach should not be used when the clinician is quite certain that the patient is suffering from the acute otitis media. However, if the clinician is not very sure, it is advisable to adopt the watchful approach. This is contained in the third recommendation of the article that talks about observation and administration of anti-bacteria agents. It can be observed that, through the adoption of the watchful waiting approach, the clinicians boost the chances of ensuring that the development of bacteria that is resistant to the treatment (American Academy of Pediatrics and American Academy of Family Physicians, 2004).

Part C

The findings in the article by the American Academy of Pediatrics and American Academy of Family Physicians are critical in the nursing practice. Notably, it can be asserted that antibiotics have been essential in the treatment of the children who have been identified to suffer from the acute otitis media. The treatment of acute otitis media through the use of antibiotics has its advantages and disadvantages. As much as it is an effective means of treating the condition, there are some shortfalls that can be associated with this mode of treatment. It has been pointed out that, when the bacteria are not removed by the antibiotic, they become resistant to the antibiotic. Nonetheless, this remains to be an effective treatment in addressing the challenge presented by acute otitis media.

The article by the American Academy of Pediatrics and American Academy of Family Physicians (2004) can be incorporated in the clinic setting. These findings are essential especially in respect to a section of the bacteria that can possibly develop resistance to the treatment if not eliminated by the antibiotic. This aspect can eventually lead to challenges in eliminating the bacteria that is responsible the development of acute otitis media. The adoption of the waiting eye approach can be said to be critical in the management and treatment of acute otitis media. This is because it guards against the development of the bacteria that is resistant to treatment criteria. The guidelines provided in the article by the American Academy of Pediatrics and American Academy of Family Physicians (2004) serves as a critical basis in treating and managing the acute otitis media. The recommendation touching on the observation and/or administration of an anti-bacteria agent is very critical in the nursing practice. This is because it allows the clinician to gauge the situation before applying the treatment. In this case, treatment is only applied when it is certain that the patient is being treated for acute otitis media. Therefore, it can be asserted that the recommendations provided by the American Academy of Pediatrics and American Academy of Family Physicians (2004) can be adopted in improving the nursing practice within the clinic.

Although the article has been hailed as being good for the nursing practice, it did not call for further research in this area of research to improve on the findings. This is a move that would have improved the nursing practice within the clinic. In addition, the article seems to suggest that for clinicians to avoid the emergence of bacteria that are resistant to the antibiotic, they should stick to the guidelines presented in the article. However, the article gives leeway to clinicians to adopt other means in treating and managing the acute otitis media. This is seen in the observation that the article only offers an option among the many established to treat and manage the condition.

Part D

There are various ethical issues associated with a research aimed at changing the clinical practice guidelines. This is because the research will need consent from the participants. In this case, those participating should be informed of the consequences of the research study. They will need to understand the research in a comprehensive manner before accepting to take part in the study. This can be sealed with a signed agreement between the participant and the researcher. For adult individuals, a consent agreement is enough for the study to proceed. However, there is a great challenge when the study involves small children. This is because the children may not be able to understand the consequences of the research undertaking thereby agreeing to what they do not understand. In some instances, the children may be too young to understand anything concerning the research. In this case, the parents are forced to enter into a consent agreement on behalf of their children. This raises many ethical issues because the rights of the child may not be protected.

In addition, there is another aspect of vulnerable population. In this case, the study is being carried out on individuals who are sick and need attention to alleviate their suffering. In stead, they are subjected to research which raises numerous ethical questions. Research studies that are done on humans should not in any way harm the subjects. Conducting the research on sick people does not adhere to this principle and thus can be considered unethical. Confidentiality is another aspect of ethical consideration that cannot be ignored. In this respect, the information from the participants should be protected to preserve their rights. In a research that aspires to establish a change in the clinical practice guidelines confidentiality is very important. This aspect is contestable since the researchers have to share the findings and evidence related to their research with their peers. This aspect is often the subject to debate.

Conclusion

It can be concluded that the various researches and studies have revealed that there has been a reduction in the diseases caused by streptococcus pneumonia. This has been attributed to the development of an effective vaccine that has been able to tame the disease. This has gone a long way in reducing the incidences of acute otitis media. Nonetheless, it is important to ensure that the antibiotic treatments that have been developed are effective in treating the acute otitis media. In this case, it is important to ensure that the development of the resistant bacteria is avoided. This can be obtained through the adoption of the waiting approach before administering any antibiotics. This is an approach that has been hailed to be having effective outcomes in the treatment of the acute otitis media.

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American Academy of Pediatrics and American Academy of Family Physicians. (2004). Clinical practice guideline:

Diagnosis and management of acute otitis media. Pediatrics, 113: 1451-1465.

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.

Block, S.L. (1997). Causative pathogens, antibiotic resistance and therapeutic considerations in acute otitis

media. Pediatric Infectious Disease Journal, 16, 449–456.

McCracken, G.H. (1998). Treatment of acute otitis media in an era of increasing microbial resistance. Pediatric

Infectious Disease Journal, 17, 576–579.

Ruohola, A. (2001). Acute otitis media: Prevention and treatment. Turku: Turun yliopisto.

Vinci, R.J. (2007). Pediatrics. Cambridge University Press.