Classify each source of evidence as either a general information resource, a filtered resource, or an unfiltered resource. Discuss whether each source of evidence is appropriate for this nursing practice situation. Classify each source of evidence as primary research, evidence summary, evidence-based guideline, or none of these. AAP/AAFP, 2004
This source of evidence is a filtered resource.
This source of evidence is appropriate because it shows clear guidelines for the diagnosis and management of AOM. It also discusses guidelines on appropriate time to treat AOM, watchful waiting and the absence of treatment. This source of evidence is an evidence base guideline because it systematically reviews several pieces of research literature and gives practice recommendations. Block, 1997
This source of evidence is an unfiltered resource.
This source of evidence is inappropriate due to the age of the article. The article was published in 1997, thus the research is not current. It does discuss the problem of antibiotic resistance in causative organisms but does not discuss watchful waiting. This source of evidence is evidence summary.
Kelly, Friedman and Johnson, 2007
The Research paper on Water as a Source of Future Conflict in Sa
... up but utilizable freshwater resources reduce, several research have been carried out ... The Convention too offers few useful guidelines for allotment -- the heart ... ‘Environmental Scarcities and Violent Conflict: Evidence from Cases’ are also reviewed ... Ministers of India and Bangladesh discussed the contentious issue at the ... regular militarized conflicts. Methods and Sources 16. The researcher begins by ...
This source of evidence is a general information resource.
This source of evidence is appropriate because it describes AOM. It provides information on assessment and treatment. It provides rationale of the findings. This source of evidence is none of these.
McCracken, 1998
This source of evidence is an unfiltered resource.
Even though this resource was published in 1998, this source of evidence is appropriate because corroborates already established guidelines that provide the risks of overuse of antibiotic therapy. This source of evidence is an evidence summary because it provides data information and supporting evidence. Interviews
This source of evidence is a unfiltered source.
This source of evidence is inappropriate because the information given by a parent is not able to be used in policy making decisions. This source of evidence is none of these.
Part B1. Review of the Article “Clinical Practice Guideline” Based on the article, “Diagnosis and Management of acute otitis Media” the ‘Watchful Waiting’ approach is an appropriate form of treatment of AOM in children in certain situations In this study, children age >2 to 12 that have no additional chronic diagnoses or birth defects are included. This resource provides evidence-based information supporting that waiting 48-72 hours before initiating antibiotic for the treatment of AOM should be considered by providers.
This resource includes results from the Dutch College of General Practitioners’ guidelines, the AHRQ evidence report and a 30 year random trial in the United Kingdom that included the use of placebos. These evidence-based results have assisted in creating guidelines for the recommendation of treatment. In these guidelines, providers are informed to obtain accurate time of onset of signs and symptoms, identify actual signs and symptoms, decide if the child is the appropriate age or has any other health risks, the severity of the AOM, and assess whether follow-up will be obtained. If these guidelines are met, the “Watchful Waiting” approach is appropriate for the child (“Diagnosis and Management of Acute Otitis Media”, 2004).
The Research paper on Treatment Guidelines Effect On Therapists Willingness
... possible education sources that might be recommending these treatments.I found some treatment guidelines that ISSD ... reactions she notes are: A: Empathic helplessness evidenced by a competent clinician suddenly feeling ... for them to have the emotional resources necessary for the demands of the ... affirmation. Chance and Glickauf-Hughes (1995) provide some differentiation between a positive therapeutic ...
Part C. Application of Findings
In the resource “Diagnosis and Management of Acute Otitis Media,” one way to apply the findings into clinical practice is provider education. If the physicians are willing to accept the changes, a learning process should be implemented. A way to approach this learning process is to form a committee. The committee would be responsible for delegating individuals for educating themselves on the current treatment trends and passing that knowledge on to the rest of the clinical staff. The education process should start with a test group so that kinks can be worked out before attempting to educated everyone, then re-educate if flaws are found. Once the clinical staff is educated, new patient teaching should be implemented.
After the new treatment process is implemented, it is important to keep track of AOM success rates vs. re-occurrences. In collecting this data, updates to patients and providers will allow them to see trends in positive outcomes that may assist in the acceptance of new EBGs. It will give the patients and providers a concrete, black and white, form of communication that will show them the significance and importance of the change and how follow-up is crucial to successfully treating the problem. Once the changes have been finalized it is imperative that a policy be written that defines the change as an agency’s current standard of practice for the treatment of AOM (“Diagnosis and Management of Acute Otitis Media”, 2004) .
Part D. Ethical Issues when Changing Clinical Practice Guidelines
Ethical issues are a major concern when doing research. Three main concerns seem to be the focus of ethical research, they are: justice, autonomy, and beneficence. Autonomy assures that research participants is able to understand why the research is being conducted and is able to provide informed consent to participate. Autonomy requires that the agency conducting the research provide a full explanation of risks and benefits of participation. Beneficence assures that conducting the research is to refrain from causing harm to the participants, and keep their welfare in mind. Justice assures a fair selection in a research project. This makes sure that everyone that wishes to participate in a research project is not discriminated against or specifically sought due to who they are (“Research ethics – Wikipedia, the free encyclopedia”).
The Research paper on Clinical Research Industry Issues
Services in the business sector becomes troublesome when customers seem to act too superior when dealing with the company’s employees (Bassett 25). Companies which disseminate excellent customer service definitely excel in the market (Bassett 26). There are plenty of physicians who run out of patients to treat, and still, there are a lot of patients who search for the right physicians (Rizzo & ...
Part D1. Ethical Issues when Research Involves Children
When research involves children, unique ethical issues arise such as autonomy, vulnerability, and confidentiality. Children are usually seen as more vulnerable than adults because they lack the ability to participate in the complex decision making that healthcare involves. This can propose an issue with vulnerability due to parents, legal guardians and healthcare professionals being trusted to look out for the best interest of the child. It seems that due to these vulnerability issues, not a lot of research is done on children which means children are unable to benefit from the advancements that research makes.
Autonomy tends to be an issue with children during research because informed consent in their age group tends to be more of a gray area instead of black and white. Some children are considered competent may be able to provide informed consent on their own, these children are usually called “mature minors.” Another way children may provide informed consent is if their parents or guardian approve of them making the decision. Some children are reliant on other to provide informed consent due to their developmental stage or age. With all of these gray areas, it is challenging for researchers to be able to include children in research (“Research Concerning Children and Young People — University of Leicester”) .
Confidentiality in the research of children bears a fine line. Researchers must assure that the participant’s identity and personal information are protected. With children, the same information must be protected unless a risk for harm or abuse is suspected. If it is guaranteed to a child by the researchers that they will not disclose personal information, they may not do so. If a breach of confidentiality does occur, legal ramifications could plague the research project (“Research Ethics: Research Involving Children and Youth — ResearchEthics.ca”).
References
Block, S. L. (1997).
The Review on “Describe and evaluate the ethical issues involved in Medicare-funded organ transplants.”
In order to make the issues of ethics involving organ transplants, we first need to understand how clearly is describe the organ transplantation process. Organ transplant is a movement from one body to another. It is also a relocation of an organ from an origin site to another potential site. Introducing the possibility of an organ transplant in the medical field was a great achievement that helps ...
Causative pathogens, antibiotic resistance and therapeutic considerations in acute otitis media. Pediatric Infectious
Disease Journal, (16), 449-456. Diagnosis and Management of Acute Otitis Media. (2004, May 1).
Retrieved May 1, 2014, from http://pediatrics.aappublications.org/content/113/5/1451.full Kelley, P. E., Friedman, N., & Johnson, C. (2007).
Current pediatric diagnosis and treatment (18th ed.).
New York, NY: Lange Medical Books/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. Research Concerning Children and Young People — University of Leicester. (n.d.).
Retrieved from http://www2.le.ac.uk/institution/committees/research-ethics/research-concerning-children-and-young-people-guidelines Research ethics – Wikipedia, the free encyclopedia. (n.d.).
Retrieved May 3, 2014, from http://en.wikipedia.org/wiki/Research_ethics Research Ethics: Research Involving Children and Youth — ResearchEthics.ca. (n.d.).
Retrieved from http://www.researchethics.ca/children-and-youths.htm
