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Acute Otitis Media


Acute otitis media is an infection in the middle ear that is very common among children and presents itself with pain and discomfort. This often causes the parents to seek help immediately as they try to relieve the child of the pain and discomfort. Clinicians have, however, noted that the pain is not always a reliable symptom for determining diagnostics in the case of acute otitis media. This is considered a bacterial infection, hence more and more physicians are recommending watchful waiting as an approach that is useful in determining whether the condition in question is AOM. What this means is that the approach is being put into serious consideration based on the numerous evidence that has been published by medical scholars on the subject.

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In this case, the nurses in question used various sources as evidence. These will be reviewed, classified and discussed for their appropriateness in terms of the subject. The paper will also review one of the sources (Clinical Practice Guideline) to find out how watchful waiting is appropriate for treating children with AOM. To conclude the paper, improvements in nursing practice, as well as ethical issues of researching and changing clinical practice guidelines, will be discussed.

Review of the Used Sources of Evidence

The ‘Clinical practice guideline’ is a filtered resource in that the evidence used was gathered from prior researches. S. L. Block’s research on the subject (‘Causative pathogens, antibiotic resistance and therapeutic considerations in Acute Otitis media’) and work of Kelley, Friedman and Johnson (‘Ear, nose, and throat’) are both filtered sources, whose evidence is based on previously conducted research. The interview on parents of children suffering from AOM is, however, an unfiltered resource as the parents would give first-hand information, thereby implying, the nurses will be taking the role of primary researchers (Block, 1997).

As a clinical practice guideline, the ‘Clinical practice guideline’ offers a step by step guide to managing AOM in the clinical setting. This provides an objective angle that is vital in scrutinizing the importance of time in starting treatment for AOM. This resource is thus very appropriate for this particular nursing situation (American Academy of Pediatrics and American Academy of Family Physicians, 2004).

In his research, ‘Causative pathogens, antibiotic resistance and therapeutic considerations in Acute Otitis media’, Block analyzes the pathogens involved in AOM, their corresponding medications, use, as well as general effectiveness. This implies that it is relevant and appropriate for consideration in terms of watchful waiting as it addresses the major aspects of infection, treatment, and effectiveness of medication.

Kelley, Friedman and Johnson’s research (‘Ear, nose, and throat’) summarizes evidence on the subject of AOM, and is also appropriate given that it contains relevant and vital information on the importance of correct diagnosis and the need to apply risks and benefits analysis in commencing treatment. The interviews with parents of affected children are appropriate as well as the parents are a vital part of the nursing process (Kelley, Friedman & Johnson, 2007). Their opinion, therefore, is very important in terms of policy changes that are bound to affect the children’s treatment by the health care facility. ‘Clinical practice guideline’ is an evidence based protocol. ‘Causative pathogens, antibiotic resistance and therapeutic considerations in Acute Otitis media’, on the one hand, and ‘Ear, nose, and throat’, on the other hand, are simply evidence summaries or rather overviews of previously conducted researches on the subject of AOM. The interviews with parents of affected children are primary research evidence as the nurses will be conducting a primary research at the clinic.

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A Review of ‘Clinical Practice Guideline’

This guideline has some recommendations that are aimed at primary care clinics professionals with an intention of guiding them in the management of AOM without complications, in children aged 2 months of age through 12 years old. The guideline focuses on ensuring proper diagnosis followed with initial treatment of the children affected with AOM. This involves pain management, followed with initial observation and antibacterial treatment, as well as proper choice of antibacterial treatment coupled with preventive measures; thus, providing a framework for clinical decision making (American Academy of Pediatrics and American Academy of Family Physicians, 2004.)

Watchful Waiting Approach

In analyzing initial observation versus antibacterial treatment, the guideline brings out the importance of waiting given that there are various other probable causes for pain in the ear including toothaches (McCracken, 1998). The guideline shows that when there are no complications present in the child, watchful waiting is the most appropriate approach in order to avoid misdiagnosis. This, however, (as stated in the guideline) depends on the age of the child, the certainty of the diagnosis, assurance on the possibility of getting a follow up as well as the severity of the pain.

Application of the Findings to Improve Nursing Practice

As the primary care givers, the nursing practitioners have a great impact on the way patients are handled, including the effectiveness of the administered treatments. This means that there is quite a lot to be borrowed and applied from the ‘Clinical Practice Guideline’. The guideline shows how the nursing practice can be a good platform to interact with and educate the parents of these children on how to reduce exposure to risk factors. This would enable parents to embrace preventive measures as opposed to waiting for the infection to set in so that they could seek treatment for their children.

From this article, it is clear that diagnosis of AOM requires a clear presentation of the relevant signs and symptoms. In seeking to improve nursing practice, these clear symptoms eliminate the occurrences of misdiagnosis and improve the chances of success in treating the condition. In addition, for better handling of AOM cases a benefit and risk analysis needs to be undertaken for each case before administering antibacterial treatment. It is imperative to note that, in most cases, medical history is not enough, and further probing is required before this medication is given to children with AOM condition (Harris & Roussel, 2009).

Ethical Issues in Researching and Changing Clinical Practice Guidelines

Clinical practice, as well as researching, involves very many ethical considerations that will, in this case, include issues of vulnerable populations, confidentiality, and informed consent as expected whenever a research involves children. For the research, the parents being interviewed require to be given full information about the aims and objectives of the study in order to obtain their informed consent of participation (Malloch & Porter, 2009). This implies that researchers are obliged to enlighten and educate their participants before they can ask the set questions or provide the established questionnaire for filling out. This is done, in order to ensure that the participant is fully aware of what he or she is getting into and is thence assured of confidentiality on the information provided. The idea is to ensure willful participation with no room for backing out after the research has been conducted.

The researcher is also expected to maximize the benefits offered by the research to the participants. This goes hand in hand with the obligation of minimizing risk or harm to the participant. In general terms, the research being conducted should have more benefits and minimal risk or harm for the participant.

Another ethical issue for consideration in conducting a research is to ensure that the concerned groups are adequately covered in the sample population. Vulnerable persons should not be left out as they too are a part of the population and usually the most important part at that. In carrying out a research on AOM, it would be unforgivable not to consider the children and/or their parents as a sample population. This is so as to ensure a fair and practical distribution of the risks and benefits (Dixon, Munro & Silcocks, 1997).

When seeking to make changes in clinical practices, it is vital to consider issues of fairness and authenticity of the evidence used to inform these policy changes. First of all, the evidence used must be proven or rather approved by various experts in the relevant subject. There must be a consensus on the admissibility of the findings from the evidence based research being considered (Little & Rubin, 2000). In addition, the new policy must be fair and beneficial to all those involved. This implies that the changes being made need to undergo a risk and benefit analysis to ensure that the clients are not subjected to more harm than good (American Psychological Association Presidential Task Force on Evidence-Based Practice, 2006). The policy must also be able to come into play without adversely impairing the delivery of relevant and effective treatments. The nursing practice must be able to meet its already set goals and objectives regardless of the new policy being implemented. If this is not so, then the change becomes unethical as it undermines the whole idea of nursing practice (Keel, 2010).


In evidence based practice, it is important to use both filtered and unfiltered sources. Filtered sources provide refined evidence that is easy to use; on contrast, unfiltered resources allow the practitioner to carry out a primary research and obtain first-hand information. In determining the applicability of the watchful waiting approach, credible sources would be experts and physicians in the field, as well as the parents of the children involved. All these sources are credibly applicable in formulating policies that are aimed at improving the primary care practice for children suffering from AOM. Thus, the nurses in this case were right in choosing the given sources and seeking to use the provided evidence to inform their ideas on practicing policy changes.

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