Research paper review and synthesis

Acute Otitis Media (AOM) is a very common occurrence among young children. Generally in the United States, the condition is treated with antibiotic medication. However, recent concerns and investigation have suggested that other approaches, including "watchful waiting," could be more appropriate. According to the Clinical Practice Guideline by the American Academy of Pediatrics and American Academy of Family Physicians, several alternative approaches to antibiotic treatment has been deemed as potentially acceptable, particularly in cases where the condition does not present complications. I therefore believe that, with the correct premise of observation and alternative treatment, watchful waiting is indeed a possible and potentially safer and more economic treatment than antibiotic treatment for AOM.

As the Guideline indicates, there is a variety of issues surrounding the use of antibacterial agents to treat AOM in children. Factors that are potentially influenced, for example, include the health of children and the cost of their care on an individual level. On a collective, social level, the illness presents a burden in terms of indirect costs such as the time lost from work and schooling in order to make visits to the doctor. To quantify, the Guideline notes that the estimated direct cost of the condition in 1995 was $1.96 billion, with an indirect cost estimated at $1.02 billion for that year. Another concern is the increase of antibacterial agents prescribed for AOM, where the ratio of prescriptions rose for fewer doctor's visits from 1990 to 2000.

It therefore makes greater sense to investigate alternative treatments to the use of antibacterial agents to address AOM in young children. The Guideline, however, also emphasizes that very careful precautions will be necessary if the watchful waiting approach is to be taken. Caregivers, for example, will have to be carefully trained to observe the children in their care. Furthermore, the physician attitude towards the pain associated with the condition needs to be treated directly, rather than as a side-effect of the main condition. Importantly, evidence does suggest that the watchful waiting approach can result in stabilization of the young patient, and ultimately healing without the need for antibiotic treatments. This indication can be very useful in terms of the children's health, as overuse of antibacterial treatments tends to result in immunity to these agents and furthermore to a breakdown in natural bacteria within the body.

Specific factors to consider when taking this approach include diagnostic certainty, age, illness severity, and assurance of follow-up. This means that not all children would be eligible for the watchful waiting approach. The guideline however suggests that further research could provide possible alternatives to antibacterial treatments for such children. Being aware of the risk factors associated with both approaches is an important step in such research.

However, authors such as Bain (2001, p. 132) warns that studies conducted on children with AOM might not be truly representative of the population. The reason for this is that reliability tends to fall by the wayside in the rush to obtain clinical results for a particular test. Hence, when studies are used to create a premise for a particular medical procedure, it is vital to monitor the situation as closely as possible to prevent possible and unnecessary harm.

In order to improve nursing practice in the clinic, I would therefore prefer the watchful waiting approach, but in such a way as to prevent the possible drawbacks of the results presented. I would, for example, implement a system of diagnosis that very clearly indicates the proper approach to be taken. Once an approach has been selected, the parent or guardian will be fully informed of his or her responsibilities. In the watchful waiting approach, for example, I would provide the parent or guardian with a sheet of criteria that must be followed in observing the child. Keeping in mind that few parents are medical professionals, I would recommend that they call the hospital immediately if they have any doubt about the health of their children. In order to do this successfully, parents will be provided with a 24-hour access to the relevant medical professionals should they need help or advice.

Depending upon the severity of the illness, I might even recommend that the child in question spend a few hours in the hospital to have professionals close by to monitor the situation. Parents will also be fully informed of the risks and benefits of either approach. After making my recommendation, the parents or guardians will be allowed to make an informed choice of the treatment options open to them. Unless the child's life or long-term health is in danger, the policy will be to follow the parents' wishes.

Another important consideration is ethics. Ethics are particularly important when doing research that involves children. The greatest challenge is that very young children -- those generally affected by AOM -- do not yet have the cognitive ability to understand and be informed of their choices. They are therefore subject to consent from their parents.