Evidence-Based Practice Resource Filtered Unfiltered Clinical Practice

Evidence-Based Practice Resource Filtered Unfiltered Clinical Practice Guidelines (1) Authors combined several studies for efficacy Block, S.L. (2) Older data (over 10 years) and used only one research study. Kelley, et.al. (3) Credible and systematic; great review of literature McCracken (4) Older data (over 10 years) and used only one research study. No scholarly or academic research, materials is hearsay and anecdotal. Resource Primary Research Evidence Evidence-Guideline Evidence Summary Clinical Practice Guidelines (1) Inclusion of Primary Research Includes Guidelines for Best Practices Summarization of a number of sources, generalized but academic. Block, S.L.

(2) X Includes Primary Research X Scholarly, peer reviewed and focused on a single research topic within an academic publication. Kelley, et.al. (3) X Summarization of a number of sources, generalized but academic. McCracken (4) X Includes Primary Research X Includes Best Practice Guidelines of AOM X Summation of Research Interviews (5) X Possible as a component of a larger study, but only if the experimental design is validated using the scientific method. X Without the addition of research methods, etc. is not valid evidence (Sources of Evidence-Based Literature, 2006).

Discussion- Each source under review has some degree of relevancy for nursing. However, each source is also segmented for a different audience and level of competence. The Clinical Practice Guidelines and the portion of the text by Kelley are good basic introductory reviews. Someone with a basic understanding of physiology and medicine would benefit from them as a review or reference. The Block and McCracken research, though, are both the most verifiable, current, and scientific.

Both Block and McCracken are peer-reviewed articles, using standard research methodologies that address a specific clinical issue. They use sound principles of research, have thorough literature reviews, good sample selections, and are written and developed in a way that would be relevant to anyone involved in clinical practice. The use of anecdotal evidence, though, is problematical in a professional situation. Particularly when dealing with medical or other personal issues, divergent people have divergent views.

When dealing with a group of mother's, for instance, who have anecdotal evidence about their child's medical issue; it is easy to extrapolate their issues into broad categories. However, in the medical field, both best practice and evidence-based guidelines require that material be scholarly and follow standard principles of scientific research. Part B -- The article Diagnosis and Management of Acute Otitis Media proposes a medical philosophy called Watchful Waiting. The basic idea is that it is not always critical to immediately medicate with strong antibiotics, etc. In some cases.

In the case of AOM, there are of course differences regarding age, severity, complications and if chronic. However, the research suggests that it is advisable to wait 48-72 hours before prescribing antibiotics. During this period it is, though, advisable to treat symptoms (fever, chills, discomfort, etc.). Rest has been shown to be one of the best ways toward recovery for children, particularly if discomfort is treated (Glaszhou, et al., 2004). Part C - Further, the data shows that in most cases AOM infections are not bacterial and thus, impervious to antibiotics.

This does not mean that antibiotics would never be used, but only that they are used appropriately instead of blindly. Instead, evidence-based practice suggests that the healthcare professional should: 1) Review and confirm the diagnosis of AOM; determine if chronic or not. If the symptoms are irregular and not chronic, treat only overt symptoms; 2) Assess the discomfort level of the patient; use Tylenol or Motrin, topical agents, warm compresses, etc.

To relieve pain and reduce symptoms; 3) Observe patient for 48-72 hours; educate parent in ways to mitigate symptoms and procedure if condition becomes worse; 4) If chronic or severe, or if AOM is worse after the watchful waiting period, Rx of amoxicillin, 80/90mg/kg per day; 5) Check in 3-4 days for reduction in symptoms, etc. Part D -- Ethical issues do surround the idea of watchful waiting. In one opinion, watchful waiting is experimenting with a human patient -- waiting to see what develops.

The other view holds that watchful waiting is actually more compassionate, because in the long run too many antibiotics are being prescribed and bacterial resistance is increasing. For the medical professional, though, the ethical mandates are: beneficence forming the locus of the Hippocratic Oath - "as to disease, do no harm;" Justice in care - providing the best care equally and fairly; and Autonomy -- the respect to allow each individual to make informed decisions and not push treatments that the client may or may not wish.

This also includes saying "no" to the parent who insists on an antibiotic. Instead, explain that viruses do not respond to antibiotics, and overuse could actually put their child in danger (Timko, 2001, 62-5, 121-45). The ethical nature of research is especially relevant when dealing with disenfranchised populations. Children, for instance, do not yet have the cognitive development to understand the issue of experimentation,.