Evidence-based Practice & Applied Nursing Research

Classification of each source of evidence into either the general information resource, the filtered resource, or the unfiltered resource

The American Academy of Pediatrics (AAP) and the American Family of Physicians (AFP) present goods examples of filtered information resources (AAP and AFP, 2004). The sources with filtered information are generated through an extensive and consultative process that involves reviewing a wide range of available research materials concerning a given clinical problem.

They provide a wide range of information when needed since they comprise of a collection of articles with valuable information. However evidence cannot be readily available from such sources and therefore additional studies are required. The publication of the information contained in the two sources was done after a sub-committee given the responsibility of managing Otitis Media had been established.

The membership of the committee consisted of professionals concerned with primary care and other sub-specialty doctors. Since the information published is peer reviewed, its authenticity is not to be doubted.

This kind of information is convenient to the clinician since it helps him/her to make certain challenging clinical decisions. However, clinicians are advised to be careful in determining the appropriate literature to use in specific clinical situations and individual patients.

Block (1997) conducted a study on pathogens that cause Otitis media, the pathogen with antibiotic resistance and their therapeutic considerations presents factual information that is reviewed, authenticated, and evaluated. This is a form of an unfiltered information resource. These are the resources that offer the highest quality of evidence to support the data given by the filtered information resources.

This is because, Block’s article is written using the latest documented research studies and materials on the management of the disease. Moreover, the source gives an alternative method to the conventional and the commonly used methods of managing the disorder. However, since most of its content has not been peer reviewed, it thus cannot be suitable for the vibrant population.

McCracken’s (1998) publication presents yet another example of a filtered source of information. Its content is based on facts analyzed from peer reviewed and published materials. In line with the characteristics of the filtered information resources, this source is prepared using a wide range of studies concerning the management of the disease.

Kelly, Friedman and Johnson (2007) provide a filtered information resource with their publication. The publication contains a number of methods for the treatment of Otitis Media that are based on the analysis of peer reviewed clinical trials and Placebos. Additionally, the content in the publication comprises of consistent and authentic information materials concerning the management of the disease.

Analysis of the results from interviews given by parents who had brought their children into the clinic for the treatment of Acute Otitis media presents yet another example of unfiltered information resource since it provides the first hand evidence of the experiences of the stakeholders and the consumers of any health-care intervention that is provided by the clinic.

Discuss whether each source of evidence is appropriate for this nursing practice situation

The American Academy of Pediatrics (AAP) and the American Family of Physicians (AFP) present a very convenient publication for application in clinical practice. The publication contains a number of methods for the treatment of Otitis Media that are based on the analysis of peer reviewed clinical trials and Placebos.

Additionally, the content in the publication comprises of consistent and authentic information materials concerning the management of the disease. Its applicability in clinical practice is hinged on its wide scope. The resource is convenient in improving the competence and success of healthcare delivery and thus management of Otitis Media since it provides a broad spectrum of accurately analyzed methods for treating the disease.

The American Academy of Pediatrics and the American Family of Physicians provides a great deal of facts-oriented practices that can find application in nursing practice.

The resource presents very crucial recommendations that can aid clinicians and other healthcare providers in managing the disease especially among patients managed without the administration of antibiotics or any other antimicrobial agent such as children showing symptoms of the uncomplicated form of the disease. Since the study is based on scientifically controlled studies, its appropriateness in the nursing practice is undoubted.

Moreover, the resource is more important to nurses and other health-care givers who meet various unique cases of the same disease. This is mainly due to the fact that the resource provides recommendations derived from careful and accurate analysis of specific cases based on age, severity of the disease, the diagnostic confidence, and assurance of follow up.

Block’s (1997) publication is relevant in this study as it focuses on pathogens that cause Otitis media such as Streptococcus pneumonia, Haemophilus influenza among other etiologic agents which have been shown to be the most frequently isolated pathogens in patients diagnosed with acute Otitis media. Block brings to the attention of the readers the emergence of an antibacterial agent resistant, S. pneumoniae.

This trend is said to be threatening the use of amoxicillin as a traditional first line intervention against acute otitis media in young children. In vitro antibiotic activity against pathogens that cause acute Otitis media and the concentration of the antibiotic released in the middle ear fluid are supposed to be strongly considered when antibiotics to be used in treating refractory Acute Otitis media are being developed.

This study is very relevant for evidence based practices because the practice prioritizes either the use of antibiotics or the use of observation as an intervention in containing acute Otitis media.

The study recommends the use of macrolides like azithromycin and clarithromycin as an intervention against S. pneumoniae that has developed resistance against antibactetrial agents like penicillin. This study is based on scientifically evaluated and published materials on the same field of study. In addition, the findings employed in the current study are derived from the published materials.

Moreover, the study is aimed at recommending the most appropriate ways of addressing the increased rates of resistance among the patients of Acute Otitis Media who are under health-care management.

This is relevant to clinical practice since it allows for clinicians to make observations of their patients before the commencement of drug therapy. In addition, the issue of drug resistance is squarely addressed in this article since it is recommended that clinicians should use Macrolides instead of the conventional drug therapy during the management of Otitis Media.

McCracken (1998) is relevant to the subject of study as it talks about treatment of acute Otitis media by use of appropriate antibacterial agents and the occurrence of resistance to the use of popular anti bacterial drugs by the AOM etiologic agent S. pneumoniae.

The resistance is said to interfere with the binding capacities of the beta lactam antibiotics after the penicillin binding proteins have been altered. McCracken’s study is concerned with finding an alternative to an antibacterial agent that the AOM causing bacteria has developed resistance to or alternatively if the infection is not so severe, the use of observation/ watchful waiting.

In this study, it is recommended that the clinicians should consider employing Amoxicillin as the first line agent in the management of uncomplicated cases of Otitis Media. McCracken bases his study on the findings of other studies that have been conducted and published in the same field.

The study is appropriate to clinical practice since it bases its recommendations on a summary of evidences on various clinical situations which can be beneficial in increasing the efficiency of nurses.

Kelly, Friedman, and Johnson (2007) provide a study that is very relevant in this evidence based practice because it proposes the use of antibiotic agents for S. pneumonia that causes AOM, but also proposes the use of watchful waiting or observation when the etiological agent becomes resistant to the antibiotic agent used as an intervention measure.

In this study, it is documented that children aged 2 years and above who had no signs of the disease did not receive the antibiotic treatment within the first three days after the development of symptoms. However, older children showing severe signs of the disease were advised to begin the antibiotic therapy immediately.

Classify each source of evidence as primary research evidence, evidence summary, evidence-based guideline, or none of these

The publication by American Academy of Pediatrics and American Family of Physicians is an evidence-based guideline on clinical situations as a multidisciplinary guideline development group was established composed of primary care specialists and subspecialty physicians.

The group based its recommendations on scientifically analyzed materials concerning the involvement of all stakeholders in the affected fields. The recommendations also involved the consumers of health-care (that is) the patients.

The study involved identification of the clinical issues and reviewing of clinical evidence systematically. The guidelines as laid down by the group provide important insights into the merits and demerits of employing the treatment methods against watchful waiting in the management of Acute Otitis Media.

Block’s (1997) publication is primary research evidence as the pathogens that were suspected to be etiologic agents for acute Otitis media were isolated from samples taken from patients and cultured in appropriate culture media.

This was followed by in vitro analysis of antibiotic activities particularly involving those antibacterial agents that had suffered resistance from the causative agents of AOM.

The study presents different perspectives of approaching the treatment of the resistant causative agents that cause AOM since it recommends a model change from the conventional methods of employing Amoxicillin indiscriminately in the treatment of AOM to a more systematic approach.

McCracken (1998) presents a study that can neither fall in the primary research category or evidence-based guidelines category. Therefore, it is an evidence summary of the findings of other relevant and published studies on the treatment of acute otitis media by different authors in the same field.

The study employs the available materials in designing the appropriate approach towards selecting the most appropriate treatment therapy for certain specific cases of the disease in addition to reviewing its effectiveness.

Kelly, Friedman, and Johnson provide a study that is an evidence summary since it comes up with recommendation on the treatment of each type of ear infection based previous studies that had been conducted on the same field of study. In addition, through consideration of the findings of randomized clinical trials and other relevant studies, the study presents the most consistent treatment methods for AOM.

Analysis of the results from interviews with parents does not fall in any of the above-named categories but the data generated can be helpful in designing intervention measures that are beneficial to the end users of health-care.

Discuss whether watchful waiting is an appropriate approach for treating children with acute Otitis media, based on the evidence presented in the article

The evidence based practice by American Academy of Pediatrics and American Family of Physicians (2004) is an appropriate approach for treating children with acute Otitis media as it suggests that the selected group of children with acute Otitis media characterized with symptomatic therapy should be observed. This is supported with evidence and may subsequently lead to decreased use of antibacterial interventions.

This is also supported by placebo controlled trials of AOM that have consistently shown that many children do well without antibacterial therapeutic interventions. The study showed that out of an average of 13 children who took antibacterial therapeutic agents, only one benefited.

Discuss how you would apply the findings in the attached article to improve nursing practice in the clinic

The evidence-based practice will make it easier for clinicians to diagnose AOM by confirming history of its acute onset and evaluation of the presence of signs and symptoms characterized by inflammation of the middle ear. Management of acute Otitis media gets major boosts when the nurses successfully assess the pain that comes with AOM.

Detection of pain enables the clinician to institute a treatment regime capable of reducing it. Children with uncomplicated AOM would be subjected to observation rather than instituting an antibacterial therapeutic intervention. Patients are recommended to be put under observation on the basis of their ages, degree of illnesses, and certainty of diagnosing the disease.

Amoxicillin is the most preferred antibacterial agent for use when patients are not put under observation. Amoxicillin use should be restricted to intake of 80 mg/kg in a day. This would help in avoiding cases of over or under dosage that encourages resistances to amoxicillin.

To improve this nursing practice and if the administration of antibacterial agents fail to deliver results within 24 to 72 hours, the other options such as observation/waiting should be considered and vice versa rather than sticking to one intervention that does not bring the desired results.

Alternatively, if one antibacterial agent fails to work, another agent should be considered in the treatment of Otitis media. It is pertinent that clinicians prioritize preventive measures by reducing Otitis media related risk factors first.

Discuss ethical issues that could arise in researching and changing clinical practice guidelines, based on the evidence-based research

Autonomy of the patient as well as that of the caregiver has always been violated in the evidence-based practices. Equity and integrity, the threads of the societal fabric are also normally interfered with by the evidence-based practices.

Evidence based clinical practices present a narrow range of accepted methodologies by employing the use of randomized control trials. Methodology puts more emphasis on randomized controlled trials developed for simple treatments. This makes it difficult to demonstrate the effectiveness of complex interventions while using randomized controlled trials, castigating the whole activities questionable.

Issues concerning the vulnerable groups and seeking informed consents when investigating matters to do with children

When children and other vulnerable populations become participants in a research study, it is the consent of the parents that is sought. But ultimately, if any problem arises; it is the child who bears the brunt of the stigma that may result from misdiagnosis of the said harmless interventions by the physicians.

On issues pertaining to confidentiality, the information obtained from children can be used by researchers to enrich themselves under pretence that they are acting in the interest of the children. The officers handling the health records in health institutions have unlimited access to these documents and may use them to the disadvantage of the participant: children and vulnerable groups if they happen to be well known to them.

More often than not, the consent form does not always elaborately explain the reason as to why the research is conducted. The participants like the children end up participating in a study whose implications are not known to them.


This paper gives a review of the types of information resources through classification of a number of sources into different categories. Additionally, the paper gives the importance of these sources to the clinical practices. Further discussions give the ways of applying the resources to the nursing practice.

Finally, the ethical issues surrounding the research studies that lead to generation of these articles are also considered. As it can be noted, there is the need to combine both the drug therapy and the observation interventions in the management of the Acute Otitis Media in order to reduce the incidences of antibiotic resistance and thereby increase the efficiency of clinical practices.

Reference List

American Academy of Pediatrics and American Academy of Family Physicians. (2004.) Clinical practice guideline: Diagnosis and management of Acute Otitis Media. Pediatrics Journal, 113(5): 1451-1465.

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

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.

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

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