It is disheartening to stand and watch infants and children come for clinical checkups and get pumped with one antibiotic after another. Sad still is the fact that most parents tend to believe that by so doing, they are helping their children overcome illnesses. Acute otitis media, an occurrence that is quite prone to children between two months and two years, has shown warring trend lately. The challenge that is present is in the fact that enormous works have supported antibiotic administration to cure and curb the spread of the infections. However, it is not until lately that the aspect of delayed administration of antibacterial drugs has been raised. It is noted that due to fast administration of antibacterial drugs, there has been development of resistant strains of otitis media that have raised the bar of challenge for health professionals and the parents alike. Sad to say is the fact that parents are grappled with fear of losing their children and any delay to administer the antibacterial drugs is perceived as an incompetence by health professionals and they [the parents] may seek alternative medication and avenue to help their children.
When an individual is used to being given a certain type of medication, there is a possibility that the individual will start developing resistance to that medication and will require a stronger medication to achieve the same objective. In infants and young children, there is a tendency in most clinical practices that they are immediately administered with antibiotics in case of a bacterial infection. This trend is worrying and one that needs to be addressed in advance to change the current state of affairs. In this research paper, the learner reviews four articles on whether they would be important in the case study where there is a proposal to impose watchful waiting strategy in the clinic.
Part A: Source of Evidence Review
In this section, there is consideration of four source of information and the authenticity of these sources for application in this case study. The first evidence source is the works of McCracken (1998). This source shows evidence of being an evidence summary as also postulated, where it is stated that the work is a “review of viral as well as bacterial etiologies that are associated with acute otitis media” (p. 1). McCracken’s (1998) work can be classified as a filtered resource since there is consideration of only the viral and bacterial etiologies only, regardless of the discussion on the history of acute otitis media, the associated illnesses and causative agents, some symptoms and proposed treatments for the condition. This material is important in that it gives an overview of the whole situation, compressed in five pages that are easy to read and grasp the content therein. The article also names some important factors that ought to be considered that include the “activity of drugs against pathogens, tolerance, physical experience of the professionals, safety, ease of administration as well as cost involved” (McCracken, 1998, p. 3). Based on this research, parents’ interview would be unnecessary.
The next article is by Kelley, Friedman and Johnson (2007). This article falls in the category of general information resource that borrows from a myriad of sources and offers immensely detailed account of prevailing illnesses that are associated with otitis media, their symptoms, diagnosis, treatment and important recommendations for each of the identified ailment. The article is crucial in this research since it details more information in form of evidence-based guidelines. The reason it is termed as evidence based is the fact that all ailments are based on clinical findings and this article will aid in deciphering important facts on infections that can have watchful waiting administered. Parental interviews with regard to this article would be advisable especially on the symptomatic section to verify the findings.
The third article is one from Block (1997) that details three fundamentally challenging otitis media causative agents that show signs of resistance to medication. This article falls in the category of unfiltered resource since there is in-depth consideration of diseases associated with otitis media that have strains that show resistance to some forms of medication. For example, “Streptococcus pneumonia, Moraxella catarrhalis and Haemophilus influenza have shown resistance to penicillin drugs” (Block, 1997, p. 1 +) that also includes past research works. The article can also be classified as an evidence summary resource and is important in showing case studies of prevailing challenges in drug administration, hence the need to impose some sort of watchful waiting. It is advisable to conduct an interview with parents concerning this matter since some children that have had recurrent attacks have found some medications unhelpful.
The last article, which is the central focus of this research, has the acronym AAPAAFP (2004). This is an evidence-based clinical practice guideline that is also filtered as noted in the passage that there were specific clinical issues that were discussed (AAPAAFP, 2004, p. 1452). The article is important due to its practicality. Since the article is evidence-based, hence an interview to verify to both the clinicians and the parents on its authenticity in this case is good.
Part B: Watchful Waiting
Based on the overwhelming evidence that is presented by AAPAAFP (2004), watchful waiting is quite practical if properly implemented to avoid mistakes of neglect. An interesting and confidence raising aspect of this research is the fact that it is based on clinical findings and thus these findings can be trusted (AAPAAFP, 2004). To ensure that there are minute chances of incorrect administration of the strategy, it is first proposed that there should be a comprehensive review of the “patient’s acute onset” (AAPAAFP, 2004, p. 1452). This should then be followed by “identification of prevailing signs of middle-ear effusion” (AAPAAFP, 2004, p. 1452).
In so doing, there will “identification of middle-ear inflammation” as a confirmatory test (AAPAAFP, 2004, p. 1452). In addition to this, it is also required to have an assessment of the level of pain. In the event that there is limited infection and the pain is on a manageable level, it is recommended that antibiotics administration should be delayed for between 48 to 72 hours and another assessment are done on the same situation. In so doing, there is a possibility that the body will have developed immunity for the pathogen and fight the pathogen without overreliance on antibiotics. From knowledge in general science, the body takes about three days, equivalent to 72 hours to manufacture an appropriate antibody to fight an antigen and thus create an immune environment for future attacks by similar antigens. Watchful waiting will aid in helping the body’s immune system to become active and stronger.
Part C: Application of Findings
It is good to note here that the implementation of this change in the current stage is likely to be faced with opposition. With this in mind, it is the interest of the clinicians to ensure that their patients get well as soon as possible. This said the clinicians would then be the first to get educated an enlightened on the changes and the underlying reasons. To make sure that this process becomes a success, it is crucial to employ the services of an acclaimed and well respected professional in the medical field, who supports that idea to offer an educative lecture to the hospital staff. This would then be followed by creation of an open forum where the hospital staff and doctors alike in addition to members of the public, would be invited to share this vital information. During this session, there will be distribution of vital and relevant materials like those aforementioned in these researches that support the idea in addition to having practical guidelines that will be followed to ensure safety in application and proper follow-up mechanisms.
Additionally, to ensure swift change into this approach, there will be dedication of shift timeframe where there will be consideration of appropriate policies and guidelines are put in place to avoid confusion. In addition to this, there will be employment of the services of professional policy makers so as to make unambiguous policies that are quite easy to understand and follow. This will ensure compliance with current and future nursing and clinical management guidelines laid down by the governing bodies. It is also possible to have monthly or quarterly open public educational forums such that the public gets educated on various aspects of health that would enable smooth ministering to their needs when in similar situations as well as understanding the procedures that are involved. With the knowledge from the research on potential drug resistance as well as some types of causative agents being drug resistant, it would help the clinicians to know which drugs not to administer to specific agents. For example, avoiding administering penicillin-based drugs to Streptococcus pneumoniae would be advisable since its administration only intoxicates instead of treating. The findings in the research will also help the clinic seek alternatives to medication and correct diagnostics especially from the works of Kelly, Friedman and Johnson (2007).
In an effort to improve nursing profession, having comprehensive interview of and assessment of similar symptoms that individuals may portray. In so doing, there will be elimination of misdiagnosis that leads to improper prescription. There is overwhelming evidence of quite similar symptoms in the research.
Part D: Ethical Issues
Some of the ethical issues that might be raised include deliberate negligence by clinicians to attend to severe cases in the name of watchful waiting that could have detrimental effects and event potential fatalities. To address this issue, it is expected that all health professional adhere to laid down codes of conduct failure to which the consequences are faced by the negligent personnel. In some cases, like when dealing with infants that are yet to know how to express themselves in speech form, there will be classification of this category as vulnerable and their cases can only be dealt with be qualified and experienced ENT specialist(s) in conjunction with a paediatrician(s).
In conclusion, all the articles reviewed are crucial in explaining the reason behind the notion to change the current medication procedure to the proposed watchful waiting procedure. From the research, it is evident that watchful waiting is quite practical and will ensure better interaction between the clinicians, children and parents to better understand the challenges and available options through informed consent. This approach is also likely to open channels for public education, an element that seems to be missing in current clinical practice.
American Academy of Pediatrics and American Academy of Family Physicians. (2004.) Clinical practice guideline: Diagnosis and management of acute otitis media. Retrieved May 17, 2008, from http://aappolicy.aappublications.org/cgi/content/full/pediatrics;113/5/1451
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.