Diagnosis and Treatment of Otitis Media. Retrieved August 13, 2013 from http://aappolicy. aappublications. org The above source is a filtered source as it was taken from the website of the American Academy of Pediatrics (AAP). It is appropriate to use in nursing clinical practice becauseit discusses studies done that suggest that watchful waiting is appropriate when treating uncomplicated cases of otitis media.The nurse can use this source to provide education to the parents of these children. The classification of source is evidence-based guideline as it contains many research articles and reviews them in a systematic way to give the clinician recommendations. Block,S. L. (1997). Causative pathogens, antibiotic resistance, and therapeutic considerations in acute otitis media. Pediatric Infectious Disease Journal, 16, 449-456 This source is unfiltered as it was taken from the biomedical database OVID. It is appropriate to use nursing practice as it discusses pathogens that have become antibiotic resistant.It is becoming more common in the pediatric population to become antibiotic resistant and education to the parents of unnecessary use of antibiotic is vital to avoid this problem. The classification of source is Evidence Summary and contains a summary of references and resources used to put together this journal. 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.This source type is General Information as it was taken from a textbook. It is appropriate to use in nursing practice because the nurse can use it to find background information related to acute otitis media such as signs and symptoms, causes of AOM, and treatment options. The classification is none of the listed. McCracken, G. H. , (1998). Treatment of acute otitis media in an era of increasing microbial resistance. Pediatric Infectious Disease Journal, 17, 576-579. This source is unfiltered. It came from the biomedical database OVID.It is appropriate for use in Nursing Practice as it discusses the problem of pathogen resistance to antibiotics and would be a great source of education to the parents who choose to use antibiotic therapy as the first line of treatment. The classification of source is Evidence Summary and several resources were used to write the journal. Results from interviews with Parents who have brought their children into the clinic for acute otitis media. The source is Unfiltered. It comes directly from the clinic and is interviews with the parents of children who are brought for AOM.Although parents can provide great insights such as signs and symptoms or their children’s response to prior treatments, this would not be appropriate for nursing practice. Clinicians must follow researched and established guidelines with predictable outcomes when treating children with AOM. The classification of the source is none of the listed. “Watchful Waiting” According to the evidence presented in the article “Diagnosis and Management of Acute Otitis Media, watchful waiting is an appropriate practice in treating children with acute otitis media (AOM) if the children meet certain guidelines.The observation practice should only be used if a parent can appropriately monitor the child; the parent has easy access to reaching the physician, and easy access to medications. In addition, the AOM must be uncomplicated and diagnosis uncertain. These are only certain guidelines the child must meet in order for “watchful waiting” to be appropriate. Other criteria include, pain must not be severe, fever must not be greater than 102. 2 Fahrenheit in the last 24 hours, and child must be greater than 6 months of age. AAP & AAFP, 2004) Antibiotic resistance is becoming a problem in the United States due to its overuse. Many practitioners are choosing to treat the symptoms initially in an uncomplicated AOM such as prescribing analgesics, fever reducer medications and anti-inflammatory medications. According to the article, many placebo-controlled trials conducted over the last 30 years showed that 61% of the children with uncomplicated AOM had decreased symptoms of AOM whether they were treated with antibiotics or not.This may be an indication that antibiotics may not have been necessary and that watchful waiting would have been appropriate in such cases. Watchful waiting is recommended for 48-72 hours. After such time and re-evaluation, if the child does not show improvement, antibiotic therapy with amoxicillin should be started. (AAP & AAFP, 2004) Applying the Findings One of the ways nurses can apply the findings of the article in the clinical practice is through education to the parents about evidence-based practices such as watchful waiting.The American Academy of Pediatrics and American Academy of Family Physicians have set forth guidelines and recommendations on which children should be given antibacterial agents and which children should be observed. These guidelines are based on the certainty of the diagnosis, age, severity of symptoms or illness, and ability of the parents to have easy access to follow up if necessary. (AAP & AAFP, 2004) The nurses can assist and put into practice by ensuring that proper assessment is made on these children and that all the questions are answered.As the children’s advocate, it is the nurse’s responsibility to ensure that the best effort is made to properly categorize the children. Also providing education about different treatment options as well as overuse of antibiotics and give assurance to parents that as long as the child meets the criteria, watchful waiting is an evidence base practice that has been found safe to use. Ethics and Issues Ethical implications must be taken into consideration any time research is involved especially when dealing with vulnerable populations such as the elderly or children.Ethics are guidelines that drive an individuals way of thinking. Medical professionals including nurses must abide by a Code of Ethics set forth to assist with ethical dilemmas. When dealing with “watchful waiting”, ethics should be considered. If the child could choose, would the child choose to wait or would the child choose to start antibiotics immediately. The parents should be fully informed of the risks of treating children with antibiotics every single time, such as becoming resistant.In addition, the potential risks of watchful waiting such as damage to eardrums, worsening of infection if not treated with antibiotics should be discussed. The benefits of both treatments should also be discussed in full. In fully informing the parents, they will be able give inform consent for their children or decline their children’s participation in such study. Other issues that arise when changing common clinical practice guidelines include safety of the patients, privacy, and obtaining consent especially when the studies involve children.It is the practitioner’s obligation and the law to maintain patient privacy at all times. It is also their responsibility to first and foremost maintain the safety of the patients at all times. The elderly are another vulnerable population and should be protected as well. They must be able to consent to any treatments of changes in their care before they occur. In conclusion, clinical research has found watchful waiting to be effective in selective patients. When using this treatment option, it is hoped that the incidences of antibiotic resistance are minimized.