INSTITUTE OF NURSING

In Partial Fulfillment of the Requirements in NCM 103

EVIDENCE-BASED NURSING CARE PROCESS

SUBMITTED BY: Marianne Angela Q. Mortero (BSN 310 Group 37) SUBMITTED TO: Maam Shiela Dancel

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I. Clinical Question Does vaccination will affect the chronic medical condition of the children? II. Citation Pneumococcal and influenza vaccination rates and their determinants in children with chronic medical conditions. Study Characteristics: a) Patients Included Children with HIV infection, cystic fibrosis, liver transplantation and diabetes mellitus were enrolled. Physicians of regional Reference Centers for each condition, primary care pediatricians and caregivers of children provided information through specific questionnaires. For diabetes, 3 Reference Centers were included. b) Interventions compared The rates of vaccination among children that would affect or will use as a determinants in children with chronic medical condition. c) Outcomes monitored The results that will help the researchers in determining the effect of vaccination in children. d) Does the study focus on a significant problem in clinical practice? This study was designed to investigate the rates of pneumococcal and influenza vaccinations and their determinants in children with chronic medical conditions. Methodology / Design: a) Methodology used Three hundred and forty-three high-risk children (174 males; median age 13 years, range 2-18) were enrolled, including 40 patients with HIV, 39 with CF, 59 with LTx and 205 with DM. The demographic features were similar in all 4 groups (table 1). Physicians involved in the management of children with chronic diseases, including pediatricians of the Reference Centers and primary care pediatricians, were enrolled and received a specific questionnaire. The study was performed in accordance with the Declaration of Helsinki. Parents or legal guardians of children received

III.

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b) Design A pragmatic, randomized, single-blinded, comparative study, designed to determine the effect of vaccination among children. c) Setting The study was conducted in Center of Infectious Diseases, National Key Laboratory of Biotherapy for human Diseases.

d) Data Sources Patients with chronic medical conditions were identified through the Regional Reference Centers for each disease. The Reference Centers for HIV infection, for CF and for LTx (Department of Pediatrics, University Federico II) and all three Reference Centers for DM located in Campania Region (University Federico II, Second University and San Sebastian Hospital of Caserta) took part into the study. e) Subject Selection 1. Inclusion criteria Children aged 2-18 years with the following conditions were included: HIV infection (HIV), cystic fibrosis (CF), type I diabetes mellitus (DM) and children who received liver transplantation (LTx). 2. Exclusion criteria Children <2 years and those diagnosed as having any of the selected chronic conditions since less than 1 year were excluded, in order to evaluate the rates for influenza vaccination in two subsequent seasons. f) Has the original study been replicated? No, the original study has not been replicated.

g) What were the risks and benefits of the nursing intervention tested in the study? BENEFIT: This will help to minimize the occurrence of some of the diseases. It will also serve as preventive measures in acquiring some diseases such as influenza, pertussis etc.

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RISK: This will be a risk for those who doesnt know the importance of having a vaccine or the usage of vaccinations.

IV.

Results of the Study

Less than 25% of children in each group received pneumococcal vaccination. Vaccination rates against influenza were 73% in patients with HIV-infection, 90% in patients with cystic fibrosis, 76% in patients with liver transplantation, and ranged from 21% to 61% in patients with diabetes mellitus. Reference Centers rather than primary care pediatricians had a major role in promoting vaccinations. Lack of information was the main reason for missing vaccination. Awareness of the severity of pneumococcus infection by key informants of atrisk children was associated with higher vaccination rate.

V. Authors Conclusion/Recommendations a) What contribution to the client health status does the nursing action/intervention make? It aims to improve and lessen the cases of children who will acquire some diseases. b) What overall contribution to nursing knowledge does the study make? The study contributes knowledge to prevent having some diseases.

VI. Applicability a) Does the study provide a direct enough answer to your clinical question in terms of type of patients, interventions and outcomes? (Y/N) Yes, this study provides direct answer in terms of patient type, interventions, and outcome. The article clearly discussed, however, the study also claimed that outcome measure tool may not be sufficient and additional tools may be needed to strengthen the validity of findings obtained.

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b) Is it feasible to carry out the nursing action in the real world? Yes, This study showed that this study is feasible to carry out the nursing action to the real world.

VII.Reviewers Conclusion/Commentary Vaccination rates in children with chronic conditions were poor for pneumococcus and slightly better for influenza. Barriers to vaccination include lack of awareness, health care and organization problems. The reviewers or the readers of this study will be aware in importance of vaccinations.

VIII.

Evaluating Nursing Care Practices

1. Safety The study does not sacrifice the clients safety. Informed consent was secured from all patients to ensure their safety. 2. Competence This article is based on Center of Infectious Diseases, National Key Laboratory of Biotherapy for Human Diseases,, making it a reliable source. 3. Acceptability This study is acceptable in caring for client who wants prevent some diseases. 4. Effectiveness The study showed that it lessen the possibility of having chronic diseases. 5. Appropriateness All subparts are related to each other in a way that all methods and tools used was to help to decrease the possibility of having complications or chronic diseases. 6. Efficiency The study is helpful on the grounds that it still needs further studies and larger group of respondents.

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