PRAC 6565 Reflections on Standard of Care

PRAC 6565 Reflections on Standard of Care

Reflections on Standard of Care

Clinical guidelines use evidence-based practice along with other patient factors in order to create a comprehensive approach to establishing safe and effective treatments (Pantazidou et al., 2022). Clinical judgment can differ among providers because of their levels of expertise, their interpretation of existing best-practice guidelines, and their focus on patient-centered priorities. This paper will reflect an instance in which my preceptor’s patient care plan and my own were different; it will evaluate both plans, provide a rationale for why another plan would be preferable, and discuss what I will carry forward into future practice based on these experiences.

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Case Summary

Patient is an 18-year-old male with severe left-sided otalgia after swimming in a pond. The pain is described as sharp and worsening, currently rated an 8-9 out of 10, with concurrent green discharge from the left ear and tenderness to touch. The patient has a past medical history of seasonal allergies and attention deficit hyperactivity disorder, and has no history of ear infections. The left external auditory canal is noted to have erythema and edema, and purulent discharge with tenderness when the tragus is palpated or the auricle is manipulated. Clinical findings indicate that the patient has acute otitis externa (Takata et al. 2023).

The patient has been taking acetaminophen to treat his pain, which has provided only minimal benefit. No laboratory tests were completed initially since the diagnosis was made clinically. Due to the fact that he does not currently have health insurance and his financial situation is constrained, the socioeconomic determinants of health were crucial for this patient (Hasan et al. 2023). The availability of treatment and the elements that should be considered about treatment adherence will both be influenced by these circumstances. Taking everything into consideration, the presentation is consistent with a mild to moderate localized infection that does not entail any systemic involvement.

Comparison of Treatment Plans

My preceptor recommended treating the patient with ofloxacin otic drops once daily for a 7-day course, as well as continuing to use acetaminophen for the purpose of providing pain relief and for providing general education about ear care. This type of treatment follows the established standard for the first-line management of uncomplicated acute otitis externa that utilizes topical antibiotic therapy (Bustamante et al., 2024). Additionally, the patient’s treatment plan included education regarding the avoidance of exposure to moisture and the instruction to return if their symptoms progressed or worsened. The emphasis was on providing effective antimicrobial therapy without using major systemic therapies.

On the other hand, I recommended a combination topical therapy containing antibiotic and corticosteroid ear drops (instead of using an antibiotic alone) and recommended more aggressive pain management with NSAIDs (such as ibuprofen), unless they were contraindicated (Feghaly et al., 2023). I also suggested placing a wick in the ear due to the patient’s swollen ear canal, which would provide for adequate delivery of the prescribed medications. I placed more emphasis on decreasing inflammation and improving the penetration of medications into the ear canal.

Justification of Alternative Approach

There are evidence-based guidelines that state the use of combined antibiotic-steroid therapy can speed up the time it takes to relieve symptoms from an ear infection because steroids (in this case, corticosteroids) reduce inflammation. In an outer ear infection (otitis externa), the inflammation is a major cause of both pain and blockage of the ear canal, so it is beneficial to address this issue for faster healing. Clinical studies demonstrate that combination therapy often outperforms antibiotics alone (Smolinski et al., 2024).

Furthermore, NSAIDs have been shown to work better than acetaminophen alone for relieving pain from inflammatory conditions. Because the patient said their pain was very bad, it was important to find the best way to control their pain to make them more comfortable and more likely to follow through with treatment. In cases of significant canal edema, an ear wick may also be a good idea, since swelling can keep topical medications from getting to the site of infection effectively (Hasan et al., 2023).

Moreover, my methodology incorporated patient-centered factors, including the symptom frequency and the extent of functional impairment. It is possible that the patient’s capacity to work and carry out everyday activities could improve if they experienced faster symptom alleviation. Despite the fact that cost was an issue, there are some combination medications that are accessible in generic forms that are reasonable, which makes this method feasible even for patients who do not have health insurance (Pantazidou et al., 2022). In general, the alternative strategy is intended to improve clinical outcomes as well as the level of comfort experienced by patients.

Reflection on Differences

The main point of divergence between my preceptor’s plan and my plan was regarding which level of intervention and degree of emphasis to put on managing inflammation. My preceptor’s plan was based on an uncomplicated, guideline-based use of antibiotics, in all likelihood due to his clinical experience and knowledge that this clinical condition is typically self-limited (Hasan et al., 2023). Therefore, my preceptor’s plan represented a conservative, cost-sensitive approach to treating this patient with the goal of avoiding additional complexities by over-treating (such as using multiple medications when one medication can achieve the same therapeutic effect).

In contrast, my approach was more active in managing inflammation and pain, indicating a heavy emphasis on current literature and evidence-based enhancements to standard therapy (Bustamante et al., 2024). This was done to meet the need for more aggressive treatment. Having clinical experience may promote simplicity and practicality, whereas newer practitioners may focus more heavily on maximizing results based on research findings. This contrast underscores the fact that clinical experience may favor simplicity and practicality. Despite the fact that both techniques were genuine, they focused on different elements of medicine.

In addition, my preceptor may have given greater weight to the factors of adherence and financial barriers, selecting a more straightforward treatment plan in order to guarantee that the patient would be able to continue with treatment. According to Takata et al. (2023), this highlights the significance of customizing therapy not just to clinical data but also to the actual conditions of the patient from the real world. The event highlighted the fact that there are various appropriate ways that can exist within the domain of care standards.

Lessons Learned

This experience reinforced to me that evidence-based practice and clinical judgement, as well as patient-specific factors, must be balanced. Although proposed guidelines support various types of interventions, practical factors like cost, adherence, and simplicity should also influence decision-making (Feghaly et al., 2023). It also reinforced the need to understand the rationale for different treatment options instead of just assuming one is better than the others.

In my future clinical practice, I will make it a priority to incorporate both evidence and practicality into my treatment plan development. I will focus more on pain and inflammation as two of the most important aspects of patient care. I will continue to assess my ability to critically determine whether a more aggressive or more conservative viewpoint will be appropriate treatment (Lambert‐Hoffert et al., 2025).

In the event of having different treatment approaches from other providers, I will maintain professionalism through evidence-based, respectful communication and discussion. I will provide current guidelines or research that support my viewpoint while also being open to different perspectives (Gattinara et al., 2025). Collaborative communication, mutual respect, and shared decision-making will be key components in providing patients with optimal outcomes and developing positive working relationships among providers.

Conclusion

Treatment planning differences are typical in the field of practice, and they indicate that healthcare decision-making is an evolving process. This case has shown that differences in interpreting the standard of care may affect management approaches as far as achieving an acceptable balance of simplicity and outcome optimization. I will reflect on my experience of these differences and continue to improve upon my clinical reasoning ability, as well as to enhance the patient’s experience through patient-centered experiences. Going forward, I will use what I have learned about clinical decision making by using evidence-based practice, improving teamwork/collaboration, and providing personalized, effective care to my patients.

 

 

Reference

Bustamante, J., Tran, T., & Rodriguez, C. R. (2024). Otitides. Primary Care Clinics in Office Practice, 52(1), 1–14. https://doi.org/10.1016/j.pop.2024.09.003

Feghaly, R. E. E., Nedved, A., Katz, S. E., & Frost, H. M. (2023). New insights into the treatment of acute otitis media. Expert Review of Anti-infective Therapy, 21(5), 523–534. https://doi.org/10.1080/14787210.2023.2206565

Gattinara, G. C., Bergamini, M., Simeone, G., Reggiani, L., Doria, M., Ghiglioni, D. G., Terminiello, A., Cosentino, F., Cursi, L., Donà, D., Chiappini, E., Galli, L., Lo Vecchio, A., Guarino, A., Villani, A., Di Mauro, G., Principi, N., Esposito, S. M. R., & Verga, M. C. (2025). Antibiotic treatment of acute and recurrent otitis media in children: an Italian intersociety Consensus. ˜The œItalian Journal of Pediatrics/Italian Journal of Pediatrics, 51(1), 50. https://doi.org/10.1186/s13052-025-01894-z

Hasan, W., Kennett, J., Bentounsi, Z., Amir-Ghasemi, A., Jones, H., & Biggs, T. (2023). Improving otitis externa management in secondary care through a standardised treatment algorithm. The Journal of Laryngology & Otology, 138(6), 615–620. https://doi.org/10.1017/s002221512300227x

Lambert‐Hoffert, A., Tarazona, V., Romdhane, T. B., Nijman, R. G., Boussageon, R., Cohen, J. F., & Francois, M. (2025). Clinical Practice Guidelines for Managing Acute Otitis Media: literature review and systematic mapping of the evidence base. Journal of Evaluation in Clinical Practice, 31(5), e70205. https://doi.org/10.1111/jep.70205

Pantazidou, G., Dimitrakopoulou, M., Kotsalou, C., Velissari, J., & Vantarakis, A. (2022). Risk Analysis of Otitis Externa (Swimmer’s Ear) in Children Pool Swimmers: A Case Study from Greece. Water, 14(13), 1983. https://doi.org/10.3390/w14131983

Smolinski, N. E., Djabali, E. J., Al-Bahou, J., Pomputius, A., Antonelli, P. J., & Winterstein, A. G. (2024). Antibiotic treatment to prevent pediatric acute otitis media infectious complications: A meta-analysis. PLoS ONE, 19(6), e0304742. https://doi.org/10.1371/journal.pone.0304742

Takata, J., Hopkins, M., Alexander, V., Bannister, O., Dalton, L., Harrison, L., Groves, E., Kanona, H., Jones, G. L., Mohammed, H., Andersson, M. I., & Hodgson, S. H. (2023). Systematic review of the diagnosis and management of necrotising otitis externa: Highlighting the need for high‐quality research. Clinical Otolaryngology, 48(3), 381–394. https://doi.org/10.1111/coa.14041

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Reflections on Standard of Care

 

You will prepare a reflections paper where you will discuss where you and your preceptor may have differed on a treatment plan. You can choose any patient you have seen in your practicum experience this quarter. This assignment is not reviewed by your preceptor.

Resources

 

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

 

Learning Resources

Required Readings

To prepare:

Select a patient case from your clinical experience this quarter where you and your preceptor approached the treatment plan differently. Reflect on these differences, using relevant and current resources, particularly those outlining standards of care. As you develop your reflection, review the assignment instructions and grading rubric for guidance. Keep your writing concise, using paragraph format, and lists for medications and diagnoses when appropriate. Be sure to include a title page and reference page.

Assignment:

Briefly summarize the case:

  • Include relevant patient information, including history, assessment, any testing that might have been done, and medications.
  • Presenting symptoms.
  • Diagnosis.

Compare Treatment plans:

  • Describe your preceptor’s recommended treatment plan.
  • Explain the alternative treatment plan you would have recommended as a nurse practitioner.

Justify Your Approach:

  • Use evidence-based guidelines, clinical research, and relevant literature to support your alternative plan.
  • Discuss why you believe your approach would be effective, considering the patient’s history, condition, and individual needs.

Reflect on Differences:

  • Analyze the differences between your plan and your preceptor’s.
  • Consider factors such as clinical experience, knowledge, patient-centered care, and the influence of evidence-based practice in decision-making.

Lessons Learned:

  • Reflect on how this experience has influenced your clinical practice and approach to treatment planning.
  • Discuss how you can apply what you learned to future patient care.
  • How might you approach another provider professionally in the future when you find treatment plans differing during collaboration on the patient case?

Submission Requirements: 

  • Length: 3-4 double-spaced pages, APA format.
  • Cite at least 3 current peer reviewed sources or evidence-based research to support your analysis.

Evaluation Criteria (also see rubric): 

  • Clarity and completeness of the case summary.
  • Depth of analysis and comparison between treatment plans.
  • Use of evidence-based rationale for your alternative plan.
  • Reflection on learning and future application.
  • Proper use of APA formatting and references.

By Day 7

Submit your Reflections on Standards of Care assignment.

submission information

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Rubric

PRAC_6565_Week8_Assignment1_Rubric

PRAC_6565_Week8_Assignment1_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning Outcome The case summary is clear, complete, and includes all relevant information. It covers the patient’s history, assessment findings, medications, any pertinent testing, presenting symptoms, and the final diagnosis. 10 to >8.0 pts Excellent The response thoroughly and accurately describes the patient’s subjective complaint, history, current medications, allergies, and review of diagnosis.

8 to >7.0 pts Good The response accurately describes the patient’s subjective complaint, history, current medications, allergies, and review of diagnosis.

7 to >6.0 pts Fair The response describes the patient’s subjective complaint, history, current medications, allergies, and review of diagnosis, but is somewhat vague or contains minor inaccuracies.

6 to >0 pts Poor The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history, current medications, allergies, and review of diagnosis.

 10 pts
This criterion is linked to a Learning Outcome Provide a thorough, insightful comparison between the alternative plan and the preceptor’s approach, analyzing key differences in clinical experience, knowledge, and patient-centered care. Thoughtfully discuss how evidence-based practice influenced decision-making in both plans, demonstrating an understanding of its role in patient care. 10 to >8.0 pts Excellent The response provides a thorough, insightful comparison between the alternative plan and the preceptor’s approach, analyzing key differences in clinical experience, knowledge, and patient-centered care.

8 to >7.0 pts Good The response compares the two approaches with reasonable detail but may miss some key differences or lack depth in analysis.

7 to >6.0 pts Fair The response provides a limited comparison, without fully exploring the differences in clinical experience or decision-making processes.

6 to >0 pts Poor The response fails to provide a meaningful comparison between the plans, or the analysis is overly simplistic or inaccurate.

 10 pts
This criterion is linked to a Learning Outcome Support the alternative plan with at least three evidence-based guidelines or peer reviewed journal articles. All sources must be current (no more than five years old), credible, and clearly aligned with the patient’s case. 20 to >17.0 pts Excellent The response provides at least three current, evidence-based resources from the literature to support the alternative treatment plan for the patient. Each resource represents the latest in standards of care and provides strong justification for treatment decisions.

17 to >15.0 pts Good The response provides at least three current, evidence-based resources from the literature to support the alternative treatment plan for the patient. Each resource represents current standards of care and supports treatment decisions.

15 to >13.0 pts Fair Three evidence-based resources are provided to support alternative treatment decisions but may not represent the latest in standards of care or may only provide vague or weak justification for the treatment plan.

13 to >0 pts Poor Two or fewer resources are provided to support alternative treatment decisions. The resources may not be current or evidence-based, or do not support the treatment plan.

 20 pts
This criterion is linked to a Learning Outcome Reflect on the differences between alternative treatment plan and preceptor’s plan. Critically analyze the rationale behind each approach and identify how these differences inform clinical decision-making and professional growth in patient care. 20 to >17.0 pts Excellent The response demonstrates a thorough, insightful reflection on the alternative plan and the preceptor’s approach, analyzing key differences in clinical experience, knowledge, and patient-centered care.

17 to >15.0 pts Good The response demonstrates reflection on the two approaches with reasonable detail but may miss some key differences or lack depth in analysis.

15 to >13.0 pts Fair The response demonstrates a limited reflection, without fully exploring the differences in clinical experience or decision-making processes.

13 to >0 pts Poor The response fails to demonstrate a meaningful reflection on the plans, or the analysis is overly simplistic or inaccurate. Reflections on the case are vague or missing.

 20 pts
This criterion is linked to a Learning Outcome Reflect on the lessons learned from comparing treatment plan approaches, assessing how the experience has influenced clinical decision-making and identify how these insights will guide approach to future patient care and collaboration with other healthcare providers. 25 to >22.0 pts Excellent The response offers a thorough reflection on how the experience has influenced clinical practice and treatment planning, showing growth in clinical reasoning, decision-making, and patient care. It clearly explains how lessons learned will guide future patient care, with specific examples. It also provides a thoughtful approach to handling differing treatment plans, emphasizing respectful, evidence-based communication and collaboration.

22 to >19.0 pts Good The response offers a solid reflection on how the experience has influenced clinical practice and treatment planning, though some areas lack depth. It shows growth in clinical reasoning, decision-making, and patient care, but examples may be underdeveloped. It explains how lessons can be applied to future care with relevant examples and provides a reasonable approach to handling differing treatment plans, though not all aspects of collaboration are fully explored.

19 to >16.0 pts Fair The response provides a basic reflection on how the experience influenced clinical practice and treatment planning but lacks detail. Shows limited growth in reasoning and decision-making. Mentions applying lessons to future care, but examples are vague. Offers a minimal approach to handling differing treatment plans, with limited focus on professionalism or evidence-based communication.

16 to >0 pts Poor The response offers little to no reflection on how the experience influenced clinical practice or treatment planning, showing no growth in reasoning or decision-making. It fails to explain how lessons will be applied to future care and provides no meaningful approach to handling differing treatment plans, lacking professionalism or evidence-based focus.

 25 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. 5 to >4.0 pts Excellent Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 to >3.5 pts Good Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

3.5 to >3.0 pts Fair Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic.

3 to >0 pts Poor Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. No purpose statement, introduction, or conclusion were provided.

 5 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5 to >4.0 pts Excellent Uses correct grammar, spelling, and punctuation with no errors.

4 to >3.5 pts Good Contains a few (1 or 2) grammar, spelling, and punctuation errors.

3.5 to >3.0 pts Fair Contains several (3 or 4) grammar, spelling, and punctuation errors.

3 to >0 pts Poor Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

 5 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. 5 to >4.0 pts Excellent Uses correct APA format with no errors.

4 to >3.5 pts Good Contains a few (1 or 2) APA format errors.

3.5 to >3.0 pts Fair Contains several (3 or 4) APA format errors.

3 to >0 pts Poor Contains many (≥ 5) APA format errors.

 5 pts

Total Points: 100

 

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