Application of Evidence-Based Practices to Global Interprofessional Collaborations Aimed at Reducing Hearing-Related Health Disparities
Repository Posting Date2017-07-13T14:17:35Z
Author(s)Page, Tracey Smith
Author DetailsTracey Smith Page, DNP, RN, FNP-BC
Lead Author Sigma AffliationIota Mu
Other Title(s)Global Interprofessional Health Disparities
Level of EvidenceN/A
Purpose: This presentation will provide an overview of the evidence based interventions and practices utilized in the development and implementation of a sustainable community owned hearing screening program for children in Jinotega, Nicaragua. Hearing loss in children can lead to social isolation, academic failure, and emotional distress (Daud, Kamarulzaman, Rahman, & Zakaria, 2013). Subsequently, hearing loss that is not effectively identified and managed can have a negative impact on a community due to increased use of resources and decreased productivity over a lifetime. Unfortunately, hearing screenings for school-aged children in Nicaragua are not routinely performed despite evidence to support effectiveness in identifying hearing related deficits (Muñoz, Caballero, & White, 2014; Prieve, Schooling, Venediktov, & Franceschini, 2015). The magnitude of hearing related deficits in children in Jinotega, Nicaragua, is documented, along with probable causation and interventions, to support the implementation of sustainable community programs to address the issue. Research conducted by Saunders, Vaz, Greinwald, Lai, Morin & Moica (2007) stands as the only evidence in publication that quantitatively reports the discrepancy in hearing screening failure rates in Jinotega, Nicaragua, (18%) when compared to the United States (<4%) and provides valuable information that can be applied to evidence based interventions for this population.
Methods: Health care professionals, educators, spiritual leaders, students and community members worked together to develop and implement a child hearing screening program that consists of educational training and direct patient care opportunities. Educational programs were provided for Nicaraguan nursing students and key community stakeholders over two separate week-long visits to Nicaragua. Direct patient care was also performed as children in three locations in and around Jinotega, Nicaragua, received a well child exam, hearing screening and other select interventions based on need.
I selected pure-tone hearing screens as the base patient intervention for this program as the literature supports this as the preferred method for hearing screens in school-aged children (Saunders, et al. 2007; Prieve, Venediktov & Franceschini, 2015; Munoz, Caballero & White, 2014; Sekhur, Zalewski & Paul, 2013). There are challenges of implementing pure-tone hearing testing in an environment without a sound booth but evidence based interventions to help manipulate the environment and perform effective screens are available (Swanpoel, McClennan-Smith & Hall, 2013). Implementing a questionnaire aimed at identifying children at risk was considered and ruled out based on a literature review conducted by Munoz, Caballero & White (2014) as it was found to be ineffective in accurately identifying children at risk of hearing loss.
The optimal frequency of providing hearing screens in school-aged children remains unproven. The literature supports hearing screens in school-aged children (Prieve, Venediktov & Franceschini, 2015; Munoz, Caballero & White, 2014; Sekhur, Zalewski & Paul, 2013; Swanepoel, Maclennan-Smith & Hall, 2013) but the frequency in which they are performed varies. Nicaragua currently does not mandate hearing screens for school-aged children and only 34 states in the United States require hearing screens in school (Sekhar, Zalewwski & Paul, 2013). The Jinotegan community was provided with information on which to base their future decisions as they assume ownership of the program.
Results: The clinical days were challenging as 302 children in three different locations were provided with well-child exams, treatment of acute health issues and hearing screenings. Speech language consults and ear lavages were also provided as needed. Although this is not a research project, basic data was collected for the purposes of program evaluation and future needs consideration. An astonishing 34% of the 302 children assessed failed some portion of the hearing screening resulting in a recommendation for either a rescreening in 3 to 6 months or immediate referral to a hearing specialist. The unexpected findings were discussed by the interprofessional team to determine the presence of a possible process problem. The hearing screening process was reviewed and found to be sufficiently controlled for this environment (Swanepoel, Maclennan-Smith, & Hall, 2013). Anecdotally, the high level of hearing screening deficits is thought to be due to a large amount of earwax, visualization of tympanic membrane scarring indicative of previous trauma or infection and presence of fluid behind the tympanic membrane interfering with sound transmission. Well cited in the literature, interprofessional collaboration was a key element for the development, implementation, and sustainability of this program (Kara, Johnson, Nicely, niemeier, & Hui, 2015; Norgaard, Draborg, Vestergaard, Odgaard, Cramer, & Sorensen, 2013).
Conclusion: Implications for nursing practice are abundant as multiple interventions and strategies were utilized to create a program using existing evidence with success. The actions are replicable and have great potential for use in a formal research study. The content of this presentation also strongly supports the Congress objective to promote transformation of knowledge and practice to advance global health and nursing.