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Nursing

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Introduction
Bronwyn visited the GP in regards to her 11-month year Old daughter’s measles, mumps and rubella’s immunization. As a Healthcare worker, Bronwyn is aware of the on going news about side effects of immunization, such as Autism. She also heard about the benefits of immunization. However, Bronwyn is confused whether she goes ahead and immunize her child or not. The purpose of this document is to investigate the effects and benefits of measles, mumps and rubella’s immunization through different literature. Different articles with different methods are going to be reviewed to identify if immunization is the cause of Autism in young children.

Moreover, the question involved in this paper is, “What are the health benefits and risks associated with measles, mumps and rubella’s immunization among infants?” This question was formulated considering the PICO principal, which is used to portray information and to guide application of investigations into clinical practice. The principal consists of population, intervention, comparison and the outcome. In this instance P in the PICO (our patient or population) is the 11-month year old infant. The intervention is immunization (Adams, Newcomb, Smith & Withaeger, 2009)
. Alternative term might include vaccination, protect, inoculate while immunization (I) can be referred to as vaccination, protect, inoculate. C in this instance is, not to immunize and O or outcome is to eliminate the chances of experiencing side effects of immunisation (Adams, Newcomb, Smith & Withaeger, 2009).

In additional the type of PICO question being used in this scenario is an intervention question because it compares two possible interventions, which are benefits versus risks involved. Research evidence, also known as external evidence will be used. This can be considered from a ranked perspective. The most valued external evidence, which delivers the most dependable information, is at the top of the list and the least reliable is at the bottom (Adams, Newcomb, Smith & Withaeger, 2009). The quality and rank of the evidence are most significant to make the best clinical decision. The research methods that deliver the best evidence will vary subject to the type of question asked. Answering a question, which comprises of an intervention and systematic reviews, it’s significant to consider the rank and quality of the evidence as well as the possibility of applying the intervention (Twycross, 2011). Any type of question can be answered using variable databases because a database indexes, diverse journals, thorough numerous databases will decrease the opportunity of missing applicable literature (Fineout-Overholt, Melnyk & Schultz, 2005). To discover evidence to Nursing Literature, The cdsr and dare databases contain systematic reviews of randomized, controlled trials. Cochrane Col lab oration is contained in the CDSR, and systematic reviews not conducted by Cochrane are indexed in the DARE. Reviews by Cochrane are considered to have the strongest level of evidence for intervention questions because they have the best study designs. Other types of evidence can be found in PubMed database, which comprises of medical and life sciences researches and the CINAHL database, which comprises of nursing and allied health information. After deciding databases to use, there is need to select the keywords to use to begin the search. The following keywords from the PICO question where used, immunisation, infant, autism, effects, risks, associated and benefits to find the right journal articles to answer the question (('Evidence-Based Practice', 2000).

According to a quantitative study conducted in America in 2010 by cohort studies among infant population of 3104 participants, immunization with one dose of MMR vaccine is at least 95% effective in preventing measles, mumps and rubella among infants. The aim of this study was to identify if MMR vaccination is effective and has any possible effects in infants such as Autism. However, the findings indicated that it is less likely to have Autism in infants after being vaccinated (MMR vaccination and autism, 2010).
A quantitative study conducted in 2004 in America with infant population of 20 478. The findings were 67% of the population had successful MMR immunisation. The investigation aimed on the benefits of measles/mumps/rubella (MMR) vaccine. There is strong evidence that MMR vaccine is not associated with autism. MMR immunisation benefits the more in reducing the chances of getting exposed to the deadly measles, mumps and rubella’s diseases. According to this study it is less likely to get any negative effects after being vaccinated. However, they are more risks if not vaccinated at all than being vaccinated (Madsen & Vestergaard, 2004).

Another qualitative study, which was conducted in 2002 with infant population of 2000. The aim of the study was to investigate if there are any risk factors associated with MMR vaccination. However the findings indicated that some children develop minor fever and unclear rash 7-10 days after the vaccination and will only last 2-3 days. These reactions are not either infectious or serious (Miller, 2002).
The above literature was chosen because they consist of the best information relating to the PICO question. Since the topic is about the effects and benefits of the MMR vaccination among infants, the above sources has the most relevant outcomes regarding the question. The information is also clearly stated, which is very easy to understand.

In conclusion the question was developed using the PICO principal. Various databases where used to search for evidence-based literature to answer the question. However the according to the literature, MMR immunisation does have health benefits which are minimising the chances of getting measles, mumps and rubella in infants. Moreover, the literature evidenced that there are no chances of getting Autism through MMR vaccination. MMR vaccination is less likely to cause any health problems to infants ((Madsen & Vestergaard, 2004).

References
Adams, C., Newcomb, P., Smith, A., & Withaeger, J. (2009). 001 – “PICO de Practice” An Easy Interactive Method to Learn the PICO Format for Clinical Questions. Journal Of Pediatric Nursing, 24(2), e1. doi:10.1016/j.pedn.2008.11.003
Elkins, M. (2010). Using PICO and the brief report to answer clinical questions. Nursing, 40(4), 59-60. doi:10.1097/01.nurse.0000369871.07714.39
Evidence-Based Practice. (2000). JAMA, 283(17), 2306. doi:10.1001/jama.283.17.2306-jbk0503-5-1
Fineout-Overholt, E., Melnyk, B., & Schultz, A. (2005). Transforming Health Care from the Inside Out: Advancing Evidence-Based Practice in the 21st Century. Journal Of Professional Nursing, 21(6), 335-344. doi:10.1016/j.profnurs.2005.10.005
Madsen, K., & Vestergaard, M. (2004). MMR Vaccination and Autism. Drug Safety, 27(12), 831-840. doi:10.2165/00002018-200427120-00001
Miller, E. (2002). MMR Vaccine: Review of Benefits and Risks. Journal Of Infection, 44(1), 1-6. doi:10.1053/jinf.2001.0930
MMR vaccination and autism 1998. (1998). BMJ, 316(7134), 796-796. doi:10.11

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