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EBP
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Annotated Bibliography
Anderson, C., Bhatia, P., Birgitta, I., Lucy, D., Overend, T., Timmermans, P., (2011). The effect
of incentive spirometry on postoperative pulmonary complications. Official Publication
of the American College of Chest Physicians, 120(3), 971-978.
This article systematically reviewed the use of incentive spirometry in reducing
pulmonary complications in the postoperative patient. It was a literature review of all research
conducted on incentive spirometry use dating from 2000 to 2010. Searches were performed
through CINAHL, Medline, and HealthSTAR. Articles were limited to human studies in English.
A total of 85 articles were collected. It was found that within the research conducted, 39
articles found that IS use in the postoperative patient did decrease the number of pulmonary
complications. 35 of the articles were unable to be deemed accurate due to flaws in the
methodology. Finally, the 11 remaining articles found that there was no difference between those
that used IS and those that did not in the postoperative state. The conclusion was that IS use,
deep breathing, and positive pressure breathing were more beneficial than no treatment at all in
reducing respiratory complications in postoperative patients.
El Dib, R., Guimaraes, M., Matos, D., Smith, A., (2009). Incentive spirometry for prevention of
pulmonary complications in upper abdominal surgery. Department of Aesthetics and
Cosmetology, 8(3), 99-105.
Upper abdominal surgeries are highly linked with postoperative respiratory complications
due to shallow breathing and lack of physical movement. The objective of the study was to find
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the difference between IS use and no use of therapy in the postop state. A total of 1754
postoperative abdominal patients were surveyed within the authors’ institution. Of the patients
surveyed, only 1160 could be included in the study due to lack of compliance with IS.
The patients at this institution were also encouraged to use the IS 10 times an hour. It was
not stated within the research the average use with compliant patients.
It was found that those who complied with IS use revealed a lesser incidence of
pulmonary complications in the postoperative state than those who were noncompliant.
Complications ranged from decreased lung sounds to pneumonia and atelectasis.
Hassanzadeh, H., Jain, A., Lemma, M., Stein, B., Stewart, N., Tan, E., Van Hoy, M., (2012).
Postoperative incentive spirometry use. Orthopedics, 35(6), 927-931.
It was hypothesized by the authors that incentive spirometry use by postoperative
orthopedic patients is less than the recommended amount. To determine its postoperative use, the
authors surveyed all patients in their institution’s orthopedic ward that underwent spinal, knee or
hip surgery. This excluded all delirious patients and those on a monitored bed. All 182 patients
were instructed initially by a respiratory therapist with reinforcement education by nurses. The
patients were instructed to use the IS approximately 10 times an hour.
On day three, data was collected by the same two RNs using the same standardized
questionnaire. The average use of IS was found to be 4.1 times hourly. Spirometry use was
correlated with surgery type, day/ time, and patient age and sex. There was found to be no link
with patient age or sex. It was found that arthroscopy patients were more likely to use IS than
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spinal patients (4.3 and 3.1 per hour). Finally, it was found that IS use increased through days 1,
2, and 3.
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Table 1
1.
Purpose (all reasoning has a purpose)
2. Questions at issue or central problem
(all reasoning is an attempt to figure
something out, to settle some question,
solve some problem)
3. Point of view (all reasoning is done
from some point of view; think about the
stakeholders)
4. Information (all information is based
on data, information, evidence, experience,
research)
5. Concepts and ideas (all reasoning is
expressed through, and shaped by,
concepts and ideas)
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1-3 sentences describing your thoughts on
the issue related to that element
Incentive spirometry is very beneficial in
maintaining clear lungs in patients after
trauma or surgery. Yet, many times patients
do not even know “what that thing is” that
is on their bedside stand. On top of this
many patients are noncompliant with using
it on a regular basis until reminded. How
can incentive spirometry become
incorporated even more, and what are the
benefits?
How is IS beneficial? Why do patients tend
to not use it? How can nurses ensure that
knowledge of the device is provided to the
patient?
Patients are not fully expanding their lungs
when lying in bed, therefore secretions
build up. This causes more issues for the
patient. Why is IS education not being
passed along to individuals?
Nurses are the front of the line in passing
along information, and teaching. Where are
they lacking that patients are not learning
about the IS?
Finally, why aren’t doctors pushing for
better orders that cause nurses to teach/
have patient demonstrate q shift?
Many times when I enter a patients room
for the first time and ask them to
demonstrate the IS, they do not know how
to use it or even why they should.
There are many benefits to IS: it
provides an effective means to restore
previous pulmonary functioning before
hospitalization. It allows the patient to
“see” their breath and watch it improve
over time, thus providing encouragement.
IS prevents atelectasis, and pneumonia. It
also allows a measurement for healthcare
workers for breathing strength.
Patients will have better outcomes with IS.
Their lung function will be maintained, or
improved over the course of
hospitalization. Patients should be
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6. Assumptions (all reasoning is based on
assumptions-beliefs we take for granted)
7. Implications and consequences (all
reasoning leads somewhere. It has
implications and when acted upon, has
consequences)
8. Inference and interpretation (all
reasoning contains inferences from which
we draw conclusions and give meaning to
data and situations)
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knowledgeable about the device and its
purpose, and this should be relayed by
health care workers.
It is assumed that patients want to an easy
prevention to complications.
It is also assumed that patients will have
better outcomes and less respiratory
complications with IS use.
Perhaps the IS will discourage patients that
have little lung capacity, therefore they will
not use it.
Practice change should include a
mandatory teaching of the IS to ensure that
all patients have a thorough understanding
of it and its use.
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Reflection on the EBP
How did the planning process, where you thought about what you wanted to change,
prepare you for the EBPP?
The planning process prepared me for what I wanted to change by forcing me to really
look around and see what needed improvement. I went to work, and rather than just following
protocol, I thought about what was wrong with protocols. Finally, I realized that there is lack in
IS use in my hospital. Doctors order it as a one-time use, and then it is forgotten about. This
caused me to realize that there needs to be a better protocol surrounding this topic.
How did the peer evaluation process prepare you for the EBPP?
I felt as though it was very constructive. It allowed me to view other’s work, and
therefore be able to critique my own work accordingly. Also, it was very helpful to receive input
from others. It provided me with confirmation that points were good, and also pointed out where
I needed to reinforce my statements. The peer evaluation process is what made me decide to
change from my original topic to incentive spirometry use.
Do you feel you are prepared to elicit change in your practice with your proposal?
How does it fit into quality health care?
I feel as though it would be “easy” to make a change with the proposal. If doctors would
follow a new order regimen causing nurses to be tasked q shift rather than a one-time order, it
would cause a great difference. This would cause nurses to be reminded as well as showing the
importance of IS use in the patient’s care. Yet, it is difficult to motivate people to do things
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differently than how they are accustomed. It could be a challenge getting doctors to change the
way they order things upon admission.
Quality health care in my view point is providing the patient with everything necessary to
make a smooth recovery to usual health. Incentive spirometry provides the patient with a means
of exercising the lungs to maintain (or improve) lung capacity and to minimize risk of respiratory
complications. Therefore, this proposal fits into quality health care.
What could you have done better?
I wish that I would have come up with this idea more quickly than I did. I struggled
somewhat with choosing a topic. This caused for an initial delay in creating the discussion thread
necessary for feedback. Although I did place a topic within the deadline time, I realized quickly
that it was not a very good topic. Therefore, if I could have had even more feedback than I did on
IS use, it would have been beneficial.
How well do you think you are using the EOR? Do they make sense to you (why or
why not?)
I believe that I am doing a fairly good job of using the EOR. In my opinion I am very
good a being unbiased, taking in all the information available, and then making a judgment based
on that information.
The EOR is a very good outline to follow in taking a stance on an issue. It forces the
writer to sit down and really think about the implications of each category and how they fit into
the topic at hand. The EOR will also show how a topic is not a strong case and should not be
backed.
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I believe that the EOR makes sense to me, but that I need more practice with using it. I
believe that I will continue to use this model with future school work, but perhaps not within my
actual practice.