PICO and Evidence Appraisal Worksheets

Published: 2019-10-15 07:00:00
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Surgical patients are usually at higher risk of contracting other infections that they might not have had when they seek medical services from health institutions. With more emphasis being laid on the improvement of patient outcomes, the application of preventive measures is warranted. This, in turn, requires the identification and application of the appropriate methods of prevention through evidence-based practice. This essay aims to identify a clinical problem that nursing can solve, develop a PICO statement and find evidence that supports the intervention that will change the outcomes.

The PICOT Question

In post-operative adult populations, how effective is the use of incentive spirometers compared to deep breathing exercises in preventing respiratory infection?

Population

Adult surgical patients in the post-operative units.

Intervention

Employing the use of Incentive Spirometers to prevent respiratory infections in the postoperative units.

Comparison

Comparing the effectiveness of using incentive spirometers for deep breathing exercises to prevent respiratory infections.

Outcome

Reducing the risk of developing respiratory problem among surgical patients in the post-operative environment.

The Practice Issue/Problem

One of the major health related issue that is prevalent in the post-operative environments is the development of respiratory infections. These include infections such as pneumonia and pulmonary complications. They occur, especially, after the administration of anesthesia, which facilitates the development of hospital-acquired infections. Nearly half of the surgical patients that requires the administration of anesthesia before undergoing surgery develop pulmonary infections (Kumar, 2016). The fact that most surgical patients usually have limited mobility within the post-operative environment has been identified as the main risk factor for such infections. Due to these hospitals acquired infections, numerous surgical patients usually incur increased medical costs and prolonged medical stay.

Practice Area

Educational interventions that have been applied to reduce the incidences of respiratory infections have often proved futile. This is because educating the patient alone does not guarantee that the techniques taught will be effectively applied for prevention purposes. As such, the issue of preventing respiratory infections falls under the clinical/nursing area. This is because it depends on the nurses role in applying the most appropriate techniques for preventing these infections based on evidence. Such techniques involve practices where patients are subjected to frequent respiratory physiotherapy. However, for the prevention activities to be fruitful, identification and appropriate application of the most efficient methods for preventing respiratory infections is warranted.

Illustration of How the Practice Issue Was Identified

The issue identified was a major concern within the clinical practice. This was due to the increased prevalence of the respiratory issues among surgical patients who were in their recovery process in the post-operative setting. Also, this problem was identified due to the safety/risk management concerns among the recovering patients. Most patients either experienced much pain when taking deep breaths or were too weak to take deep breaths for long periods. In addition, the patient outcomes were unsatisfactory. Most of the surgical patients had complained of their discomfort and inability to sleep well. Such patients also had a longer hospital stay, and they also developed additional infections, which were not initially diagnosed.

Evidence Gathered

The evidence gathered was mostly literature studies. This was aimed at identifying the most appropriate evidence-based practice for the application. It included an evidence of its application as well as the outcomes that had been recorded. It also incorporated clinical trials that had been conducted as well as their outcomes. In addition, the clinical expertise through which such techniques would be applied were also researched. This aimed at determining the appropriateness of incentive spirometers when properly applied.

Search Terms

The terms that were used to search for this evidence included breathing exercises, respiratory infections and incentive spirometer. These terms were used both independently and together so as to collect comparative evidence. In addition, such evidence would be used to pinpoint the most appropriate techniques to be used for the study.

Database Searched

When conducting the research for this nursing issue, the Medscape and CINAHL databases were used to identify the studies that would be included in the research.

Search Strategies

To remain with the literature evidence that was fit and relevant for the research, the result of the research was filtered. As such, only articles that were written in English and were peer-reviewed were included in the research group. In addition, literature, as well as the clinical trials that were used, were dated six years to the recent. Also, all the trials that were included were limited to the adult population.

Evidence Appraisal

PICO question

In post-operative adult populations, how effective is the use of incentive spirometers compared to deep breathing exercises in preventing respiratory infection?

Article 1

Agostini, P., Naidu, B., Cieslik, H., Steyn, R., Rajesh, P. B., & Bishay, E., Kalkat, M. S., & Singh, S. (2013Effectiveness of incentive spirometry in patients following thoracotomy and lung resection including those at high risk for developing pulmonary complications. Thorax, 68(6), 580-585. http://dx.doi.org/10.1136/thoraxjnl-2012-202785

This was a peer-reviewed article that documented a prospective, single-blind randomized controlled trial. The evidence provided by this source is high. This is because its consistent ad provides evidence based on clinical expertise. In this research, the 180 patients chosen as participants for this research were scheduled for lung resection and thoracotomy. After the operation, all the participants were subjected to breathing exercises, early mobilizations as well as airway clearance. For the trial, the intervention group employed an incentive spirometer while the control group was only involved in thoracic expansion exercises.

The results from this controlled trial revealed that there was no significant difference in the mean forced expiratory volume for both groups by the fourth day in the postoperative unit. It also indicated no significant improvement in the length of hospital stay. This research applies to the project problem as it tries to identify whether there is a significant improvement in the patients when the incentive spirometer is applied in place of the breathing exercises. Any improvement in the pulmonary function may be associated with reduced risk of developing infections. The research also highlights the minimal changes that are brought about by the proposed intervention. It, therefore, recommends further research by carrying out the trials for the total length of hospital stay and with more risk factors being put into consideration (Agostini et al., 2013).

Article 2

Hall, J., Tarala, R., Harris, J., Tapper, J. Christiansen, K. (2012). Incentive spirometry versus routine chest physiotherapy for prevention of pulmonary complications after abdominal surgery 1991 April (The Cochrane Controlled Trials Register (CCTR/CENTRAL)). In: The Cochrane Library, Issue 1, 2012. Oxford.

This article is also a randomized clinical trial that examined the effectiveness of breathing exercise and incentive spirometry as techniques of chest physiotherapy. This source of evidence is strong given that it is a comprehensive comparison and it utilizes a larger population for the study. This study surveyed a total of 876 patients who had undergone abdominal surgery. They were divided into two groups. The group that was subjected to incentive spirometry were closely monitored to ascertain that the equipment was used for at least five minutes every hour. The other group was led through a breathing exercise every hour after being educated on how to complete the breathing exercise.

Overall, both these groups were monitored for any complications. The results showed that both breathing exercises and incentive spirometry proved to be an effective means of preventing the development of respiratory complications. In addition, there were no substantial variations between the two groups that participated in the trial (Hall et al., 2012). This study contributes to this research by highlighting that the two methods that are mostly employed to prevent respiratory infections exhibited no significant variations. The study, therefore, recommends further research using varied populations as well as an inclusion of more risk factors, which may contribute to the development of respiratory infections.

Article 3

Kumar, A. (2016). Comparison of Flow and Volume Incentive Spirometry on Pulmonary Function and Exercise Tolerance in Open Abdominal Surgery: A Randomized Clinical Trial. JCDR. http://dx.doi.org/10.7860/jcdr/2016/16164.7064

This source is a peer-reviewed article that presents a randomized clinical trial. The authors set to identify the overall effect of using an incentive spirometer in on the pulmonary functions in surgical patients as well as their tolerance to exercise. This is a good source of evidence at it highlights the effectiveness of the incentive spirometer and its application to practice. The research involved 13 female ad 37 males who were scheduled for abdominal surgery. All the participants were subjected to incentive spirometry with their Forced Vital Capacity (FVC), Forced Expiratory Volume (FEV) and Peak Expiratory Flow (PEF) being measured before and after the operation.

The results revealed that their pulmonary function (FVC, FEC, and PEF) had significantly decreased within the first three days in the post-operative unit (Kumar, 2016). This was compared to the results before they underwent the operation. After discharge, the patients also portrayed a high exercise tolerance. This publication applies to the study as it highlights the additional benefits of employing the incentive spirometers. It, therefore, recommends that patients who are undergoing abdominal surgery may be subjected to incentive spirometry as this will reduce their chances of developing respiratory infections.

Articles 4

Mueenudheen, T., Moiz, J. A., & Gupta, V. (2012). A comparative study on the effects of incentive spirometry and deep breathing exercise on pulmonary functions after uncomplicated coronary artery bypass grafting surgery. Indian Journal of Physiotherapy & Occupational Therapy, 6(2), 63-67.

This article documents a randomized clinical trial, which aimed to measure the effects of both incentive spirometry and breathing exercise for patients who had undergone surgery on the coronary artery. This is a high source of evidence that presents a comparative study between two methods of practice. The trial used 32 participants who were selected into two groups. One group used the incentive spirometers, and the other was engaged in breathing exercises. Their level of Arterial Blood Gasses (ABG) was then measured after this intervention.

The research also revealed minimal differences between engaging in breathing exercises and incentive spirometry. Nevertheless, the patients who participated in the breathing exercises recorded a high ABG than those who were subjected to incentive spirometry. In addition, although the results were very similar, those that used the incentive spirometer recorded higher patient outcomes in terms of comfort during recovery (Mueenudheen et al., 2012). These results can be implicated to this researc...

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