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Surgical patients are usually at higher risk of the development of respiratory infections they did not have when they sought 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 the evidence that supports the intervention that will change the outcomes.

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Definition of the Practice Issue/Problem

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

Educational interventions applied to reduce the incidences of respiratory infections often prove futile. It happens because educating patients alone does not guarantee that the techniques taught will be effectively applied for the prevention purposes. As such, the issue of preventing respiratory infections falls in the clinical/nursing area. 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.

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Respiratory infections are a major concern within a clinical practice. There is an increased prevalence of the respiratory issues among surgical patients who are in their recovery process in the post-operative setting. Also, this problem has been identified due to the safety/risk management concerns among the recovering patients. Most patients either experienced much pain when taking deep breaths or became too weak to take deep breaths for long periods. In addition, from an investigation done on surgical patients’ outcomes, it is clear that most of them are unsatisfactory. Also, numerous surgical patients have in the past complained about their discomfort and inability to sleep well. Such patients also have a longer hospital stay, and they also develop additional infections, which are not initially diagnosed.

PICOT Question

In post-operative adult populations, how effective is the use of incentive spirometers compared to deep breathing exercises in preventing respiratory infection when administered over a period of four months?

Population: Adult surgical patients in the post-operative units.

Intervention: The use of incentive spirometers to prevent respiratory infections in the postoperative units.

Comparison: Patents’ deep breathing exercises so as to avert the development of respiratory infections.

Outcome: Reducing the risk of developing respiratory problem among surgical patients in the postoperative environment.

Time: Expected time for the implementation of the intervention is four months.

Literature Review

Literature Appraised

Qualitative and quantitative studies were gathered as the evidence for the study. This strategy was aimed at identifying the most appropriate evidence-based practice for the application. The collected literature included an evidence of the application of various strategies for preventing respiratory diseases in post-operative patients as well as the outcomes. It also incorporated clinical trials and their outcomes. In addition, the literature review researched the clinical expertise through which such techniques would be applied. Additionally, this aimed at determining the appropriateness of incentive spirometers when properly applied.

The terms used to search for this evidence included breathing exercises, respiratory infections, and incentive spirometer. The stated terms were used both independently and in combination to collect comparative evidence. In addition, such evidence would be used to pinpoint the most appropriate techniques to be used for the study. When conducting the research for this health problem, the Medscape and CINAHL databases were used to identify the studies to be included in the research. Additionally, to keep the literature evidence that fit the research properly, the result of the research was filtered. Therefore, only peer-reviewed articles written in English were included in the research group. In addition, only the literature not older than six years was used. Finally, all the trials included in the literature review were limited to the adult population.

Reviewed Publications

A publication by Agostini et al. (2013) can support the formulated PICOT question. It is a peer-reviewed journal research that documents a prospective, single-blind, and a randomized controlled trial (Agostini et al., 2013). The evidence provided by this source is high because it is consistent, and it provides evidence-based clinical expertise. In this research Agostini et al. (2013) scheduled 180 patients for lung resection and thoracotomy. After the operation, all the participants were subjected to breathing exercises, early mobilizations, and 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 have revealed that there i no significant difference in the mean forced expiratory volume for both groups by the fourth day in the postoperative unit. It has also indicated no significant improvement in the length of hospital stay. Also, 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 substituts the breathing exercises. Any improvement in the pulmonary function may be associated with the reduced risk of developing infections. The research also highlights the minimal changes 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 into consideration.

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Kumar et al. (2016) identify the overall effect of using an incentive spirometer on the pulmonary functions in surgical patients as well as their tolerance to exercise. The publication by Kumar et al. (2016) is a peer-reviewed article that presents a randomized clinical trial. It is a valuable source of evidence as it highlights the effectiveness of the incentive spirometer and its application to practice. The research involves 13 females and 37 males scheduled for abdominal surgery. All the participants were subjected to incentive spirometry (Kumar et al., 2016). The study refers to the following measures, namely Forced Vital Capacity (FVC), Forced Expiratory Volume (FEV) as well as Peak Expiratory Flow (PEF) being measured before and after the operation.

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

Another publication by the Tyson et al. (2015) can also be employed to support the hypothesis that spirometry is effective in preventing pulmonary infections for postoperative patients. The publication is a summary of a single-centered, randomized controlled trial executed among a sample population from Malawi. The research was conducted between February and November 2013 at the Kazungu Central Hospital in Malawi’s capital, Lilongwe (Tyson et al., 2015). The participants of the study undergone through a clinical exploratory laparotomy and later randomized into interventions or control groups.

The findings of the research conducted by Tyson et al. (2015) illustrate that all forms of deep breathing exercises with the help of an incentive spirometry have the potential of reducing the level of infection in the pulmonary system. Nevertheless, in this particular research, Tyson et al. (2015) states that the effectiveness of using incentive spirometry in the client’s role of treating and preventing postoperative atelectasis can only be reflected as inconclusive. The offered methodology can be employed to protect individuals who have undergone surgery from contracting different forms of respiratory ailments.

The effectiveness of incentive spirometer training on the patients’ vital capacity over the use of resisted breathing exercises could also be supported by a randomized controlled trial conducted by Othman, Abaas, and Hassan (2016). The focus of the study is the investigation of the effectiveness of the resisted breathing exercises as opposed to the use of incentive spirometer (IS) training technique in the determination of vital capacity (VC) outcomes in cases of postoperative radical cystectomy (Othman, Abaas, & Hassan, 2016). The sample population that took part in the study composed of 40 men and women that were aged between 40 and 80 and who recently undergone radical cystectomy (Othman, Abaas, & Hassan, 2016).

The results of the study portrayed that both resisted breathing exercises and IS illustrated a positive improvement in VC when both were administered as an intervention on separate occasions. Nevertheless, IS created better results when administered as an intervention compared to the use of resisted breathing in managing pulmonary complications after the patients underwent a radical cystectomy (Othman, Abaas, & Hassan, 2016). Nevertheless, the two were considered by Othman, Abaas, and Hassan (2016) as the gold therapeutic tools that could be utilized in the clinical settings in treatment and prevention of the respiratory infections.

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The effectiveness of using incentive spirometers could also be supported by a research publication that was developed by Alaparthi, Augustine, Anand, and Mahale (2016). The focus of the research was to measure the effects of diaphragmatic breathing exercises in comparison to the use of incentive spirometry that was volume-oriented as interventions for the patients in the clinical settings. In this case, the patients underwent a laparoscopic abdominal surgery. In the study, a sample of 260 individuals was used for the research (Alaparthi et al, 2016). Among them, 65 patients underwent diaphragmatic breathing exercises and 65 patients undertook a flow incentive spirometry). Lastly, 65 individuals in the sample population were used as the members of the control group (Alaparthi et al., 2016). The results of the study illustrate that there is a significant difference between the effectiveness of using diaphragmatic breathing exercises and an incentive spirometry group. However, the findings of the research prove that the incentive spirometry group is more effective in facilitating a good breathing procedure for patients who took part in the sample population during the postoperative day pulmonary function. The statistical difference was represented by the equation P < 0.05 (Alaparthi et al., 2016).

Ultimately, a research publication developed by Tripathi and Sharma (2017) can also be used to develop a conclusion of the formulated PICOT statement. The focus of the research is to investigate the changes that can be evidenced in pulmonary dynamics in patients after they have undertaken an abdominal surgery. The research was a pilot study that executed a quasi-experimental research technique. A sum of 40 participants was used as the members of the sample population (Tripathi & Sharma, 2017). In this case, 20 patients were used as the experimental group while the remaining 20 people were employed as the control group.

The findings of the research portray that the results of using spirometry interventions are more effective compared to using breathing exercises (Tripathi & Sharma, 2017). Additionally, in the sample population of patients that used spirometry, the level of oxygen gas saturation maintained a constant level. Also, the patients who used the incentive spirometry equipment did not portray any form of medical complications during the postoperative period. Ultimately, from the research, it is evident that using the incentive spirometer can help patients who have recently undergone surgery to have a healthy enhancement of their lung capacity (Tripathi & Sharma, 2017). Also, it would also prevent them from post-operative complications.


The literature analysis has portrayed that the use of an incentive spirometer can be the most effective intervention to protect surgical patients from respiratory system infections. In the clinical settings, the incentive spirometer can help to keep an individual’s lungs in an active mode while a patient is in the recovery process after the surgery. As such, it is a device that should be offered to enable patients to improve the functioning of their respiratory and also prevent such patients from jeopardizing the respiratory functions. As such, it should be recommended to all clinical facilities dealing with operations of patients’ respiratory systems.

The incentive spirometers could be effective in such clinical cases because they gently exercise the patients’ lungs and gradually enable them to function optimally and at a healthy rate. Furthermore, the incentive spirometers also help to retrain operated patients’ lungs on how to take in deep breaths slowly. Also, the incentive spirometers enable patients to increase their lung capacity and promote the patients’ abilities to breathe. As such, incentive spirometers are the primary tools that should be used as the first intervention in the treatment of surgical patients who have undergone a respiratory system operation in a healthcare setting.


In conclusion, it is evident that patients in the post-operative units are often at high risk of developing respiratory infections. As the evidence submits, the breathing exercises as well as the employment of incentive spirometers can be deemed effective in the prevention of respiratory infections. Even though there are no significant variations in the outcome from the two methods, incentive spirometry is recommended for practice as it produces better positive patient outcomes. It happens as it facilitates the performance of the pulmonary functions in such a way that the patient is more comfortable and avoids strenuous forced breathing, especially for weak patients. When effectively applied by the nurses, the prevalence of respiratory infections will reduce, and the patient outcomes will also improve.

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