Amy

Boyd
N360 M/S Reflective Journal
Professor KaUa @ Kuakini
10/27-10/28 2015

Week 4: Evaluate and apply the facts and principles of biological, psychological,
sociological, cultural and spiritual functioning while providing nursing care to clients with
needs resulting from altered states of wellness throughout the lifespan.
Address the question listed below:
a.

Evidence Based Practice

Select one nursing intervention you implemented for your patient today and
explain the scientific rationale for its use. Use electronic resources to select an
original research article supporting its use. Please provide at least a 10 sentence
synopsis of the article and provide appropriate reference.

One of the interventions I implemented this week was the encouragement of the use
of the incentive spirometer for a patient who was on his first day post-op for a laminectomy.
I decided to research incentive spirometry use because we are always taught that this is an
effective measure to decreases the risk for patients to acquire pulmonary complications
post-operatively. Surprisingly enough, the first article I read said that there is not sufficient
evidence to support the use of incentive spirometer (IS) pre or post-operatively to decrease
pulmonary complications. Although this finding was somewhat discouraging, I did find a
second article that supports its use but only in certain circumstances.

The article I found is called Incentive spirometry: 2011 from the journal, Respiratory
Care (Restrepo, Wettsetein, Wittnebel, & Tracy, 2011). These authors searched the
MEDLINE, CINAHL, and Cochrane Library databases to find articles that were published
between January 1995 and April 2011 in order to write a review of their findings on the
topic of incentive spirometry (Restrepo, Wettsetein, Wittnebel, & Tracy, 2011). First of all,
the goals of therapeutic therapies pre and post-operatively are to improve airway clearance
and reverse atelectasis (Restrepo, Wettsetein, Wittnebel, & Tracy, 2011). These therapies

achieve these goals by increasing lung volume (Restrepo, Wettsetein, Wittnebel, & Tracy,
2011). The article states that incentive spirometry is essentially a device that mimics a
natural yawn or signing by promoting the patient to take slow, deep, long breaths
(Restrepo, Wettsetein, Wittnebel, & Tracy, 2011). I know I am supposed to find an article
that supports the use of IS, and this article does; however, it also points out the interesting
fact that its use is controversial (Restrepo, Wettsetein, Wittnebel, & Tracy, 2011). The
article states that incentive spirometry is controversial because studies have shown that
other therapies have been effective with or without the use of IS, such as deep breathing
exercises, early mobilization, directed cough, and optimal analgesia (Restrepo, Wettsetein,
Wittnebel, & Tracy, 2011). Also, the effectiveness of IS use relies heavily on instruction on
how to use this device properly and adequate supervision by healthcare professionals
(Restrepo, Wettsetein, Wittnebel, & Tracy, 2011). Furthermore, this article states that there
is not a significant difference between IS and deep breathing exercises in reducing
pulmonary complications with some surgeries postoperatively (Restrepo, Wettsetein,
Wittnebel, & Tracy, 2011). I am glad I read this article because it supported how important
it is for me as a nurse to educate and supervise pre and post-operative patients on the use of
incentive spirometry in order to ensure its effectiveness.
Reference:
Restrepo, R., Wettstein, R., Wittnebel, L., Tract, M. (2011). Incentive spirometry: 2011.
Respiratory Care, 56(10), 1600-1604. doi:10.4187/respcare.0147