Surgical patients who suffer from postoperative pneumonia usually undergo an abdominal surgery; it is a frequent and severe complication. It may cause more morbidity, mortality, longer in-patient status, and healthcare cost. As such, it is necessary to design measures which will be successful in preventing postoperative pneumonia and reducing the incidence of this condition in patients who undergo surgeries. The present interventions aimed at lowering the incidence of postoperative pneumonia include the ICUHG bundle and early ambulation aimed at TBA enhancing pulmonary function, mobilization and oral hygiene. Although they demonstrate their effectiveness and feasibility, its evidence is limited and inconsistent. The purpose of this paper is to answer the following PICOT question: Compared to current practice, how will the implementation affect postoperative pneumonia rates within a period of time that is about 56 days for staff caring for postoperative patients in postoperative ICOUGH bundle and early ambulation? In this paper, the process of searching through the literature plus a breakdown of the evidence and major themes therefrom based on the level of evidence of the PICOT question will be described.
Literature Search Strategy
Various databases, search engines and other sources, well enough prove effective in searching useful literature. CINAHL Plus with Full Text is a database that includes all the pertinent research literature about nursing and allied health practices, including topics such as nursing, biomedicine, health sciences, alternative medicine, and consumer health. Second to this, PubMed is an open-access database of biomedical and Life Sciences literature ranging from Medicine, nursing, dentistry, veterinary medicine and all health issues (Gusenbauer & Haddaway, 2020). Simultaneously, Cochrane Library is a database suite with high-quality evidence, which acts as a guide in the health care choice by individuals, such as systematic review, clinical trials, and guidelines.
Criteria have to be set in place in order to make the results obtained by searching in these many databases more accurate and inseparable so that the results of search could be minimized. Several key concepts from the main part of the PICOT question should be used as keywords and phrases to include the following: The use of synonyms, acronyms and related terminologies which include post-surgical pneumonia, ICOUGH bundle, early mobilization and laparotomy is essential in enhancing the approaches of documenting the same concepts. A few Boolean operators often employed to connect the keywords and phrases to narrow or broaden the result of searching are usually, AND, OR, and NOT. For example, the advantage of postoperative pneumonia and ICOUGH bundle and early ambulation and abdominal surgery regarding all four content areas of the PICOT question with empirical data retrieval is needed and essential.
In essence, the linguistic filter is used to screen out monolingues not written in the English language. In contrast, the publication type filter has been created to only select studies that are peer-reviewed and may include those in the form of journal articles, systematic reviews, and meta-analyses. Alternatively, the study design filter excludes, for these prevention questions, randomized controlled trials, cohort studies, and case-control studies, which provide the strongest form of evidence (Harari et al., 2020). Other indicators in evaluating reliable sources for importance and quality of eligibility are the relevance, accuracy, trust and practicability of the sources towards the PICOT question and nursing practice.
These sources are the primary ones which are sourced and retrieved from the databases, search engines, or other relevant resources before applying filters that include date, language, publication type, study design, relevance, validity, reliability, and applicability that are used within the search strategy, such as literature search type. Consequently, 20 of these sources are selected to undergo closer scrutiny and synthesis where several main themes, mission, and dialogues about this literature should be delineated. The reference analysis of the top three topics associated with the ICOUGH bundle and early ambulation include the post anesthesia care context. Along with this theme 1, its effectiveness is discussed in preventing postoperative pneumonia and has a positive impact on patient outcomes, including the provision of pulmonary impaction, low stay-time in the hospital, and quality of life. Theme 2 emphasizes the practicality and demand of the ICOUGH bundle and early mobility, emphasizing their simplicity, creditability, and patient- and staff-preferred nature (Dhillon et al., 2023). Concerning that, Theme 3 discusses the role of some influencing factors that affect the implementation and the validity of these interventions and speaks about the character of the patients, the teachings of the personnel, the support of the organization, and the other barriers in the environment.
The included literature could not be completely compared to each other due to the lack of standardized definitions and measurements for postoperative pneumonia, ICOUGH bundle, and early ambulation, advancing the variability of invalid results. Furthermore, the absence of long-term follow-up provides incomplete information regarding the sustainability and consequence of these interventions on patient outcomes (McClinton, 2022). A second knowledge gap is the scarcity of comparative studies between the ICOUGH bundle and early ambulation, as they have problems finding the best interventions for postoperative pneumonia prevention.
Two controversies emerge from the literature: Controversy 1 deals with arguments regarding the maximum length, frequency, and period of the ICOUGH bundle and premature gait due to differences in parameters and outcomes that are noted. In controversy 2, the seeming lack of attention given to components results in great debates over the proportion and significance of each element, with different research studies recommending that specific elements are or are not effective or essential (Dhillon et al., 2023). These themes, gaps, and controversies provide direction for further research.
Conclusion
Examining the effects of implementing the ICOUGH bundle and early ambulation, this paper explored how these interventions impact postoperative pneumonia rates among healthcare staff attending to surgical patients. The literature review revealed that these interventions are effective and feasible but are influenced by factors affecting adherence and effectiveness. Nurses are encouraged to integrate these practices into postoperative care, addressing hindering factors. Recommendations include standardizing definitions, long-term evaluations, and comparing interventions. Limitations include study heterogeneity, publication bias, lack of blinding, and protocol variations, potentially impacting result validity and generalizability.
References
Dhillon, G., Buddhavarapu, V. S., Grewal, H., Munjal, R., Verma, R. K., Surani, S., & Kashyap, R. (2023). Evidence-based Practice Interventions for Reducing Postoperative Pulmonary Complications: A Narrative Review. The Open Respiratory Medicine Journal, 17(1). http://dx.doi.org/10.2174/0118743064271499231129100009
Gusenbauer, M., & Haddaway, N. R. (2020). Which academic search systems are suitable for systematic reviews or meta‐analyses? Evaluating retrieval qualities of Google Scholar, PubMed, and 26 other resources. Research synthesis methods, 11(2), 181-217. https://doi.org/10.1002/jrsm.1378
Harari, M. B., Parola, H. R., Hartwell, C. J., & Riegelman, A. (2020). Literature searches in systematic reviews and meta-analyses: A review, evaluation, and recommendations. Journal of Vocational Behavior, 118, 103377. https://doi.org/10.1016/j.jvb.2020.103377
McClinton, T. D. (2022). A guided search: Formulating a PICOT from assigned areas of inquiry. Worldviews on Evidence‐Based Nursing, 19(5), 426-427. https://doi.org/10.1111/wvn.12598
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