| Course | NSG 660 Scholarly Practice |
|---|---|
| Unit | Unit 4 |
| Paper type | Study comparison grid |
| Length | About 680 words, 5 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | BSN |
| Updated | October 2026 |
Free sample paper for NSG 660 Unit 4
Five Studies of Incentive Spirometry in One Grid: What "Pulmonary Complications" Meant in Each, and What the Set Supports for an Abdominal Surgery Floor
Student Name
Department of Nursing, Herzing University
NSG 660: Scholarly Practice
Instructor Name
February 3, 2026
Five Studies of Incentive Spirometry in One Grid: What "Pulmonary Complications" Meant in Each, and What the Set Supports for an Abdominal Surgery Floor
How the Columns Were Set
The columns were fixed before any study was entered, so that each one means the same thing in every row. Design and citation come first. Population and setting follow, because everything to the right of them has to be read in their light. The third column records what was actually compared, since "incentive spirometry" was tested against different things in different studies. The fourth holds the outcome and its exact definition, kept apart from the result so that two studies using the same name for different measurements can be seen side by side. The fifth gives the result as a direction and a size, with the number of participants. The last column judges fit to the working question from Unit 1, which concerns adults after abdominal surgery on a general surgical floor, with the device added to deep breathing, coughing, and walking.
Five studies were chosen from the Unit 1 search: two systematic reviews and three trials, covering abdominal, cardiac, and bariatric surgery. Studies were entered as reported, without smoothing their differences.
The Grid
Each row is one study; each column holds only what its heading names.
| Citation and design | Population and setting | What was compared | Outcome and exact definition | Result: direction and size (n) | Fit to the working question |
|---|---|---|---|---|---|
| Hall et al. (1991); randomized trial | Adults having abdominal surgery; single teaching hospital, Australia | Device used for 5 minutes each waking hour vs conventional chest physiotherapy | Pulmonary complications, a composite of clinical signs, fever, chest X-ray changes, sputum pathogens, and respiratory failure | No difference: 15.8% vs 15.3% (n = 876) | Good on population; the comparison is device vs physiotherapy, not device added to usual care |
| Cochrane systematic review (do Nascimento Junior et al., 2014) | Adults after upper abdominal surgery, including laparoscopic; 12 trials | Device vs no treatment, deep breathing, or other chest physiotherapy | All-cause postoperative pulmonary complications as each trial defined them, pooled by comparison | No evidence of benefit; device vs no treatment RR 0.59, 95% CI 0.30 to 1.18 (1,834 total; 1,160 analyzable) | Good on population; trials did not report adherence |
| Freitas et al. (2012); Cochrane systematic review | Adults after coronary artery bypass surgery; 7 trials | Device vs physiotherapy, positive pressure breathing, breathing techniques, or education | Any pulmonary complication; lung function and oxygenation | No difference in complications; lung function and oxygenation worse with the device than with positive pressure breathing (n = 592) | Poor; cardiac surgery with sternotomy |
| Pantel et al. (2017); randomized noninferiority trial | Adults after bariatric surgery; single referral center, U.S. | Device with hourly order vs no device | Hypoxemia, saturation below 92% on room air at 6, 12, and 24 hours; 30-day pulmonary complications | No difference; e.g., 11.9% vs 10.4% hypoxemic at 6 h; complications 7.1% vs 3.6% (n = 224) | Good on comparison; younger patients, mostly laparoscopic upper abdominal surgery |
| Eltorai et al. (2019); randomized trial | Adults after coronary artery bypass surgery; teaching hospital, U.S. | Device with hourly reminder bell on vs the same device with bell off | Radiographic atelectasis severity score, 0 to 10, on the final chest X-ray before discharge | Less atelectasis with the reminder: mean 1.5 vs 1.8; breaths per day about 35 vs 17 (n = 145 per protocol) | Poor on population; the only study measuring actual use |
Where the Studies Agree
Four of the five find no benefit from the device as usually given, and they reach that result in different populations, with different comparators, over more than twenty-five years. Hall et al. (1991) found almost identical complication rates in 876 abdominal surgery patients whether they used the device or received physiotherapy. The two Cochrane reviews found no evidence of benefit in abdominal or cardiac surgery (do Nascimento Junior et al., 2014; Freitas et al., 2012). The bariatric trial found no difference when the device was removed altogether (Pantel et al., 2017). That consistency, across settings, is the strongest feature of the set.
Where the Agreement Is an Artifact
Reading down the outcome column shows that "pulmonary complications" does not mean one thing. In Hall et al. it is a broad composite that includes a fever or an abnormal X-ray. In the Cochrane reviews it is whatever each included trial called a complication, pooled together. In the bariatric trial the main outcome is a saturation reading at fixed hours, and complications are a secondary 30-day count. In the reminder trial the outcome is an X-ray score, which is not a complication at all. So when four studies "agree" that the device does not prevent pulmonary complications, they are agreeing across several different measurements, some of which a floor nurse would never see.
The comparison column shows a second artifact. Only the bariatric trial compared the device with no device on top of the same usual care, which is the comparison in the working question. Hall et al. and the reviews mostly compared the device with another active treatment, such as physiotherapy. A finding of "no difference from physiotherapy" means the device is about as good as physiotherapy, not that it adds nothing to it.
What the Set Supports
Taken together, the five studies support one claim with reasonable confidence: handing patients the device with a standard order, as this floor does, has not been shown to reduce pulmonary complications after abdominal surgery, whether it is compared with physiotherapy or with no device. They do not support the stronger claim that the device can never help. The only study that measured and increased actual use found a modest radiographic improvement in cardiac surgery patients (Eltorai et al., 2019), and none of the abdominal surgery studies measured use at all.
For the working question, the set therefore points toward treating the device as optional and focusing nursing time on the measures in the comparison arm, deep breathing, coughing, walking, and pain control, while noting that the evidence cannot say whether supported, measured use of the device would add anything for older patients after open surgery. That is the gap a practice change on this floor would have to respect.
References
do Nascimento Junior, P., Módolo, N. S., Andrade, S., Guimarães, M. M., Braz, L. G., & El Dib, R. (2014). Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery. Cochrane Database of Systematic Reviews, (2), Article CD006058. https://doi.org/10.1002/14651858.CD006058.pub3
Eltorai, A. E. M., Baird, G. L., Eltorai, A. S., Healey, T. T., Agarwal, S., Ventetuolo, C. E., Martin, T. J., Chen, J., Kazemi, L., Keable, C. A., Diaz, E., Pangborn, J., Fox, J., Connors, K., Sellke, F. W., Elias, J. A., & Daniels, A. H. (2019). Effect of an incentive spirometer patient reminder after coronary artery bypass grafting: A randomized clinical trial. JAMA Surgery, 154(7), 579-588. https://doi.org/10.1001/jamasurg.2019.0520
Freitas, E. R., Soares, B. G., Cardoso, J. R., & Atallah, Á. N. (2012). Incentive spirometry for preventing pulmonary complications after coronary artery bypass graft. Cochrane Database of Systematic Reviews, (9), Article CD004466. https://doi.org/10.1002/14651858.CD004466.pub3
Hall, J. C., Tarala, R., Harris, J., Tapper, J., & Christiansen, K. (1991). Incentive spirometry versus routine chest physiotherapy for prevention of pulmonary complications after abdominal surgery. The Lancet, 337(8747), 953-956. https://doi.org/10.1016/0140-6736(91)91580-N
Pantel, H., Hwang, J., Brams, D., Schnelldorfer, T., & Nepomnayshy, D. (2017). Effect of incentive spirometry on postoperative hypoxemia and pulmonary complications after bariatric surgery: A randomized clinical trial. JAMA Surgery, 152(5), 422-428. https://doi.org/10.1001/jamasurg.2016.4981
Reading the NSG 660 Unit 4 instructions
Unit 4 asks you to compare several studies in one grid and judge what they support together. Expect to set columns before entering studies, fill one row per study, identify agreement, check whether agreement is real and state what the set supports. Students often ask which columns to use and how many studies to include. Five studies is workable. Columns usually include design, sample, intervention, comparison, outcome definition, findings and limits. Setting columns first prevents shaping the grid to a favored answer. Read down each column, not just across rows, since differences in definitions can make agreement misleading. State a conclusion only as strong as the weakest shared element. Include sample size in a column so small studies are not weighed like large ones.
How this NSG 660 Unit 4 example is built
The grid opens with how columns were chosen and fixed before any study was entered. The table holds five rows, one per study, with short entries in each cell. The agreement section notes that four studies point the same way and explains how. The artifact section reads down the outcome column and shows how different definitions, from fever and cough to imaging-confirmed pneumonia, weaken the apparent agreement. The support section states a modest conclusion and explains its limits, such as few trials in older adults. Reading down columns is the grid's key move, and each entry is drawn directly from the studies, so the grid can be checked. Sample sizes sit in their own column, so the reader can see that one large trial carries more weight than two small ones.
Reading the NSG 660 Unit 4 rubric
Herzing's rubric for a study comparison grid typically covers column selection, accuracy of entries, analysis of agreement, attention to definitions and the supported conclusion. Outcome definitions draw the closest reading, because differing definitions can make studies seem to agree when they do not. Column points reward choices fixed before entry. Entry criteria look for accurate, concise data taken from the full papers. Agreement earns credit when patterns are noted with caution. Conclusion points go to claims matched to the evidence and its gaps. Mixed designs noted plainly are often credited. A readable table matters. The Cochrane review and the individual trials support the grid.
Common NSG 660 Unit 4 mistakes, and how to avoid them
A Unit 4 comparison grid often weakens when the rows are read only across. Another frequent problem is an outcome column that hides different definitions. Students often add columns after entering studies, which invites bias. Conclusions are stronger than the evidence. Entries are copied from abstracts. Limits are missing. Study designs are mixed without noting it. Sample sizes are left out, so small studies weigh as much as large ones. Populations are not compared with the writer's floor. Finally, read down the outcome column, because graders reward a grid that catches when apparent agreement is an artifact. Another gap is a grid with no column for who delivered coaching, which turns out to matter more than the device itself.
Get a NSG 660 Unit 4 example written to your instructions
Send the Unit 4 instructions and the rubric from your NSG 660 classroom, with the question and the studies the grid should hold. We write a custom example that settles the columns first, gives outcome definitions their own column, judges fit row by row and carries a reading underneath. First custom sample free, returned in 24 to 48 hours.
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NSG 660 Unit 4 questions, answered
How many studies belong in the grid?
Follow the number in the instructions, and where it is open, five read properly beats ten entered thinly. Every row has to be read closely enough to fill the outcome definition column honestly, which is slower than it looks. A short grid with a real reading under it usually scores above a long one built from abstracts.
Can the grid hold different study designs?
Usually yes, and the mixture often makes the reading interesting, provided the design column says plainly what each one is. What loses points is treating a small observational study and a randomized trial as equivalent rows in the closing prose. Say what the mixture allows the set to support and what it does not.
Does the reading underneath repeat the table?
It should not, and drafts that do lose the section. The prose exists to say what cannot be tabulated: where an agreement rests on different definitions, which result you weigh most and why, and what the set leaves unanswered. If a sentence could be replaced by pointing at a cell, it belongs in the cell.
Where can I find a free NSG 660 Unit 4 sample paper?
Read the complete NSG 660 Unit 4 comparison grid here at no charge, five spirometry studies with outcome definitions compared. Ask for a custom grid on your own studies.
Why compare outcome definitions across studies?
Studies may use the same words for different things, such as pulmonary complications meaning fever in one and confirmed pneumonia in another. This sample shows how that can make studies seem to agree more than they do.