| Course | NSG 660 Scholarly Practice |
|---|---|
| Unit | Unit 5 |
| Paper type | Clinical guideline trace |
| Length | About 1,030 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | BSN |
| Updated | October 2026 |
Free sample paper for NSG 660 Unit 5
A Strong Recommendation With the Device Along for the Ride: Tracing AARC Recommendation 14.2 on Incentive Spirometry Back to Its Sources
Student Name
Department of Nursing, Herzing University
NSG 660: Scholarly Practice
Instructor Name
February 10, 2026
A Strong Recommendation With the Device Along for the Ride: Tracing AARC Recommendation 14.2 on Incentive Spirometry Back to Its Sources
The Recommendation, Quoted
The recommendation traced here is item 14.2 of the American Association for Respiratory Care guideline on incentive spirometry (Restrepo et al., 2011): "It is recommended that incentive spirometry be used with deep breathing techniques, directed coughing, early mobilization, and optimal analgesia to prevent postoperative pulmonary complications (1A)."
It was chosen because it is the recommendation this surgical floor's practice rests on. The standard postoperative order set hands every patient a spirometer and lists it first among the breathing measures, and staff defend the practice by pointing to this guideline. It is also the strongest statement in the document that includes the device.
The Strength Label and What It Means
The guideline states that its recommendations follow the GRADE system. Under that system, the number gives the strength of the recommendation and the letter gives the quality of the evidence: "1" is a strong recommendation, and "A" is high-quality evidence. The wording follows the same convention, so "it is recommended" marks a strong recommendation and "it is suggested" a weaker one. Item 14.2 therefore claims the strongest possible combination.
The labels on the neighboring items matter for the trace. Item 14.1, that the device alone is not recommended for routine use, is graded 1B. Item 14.3, that breathing exercises without a device work as well as the device, is graded 2C, a weak suggestion on low-quality evidence. Item 14.4, that routine use to prevent atelectasis after upper abdominal surgery is not recommended, is graded 1B. So the guideline rates its advice against the device used alone after abdominal surgery as strong, and its advice for the device inside a package as strong and better supported.
What the Recommendation Cites
The recommendations section of the guideline carries no citation numbers of its own. Its evidence has to be found in the body of the document, in section 3.3.1, which states that respiratory therapy including deep breathing, directed cough, early mobilization, and optimal analgesia, "with or without incentive spirometry," appears effective after thoracic, cardiac, and abdominal surgery. For abdominal surgery it cites references 23 to 29, and for analgesia references 12 to 14. The abdominal references were located and read at the level of their titles and abstracts; each is described below.
Reference 23 is a 1991 item in the Lancet by Mang and Kacmarek. It appears in the correspondence pages of that journal, a response to a trial rather than a study. Reference 24 is a randomized trial of 456 abdominal surgery patients by Hall et al. (1996), which found respiratory complications in 15% of patients given the device and 12% of patients given a mixed regimen based on risk, with no significant difference; its authors concluded that deep breathing exercises were the efficient choice for low-risk patients. The guideline lists this trial under a slightly different title from the published one. Reference 25 is a meta-analysis by Thomas and McIntosh (1994), which found the device and deep breathing exercises both better than no physical therapy after upper abdominal surgery, with no evidence of a difference between them. Reference 26, a systematic review by Pasquina et al. (2006), concluded that routine respiratory physiotherapy after abdominal surgery did not seem justified. Reference 27 is the 2009 version of the Cochrane review later updated in 2014, which found no evidence that the device prevents complications. Reference 28 is a narrative review of preoperative evaluation. Reference 29, a systematic review by Overend et al. (2001), concluded that the evidence did not support the device for reducing complications after cardiac or upper abdominal surgery.
What the Sources Support
Read together, the sources under item 14.2 support two things: that lung expansion measures in general are better than doing nothing, and that the device is not better than deep breathing exercises. None of them tests the specific claim in the recommendation, that the device should be added to deep breathing, coughing, walking, and pain control. No cited study compares that full package with the same package minus the device. The guideline's own text says as much: its evidence statement is that the package works "with or without" the device.
The recommendation's grade therefore reflects the quality of the evidence that the package helps, not evidence that the device adds anything to it. The inclusion of the device in item 14.2 reads as an expert judgment layered onto strong evidence about the package. The guideline does not label that part as consensus, and a reader who takes the 1A as applying to the device has been misled by the sentence structure rather than by the evidence.
A Second Body's Position
The American College of Physicians commissioned a systematic review of strategies to reduce pulmonary complications after noncardiothoracic surgery (Lawrence et al., 2006). It found good evidence that lung expansion interventions reduce pulmonary risk, and it listed incentive spirometry, deep breathing exercises, and continuous positive airway pressure as examples of that class, treating them as alternatives. That position is consistent with the trace: the evidence supports lung expansion, and the device is one way of achieving it, not a required addition to the others.
What the Recommendation Rests On, in Plain Words
Item 14.2 rests on good evidence that breathing exercises, coughing, walking, and pain control help patients after surgery, and on expert judgment that the device belongs in that package. The device's place is the weakest part. If the Thomas and McIntosh meta-analysis were removed, the evidence that lung expansion of any kind beats no treatment after abdominal surgery would become thinner, since it is the only cited abdominal source that reports that comparison. If any other single study were removed, the recommendation would not change, because none of them supports adding the device.
The guideline is from 2011. Its search ended in April of that year, and the trials examined in the earlier units of this course, including the bariatric trial that removed the device without harm, came later. A floor that relies on item 14.2 should rely on it for the package, not for the plastic device at the bedside.
References
Hall, J. C., Tarala, R. A., Tapper, J., & Hall, J. L. (1996). Prevention of respiratory complications after abdominal surgery: A randomised clinical trial. BMJ, 312(7024), 148-152. https://doi.org/10.1136/bmj.312.7024.148
Lawrence, V. A., Cornell, J. E., & Smetana, G. W. (2006). Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: Systematic review for the American College of Physicians. Annals of Internal Medicine, 144(8), 596-608. https://doi.org/10.7326/0003-4819-144-8-200604180-00011
Overend, T. J., Anderson, C. M., Lucy, S. D., Bhatia, C., Jonsson, B. I., & Timmermans, C. (2001). The effect of incentive spirometry on postoperative pulmonary complications: A systematic review. Chest, 120(3), 971-978. https://doi.org/10.1378/chest.120.3.971
Pasquina, P., Tramèr, M. R., Granier, J.-M., & Walder, B. (2006). Respiratory physiotherapy to prevent pulmonary complications after abdominal surgery: A systematic review. Chest, 130(6), 1887-1899. https://doi.org/10.1378/chest.130.6.1887
Restrepo, R. D., Wettstein, R., Wittnebel, L., & Tracy, M. (2011). Incentive spirometry: 2011. Respiratory Care, 56(10), 1600-1604. https://doi.org/10.4187/respcare.01471
Thomas, J. A., & McIntosh, J. M. (1994). Are incentive spirometry, intermittent positive pressure breathing, and deep breathing exercises effective in the prevention of postoperative pulmonary complications after upper abdominal surgery? A systematic overview and meta-analysis. Physical Therapy, 74(1), 3-16. https://doi.org/10.1093/ptj/74.1.3
What the NSG 660 Unit 5 instructions ask for
Unit 5 asks you to trace a guideline recommendation to its evidence. Expect to quote the recommendation, explain its strength label, identify what it cites, judge what the cited evidence supports, compare another body's position and state plainly what the recommendation rests on. Students often ask what to do when a guideline cites little and how to read strength labels. Strength labels, such as GRADE's strong or weak, describe confidence and balance of benefit and harm. When citations are thin, follow the evidence summary sections. Compare with a second organization, since disagreement is informative. A strong recommendation can rest on evidence for a broader intervention than the one it names.
Inside the NSG 660 Unit 5 example
The trace opens with the recommendation quoted exactly, with its item number. The strength section explains GRADE terms in plain language, separating confidence from quality of evidence. The citation section describes how the guideline links evidence to recommendations and what the evidence sections contain. The support section explains that evidence favors lung expansion as a bundle, not the spirometer alone. The second body section summarizes the ACP review and notes where it agrees and differs. The final section restates the recommendation's foundation in a short paragraph a staff nurse could use. The trace shows how a device can ride along on a strong label earned by the whole bundle, and every step names its source.
NSG 660 Unit 5 rubric: what full points look like
Herzing's rubric for a guideline trace usually covers the quoted recommendation, the strength label, the cited evidence, judgment of what it supports, comparison with another body and a plain summary. Most marks go to judging what the cited evidence actually shows, since a strong label can rest on evidence for something broader than the item named. Quotation points reward exact wording and the item number. Strength criteria look for a correct explanation of GRADE terms. Citation points go to an honest account of what is cited and what is missing. Comparison earns credit when a second organization's view is weighed rather than listed. A plain summary a staff nurse could use is often credited. The guideline's date should be noted. The AARC guideline by Restrepo and colleagues and the ACP review by Lawrence and colleagues anchor the trace.
NSG 660 Unit 5 help: mistakes that cost points
Guideline traces in Unit 5 often slip by accepting a strong label without checking the evidence. Another frequent problem is paraphrasing the recommendation instead of quoting it. Students often misread GRADE strength as quality of evidence alone. Missing citations are not noticed. A second body's position is skipped. The plain summary is missing. The guideline's date is not noted, though newer trials may change the picture. The difference between a bundle and a single device is missed. Finally, say what the recommendation rests on in plain words, because graders reward a trace that a staff nurse could use to question a habit.
Get a NSG 660 Unit 5 example written to your instructions
Send the Unit 5 instructions and the rubric from your NSG 660 classroom, and name the guideline and the recommendation the trace should work on. We write a custom example that quotes the wording, records the label with its definition, opens the citations in order and reports the consensus points. First custom sample free, back in 24 to 48 hours.
More NSG 660 papers and BSN samples
- NSG 660 Unit 1: Practice question refinement
- NSG 660 Unit 2: Single study read-through
- NSG 660 Unit 3: Source credibility comparison
- NSG 660 Unit 4: Study comparison grid
- NSG 660 Unit 6: Practice change proposal
- NSG 660 Unit 7: Evidence presentation for colleagues
- NSG 660 Unit 8: Scholarly reading portfolio
- NSG 122 Unit 5: Patient needs ordering brief
- NSG 123 Unit 5: Preoperative and postoperative record
- NSG 124 Unit 5: Monitoring and counseling brief
- NSG 126 Unit 5: Citation and reference set
NSG 660 Unit 5 questions, answered
What if the guideline cites dozens of studies?
Trace one recommendation rather than the document, and inside it read only the citations attached to that recommendation. Where even those run long, say how many there are, read the ones the guideline leans on, and state the selection openly. A trace admitting its own sampling reads better than one implying every reference was opened.
Can a published guideline be wrong?
It can be out of date, built on thin evidence, or in disagreement with another body, and reporting that is the work rather than an act of defiance. What the trace should not do is convert a finding into advice about care. Say what the recommendation rests on and where a second organization differs, and leave clinical decisions with the people who make them.
Which guidelines are acceptable to use?
Ones published by a professional body, a government agency or a recognized panel, reachable in full text so the citations can be opened. Internal protocols from an employer are not usable in a submitted file even when they are better written. Record the publication year and check whether a newer version exists before the trace begins.
Where can I find a free NSG 660 Unit 5 sample paper?
The full NSG 660 Unit 5 guideline trace is free on this page, one AARC recommendation followed to its evidence and compared with ACP. A trace of a different recommendation can be prepared on request.
What does a strong guideline recommendation mean?
Under GRADE, strong means the authors are confident benefits outweigh harms for most patients. This sample shows that a strong recommendation on lung expansion can rest on evidence for breathing exercises rather than on the spirometer itself.