| Course | NSG 660 Scholarly Practice |
|---|---|
| Unit | Unit 6 |
| Paper type | Practice change proposal |
| 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 6
Breathe, Cough, Walk, and a Spirometer Only for Those at Higher Risk: A Practice Change Proposal for Adults After Abdominal Surgery
Student Name
Department of Nursing, Herzing University
NSG 660: Scholarly Practice
Instructor Name
February 17, 2026
Breathe, Cough, Walk, and a Spirometer Only for Those at Higher Risk: A Practice Change Proposal for Adults After Abdominal Surgery
Current Practice, in Steps
On this composite 30-bed general surgical floor, the postoperative order set for abdominal surgery runs as follows for every adult patient. In the recovery unit, a respiratory therapist or nurse gives the patient an incentive spirometer, sets the marker, and shows one breath. On arrival to the floor, the order reads "incentive spirometer 10 times per hour while awake." Every four hours the nurse charts "IS encouraged" in a checkbox; there is no field for how many breaths were taken or what volume was reached. Deep breathing and coughing are not ordered separately. Walking is ordered as "ambulate as tolerated," with no number of walks. Pain is managed by the surgical team's standard order set.
In practice, as recorded in Unit 1, many devices go unused, the charting records encouragement rather than use, and the one measure the evidence supports most consistently, walking, has no target.
The Reading Behind the Change
The reading done in Units 2 to 5 supports three statements. First, after upper abdominal surgery the pooled trials show no complication benefit from the device (do Nascimento Junior et al., 2014). Second, the professional guideline for respiratory therapists advises against the device used alone and grades its advice strongly, while supporting deep breathing, directed coughing, early mobilization, and good pain control as a package (Restrepo et al., 2011). Third, removing the device from usual care after bariatric surgery made no detectable difference to oxygen levels or complications (Pantel et al., 2017).
The evidence does not support removing the device for everyone. The trials mostly enrolled lower-risk patients, none measured whether patients used the device, and one randomized trial in abdominal surgery concluded that the device was the efficient choice for high-risk patients while deep breathing suited low-risk patients (Hall et al., 1996). The proposal is therefore limited to what the sources support: structured breathing and walking for everyone, and the device kept for patients at higher risk.
The Change
For adults after abdominal surgery on this floor, the automatic incentive spirometer order is replaced by a nurse-led breathe, cough, and walk routine (ten slow deep breaths with a held breath and a supported cough each waking hour, and at least three walks a day from the first day after surgery), with the spirometer ordered only for patients who meet a higher-risk flag: chronic obstructive pulmonary disease or asthma, current smoking, age 70 or over, or an upper abdominal incision.
What it replaces: the default spirometer for every patient, the "10 times per hour" order, and the "IS encouraged" checkbox. What it adds: a checkbox replaced by two numbers the nurse records every four hours, the number of walks since the last check and whether the patient could demonstrate the breathing routine. Who is affected: all nurses on the floor, the recovery unit staff who issue devices, respiratory therapy, and the surgical team who own the order set.
Who Must Approve
Because the change alters a physician order set, it needs the surgical department's order set committee, with the section chief of general surgery as the signing member. Nursing documentation changes need the nursing practice council. The respiratory therapy manager must agree, since therapists currently issue devices in the recovery unit. The unit manager sponsors the trial on this floor. A charge nurse cannot authorize this change alone, and the proposal is written for the order set committee as its first reader.
How the Trial Would Start
The first two weeks are the part most likely to fail, so they are planned in detail. Before the start date, the floor's educator and one respiratory therapist would run three ten-minute huddles, one on each shift, showing the breathing routine and the new documentation fields. The routine is printed on a single card left at every bedside, in plain language, with a line for the family: "Help him walk three times today." The higher-risk flag is built into the order set as four checkboxes, so the surgeon or resident answering them decides whether a spirometer is ordered, and the recovery unit issues devices only to flagged patients.
Two predictable problems are addressed in advance. Patients who already have a device from a preoperative clinic will keep it; the change removes the automatic order, not patients' own equipment. And nurses who believe the device helps may keep encouraging it for unflagged patients. That is acceptable during the trial as long as the breathing routine and walks are also done and recorded, because the question being tested is whether the floor can deliver the package reliably, not whether a device is forbidden.
Measure, Baseline, and Review
Primary measure: the share of adults after abdominal surgery who need new supplemental oxygen on the floor after the first postoperative day, or who are diagnosed with postoperative pneumonia, before discharge. A three-month look-back on the floor's records found 11 of 142 such patients (7.7%) met this definition. The data come from the medication record and the problem list, and the floor's quality nurse can count them monthly without a request to another department.
Process measure: the proportion of patients with three or more recorded walks on the first day after surgery. The baseline cannot be counted from current charting, because walks are not recorded; the first two weeks of the trial will establish it.
Review point: the order set committee will receive the counts at three months, on a date fixed when the trial begins, with at least 120 patients expected in that period.
When the Change Should Be Reversed
The change should be reversed if, at three months, the share of patients needing new oxygen or diagnosed with pneumonia is above 10%, a rise that would be unlikely to arise by chance from the 7.7% baseline with this number of patients. It should also be reversed if nurses report, through the council, that the breathing routine is not being done, since removing the device without delivering its replacement would leave patients with less than before. Either result would mean returning to the old order set while the floor examines why the replacement failed.
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
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
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
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
What the NSG 660 Unit 6 instructions ask for
Unit 6 asks you to propose a practice change based on the evidence you have read across the course. Expect to describe current practice, summarize what the reading supports, specify the change, name approvers, plan the start, choose a measure with a starting value and a review point, and state when the change should be reversed. Students often ask how specific the change should be and who must approve. Be specific enough that a nurse on any shift could follow it. Order set changes need medical approval as well as nursing support. The first weeks matter most, so plan education, supplies and documentation. Choose a measure the unit already collects. A reversal condition shows honesty about evidence that is mixed.
How the NSG 660 Unit 6 example is put together
The proposal opens with current practice in numbered steps. The evidence section states three supported claims with sources. The change section describes the new routine and the criteria for keeping the device. The approval section names the order set committee and nursing practice council. The start section plans the first two weeks day by day. The measure section defines the primary outcome, gives a baseline from recent months and sets a review. The reversal section names the threshold for going back. The proposal reads as ready to submit, and each element traces back to earlier reading. Documentation is planned too, with a simple walk count and a breathing checkbox replacing the spirometer volume field.
Reading the NSG 660 Unit 6 rubric
Herzing's rubric for a practice change proposal typically covers current practice, the evidence summary, the specific change, approvals, implementation start, measurement and reversal criteria. Measurement and reversal criteria draw the closest reading, because a change built on mixed evidence must be testable and reversible. Current practice points reward a step-by-step description. Evidence criteria look for supported claims with sources from earlier units. Change points go to specific actions and clear criteria for who keeps the device. Approval earns credit when the order set committee and practice council are named. A detailed plan for the first two weeks is often credited. A baseline from recent months is expected. The Cochrane review and Canet's ARISCAT risk score support the proposal.
NSG 660 Unit 6 help before you submit
A Unit 6 practice change proposal often weakens when the change is vague, such as encourage breathing exercises. Another frequent problem is skipping who must approve an order set change. Students often plan the change but not its start. Measures lack baselines. Reversal conditions are missing. Higher-risk patients are not defined, so nurses cannot tell who keeps the device. Evidence is overstated. Documentation of walks and breathing is not planned. Physician and surgeon concerns are not anticipated. Finally, say when you would go back, because graders reward a proposal that treats the change as a test rather than a certainty.
Get a NSG 660 Unit 6 example written to your instructions
Send the Unit 6 instructions and the rubric from your NSG 660 classroom, along with the routine the change should alter. We write a custom example that describes current practice in steps, states the evidence with its limits, names the approver by role and ends on a baseline carrying its reversal condition. First custom sample free, returned 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 5: Clinical guideline trace
- NSG 660 Unit 7: Evidence presentation for colleagues
- NSG 660 Unit 8: Scholarly reading portfolio
- NSG 233 Unit 6: High acuity case file
- NSG 298 Unit 6: Readiness self-audit
- NSG 421 Unit 6: Chart access boundary record
- NSG 423 Unit 6: Staffing and safe practice argument
NSG 660 Unit 6 questions, answered
Does the change have to be one I could really make?
In many sections yes, and the constraint improves the paper. A change inside one routine on one kind of floor can be described exactly, approved by somebody you can name by role, and measured with a number a nurse can count. Proposals aimed at a whole organization tend to lose the specificity the rubric is reading for.
Where does the baseline number come from?
Not from an employer's reports, which are not available for a submitted file. Where the instructions expect a figure, use published rates from the literature and label them as such, or describe how the baseline would be collected in the fortnight before the change starts. An honest method beats a number with no source attached.
How much evidence does the proposal need behind it?
Enough to support the specific alteration rather than the general subject. Two or three sources read closely, with what they support stated exactly, carry more weight than a list of ten. Where the evidence supports something narrower than the proposal, say so and narrow the proposal, since that adjustment is itself the reasoning the section rewards.
Where can I find a free NSG 660 Unit 6 sample paper?
Read the complete NSG 660 Unit 6 practice change proposal here at no charge, breathe, cough and walk with a measure and a reversal point. Ask for a custom proposal on your own evidence.
What can replace incentive spirometers after surgery?
Hourly deep breathing and supported coughing while awake, plus early walking, are supported by evidence. This sample proposes those for all abdominal surgery patients and keeps the device for higher-risk patients.