NSG 660 Unit 8 scholarly reading portfolio example

One Question About Incentive Spirometry, Eight Weeks of Reading: A Portfolio With the Early Mistakes Left In and Annotated

Student Name

Department of Nursing, Herzing University

NSG 660: Scholarly Practice

Instructor Name

March 3, 2026

One Question About Incentive Spirometry, Eight Weeks of Reading: A Portfolio With the Early Mistakes Left In and Annotated

Piece 1: The Question in Its First Form

Original, as said at the nurses' station on the composite surgical floor: "Nobody uses these things. Do they even work?"

Annotation: the sentence packs three problems into one: the effect of the device, the habits of the patients holding it, and the value of a checkbox nobody reads. Unit 1 separated them and set the second and third aside. That decision turned out to be half wrong, as the commentary after Piece 3 explains.

Commentary: From Question to Search

The first question could not be searched, so it produced the four drafts in Unit 1, ending with a PICO question about adults after abdominal surgery, the device added to breathing, coughing, and walking, compared with those measures alone, and new oxygen needs or pneumonia as the outcome. The drafting forced a decision the original complaint had hidden: the real comparison on this floor was never device versus nothing, because every patient on this floor already gets breathing exercises.

Piece 2: The Search Record, Including What Failed

The final PubMed search is in Unit 1, with each step's count. Two attempts that returned nothing useful are recorded here because they changed the approach. A first search restricted to the last ten years returned mostly cardiac and thoracic studies and removed the abdominal surgery trials from 1991 and 1996 that the guideline still cites; the date limit was dropped. A CINAHL search for nursing studies on spirometer adherence returned surveys of staff opinion and no measurement of patient use; that search was not repeated, and its failure is itself a finding about the literature.

Annotation: the Unit 1 document said the search did not change the question. That was true of the wording. It was not true of the scope, because the failed adherence search is what later pulled a cardiac surgery trial into the reading.

Piece 3: Appraisals, Shortened, Not Rewritten

Unit 2, the bariatric trial (Pantel et al., 2017), shortened: a randomized noninferiority trial in 224 mostly middle-aged women after weight-loss surgery; removing the device made no detectable difference to low oxygen levels or 30-day complications. The comparison matches our question; the population does not. The trial reports what patients were told to do, not what they did.

Unit 3, four sources compared, shortened: the Cochrane review (do Nascimento Junior et al., 2014) is the strongest source for our population and finds no evidence of benefit; the guideline (Restrepo et al., 2011) advises against the device used alone; the reminder trial in cardiac surgery (Eltorai et al., 2019) is the only source that measured use; the consumer page promises healthier lungs while citing a review that found no general benefit.

Annotation on Unit 3: that document called the reminder trial poor in fit because it was in cardiac surgery. The judgment was correct about the population and too quick about the question. Because the adherence question set aside in Piece 1 had no abdominal surgery evidence at all, the cardiac trial became the only evidence available for it. The original decision to set adherence aside is the early judgment that did not survive.

Commentary: What the Appraisals Did to the Comparison

The appraisals changed what the comparison grid in Unit 4 had to do. Reading the trials one at a time made it clear that they measured different things under the same name, so the grid was built with the outcome definition in its own column. That column produced the main finding of the whole course: the studies agree that the routine device makes no measurable difference, but they agree across several different definitions of complication, and only one trial tested the comparison in our question.

Piece 4: The Comparison and the Guideline Trace, in Brief

Unit 4 set five studies in one grid and concluded that handing out the device with a standard order has no demonstrated effect on complications after abdominal surgery, and that whether use which is measured and supported would do better remains unknown. Unit 5 then traced the guideline's strongest recommendation that includes the device, graded 1A, and found that its cited sources support breathing, coughing, walking, and pain control as a package, with the device's place in it resting on judgment rather than on a study that tested it.

Annotation: the trace was the piece that most changed my reading habits. Before it, a 1A label would have ended the question for me.

Piece 5: The Change and Its Measure

Unit 6 proposed swapping the default spirometer order for hourly deep breaths, supported coughs, and three daily walks, led by nurses, for all adults after abdominal surgery, keeping the device for patients with a higher-risk flag, with a baseline of 11 in 142 patients (7.7%) with a new oxygen need or pneumonia, a review at three months, and reversal above 10%. Unit 7 turned it into a five-minute huddle presentation. The risk flag came directly from the one abdominal trial that compared approaches by risk (Hall et al., 1996), which is why the proposal is narrower than the evidence summary alone would suggest.

What I Now Read Differently

Looking back across the eight weeks, the most useful habit the course built was keeping the earlier versions. Each time a later unit contradicted an earlier one, the earlier document was still there to show what I had believed and why, which made it possible to see whether the change came from new evidence or from a better reading of evidence I already had. Most of the changes turned out to be the second kind.

I now read the methods section before the abstract's conclusion, and I look for what the comparison group actually received before I look at any result. I read strength labels as two separate claims, one about how firmly a body recommends and one about how good the evidence is. And I no longer treat a population mismatch as a reason to discard a study; I ask which part of my question the study can still answer. The judgment from the first week that has not survived is that adherence was a separate problem. It was the problem the literature could least answer, and it is where the proposal's trial will have to produce its own evidence.

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

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