1. RUNNING HEAD: NURSING IMPACT PROJECT: CLINICAL SUGGESTIONS
Alexander G. Skomra
Nursing Impact Project: Pulmonary Resiliency, Clinical Suggestions
NSG405 – Acute Care Nursing
March 2, 2015

2. Nursing Impact Project: Clinical Suggestions 2
“Nursing Impact Project Part IV: Clinical Suggestions”
In specific analysis regarding pulmonary efficiency in patients post cardiac surgery, it
is important to note that those patients on a ventilator only specifically benefit from certain
complimentary interventions by the nurse. In practice, ventilator-dependent post-
operative patients may not directly benefit from certain nursing interventions focused on
coughing and deep breathing, splinting, incentive spirometry, or early ambulation until
they are able to breathe independently. Also, through my observation in the past, I can
conclude that the majority of patients on ventilator assistance post-cardiac surgery are
unable to clear their own secretions, maintain their own tidal volumes, or ambulate
independently. All of this information is consistent with what I have learned in text through
my nursing curriculum, as well as through evidence-based research.
I attest that some respiratory problems associated with certain preventable
complications can be primarily addressed before surgery. Examples include education on
pain management [whether pharmacologically controlled or not], anxiety reduction, with a
focus on inspiratory muscle training and early ambulation. I feel that pre-operative nurse-
patient education for cardiac surgery plays a significant role in reduction of stress and
organization of interventions after the procedure for both parties involved.
Post-operatively, immediate complimentary modalities of the intensive care nurse
can also have influence on positive pulmonary efficiency. An emphasis by the nurse to
address sleep preservation for the patient, utilize music and message therapy to reduce
anxiety and relinquish pain, with preventing and managing delirium can prevent
pulmonary problems. I feel that in practice, based on evidence-based research, assessment

3. Nursing Impact Project: Clinical Suggestions 3
and management of patient comfort can directly affect pulmonary resilience in an intensive
care milieu.
I feel that throughout my work as a student nurse, as well as throughout my career
working in healthcare, I have both witnessed and practiced methods to control comfort.
Simple practices like therapeutic touch, reinforcement, and clear communication facilitate
the best of outcomes for patients with health problems. Specific to the idea of ensuring
pulmonary efficiency, I feel my current clinical rotation has given me insight into best
practices to promote lung function, such as early ambulation, and incentive spirometry use.
Also, I have most recently experienced the importance of suctioning, positioning, clustering
care for a patient who was ventilator dependent on the unit. All actions, in contribution
with certain methods of pain and anxiety reduction efficiently promote pulmonary
efficiency. Although not specific to post-operative cardiac care, all are still absolutely
relevant interventions.
Specific suggestions for incorporating the best-nursing based research and evidence
on this practice are focused towards nurse staff training. My recommendation, nursing
seminars addressing problems with pulmonary resilience or pain management are
essential. Understanding the productivity of a multitude of complimentary interventions,
while paired with traditional medicine, is vital for the holistic nurse to care for a post-
cardiac surgery patient. An emphasis during these seminars, most specifically on recent
evidence-based research is key. Dyspnea linked to pain and anxiety has always been of
concern in acute care. A review of content addressing the basic knowledge of pulmonary
nursing care, specific to post-operative cardiac surgery is key. Providing resources for the

4. Nursing Impact Project: Clinical Suggestions 4
staff to utilize, administering a competency skill test, and promoting teamwork in the
process will facilitate the best of compliance.
The proper data publications to provide nurses that centers on complimentary
medicine should prove its effectiveness with numerical results. A plethora of information
exists on the correlation of positive health outcome and certain complimentary
interventions. The influence of non-pharmacological nursing interventions to directly
control factors like pain and anxiety is supported with evidence. Publications can be found
at the National Institute of Health, Journal of Acute and Critical Care, and the American
Association of Critical Care Nurses to support nurses in the development of proper practice
in post-cardiac patients. Data specifically addressing the positive outcomes of music
therapy and hand message to pain reduction and pulmonary efficiency to verify successful
practice. Further data should also address nursing interventions and teaching strategies
discussed previously to compliment traditional medical practice and treatment. Above all,
after implementation of any purposed intervention, data should then be collected to prove
its productivity. For example, if recommendations are made and required substantiating
music therapy to reduce pain and anxiety, thereby promoting lung function, then proof of
quicker pulmonary resilience in the form of patient health outcome should be measured.
Essentially, the intervention should have a valid impact.