In a paper of 1,250-1,500 words, select 4 of the 6 articles you evaluated that demonstrate clear support for your evidence-based practice and complete the following for each article: 1. Introduction – Describe the clinical issue or problem you are addressing. Present your PICOT statement. 2. Search methods – Describe your search strategy and the criteria that you used in choosing and searching for your articles. 3. Synthesis of the literature – For each article, write a paragraph discussing the main components (subjects, methods, key findings) and provide rationale for how the article supports your PICOT. 4. Comparison of articles – Compare the articles (similarities and differences, themes, methods, conclusions, limitations, controversies). 5. Suggestions for future research: Based on your analysis of the literature, discuss identified gaps and which areas require further research.
Literature Review
One of the major challenges that come with surgery, especially surgeries with long recovery periods like Coronary artery bypass grafting (CABG) is immobilization. Long periods of immobilization have been associated with several adverse effects that affect the patient’s general well-being in the short and long run. Some issues related to immobilization include intensive care unit (ICU)-acquired weakness (ICU-AW), which in turn results in longer hospitalization period and cost of care, increased risk of getting pressure ulcers, and long-term mobilization issues, for example, reduced functional range of motion, and depressed recovery of functional walking capacity, to list a few (Borges et al., 2022).
Early mobilization is one of the interventions suggested by scholars that can help improve patient outcomes for patients who have undergone surgery or are admitted to the ICU. This paper will therefore evaluate the literature on the option of using early mobilization using the following PICOT question; In adult patients after coronary artery bypass graft surgery, what is the impact of early mobilization compared to delayed mobilization in preventing postoperative complications during the first week of postoperative hospital stay?
Search Methods
Having the right search strategy is critical in collecting quality evidence to implement an evidence-based quality improvement change initiative or a clinical inquiry. The first step when conducting a literature search is to identify the right databases from which quality and relevant evidence can be collected. In this case, some of the databases that were considered when looking for the articles include PubMed, CINHAL Plus with full text, Medline, ScienceDirect, and Cochrane Library of Systematic Reviews. After identifying the databases, the researcher conducted a planned search using keywords relevant to the PICOT question.
Some keywords considered included early mobilization after surgery, early mobilization interventions, and enhanced recovery for CABG surgery. The use of Booleans AND and OR were used to narrow and specify the research results to capture articles that were relevant to the PICOT question. Research results were then filtered to only capture peer-reviewed articles and limited the search results to only articles written within the past five years. The researcher then selected the most relevant articles from the list to incorporate into the literature review.
Synthesis of Literature
The first article selected for review is the article by Allahbakhshian et al. (2023). The authors wanted to find out the effects of various early mobilization strategies on patient outcomes. Some outcomes considered in the study include postoperative cognitive dysfunction (POCD), length of hospital stay (LOS), and pain intensity in patients undergoing CABG. The research selected 120 patients undergoing CABG surgery who were randomly assigned to the various intervention and control groups. The participants had almost similar demographic and clinical characteristics. The study was a randomized controlled trial where the participants were assigned to two intervention groups and one control group.
Participants in the first intervention group received a four-phase early mobilization protocol; those in the second intervention group received a three-phase early mobilization protocol; while those in the control group received routine care. The study findings revealed that early mobilization protocol focused on deep breathing exercises and chest physiotherapy had better postoperative outcomes, including POCD and LOS. The results were better than those placed in early mobilization protocol focused on passive and active range of motion activities or routine care. The study provides evidence of the effect of early mobilization on outcomes for patients after CABG. The study also gives directions on the most effective early mobilization protocol for the target population.
The second study is a research by Esmealy et al. (2023). The authors wanted to compare the effects of different mobilization protocols on respiratory parameters and complications in patients following CABG. The participants in the study included 120 participants with comparable demographic and clinical characteristics, who were randomly assigned into three groups. The first group involved a four-phase early mobilization protocol, the second a three-phase early mobilization protocol and the final group was the control group.
The researchers measured the parti