Nurturing the seeds of evidence-based practice: Early ambulation among cardiac surgery patients

ABSTRACT

BACKGROUND: Cardiovascular disorders continue to be the most prevalent cause of morbidity and mortality in the Philippines and worldwide. Surgical treatments used to manage cardiovascular disorders (unfortunately) have multiple complications. As part of the health care team, nurses need to develop interventions that are safe, scientifically grounded, and cost-effective in order to counteract these complications. One of the nursing interventions that can be implemented is nearly ambulation. AIM: To search, appraise and synthesize the best evidence surrounding early ambulation among cardiac surgery patients. METHODS: This study employed an evidence-based review method suggested by Melnyk and Fineout-Overholt (2005). Systematic literature search was done to the following databases Cochrane, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Joana Briggs Institute (JBI), MEDLINE, National Guideline Clearinghouse (NGC), and Nursing/Academic edition. Post-operative patients who have undergone coronary artery bypass surgery(CABG), percutaneous coronary intervention (PCI), and transfemoral cardiac catheterization (TCC) are included in this study. The final review also included six articles. RESULTS AND DISCUSSION: Findings show that early ambulation among patients who underwent coronary artery bypass surgery(CABG), percutaneous coronary intervention (PCI), and transfemoral cardiac catheterization (TCC) improves patient care outcomes (i.e., reduce complications such back pain, puncture bleeding,and urinary discomfort, improves general well-being, and decrease health care costs).Parameters for early ambulation (ranges from 3 hours to 24 hours)and late ambulation (ranges from 12 hours to 48 hours) are used in the study reviewed. The non-randomized comparative study found that the complication rate in the early ambulation group is not increased compared to the late ambulation group (test for non-inferiority p=0.002). Randomized controlled trial found out that early ambulation among cardiac surgery patients could reduce back pain (OR=0.19, 95% Cl 0.08-0.45, p CONCLUSION AND RECOMMENDATIONS: This evidence-based practice (EBP) review ascertains that early ambulation among postoperative coronary artery bypass surgery (CABG), percutaneous coronary intervention (PCI), and transfemoral cardiac catheterization (TCC) could improve patient care outcomes such as reduction of complication rate, improvement of general well-being, and decrease of healthcare costs. This study, therefore, recommends the use of early ambulation among CABG,PCI, and TCC postoperative patients to complete the last two phases of evidence-based practice.