Nurturing the Seeds of Evidence-Based Practice

Abstract

Background: Management of cardiovascular diseases is an essential and a timely global health issue. Extensive research on early ambulation for cardiac surgery patients has been conducted, but no evidence-based paper has evaluated the overarching effects in improving patient care outcomes. Objectives: To evaluate the effects of early ambulation on cardiac surgery patients on improving patient care outcomes. Methods: A systematic review was conducted. Six electronic database were searched: Health source: Nursing/ Academic Edition, CINAHL, Cochrane Library, MEDLINE, The National Guidelines Clearinghouse, and The Joanna Briggs Institute from 2000–2015. Each study was appraised using different quality tools: for observational cohort and cross sectional studies, randomized controlled trial, and systematic review/ meta-analysis is used National Heart, Lung, and Blood Institute Quality Assessment Tool, and for the clinical guideline,the AGREE (Appraisal of Guidelines, Research and Evaluation) collaboration tool. Results: The evidence-based review involved five-thousand fifty-one (n = 5051) participants, with study sizes ranging between 31–4091 patients. Early ambulation time ranges from 2–4 hours after the patient has been stabilized while the late ambulation ranges from 12–24 hours. As to the patient outcomes, three studies utilized vascular complications as an outcome: hematoma, bleeding, false aneurysm, and arteriovenous fistula. Secondary end points were also considered, such as patient comfort, lesser hospital costs (where early ambulatory patients have lesser charge of US$105), vasovagal collapse, back pain (OR = 0.19, 95% CI: 0.08–0.45, p < 0.001), urinary problems(OR = 0.35, 95% CI:0.14–0.90, p = 0.03), mixed venous oxygen saturation using ejection fraction, and lastly general well-being and satisfaction level (p = 0.0005 for vitality scale and p = 0.014 for the total general well-being). Conclusion: Evidence from the review indicates that early ambulation may improve patient care outcomes. Caution may be instated since there are idiosyncratic effects that can pose problems toward the patients such as arrhythmia or bleeding. Overall, healthcare providers may render cost-effective and scientifically-grounded interventions.