Structured Preoperative Nurse-Led Education on Incentive Spirometer Use to Reduce Postoperative Pneumonia in Elderly Surgical Patients
Overview
This paper identifies a discrepancy in preoperative care for patients over 65 undergoing non-cardiac surgery, noting that while structured education on incentive spirometer use is recommended to prevent postoperative pneumonia, many patients do not receive consistent, high-quality instruction. The authors propose a hypothesis that structured preoperative nurse-led education on incentive spirometer use will improve postoperative compliance and reduce pneumonia incidence in this vulnerable population.
What this research paper covers
- Problem identification: postoperative pneumonia in elderly patients causes prolonged hospital stays, increased costs, and higher mortality
- Current discrepancy: gap between recommended preoperative spirometer education and actual inconsistent practice in surgical settings
- Supporting evidence: four key facts establishing the relationship between preoperative spirometry training, patient compliance, and reduced pulmonary complications
- Hypothesis and research question: testing whether structured nurse-led education reduces postoperative pneumonia incidence compared to standard care
Preview
Discrepancy Problem and Hypothesis
Big Problem: Postoperative pneumonia in persons over 65 years of age causes prolonged hospital stays, increased healthcare costs, and higher mortality risk in the United States (Cong et al., 2025).
Current Discrepancy: All patients over 65 undergoing non-cardiac surgery should receive structured preoperative education on the proper use of an incentive spirometer (IS) to promote lung expansion and reduce complications, but many do not receive consistent, high-quality preoperative teaching on incentive spirometer use.
Four facts that help to build the current argument about the problem:
- Preoperative training with incentive spirometry improves patient technique, compliance, and can reduce postoperative pulmonary complications, including pneumonia (Bilyy et al., 2020).
- Elderly patients (over 65) undergoing non-cardiac surgery have a significantly elevated risk of developing postoperative pneumonia, with incidence rates reported as high as 7.1% in large cohorts (Cong et al., 2025).
- Proper and consistent use of an incentive spirometer promotes lung expansion and helps prevent postoperative pulmonary complications such as atelectasis and pneumonia (Bilyy et al., 2020).
- Structured preoperative education by nurses on incentive spirometer use is a recommended component of perioperative care to prepare patients for effective postoperative breathing exercises.
However, in many US surgical settings, preoperative education on incentive spirometer use remains inconsistent due to time constraints, varying nurse training, and lack of standardized protocols, leaving many older adults inadequately prepared (the current problem).