Translating Evidence into Practice: A Systematic Review of Chest Physiotherapy for Pediatric Acute Bronchiolitis and an Evaluation of EBP Outcomes

Wednesday, 1 August 2012: 10:50 AM

Hsin-Mei Ho, BSN, RN1
Yueh-Yen Fang, PhD, RN2
Heng-Hua Wang, BSN, RN1
Pao-Ping Shao, BSN, RN1
Weng-Ya Chun, BSN, RN1
Kuan-Ling Chou, BSN, RN1
(1)Department of Nursing, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
(2)School of Nursing, Fooyin University, Kaohsiung, Taiwan

Learning Objective 1: The learner will be able to understand the limitation of present evidence in supporting the practice of chest physiotherapy in acute pediatric bronchiolitis.

Learning Objective 2: The learner will be able to describe the physiological and emotional differences between children who received chest physiotherapy and those who do not.

Acute bronchiolitis is a major respiratory problem in children under two years old. Chest physiotherapy (CP) is routinely integrated into its treatment but the effectiveness of this procedure in improving respiratory functions is inconsistent concluded across research evidence. The current project intended to resolve problems evolved from the CP in children under two years old. The EBP team of a pediatric nursing unit conducted a systematic review to evaluate effectiveness of CP in treating pediatric bronchiolitis. A literature search using eight English and Chinese databases located four randomized clinical trials from 159 citations. Results of the review presented a lack of evidence to support utilization of CP in treating bronchiolitis and limited research quality of these primary studies. Results of the review and the experience of nurse clinicians who provided the CP were communicated among multidisciplinary professionals. Practice protocols were changed based on the evidence-based decision. After the implementation of the evidence-based decision of discontinuing the CP order, physiological indicators of respiratory functions and emotional distress between children under two who received or not received CP were compared to evaluate the outcome of the evidence-based decision. Results of the evaluation indicated that there was no physiological difference among children of CP and no CP groups. The qualitative exploration from five nurses’ observations presented that children under two years old showed fear, crying, sleep disruption, and increased respiration and agitation after CP. Children without CP presented a stable state of emotion and respiration, and full eight-hour overnight sleep. Parents of these children also presented lower care-giving stress and anxiety on their face.