Andrzejowski, J.; Hyle, J.; Eapen, G.; Turnbull, D. (2008), refers to review of literature of previous publications, such as the study by Vanni and colleagues. This study showed an notable effect of prewarming, but was flawed both by inadequate power (10 patients per group) and by having a control group that was significantly hypothermic before anesthetic induction. Two additional studies also showed a smaller decrease in core temperature during surgery after a period of prewarming, but neither study warmed patients intraoperatively A large randomized trial of prewarming, by Melling and colleagues involved more than 400 patients. Their study looked for differences in postoperative complications and showed a significant decrease in postoperative wound infections in patients who were prewarmed either locally or systemically. The authors suggested that prewarming improved peripheral circulation in the preoperative period, thus increasing tissue oxygenation (Andrzejowski, Hyle, Eapen & Turnbull, 2008).
Theoretical of Conceptual Framework
A theoretical framework was not clearly spelled out in this research article; however research on prewarming patients in the surgical setting can be easily based on the Neuman Systems Model. This model focuses on client assessment and response to environmental stressors which is consistent with the practice of prewarming surgical patients. In this model, human beings are described as systems that consciously and unconsciously create their environments both within and around themselves (Avlward, 2010). Prewarming patients is a primary prevention intervention in relation to the Neuman Systems Model. When patients arrive in the preoperative holding area, they usually are not hypothermic. If nurses app...
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British Journal of Anesthesia. (2009, January). Effect of prewarming on patients undergoing general anesthesia. AORN, 89(1), 209-210.
Burns, N., & Grove, S. K. (2009). Strategies for promoting evidence-based nursing practice. In The practice of nursing research (pp. 616-638). St. Louis, Missouri: Saunders.
Cooper, S. (2006, May). The effects of preoperative warming on patients'postoperative temperatures. AORN, 83(5), 1074-1084.
Laureate Education, I. (Producer). (2010). Research analysis [DVD]. In Foundations in nursing practice.
Laureate Education, I. (Producer). (2010). Research design [DVD]. In Foundations in nursing practice.
Reavy, K., & Tavernier, S. (2008, April). Nurses reclaiming ownership to their practice: Implementation of an evidence-based practice model and process. The Journal of Continuing Education in Nursing, 39(4), 166-172.
Maintaining normal core body temperature (normothermia) in patients within perioperative environments is both a challenging and important aspect to ensure patient safety, comfort and positive surgical outcomes (Tanner, 2011; Wu, 2013; Lynch, Dixon & Leary, 2010). Normorthermia is defined as temperatures from 36C to 38C, and is maintained through thermoregulation which is the balance between heat loss and heat gain (Paulikas, 2008). When normothermia is not maintained within the perioperative environments, and the patient’s core body temperature drops below 36C, they are at risk of developing various adverse consequences due to perioperative hypothermia (Wagner, 2010). Perioperative hypothermia is classified into three
Inadvertent perioperative hypothermia is a common anesthesia-related complication with reported prevalence ranging from 50% to 90%.(ref 3,4 of 4) The clinical consequences of perioperative hypothermia include tripling the risk of morbid myocardial outcomes and surgical wound infections, increased blood loss and transfusion requirements, and prolonged recovery and hospitalization.(ref 5)
Targeted Temperature Management at 33 degree versus 36 degree after Cardiac Arrest (Neilsen et al)
The first was to see how long it would take to lower body temperature, and the next to decide how best to resuscitate a frozen victim. The doctors submerged a naked victim in an icy vat of water. They would insert an insulated thermometer into the victim’s rectum in order to monitor his or her body temperature. The icy vat proved to be the fastest way to drop the body’s temperature. Once the body reached 25 degrees Celsius, the victim would usually die.
Hypothermia is a common problem in surgical patients. Up to 70% of patients experience some degree of hypothermia that is undergoing anesthetic surgery. Complications include but are not limited to wound infections, myocardial ischemia, and greater oxygen demands. The formal definition of hypothermia is when the patient’s core body temperature drops below 36 degrees Celsius or 98.6 degrees Fahrenheit. Thus, the purpose of the paper is to synthesize what studies reveal about the current state of knowledge on the effects of pre-operative warming of patient’s postoperative temperatures. I will discuss consistencies and contradictions in the literature, and offer possible explanations for the inconsistencies. Finally I will provide preliminary conclusions on whether the research provides strong evidence to support a change in practice, or whether further research is needed to adequately address your inquiry.
Hinkle, J., Cheever, K., & , (2012). Textbook of medical-surgical nursing. (13 ed., pp. 586-588). Philadelphia: Wolters Kluwer Health
Werner-Rutledge, C. (2012). Evidence-Based Practice Preparation in Nursing Education: Recent BSN Graduates and Their Experience With Applying Evidence-Based Practice. (Doctoral Dissertation). Capella University. Retrieved from ProQuest Digital Dissertations. (3502734) http://search.proquest.com.ezp-02.lirn.net/pagepdf/993006005/Record/3CA1ED1ED991402DPQ/1?accountid=158614
LoBiondo-Wood, G., & Haber, J. (2014). Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice (8th ed.). St. Louis, MO: Elsevier, Inc.
A few minutes prior to first operation at 7:30 AM, the surgeon assigned to patient administer local anesthesia.
Hinkle, Janice L, Cheever, Kerry H. (2014). Brunner &Suddarth’s textbook of Medical-Surgical Nursing. Philadelphia: Wolters Kuwer/Lippincott Williams &Wilkins.
In the profession of nursing, evidence-based practice skills are used to help patients’ return to their normal state of being before illness or injury. New skills and knowledge that is brought to patient care by the nurse should be researched and supported by evidence – based practice.
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner & Suddarth’s textbook of medical-surgical nursing (12th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Burns, N., & Grove, S. K. (2011). Understanding nursing research: building an evidence-based practice (5th ed.). Maryland Heights, MO: Elsevier/Saunders
Evidence-based practice integrates best current evidence with clinical expertise and patient/family preferences and values for the delivery of optimal health care (qsen.org). Like most medical professions, nursing is a constantly changing field. With new studies being done and as we learn more about different diseases it is crucial for the nurse to continue to learn even after becoming an RN. Using evidence-based practice methods are a great way for nurses and other medical professionals learn new information and to stay up to date on new ways to practice that can be used to better assess
Cullum, N. Ciliska D. and R. Haynes, Marks (2008;) Evidence – based Nursing: An Introduction.