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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...A. Davis Company.
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.
The various modes of heat loss during this phase include radiation, convection, conduction and evaporation. Radiation contributes to maximum heat loss (approximately 40%) and is determined by the fourth power of difference between ambient and core temperature. Convection is the next most important mode of heat loss (upto 30%), and is due to loss of heat to air immediately surrounding the body. It is proportional to the square root of the velocity of the air currents. Evaporation contributes to less than 10% of heat loss and occurs from cleaning fluids as well as skin, respiratory, bowel and wound surfaces. Conduction accounts for least heat loss (upto 5%) and is due to cold surfaces in contact with the body such as operating room table. After 3-4 hours, a plateau phase is realized when core heat production equals heat loss to the periphery and core temperature reaches a
Burns, N., & Grove, S. K. (2011). Understanding nursing research: building an evidence-based practice (5th ed.). Maryland Heights, MO: Elsevier/Saunders
The Johns Hopkins Nursing Evidence-Based Practice Model provides nurses with a system to formulate a practice question, appraise both research and non-research evidence, and to develop recommendations for practice (Dearholt & Dang, 2012). This model guides nurses through the evidence-based research process with ease and minimal difficulty using a problem solving approach.
According to ASHA Evidence Based Practice is the combination of clinical expertise opinion, data, and patient’s perspectives, with the goal of providing high-quality services (2013). The process of evidence-based practice consists of formulating a research question, collecting evidence, including views, and then evaluating the entire process. This project introduces the research topic I’ve chosen, which identifies a researchable problem, and formulates an answerable question that is relevant to nursing and evidence-based practice.
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.
A few minutes prior to first operation at 7:30 AM, the surgeon assigned to patient administer local anesthesia.
Levin, R. F. (2010). Integrating evidence-based practice with educational theory in clinical practice for nurse practitioners: bridging the theory practice gap. Research and Theory for Nursing Practice: An International Journal, 24, 213-216. doi: 10.1891/1541-6577.24.4.213
Cullum, N. Ciliska D. and R. Haynes, Marks (2008;) Evidence – based Nursing: An Introduction.
Polit, D. F. & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia: Lippincott.
Augustine Medical, Inc. was founded by Dr. Scott Augustine, an anesthesiologist from Minnesota, in 1987. The company was created to develop and market products for hospital operating rooms and postoperative recovery rooms. The company provides innovative solutions to combat postoperative conditions such as hypothermia. Medical research indicates that 60 to 80 percent of all postoperative recovery room patients are clinically hypothermic. Hypothermia is caused by a patient’s exposure to cold operating room temperatures that are required by surgeons to control infection, and for the personal comfort of the surgeon. Hypothermia can also be a result of heat loss due to evaporation of the fluids used to scrub patients, evaporation from exposed bowel, and breathing of dry anesthetic gases. Dr. Augustine’s personal experience in the operating room convinced him that there was a need for a new system to warming patients after surgery. Dr. Augustine also realized that the market for this new product would be enormous! Statistics indicate that approximately 21 million surgical operations are performed annually in the United States, and that approximately 5,500 hospitals have operating rooms and postoperative recovery rooms that include 31,365 postoperative recovery beds and 28,514 operating rooms. Upon the realization of this need and existence of the market, Dr. Augustine went on to develop The Bair Hugger Patient Warming System then he acquired a patent. The Bair Hugger Patient Warming System consists of a heat source and a separate disposable warming cover that directs a gentle flow of warm air across the body. The Bair Hugger heat source uses a reliable high efficiency blower, a sealed 400W heating element, and a microprocessor based temperature control to create a continuous flow of warm air. The heat source complies with all safety requirements for hospital equipment. Augustine Medical, Inc. was able to find investors that contributed to the initial capitalization of $500,000. These initial funds that were collected were used for staff support, facilities, and marketing. The funds were also used to cover the fixed costs of the company while in its first year. The company subcontracted the production of the heater/blower unit and manufactured the warming covers in-house. The company only par...
Stomberg, M., Sjöström, B., & Haljamäe, H. (2003). The Role of the Nurse Anesthetist in the Planning of Postoperative Pain Management. AANA Journal, 71(3), 197.
A key characteristic of Advanced Practice Nurses (APN) is to develop and refine the ability to generate and synthesize research and use this information to influence positive changes to everyday nursing practice (Burns & Quatrara, 2013). APNs are well placed as clinical leaders to facilitate for frontline nurses the links between practice and research. Stevens (2013) reminds us that evidence-base practice can result in improved care, positive patient outcomes and enhanced nursing satisfaction. Nurses are professionally obligated to ensure that the best evidence supports their nursing work, with the end goal being the delivery of the best care
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.
One feature of evidence based practice is a problem-solving approach that draws on nurses’ experience to identify a problem or potential diagnosis. After a problem is identified, evidence based practice can be used to come up with interventions and possible risks involved with each intervention. Next, nurses will use the knowledge and theory to do clinical research and decide on the appropriate intervention. Lastly, evidence base practice allows the patients to have a voice in their own care. Each patient brings their own preferences and ideas on how their care should be handled and the expectations that they have (Fain, 2017, pg.
The role of the nurse in the preoperative area is to determine the patient’s psychological status to help with the use of coping during the surgery process. Determine physiologic factors directly or indirectly related to the surgical procedure that may cause operative risk factors. Establish baseline data for comparison in the intraoperative and postoperative period. Participate in the identification and documentation of the surgical site and or side of body on which the procedure is to be performed. Identify prescription drugs, over the counter, and herbal supplements that are taken by the patient that may interact and affect the surgical outcome. Document the results of all preoperative laboratory and diagnostic tests in the patient’s record