Operating theatre is a cold environment and hypothermia (core body temperature lower than 36C) is prevalent among patients undergoing operations. Possible causes of this adverse condition include anesthetic effect, body part exposure, blood loss, and the low room temperature in the theatre. Hypothermia can impair wound healing, decrease drug metabolism, increase oxygen consumption, which in turn causing respiratory distress, bradycardia as well as atrial fibrillation. In extreme cases, it can be lethal. Numerous research studies have explored ways of interventions and new technologies to maintain normal body temperature of patients during operations. However, perhaps without proper translation to clinical practice, the rate of postoperative hypothermia still remains high in many hospital setting. The objectives of this thesis are to systematically review the current literature on the effectiveness of preoperative warming on reducing postoperative hypothermia of patients undergoing general anesthesia. Data from the relevant literature is extracted for setting up a table of evidence. Also, quality assessment is performed. An evidence-based practice guideline for preoperative warming is developed and its feasibility and transferability to the target patients is examined. The purpose of the guideline is to provide better care for patients undergoing general anesthesia. In this thesis, preoperative forced air warming is proposed. The target setting is the operating theatre department and day surgery centre in a local public acute hospital. The target population is patients who undergo general anesthesia. Data is extracted from six articles. The implementation potential of the proposed guideline is high, because of the high transferability, feasibility and cost-effective ratio. An evidence-based practice guideline is developed based on the evidence. Well-designed implementation and evaluation plan are developed for the implementation of the proposed guideline. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Hypothermia at birth is strongly associated with mortality and morbidity in preterm infants. Unfortunately, infants are prone to hypothermia immediately after birth. A large proportion of preterm infants, especially those of gestational age at less than 30 weeks, experience different levels of hypothermia. A frequently used possible preventive measure is the application of an occlusive wrap immediately after birth. However, no systematic review on this preventive measure supports its translation into practice. This dissertation aimed to evaluate the current evidence on the application of occlusive warp for preterm infants. Four electronic databases, Cochrane Library, PubMed, CINAHL, and Medline, were searched. Eight studies met the inclusion criteria of this dissertation. Data were extracted and the quality of the included studies was evaluated by the Scottish Intercollegiate Guidelines Network (SIGN). Six studies were graded as high quality studies and showed that occlusive wrapping significantly prevented the incidence of hypothermia among the preterm infants smaller than 30 weeks. An evidence-based Superwarm guideline was developed, which was deemed to be transferable to the local setting of neonatal intensive care unit with similar target clients and philosophy of care as with those in the identified studies. Also, the proposed innovation was considered to be feasible after examination of staff competency, resources, and approval methods. The potential benefits to preterm infants, nurses, and also the hospital were high, and risks to the patient were minimal. The estimated set-up cost including manpower and consumable cost was $1,720, and the running cost was also $1,720 per year. A 12 -month implementation program scheduled including communication with stakeholders, training to the frontline nurses, and a pilot of the guideline. Patient outcomes will be measured by admission temperature, temperature one hour after admission, and mortality rate. Healthcare provider outcomes include compliance rate, workload, acceptance of the proposed guideline, job satisfaction, knowledge, and skill enhancement in thermoregulation of the preterm infants. The quality of patient care was also considered in the system outcomes. Guideline effectiveness will be evaluated by the increase in admission temperature, nurse and physician satisfaction, and controlled program expenditure. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Hypothermia is commonly found in injured victims who suffer from central nervous system injury, hypovolemic shock, exposure to environment, administration of anesthetic drugs and cold intravenous fluid. All these factors decrease the abilities of trauma victims to maintain normothermia and conserve body heat. Hypothermia in injured victim is a significant contributor to a well known cycle—triad of death and associated with increased mortality, morbidity and length of hospital stay. Hypothermia is one of the preventable complications in trauma patients. Therefore nurse plays a vital role to evaluate the methods of preventing hypothermia. However, there is no systematic review of effectiveness of different warming methods in local setting. The purpose of this dissertation is to develop an evidence-based guideline to prevent hypothermia in trauma patients by reviewing existing evidence, to assess the feasibility and transferability of implementing the guideline and to develop its implementation and evaluation plan. Five articles meeting the inclusion and exclusion criteria are identified after a systematic research of six electronic databases. Among these articles, four of them are randomized controlled trials while the remaining one is quasi-experimental design with prospective randomized assignment. The quality of these identified articles is evaluated with the methodology checklist for randomized controlled trials which is developed by Scottish Intercollegiate Guideline Network (SIGN). All studies of medium and high quality would be considered as sufficient evidence to support the proposed innovation in preventing hypothermia for trauma patients in Accident & Emergency Department. After assessing the implementation potential, an evidence-based guideline in preventing hypothermia for adult trauma patients is established. The proposed innovation is necessary and beneficial for adult trauma patients to prevent hypothermia. The grade of recommendation in the guideline is rated based on the SIGN grading system from A to D. Communication plans with stakeholders and 3-month pilot study on 20 patients are conducted before implementing the innovation into clinical setting. Evaluation is made to assess the effectiveness of the proposed guideline after the end of pilot study and the end of implementation of guideline. The effectiveness of the proposed innovation is determined by change of core temperature as + 1.1 °C/hr and at least 90% reduction in shivering and thermal discomfort which are reported in the reviewed articles. The guideline is considered as clinical effective when similar outcome is obtained. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Bakgrund: Hypotermi definieras som en kärntemperatur under 36 grader och är en vanlig komplikation i samband med anestesi. Hypotermi vid kirurgi är förknippat med ökad mortalitet och kan leda till komplikationer som innebär lidande, förlänger tid för återhämtning och orsakar ökade vårdrelaterade kostnader. Komplikationer på grund av hypotermi är exempelvis försämrad sårläkning, ökad risk för blödning och ökad incidens av infektioner. För många patienter innebär det ett lidande att frysa eftersom att vara kall är förknippat med känslor av utsatthet, sårbarhet och att få sämre vård. Olika metoder och hjälpmedel för att förhindra att hypotermi uppstår under anestesi finns att tillgå. I Sverige saknas specifika riktlinjer på nationell nivå. Forskning har visat att följsamheten till lokala riktlinjer är låg. Patienten behöver hjälp med att bibehålla adekvat kroppstemperatur och här har anestesisjuksköterskan en viktig uppgift. Syfte: Syftet var att sammanställa tillgängliga interventioner för att förhindra oavsiktlig intraoperativ hypotermi.  Metod: En strukturerad litteraturöversikt med narrativ analys genomfördes. Informationssökning gjordes i databaserna PubMed och CINAHL.  Resultat: Tre grupper av värmebevarande metoder identifierades: aktiv, passiv och invasiv uppvärmning. Den mest förekommande metoden var aktiv värmning med forced-air warming, som också verkade vara den mest effektiva metoden för att bibehålla normal kroppstemperatur och förhindra hypotermi. Skillnaderna i effektivitet mellan metoderna varierade. Ingen aktiv eller passiv metod förhindrade hypotermi helt. Slutsats: Trots att effektiva metoder för att förhindra oavsiktlig intraoperativ hypotermi finns och används är incidensen av hypotermi hög. Ytterligare forskning behövs för att undersöka orsaker till den höga incidensen. / Bakgrund: Hypotermi definieras som en kärntemperatur under 36 grader och är en vanlig komplikation i samband med anestesi. Hypotermi under operation är förknippad med ökad dödlighet och kan leda till komplikationer som skapar lidande, förlänger återhämtningstiden och orsakar ökade vårdrelaterade kostnader. Komplikationer på grund av hypotermi är till exempel försämrad sårläkning, ökad blödningsrisk och ökad förekomst av infektioner. För många patienter innebär frysning lidande eftersom förkylning är förknippad med känslor av exponering, sårbarhet och att få sämre vård. Olika metoder och hjälpmedel finns tillgängliga för att förhindra hypotermi uppstår under anestesi. I Sverige finns inga särskilda riktlinjer på nationell nivå. Forskning har visat att efterlevnaden av lokala riktlinjer är låg. Patienten behöver hjälp med att upprätthålla en tillräcklig kroppstemperatur, och här har anestesisjuksköterskan ett viktigt ansvar. Syfte: Målet var att sammanställa tillgängliga interventioner för att förhindra oavsiktlig intraoperativ hypotermi. Metod: En strukturerad litteraturstudie med narrativ analys genomfördes. En informationssökning gjordes i databaserna PubMed och CINAHL. Resultat: Tre grupper av värmebevarande metoder identifierades: aktiv, passiv och invasiv uppvärmning. Den vanligaste metoden var aktiv uppvärmning med påtvingad luftuppvärmning, vilket också visade sig vara den mest effektiva metoden för att upprätthålla normal kroppstemperatur och förhindra hypotermi. Skillnaderna i effektivitet mellan metoderna varierade dock. Ingen aktiv eller passiv metod förhindrade helt hypotermi. Slutsats: Även om effektiva metoder för att förhindra oavsiktlig intraoperativ hypotermi finns och används, är förekomsten av hypotermi hög. Ytterligare forskning behövs för att undersöka orsakerna till den höga förekomsten. Sökord: Anestesi, kroppstemperatur, värmebevarande metoder, förebyggande och kontroll av hypotermi, oavsiktlig hypotermi, intraoperativ vård, kvantitativ, litteraturöversikt, perioperativ vård, kirurgi.