Background Patients’ cold exposure is a neglected problem in prehospital emergency care. Cold stress increases pain and anxiety and contributes to fear and an overall sense of dissatisfaction. When left untreated, cold stress disturbs vital body functions until ultimately reaches hypothermia. Aim The overall aim was to investigate patients’ experiences of thermal comfort and reactions to cold exposure in prehospital emergency care and to evaluate the effects of an intervention using active warming from underneath. Method Study I: Persons (n=20) injured in a cold environment in the north of Sweden were interviewed. Active heat was given to 13 of them. Study II: In wintertime, 62 patients were observed during prehospital emergency care. The field study was based on observations, questions about thermal discomfort, vital signs, and temperature measurements. Study III: Healthy young persons (n=23) participated in two trials each. Data were collected inside and outside a cold chamber. In one trial, the participants were lying on a regular ambulance stretcher and in a second trial on a stretcher supplied with a heated mattress. Outcomes were the Cold Discomfort Scale (CDS), back, finger, and core body temperature, four statements from the State-TraitAnxiety-Inventory (STAI), vital signs, and short notes about their experiences of the two stretchers. Study IV: A quantitative intervention study was conducted in prehospital emergency care in the north of Sweden. The patients (n=30) in the intervention group were transported in an ambulance supplemented with a heated mattress on the stretcher, whereas only a regular stretcher was used in the ambulance for the patients (n=30) in the control group. Outcomes were the CDS, finger, core body, and air temperature, and questions about cold experiences. Results Study I: Patients suffered more because of the cold than from the pain of their injuries. The patients were in a desperate need of heat. Study II: Patients are exposed to cold stress due to cold environments. There was a significant decrease from the first measurement in finger temperature of patients who were indoors when the ambulance arrived, compared to the measurement taken in the ambulance. In the patient compartment of the ambulance, 85% of the patients had a finger temperature below the comfort zone and almost half of them experienced the patient compartment in the ambulance to be cold. The regular mattress surface temperature at the ambulance ranged from -22.3 to 8.4 ºC. Study III: A statistical increase of the participants’ back temperature was found between those lying on the heated mattress compared to those lying on the regular mattress. The heated mattress was experienced as warm, comfortable, providing security, and easy to relax on. Study IV: Thermal comfort increased for the patients in the intervention group and decreased in the control group. A significant higher proportion of the participants rated the stretcher as cold to lie on in the control group compared to the intervention group. Conclusion The ambulance milieu is too cold to provide thermal comfort. Heat supply from underneath increased comfort and might prevent cold stress and hypothermia

Postoperativ shivering (PAS) definieras som en serie ofrivilliga muskelrörelser som ökar den metabola värmeproduktionen i kroppen. Förekomsten av postoperativ shivering är ett problem inom den perioperativa vården. Det finns flera orsaker till shivering. Termoregulativa och icke termoregulativa. PAS förekommer i ca 5-65% av alla anestesier, men frekvensen har under åren minskat. Det är tidigare känt att anestesi sätter termoregulationen ur spel. Konsekvenserna kan leda till vårdlidande för patienten och högre kostnader för samhället. Syftet med studien är att undersöka orsaken till shivering. Arbetet utgår från en kvantitativ metod. I samarbete med SÄS utarbetades ett datainsamlingsformulär. Studien som genomfördes på tre sjukhus i västra delen av Sverige inkluderade 350 patienter >18 år. Materialet analyserades i SPSS, version 19. Resultatet visade att ålder, kön, operationstid (knivtid) och vissa typer av operationsingrepp (öron- ögon- hals- käk- näs- och endoskopisk kirurgi), hade signifikans för uppkomsten av PAS. Övriga variabler som undersöktes (anestesimetod, temperatur och övriga undersökta operationsingrepp) hade ingen signifikans. Resultatet talar delvis emot tidigare forskning, som visar att anestesimetod har betydelse för uppkomsten av PAS. Studien överensstämmer med tidigare forskning gällande signifikans för kön, ålder, operationstid och temperatur. Genom identifiering av olika faktorer, som kan leda till postoperativ shivering, kan vi, som anestesisjuksköterskor, förebygga fenomenet och ge patienten en trygg och säker vård samt minska vårdlidande. / Program: Specialistsjuksköterskeutbildning med inriktning mot anestesisjukvård