A qualitative study of nurse-perceived barriers to body temperature management in postoperative patients.

Although evidence-based practices exist for preventing hypothermia in patients during surgery, few studies have focused on this concern in postoperative patients. The aim of this qualitative study was to explore the most challenging issues experienced by surgical ward nurses while managing the body temperature of adult surgical patients. To address this research gap, this study used a qualitative descriptive design to document barriers to body temperature management as reported by a sample of 16 perioperative nurses. The semi-structured, face-to-face interviews were digitally recorded, transcribed verbatim and analysed using inductive content analysis. The main barriers fell into three categories: professional nursing ability limitations, unfavourable working conditions and management of human resources. The eight subcategories were disadvantageous professional views, professional knowledge limitations, low motivation to provide nursing care, non-standard treatment environment, inadequate equipment and care protocols, heavy nursing care loads, inadequate staff training and ineffective staff supervision. These findings highlighted the importance of adequate resources, proper education and evidence-based care protocols in the effective delivery of body temperature management to postoperative patients.

Impacto de uma intervenção educativa no manejo da hipotermia terapêutica neonatal: estudo quase experimental / Impact of an educational intervention in the management of neonatal therapeutic hypothermia: a quasi-experimental study

Introdução: A hipotermia terapêutica é o tratamento indicado para encefalopatia moderada a grave em recém-nascidos. A terapia requer uma equipe de enfermagem capacitada e integrada, visando um cuidado qualificado, efetivo e seguro. Modelos teóricos têm sido desenvolvidos para auxiliar a incorporação de evidências científicas à prática dos enfermeiros, representando um desafio na área da saúde. A implementação de uma intervenção educativa, guiada pela estrutura i-PARIHS (Estrutura Integrada de Promoção da Ação na Implementação de Pesquisa em Serviços de Saúde), poderá preencher a lacuna entre a teoria e a prática, beneficiando a assistência e tornando os sujeitos ativos no manejo do recém-nascido em hipotermia terapêutica. Objetivo geral: avaliar o impacto de uma intervenção educativa, guiada pelo referencial teórico i-PARIHS, sobre o manejo do recém-nascido com asfixia perinatal em hipotermia terapêutica na unidade intensiva neonatal no conhecimento, atitudes e práticas de enfermeiros. Objetivos específicos: analisar o conhecimento, atitude e prática dos enfermeiros sobre o manejo do recém-nascido com asfixia perinatal em hipotermia terapêutica pré e pós-intervenção educativa; identificar as barreiras e facilitadores percebidos pelos enfermeiros sobre o manejo do recém-nascido com asfixia perinatal em hipotermia terapêutica na unidade intensiva neonatal; implementar uma intervenção educativa, guiada pelo referencial i-PARIHS, para melhorar o conhecimento, a atitude e a prática dos enfermeiros sobre o manejo do recém-nascido com asfixia perinatal em hipotermia terapêutica na unidade intensiva neonatal; comparar o conhecimento, atitude e prática dos enfermeiros após a intervenção educativa e os indicadores quanto ao manejo do recém-nascido com asfixia perinatal em hipotermia terapêutica. Método: trata-se de um estudo de intervenção, do tipo quase-experimental, realizado com 29 enfermeiros de uma unidade intensiva neonatal, referência no Rio de Janeiro. O desfecho principal: conhecimento, atitudes e práticas dos enfermeiros no manejo do recém-nascido com asfixia perinatal em hipotermia terapêutica na unidade intensiva neonatal A intervenção compreendeu três fases: pré-intervenção - intervenção educativa- pós-intervenção. A intervenção educativa contou com cinco encontros: "Asfixia Perinatal x Hipotermia Terapêutica", "Controle da temperatura", "Cuidados de enfermagem na HT: avaliação de dor", "Monitoramento neurológico" e "Cuidado Centrado na Família". Para a análise estatística utilizou-se de análise descritiva e aplicação dos testes Wilcoxon-Mann-Whitney e Mc Nemar, sendo o nível de significância adotado de 0,05. Resultados: a análise dos resultados do pré e pós-teste demonstrou um incremento no escore de acertos das questões sobre conhecimento, atitude e prática dos enfermeiros no manejo do recém-nascido submetido à hipotermia terapêutica na unidade intensiva neonatal, apresentando significância estatística para a maioria dos itens. Para a inovação foram construídos lembretes, fluxo de admissão para recém-nascido da instituição e uma cartilha para os pais como produto da intervenção com os enfermeiros. Conclusão: O resultado das auditorias realizadas, após a implementação das evidências, constatou uma transformação positiva da prática dos enfermeiros. A utilização da estrutura i-PARIHS evidenciou a necessidade e o valor de investir no engajamento das partes interessadas, na avaliação colaborativa do contexto e na cocriação de inovação usando facilitação qualificada. A intervenção educativa, guiada pela estrutura i-PARIHS, mostrou ter impacto no manejo do recém-nascido submetido à hipotermia terapêutica por enfermeiros.

Introduction: Therapeutic hypothermia is the currently indicated treatment for moderate to severe encephalopathy in newborns. Therapy requires a trained and integrated nursing team, aiming at qualified, effective and safe care. Theoretical models have been developed to help the incorporation of scientific evidence into nurses' practice, representing a challenge in the health area. The implementation of an educational intervention, guided by the i-PARIHS (Integrated Promoting Action on Research Implementation in Health Services Framework) framework, can fill the gap between theory and professional practice, benefiting care and making subjects active in the management of newborns with therapeutic hypothermia. General objective: to evaluate the impact of an educational intervention guided by the theoretical framework i-PARIHS, on the management of newborns with perinatal asphyxia in therapeutic hypothermia in the neonatal intensive care unit on the knowledge, attitudes and practices of nurses. Specific objectives: to analyze the knowledge, attitude and practice of nurses on the management of newborns with perinatal asphyxia in pre- and post-educational therapeutic hypothermia; to identify barriers and facilitators perceived by nurses on the management of newborns with perinatal asphyxia in therapeutic hypothermia in the neonatal intensive care unit; implement an educational intervention, guided by the i-PARIHS framework, to improve nurses' knowledge, attitude and practice on the management of newborns with perinatal asphyxia in therapeutic hypothermia in the neonatal intensive care unit and compare the knowledge, attitude and practice of nurses after the participatory educational intervention program and indicators regarding the management of newborns with perinatal asphyxia in therapeutic hypothermia. Method: this is a quasi-experimental intervention study carried out with 29 nurses from a neonatal intensive care unit, a reference in Rio de Janeiro. The main outcome: knowledge, attitudes and practices of nurses in the management of newborns with perinatal asphyxia in therapeutic hypothermia in the neonatal intensive unit The intervention comprised three phases: pre-intervention - educational intervention - post-intervention. The educational intervention had five meetings: "Perinatal Asphyxia x Therapeutic Hypothermia", "Temperature control", "Nursing care in HT: pain assessment", "Neurological monitoring" and "Family-Centered Care". For the statistical analysis, descriptive analysis and application of the Wilcoxon-Mann-Whitney and Mc Nemar tests were used, with the adopted significance level of 0.05. Results: the analysis of pre- and post-test results showed an increase in the correct score of questions about nurses' knowledge and practices in the management of newborns submitted to therapeutic hypothermia in the neonatal intensive care unit, showing statistical significance for most items. For innovation, reminders, admission flow for newborns at the institution and a booklet for parents were created as a product of the intervention with nurses. Conclusion: The result of the audits carried out, after the implementation of the evidence, found a positive transformation of the nurses' practice. Using the i-PARIHS framework highlighted the need and value of investing in stakeholder engagement, collaborative context assessment, and co-creation of innovation using qualified facilitation. The educational intervention guided by the i-PARIHS framework was shown to have an impact on the management of newborns with perinatal asphyxia in therapeutic hypothermia by nurses.

A Web-Based Nursing Education for Thermoregulation.

Neonatal nurses provide essential care in the hospital setting for improving infants' morbidity and mortality outcomes by preventing hypothermia after delivery. This quality improvement project describes the development and implementation of a web-based educational activity, demonstrating that online education effectively increases nurse knowledge and commitment to thermoregulation practices. A learning management system provides nursing professional development practitioners an effective method of improving nursing knowledge using a web-based educational curriculum in the clinical setting.

The effect of thermoregulation quality improvement initiatives on the admission temperature of premature/very low birth-weight infants in neonatal intensive care units: A systematic review.

PURPOSE: The purpose of this review was to ascertain the impact of thermoregulation quality improvement initiatives (QIs) on the admission temperatures of premature/very-low-birth-weight infants in neonatal intensive care units (NICUs). METHODS: A systematic search of databases Cumulative Index to Nursing and Allied Health Literature, Medline, Embase, and the Cochrane library was carried out. Specific inclusion and exclusion criteria were adhered to, with no publication date limitations added. The chosen studies were examined for quality, data were extracted and analysed, before a narrative synthesis was performed. The last search occurred on January 7, 2019, with PRISMA flow diagrams completed for identified studies. RESULTS: Ten studies of varying methodology design were included in this review. Variations of thermoregulation interventions were included in the 10 studies. Nevertheless, all of them demonstrated that admission temperature rates can be significantly improved by implementing a thermoregulation QI. The multidisciplinary team and ongoing education were seen as much needed components to the overall sustainability, and continuing success of the QI's. PRACTICAL IMPLICATIONS: This systematic review determines that thermoregulation QIs can positively impact the admission temperatures of premature/very-low-birth-weight infants in the NICU. Prevention of hypothermia is aimed at reducing the risks of developing major neonatal morbidities. The pooling of the results from the 10 studies helps in the sharing of outcome measures and thus, improving quantitative synthesis. More frequent monitoring of the axillary temperature would help in preventing hypothermia and hyperthermia occurring. Ongoing education and staff training are essential for managing thermoregulation successfully. Examining the compliance rates to such quality initiatives, and the variations in interventions would benefit from further research to ensure better standardisation of clinical practice.

[Project to Decrease the Incidence of Neonatal Hypothermia in the Newborn Center].

BACKGROUND & PROBLEMS: An investigation found that 66.7% of the neonatal hypothermia (body temperature < 36.5°C) cases diagnosed within one hour of transfer from the delivery room in our hospital were affected by a significantly increased risk of physiological abnormalities, which subsequently increased their risk for mortality. Therefore, monitoring and maintaining the normal body temperature of newborn infants are vital in infant care. PURPOSE: This project aimed to improve the current situation of neonatal hypothermia. RESOLUTION: This project was implemented from Oct. 1, 2016 to Oct. 31, 2017 and used several approaches to improve neonatal hypothermia. A neonatal hypothermia caring protocol was developed and the infant admission materials were standardized; the infant hypothermia alert card and posters were displayed in easy-to-notice locations; an in-service training course on neonatal hypothermia was provided; and an infant hypothermia care checklist was tabulated for examination and recognition. RESULTS: After the implementation of this project, the average time required to raise the body temperature of infants to normal (36.5°C) was 1.5 hours, which was 2 hours faster than the pre-project time of 3.5 hours. Moreover, the time needed to raise the body temperature to normal was one hour for newborn infants with birthweights ≥ 2,500 grams, which was one hour faster than the pre-project time of two hours, and 1.5 hours for newborn infants with birthweights < 2,500 grams, which was three hours faster than the pre-project time of 4.5 hours. The goals of this project were effectively achieved in both groups. CONCLUSIONS: Neonatal hypothermia is an important issue affecting the health status of newborn infants. This project strengthened the awareness of nurses regarding neonatal hypothermia and is worthwhile to be implemented in clinical neonatal care.

Accuracy of the Defining Characteristics of the Nursing Diagnosis Hypothermia in Newborns.

PURPOSE: To analyze the accuracy of the defining characteristics of hypothermia in newborns and to verify associations between defining characteristics and clinical variables. METHODS: A cross-sectional accuracy study with statistical analysis. FINDINGS: Slow capillary refill, decrease in ventilation, peripheral vasoconstriction, and insufficient weight gain were the defining characteristics with the highest specificity values, while slow gastric emptying, skin cool to touch, irritability, and bradycardia were the defining characteristics with the highest values for both sensitivity and specificity. CONCLUSION: Slow gastric emptying, skin cool to touch, irritability, and bradycardia are good clinical indicators to infer initial stages of hypothermia and to confirm its presence. IMPLICATIONS FOR NURSING PRACTICE: Accuracy measures may contribute to the improvement of the diagnostic inferential process. OBJETIVO: Analisar acurácia das características definidoras de Hipotermia em recém-nascidos e identificar a associação delas com variáveis clínicas. MÉTODO: Estudo de acurácia transversal com análise estatística. RESULTADOS: Preenchimento capilar lento, diminuição da ventilação, vasoconstrição periférica e ganho de peso insuficiente apresentaram valores altos de especificidade enquanto esvaziamento gástrico lento, pele fria, irritabilidade e bradicardia apresentaram valores elevados de sensibilidade e especificidade. CONCLUSÃO: Esvaziamento gástrico lento, pele fria, irritabilidade e bradicardia são úteis para inferir estágios iniciais de hipotermia e para confirmação diagnóstica. IMPLICAÇÕES PARA PRÁTICA DE ENFERMAGEM: Medidas de acurácia podem contribuir para o processo de inferência do diagnóstico hipotermia.

Back to Basics: Unplanned Patient Hypothermia: 1.3 www.aornjournal.org/content/cme.

Unplanned perioperative hypothermia is a common occurrence and can negatively affect a patient's postoperative course. Perioperative nurses are responsible for identifying patients at risk for hypothermia and working with the entire surgical team to prevent this complication from occurring. Multiple interventions can be implemented to address hypothermia, including active or passive warming and warm IV and irrigation fluids. This Back to Basics article addresses patient assessment concerns, identifies a variety of evidence-based interventions that can prevent or mitigate perioperative patient temperature changes, and provides basic steps for perioperative RNs to follow to help prevent perioperative hypothermia in their patients.

Quality Improvement Initiative to Prevent Admission Hypothermia in Very-Low-Birth-Weight Newborns.

OBJECTIVE: To decrease rates of admission hypothermia (<36 °C) in very-low-birth-weight (VLBW) newborns (<1,500 g). DESIGN: Quality improvement initiative. SETTING/LOCAL PROBLEM: Urban, Level IV NICU with 32 patient beds. The number of VLBW newborns admitted with temperatures less than 36 °C was greater than in comparable NICUs in the Vermont Oxford Network. PARTICIPANTS: Neonates born in 2016 who weighed less than 1,500 g at birth. INTERVENTION/MEASUREMENTS: Based on the literature and the needs of our unit, our team decided to focus efforts on equipment (chemical mattresses and polyurethane-lined hats for newborns who weighed <1,000 g and polyurethane-lined hats for newborns who weighed <1,500 g), staff education/awareness, and temperature documentation and workflow. Axillary temperature measurements for all neonates who weighed less than 1,500 g were tracked on admission. RESULTS: The processes involved in this quality improvement initiative were successfully implemented, and use of new equipment began January 1, 2016. In 2016, only 9.6% (n = 7) of VLBW newborns were admitted with temperatures less than 36 °C, compared with 20.2% (n = 19) in 2015 and 32.4% (n = 24) in 2014 (p = .003). Overall, the mean admission temperature for neonates who weighed less than 1,500 g rose from 36.2 °C in 2014 to 36.6 °C in 2016 (p = .001). CONCLUSION: We reduced the number of VLBW neonates admitted with temperatures less than 36 °C and increased overall admission temperatures for neonates who weighed less than 1,500 g with the addition of polyurethane-lined hats and chemical mattresses.

GUIDANCE FOR PERIOPERATIVE NURSES TO PREVENT PERIOPERATIVE HYPOTHERMIA IN OBSTETRICS.

The prevention of perioperative hypothermia is a responsibility of all members of the perioperative team. Nurses are well placed to have a central role in implementing strategies to reduce perioperative heat loss, which is associated with a host of adverse outcomes (National Collaborating Centre for Nursing and Supportive Care 2008).

An Integrative Review of Postoperative Accelerated Recovery Protocols.

We undertook an integrative literature review of articles pertaining to perioperative nursing care provided to patients using postoperative accelerated recovery protocols. To select the articles, we searched the MEDLINE, PubMed, Cumulative Index to Nursing and Allied Health Literature, and LiteraturaLatino-Americana e do Caribe em Ciências da Saúde databases. We identified 329 studies, 13 of which met our inclusion criteria and described perioperative nursing care activities. Nursing activities noted in these articles were hypothermia prevention and maintenance of normothermia, restriction of IV fluids, assessment of vital signs, management of symptoms and pain, support of early ambulation, care for tubes and drains, oral administration of carbohydrate-rich foods, assessment of ability to tolerate diet, and encouragement to resume activities of daily living. There was a lack of research on this topic by nursing professionals; additional research by nursing professionals is needed regarding nurses' roles in providing this care.

Hope, hypothermia and human spirit: Refugee Support First Aid and Care Team.

Brighid Langtry reflects on her life-changing experiences as a volunteer medic with Refugee Support in 'The Jungle' camp in Calais.

Métodos de aquecimento na prevenção da hipotermia no intraoperatório de cirurgia abdominal eletiva / Heating methods in the prevention of intraoperative hypothermia of elective abdominal surgery / Métodos de calentamiento en la prevención de la hipotermia en el proceso intraoperatorio de unacirugía abdominal electiva

Objetivo: Identificar os métodos de aquecimento para prevenir hipotermia em pacientes adultos no intraoperatório de cirurgia abdominal eletiva com exposição visceral. Métodos: Estudo quantitativo, exploratório e descritivo, prospectivo, realizado num hospital público da região sul do Brasil. Constituiu a amostra 63 pacientes. Observaram-se os métodos de aquecimento utilizados e foi aferida a temperatura timpânica. Para tratamento dos dados, aplicou-se a estatística descritiva por meio do software SEstatNet. Resultados: Foram utilizados métodos de aquecimento ativo e passivo. A infusão de fluidos aquecidos para irrigação da cavidade abdominal foi a medida mais empregada (nº 63; 100%) do método ativo, enquanto que a manutenção do sistema de refrigeração desligado até o início da cirurgia foi a medida mais utilizada (nº 57; 90,5%) do método passivo. Conclusão: Com os métodos de aquecimento empregados não houve hipotermia grave, porém, existem métodos atuais mais eficientes que poderiam prevenir a hipotermia leve e moderada encontradas.

Objective: To identify heating methods to prevent intraoperative hypothermia in elective abdominal surgery with visceral exposure,in adult patients. Methods: Quantitative, exploratory, descriptive and prospective study performed in a public hospital, in southernBrazil. The sample consisted of 63 patients. It was possible to observe the heating methods used and measure the tympanictemperature. For data processing, it was used descriptive statistics through the SEstatNet software. Results: Active and passiveheating methods were used. The infusion of heated fluids for abdominal cavity irrigation was the most used measure (nº 63;100%) of the active process, while maintaining the cooling system off until the surgery beginning was the most used measurement(nº 57; 90.5%) of the passive method. Conclusion: There was no severe hypothermia with the heating methods utilized. However,there are more efficient current methods that could prevent mild and moderate hypothermia found.

Objetivo: Identificar los métodos de calentamiento para prevención de la hipotermia en pacientes adultos en el intraoperatorio decirugía abdominal electiva con exposición visceral. Métodos: Estudio cuantitativo, exploratorio, descriptivo y prospectivo realizadoen un hospital público de la Región Sur de Brasil. Participaron 63 pacientes. Fueron observados los métodos de calentamientoy la temperatura timpánica. Para el tratamiento de los datos, se utilizó la estadística descriptiva a partir del software SEstatNet.Resultados: Se utilizaron métodos de calentamiento activo y pasivo. La infusión de fluidos calentados para la irrigación de lacavidad abdominal fue la medida activa más empleada (nº 63; 100%), mientras el mantenimiento del sistema de refrigeraciónapagado hasta el inicio de la cirugía fue la medida más utilizada (nº 57; 90,5%) del método pasivo. Conclusión: No hubohipotermia grave con los métodos empleados, sin embargo, existen métodos actuales más eficientes que podrían prevenirhipotermias leves y moderadas encontradas.

Características definidoras dos diagnósticos de enfermagem identificados nos indivíduos em hemodiálise / Defined characteristics of the nursing diagnosis identifield on individuals in hemodialysis

Diagnóstico de enfermagem consiste no julgamento clínico do enfermeiro diante das respostas do indivíduo, família ou comunidade a problemas de saúde reais ou potenciais. É composto por características definidoras que representam sinais e sintomas que indicam a presença do diagnóstico. Assim, objetivou-se identificar as características definidoras dos indivíduos com doença renal crônica em hemodiálise. Estudo transversal desenvolvido em uma unidade de diálise localizada em uma cidade do nordeste do Brasil. A amostra foi de 178 pacientes. A coleta de dados se deu por entrevista e exame físico, nos meses de outubro/2011 a fevereiro/2012. Os dados foram analisados de forma descritiva, onde foram identificadas a frequência absoluta, percentual, médias, desvio padrão e percentil de cada variável. Como resultados, identificou-se a presença de 37 características definidoras que determinaram 14 diagnósticos de enfermagem da NANDA Internacional. As características definidoras: Azotemia, Eletrólitos alterados e Ganho de peso em curto período foram as mais prevalentes. Essas estavam relacionadas ao diagnóstico Volume de líquidos excessivo. Conclui-se que as principais características definidoras identificadas na clientela estudada estavam relacionadas aos aspectos fisiológicos da doença renal crônica, entretanto destaca-se que existiram também características voltadas aos aspectos psicológico e social do paciente renal crônico em hemodiálise.

Nursing diagnosis is the clinical judgment of the nurse in the face of the individual, family or community problems or potential health responses. It consists of defining characteristics representing signs and symptoms that indicate the presence of diagnosis. Thus, this paper aims to identify the defining characteristics of individuals with chronic kidney disease on hemodialysis. Cross-sectional study conducted in a dialysis unit located in a city in northeastern Brazil. The sample consisted of 178 patients. Data collection occurred by interview and physical examination in October/2011 to February/2012. Data analyzed descriptively, where the absolute frequency, percentage, mean, standard deviation and percentile of each variable identified. As a result, we identified the presence of 37 defining characteristics that determined 14 nursing diagnoses from NANDA International. Defining characteristics: azotemia, altered electrolytes, and weight gain in a short period were the most prevalent. These related to the diagnosis of excessive fluid volume. It concluded that the main defining characteristics identified in clientele studied related to the physiological aspects of chronic kidney disease; however, it said that there were also features geared to psychological and social aspects of chronic renal patients on hemodialysis.