Development and Feasibility Testing of Clinical Nursing Practice Guidelines for Prevention of Perioperative Hypothermia

Abstract

Intraoperative hypothermia is a preventable condition. Therefore, establishing nursing practice guidelines for its prevention can ensure systematic and comprehensive patient care, including assessment and preventive measures. The implementation of such guidelines has been shown to reduce the incidence of intraoperative hypothermia significantly. These guidelines should be tailored to the specific context of each healthcare setting. This study focused on the development of nursing practice guidelines for preventing intraoperative hypothermiaina in a secondary hospital setting.The research process involved a review of evidence-based practices and an assessment of feasibility and anesthetic nurses’satisfaction with guideline implementation. The goal is to create standardized nursing tools that enhance the quality of anesthesia services, ensuring that patients receive optimal care for hypothermia prevention throughout the perioperative period.This study aimed to develop and evaluate clinical nursing practice guidelines(CNPGs) for the prevention of perioperative hypothermia.Based on Soukup’s and Donabedian’sframeworks, the study was divided into two phases.Phase 1, the development of CNPGs for the prevention of perioperative hypothermia, consisted of five steps: 1)defining the problem and scope, 2)defining the objectives, target group,and outcome of the guideline, 3)searching and evaluating the evidence-based practices, 4)drafting the CNPGs,and 5)content validation conducted by three experts.Phase 2 included feasibility testing and evaluation of the CNPGs.The study consisted of two sample groups. The Phase 1 sample group included academic articles and research studies related to patient care guidelines for preventing intraoperative hypothermia in anesthetized patients. The selected publications, both in Thai and English,were published between 2011 and 2021. The Phase 2 sample group included nine anesthetic nurses who implemented the CNPGsand 35 surgical patients who received anesthesia during the designated study period. The four research instruments were used in this study: 1) the CNPGs for preventing intraoperative hypothermia, 2)a feasibility and satisfaction assessment form for the implementation of the CNPGs, 3) an intraoperative data recording form, and 4)core body temperature measurement devices. Data were analyzed using descriptive statistics and repeated measures analysis of variance.The results revealed that the CNPGs covered risk assessment, hypothermia prevention,and management throughout the operation. After the CNPG implementation in 35 patients for three months, it could prevent perioperative hypothermia in surgical patients. It was found that the CNPGs could prevent perioperative hypothermia by maintaining a core body temperature not lower than 36oC throughout the operation. The average core body temperature intraoperative was significantly lower bothpre- and post-operative(F = 46.65,p < .05). Nurse anesthetists reported that the CNPGs were highly feasible and satisfying to use. The CNPGs could improve the quality of nursing care and increase patient satisfaction with the quality of health care services. The recommendations include the implementation of the CNPGs for intraoperative hypothermia prevention in other hospitals, which may require modifications to align with the specific context of each institution. Further studies explore additional risk factors for intraoperative hypothermia, including the size of the surgical site and the duration of the procedure. Additionally,patient demographic data, such as underlying medical conditions and types of surgical procedures performed should be collected. This would allow for a more detailed discussion of potential complications related to intraoperative hypothermia and improve the overall effectiveness  of preventive strategies.
Keywords: Clinical nursing practice guidelines, Feasibility, Perioperative hypothermia,Prevention,Satisfaction