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Being cold when injured in a cold environment: Patients' experiences
Umeå University, Faculty of Medicine, Department of Nursing. (Arcum)
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
Umeå University, Faculty of Medicine, Department of Nursing. (Arcum)
2013 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 21, no 1, 42-49 p.Article in journal (Refereed) Published
Abstract [en]

Background: Patients in prehospital care, irrespective of diseases or trauma might experience thermal discomfort because of a cold environment and are at risk for decreasing body temperature which can increase both morbidity and mortality. Objective: To explore patients' experiences of being cold when injured in a cold environment. Method: Twenty persons who had been injured in a cold environment in northern Sweden were interviewed. Active heat supply was given to 13 of them and seven had passive heat supply. The participants were asked to narrate their individual experience of cold and the pre- and post-injury event, until arrival at the emergency department. The interviews were transcribed verbatim, then analyzed with qualitative content analysis. Results: Patients described that they suffered more from the cold than because of the pain from the injury. Patients who received active heat supply experienced it in a positive way. Two categories were formulated: Enduring suffering and Relief of suffering. Conclusion: Thermal discomfort became the largest problem independent of the severity of the injuries. We recommend the use of active heat supply to reduce the negative experiences of thermal discomfort when a person is injured in a cold environment.

Place, publisher, year, edition, pages
2013. Vol. 21, no 1, 42-49 p.
Keyword [en]
Active warming, Emergency care, Patients' experiences, Thermal discomfort
National Category
Nursing
Identifiers
URN: urn:nbn:se:umu:diva-66234DOI: 10.1016/j.ienj.2011.10.006OAI: oai:DiVA.org:umu-66234DiVA: diva2:606049
Available from: 2013-02-18 Created: 2013-02-18 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Cold exposure and thermal comfort among patients in prehospital emergency care: innovation research in nursing
Open this publication in new window or tab >>Cold exposure and thermal comfort among patients in prehospital emergency care: innovation research in nursing
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

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

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2015. 50 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1718
Keyword
thermal comfort, thermal discomfort, cold exposure, cold stress, hypothermia, patients’ experiences, active warming, prehospital emergency care, finger temperature, back temperature
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-102599 (URN)978-91-7601-234-5 (ISBN)
Public defence
2015-05-22, Vårdvetarhuset, Aulan, Institutionen för omvårdnad, Umeå, 09:00 (English)
Opponent
Supervisors
Funder
Swedish National Board of Health and Welfare
Available from: 2015-04-30 Created: 2015-04-28 Last updated: 2016-06-30Bibliographically approved

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