ORIGINAL ARTICLE

The effectiveness of the newly designed thermal gown on

hypothermic patients after spinal surgery
Wen-Ping Lee, Pao-Yuan Wu, Whei-Mei Shih, Meng-Ying Lee and Lun-Hui Ho

Aims and objectives. To develop the newly designed thermal gown to test the
effectiveness in relieving postoperative hypothermia as compared to traditional What does this paper contribute
cotton cloth. to the wider global clinical
Background. Hypothermia is a common problem after spinal surgery. A patient’s community?
safety and comfort are significant. Currently, most research is focused on instru- • This newly designed thermal
ments that relieve a patient’s hypothermia. Studies have rarely considered a gown given to patients after sur-
patient’s comfort while caring for their body temperature. gery can significantly reduce the
duration of their PACU stay,
Design. This study employed an experimental design. The participants were
thus reducing the cost of care as
assigned randomly to two groups: the experimental group (N = 50) and the con- well as providing comfort.
trol group (N = 50). Therefore, this study can provide
Methods. The experimental group received the newly designed thermal gown references for the care of postop-
intervention. The control group received the standard postanaesthesia care unit erative patients recovering from
re-warming intervention. The material used to collect data included demographic anaesthesia in the PACU world-
wide.
data, postoperative management and comfort level. Nurses measured patients’
vital signs and asked for patients’ subjective comfort level on admission to the
postanaesthesia care unit every 10 minutes until their discharge from the postan-
aesthesia care unit.
Result. The accumulated percentage for thermal gown group patients in reaching
36 °C during the first 20 minutes of admission was significantly higher than that of the
cotton cloth group. The thermal gown group individuals showed significantly higher
comfort levels (score = 4) at 10 minutes, when compared to the cotton cloth group.
Conclusion. Results suggested that the newly designed thermal gown had effec-
tively improved postoperative temperature and comfort level with an evidence-
based intervention.
Relevance to clinical practice. Maintaining a patient’s body temperature is a
major task for nurses working in the post-anaesthesia care unit. With the newly
designed thermal gown, the duration of a patient’s stay in the postanaesthesia
care unit was shortened and the patient’s comfort was increased.

Authors: Wen-Ping Lee, RN, BSN, Assistant Head Nurse, Chang
Gung Medical Foundation; Pao-Yuan Wu, RN, MS, Head Nurse,
Chang Gung Medical Foundation; Whei-Mei Shih, RN, PhD, Associ-
ate Professor, Chang Gung University of Science and Technology;
Meng-Ying Lee, RN, MSN, Supervisor, Department of Nursing,
Chang Gung Medical Foundation; Lun-Hui Ho, RN, MS, Assistant
Director, Department of Nursing, Chang Gung Medical Foundation
Correspondence: Lun-Hui Ho, Assistant Director, Department of
Nursing, Chang Gung Medical Foundation. No. 5, Fuxing st.,
Guishan Dist., Taoyuan city, 333, Taiwan, R.O.C. Telephone:
886-3-3281200 ext. 2802.
E-mail: ho1180@cgmh.org.tw
Whei-Mei Shih and Lun-Hui Ho contributed equally in this study.
This is an open access article under the terms of the Creative Com-
mons Attribution-NonCommercial License, which permits use, dis-
tribution and reproduction in any medium, provided the original
work is properly cited and is not used for commercial purposes.

© 2015 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.
Journal of Clinical Nursing, 24, 2779–2787, doi: 10.1111/jocn.12873 2779
W-P Lee et al.
Key words: comfort, cotton cloth, hypothermic, newly designed thermal gown,
spinal surgery
Accepted for publication: 4 April 2015
Introduction
Goals of the postanaesthesia care unit (PACU) include
assisting patients in safely awakening from anaesthesia,
allowing patients to regain their physical balance, reducing
postoperative surgery pain and preventing postoperative
anaesthesia complications (Wu et al. 2006). Common post-
operative anaesthesia complications are respiratory issues,
circulatory issues, digestive system complications, hypother-
mia, and excitability or irritability. Hypothermia is defined
as a core temperature of lower than 36 °C (Macario &
Dexter 2002). Kiekkas et al. (2005) have shown that for
170 spinal surgeries, 73
5% of patients developed unex-
pected hypothermia in the PACU. Although temporary
hypothermia is not life threatening, it may create physical
stress, increase the chance of infection, increase hospitalisa-
tion duration and cost, delay rehabilitation, increase mor-
tality rate, increase metabolic stress, induce peripheral
vascular contraction and reduce subcutaneous oxygen satu-
ration (Sessler 2001, Harper et al. 2003, Yan 2010). It may
also increase surgery recovery time, induce cardiac events,
and induce hemodynamic instability or impair cognitive
function due to delayed anaesthetic metabolism (Lenhardt
et al. 1997, Leslie & Sessler 2003, Paulikas 2008). One
study showed that postoperative patients had body temper-
atures at 1
5 °C lower than that of a normal postoperative
temperature. Different types of surgery could increase the
hospitalisation cost for a patient by an additional 2500–
7000 US dollars (Mahoney & Odom 1999).
Therefore, assisting patients in returning to a normal range
of body temperature is an important goal in postoperative
patient care. The nursing staff should provide ample body
temperature care, to decrease the occurrence and minimise
the damage resulting from hypothermia (Moss 1998).
Currently, many studies have shown that the usage of heat
preservation methods effectively reduce postoperative hypo-
thermia. However, these heat preservation methods often
involve heat lamps, radiative heat and electrically heated
blankets (Lee et al. 2005, Torrie et al. 2005, Torossian 2008,
Pikus & Hooper 2010, Chen & Wei 2011). These methods
are often complemented by the use of cotton cloth; however,
the cloth must be replaced regularly and often five or more
cloths are required to provide adequate comfort for the
patient (Leeth et al. 2010). The comfort and effectiveness of
© 2015 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.
2780
designed heat-preserving postoperative thermal gowns are
rarely studied. Therefore, this study was aimed at developing
a postoperative heat-preserving gown and comparing it to the
cotton cloths that are currently used. The research questions
were used to test whether newly designed thermal gowns can
shorten a patient’s hypothermia time and increase cost effec-
tiveness. This study can be a reference for surgical nurses in
providing heat preservation for postoperative patients and
for achieving comprehensive care and medical service.
Literature research
Physiological changes in a cold body
The normal human core temperature is between 36–37
5 °C.
During feverish conditions, the body temperature should
only deviate  0
6 °C (Guyton & Hall 2000). When the
ambient temperature drops, the skin and spinal cord are
stimulated, and this stimulation activates the hypothalamic
preoptic area, resulting in an increase in systemic skeletal
muscle tension. When this tension increases above a certain
threshold, shivering occurs (Guyton & Hall 2000). Humans
are endothermic. To maintain a constant body temperature,
the body will regulate its temperature according to the envi-
ronmental conditions (Lin & Du 2006, Lu & Dai 2006).
When the body temperature is too low, the stimulation origi-
nating from the skin and other organs create an intense dis-
comfort (Guyton & Hall 2000). A low body temperature
can induce shivering to increase metabolic heat. However,
shivering can cause pain to some patients, surpassing the
pain originating from any surgical wounds. Furthermore,
shivering can increase oxygen consumption and significantly
increase carbon dioxide production (Shih et al. 2010).
Factors in affecting body temperature
Hypothermia is defined as a core body temperature of lower
than 36 °C (Macario & Dexter 2002). The factors which
affect body temperature can be categorised as follows:
Individual factors
In terms of age, newborns and infants have underdeveloped
thermoregulatory centres and large body surface areas to
volume ratio; therefore, it is easy for them to dissipate body
Journal of Clinical Nursing, 24, 2779–2787
Original article
heat. The older people tend to have lower body tempera-
tures due to the thinning of the subcutaneous adipose tis-
sue, reduced metabolic rates, deterioration of body
temperature regulation functions and sensitivity to changes
in ambient temperature (Lu & Dai 2006, Tsao et al. 2009).
In terms of gender, females tend to have higher body tem-
peratures and a reduced ability to dissipate heat when com-
pared to males of similar size and age (Tsao et al. 2009). In
terms of body weight, lighter individuals are more prone to
hypothermia due to the reduced insulation ability resulting
from the reduced amount of adipose tissue. Individuals with
a higher blood pressure often have more active sympathetic
nervous systems, and thus have a lower chance of becoming
hypothermic (Shih 2008).
Environmental and temperature factors
The operating room should be maintained at the desired
temperature range of 20–27 °C. This temperature is the most
suitable in lowering a patient’s metabolism. The relative
humidity should be no <50%, which may reduce bacterial
growth and static discharges (Yan 2010). According to some
studies, about 50–90% of surgical patients in the USA each
year experienced postoperative hypothermia in the recovery
room due to environmental factors, such as operating room
conditions and anaesthesia conditions (Lynch et al. 2010).
Medical treatment factors
Different medical treatments influence a patient’s body tem-
perature, such as a cold intravenous (IV) transfusion, surgi-
cal site exposure and a decreased basal metabolic rate
caused by anaesthesia (Good et al. 2006, Lynch et al.
2010). Paulikas (2008) pointed out that a slight drop in
body temperature (0
05–1
5 °C) has been shown to trigger
hypertension, which increases the serum concentrations of
adrenaline. The increase in adrenaline concentration can
increase systemic vascular resistance and systemic vasocon-
striction, which can induce a cardiac event. Low body tem-
perature increases metabolic stress which includes
vasoconstriction and reduced subcutaneous oxygen (Sessler
2001, Harper et al. 2003, Yan 2010). This leads to pro-
longed recovery from surgery, possible wound infections,
induced cardiac events and prolonged anaesthetic drug
metabolism. The reduced anaesthetic metabolism can cause
hemodynamic instability or cognitive function impairment
and delay anaesthetic recovery time (Lenhardt et al. 1997,
Leslie & Sessler 2003, Paulikas 2008). According to Len-
hardt et al. (1997), a mild hypothermia may delay anaesthe-
sia recovery, resulting in hypothermic patients taking more
than 40 minutes to recover. After 90 minutes, hypothermic
patients are to be discharged from the recovery room.
© 2015 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.
Journal of Clinical Nursing, 24, 2779–2787
The newly designed thermal gown on hypothermic patients
Metabolic disease factors
Some metabolic diseases can inhibit the generation of heat
and restrict physiological reactions to counteract against
the external environment. These diseases include diabetes,
hypothyroidism, and degradation of adrenal glands and
brain pituitary functions. These are all causes of low
temperature sensitivities (Lin & Du 2006, Ford 2008).
Postoperative body temperature recovery methods
According to past studies, the use of hot air blowers, radia-
tion heat, warm lights and temperature regulators are the
most effective methods in reducing hypothermia and anaes-
thesia recovery time in postoperative patients. However,
infection possibilities and costs must be taken into consider-
ation when using these methods. If the temperature was not
regulated properly, there was the possibility of causing
burns to unconscious patients (Lee et al. 2005, Pikus &
Hooper 2010). Nurses should assess the situation and pro-
vide precautionary measures by safely using the equipment
to warm the patient and recover their body temperature.
The comfort levels of body temperature recovery methods
Pikus and Hooper (2010) pointed out that postoperative
body temperature recovery methods must increase and
improve the overall comfort of patients to reduce their time
in the PACU. The term ‘comfortable’ refers to a physically
and mentally relaxed state, with no pain, anxiety or stress
(Tsao et al. 2009). Leeth et al. (2010) studied the warming
devices given to 150 postoperative patients. They found at
least 30 minutes was required before the thermal comfort
of the patient was acceptable and appreciated.
Methods
Design and subjects
This is an experimental research design. Subjects were ran-
domly chosen from postspinal surgery patients in the PACU
in a medical centre. Fifty control group tags and 50 experi-
mental group tags were put into a box covered with black
cloth. The researcher drew a tag from the box and ran-
domly assigned patients, according to the order of their
admittance, to the control group or the experimental group.
The sample size was estimated by the G-POWER version
3.010 software (Website: http://www.gpower.hhu.de/), and
the selection parameters were as followings: power = 0
8;
a = 0
05; effect size = 0
3; two-tailed test; estimated total
sample size of 84. In considering intention to treat, a total
of 100 samples were selected then split into two groups of
50 subjects. The inclusion criteria were: (1) between the
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W-P Lee et al.
Concept
Thermal gown vs. cotton cloth
Patient demographic data: gender,
age, height, weight, diagnosis,
surgical procedure, method of
anesthesia, preoperative body
temperature, postoperative body
temperature
ages of 20–64; (2) underwent general anaesthesia with total
surgery duration being longer than 60 minutes; (3) body
temperature being lower than 36 °C when admitted into
the PACU; (4) no vision or hearing impairments, conscious,
literate and can communicate in Mandarin or Taiwanese;
and (5) completed and signed the consent form after being
thoroughly informed of the study purpose. The exclusion
criteria were: (1) received local or spinal anaesthesia; (2)
contracted an infectious disease prior to surgery; (3) having
a metabolic disease; (4) having a preoperative body temper-
ature below 36 °C or higher than 37
5 °C; and (5) having
tracheostomy or endotracheal tube.
Concept
Since the newly designed thermal gown was introduced to
this research, the structure of the research follows the pat-
tern as illustrated in Fig. 1.
Ethical considerations
This study was approved by the institutional review board
(No: 102-0191A3) in a medical centre. The researchers dis-
closed the purpose of the study, the research methods and
other precautions to the subjects and their families prior to
their participation. The participants’ rights and privacy were
protected throughout the study. Each participant completed
a consent form, and had the right to withdraw from the study
at any given time for any given reason. Two researchers were
given ear thermometer measurement consistency and thermal
gown instruction trainings two weeks prior to the com-
mencement of the study. The researchers were able to reach a
temperature measurement consistency of 95%. Findings of
the research were also secured for each patient’s bill of right.
Methods
The purpose of the study was explained and consent forms
were obtained when patients arrived in the operating room
© 2015 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.
2782
Postoperative patient’s body
temperature, comfort, and
improvement of
physiological conditions
Figure 1 Structure of the research.
waiting area. Body temperature was taken in the mean-
time. After completion of the consent form, patients were
sent to an operating room for surgery, and then sent to
the PACU. The room temperature of the PACU was set at
22–24 °C and humidity was maintained at 60–70%. A
patient entered the study when his/her body temperature
was below 36 °C upon arriving at the PACU. Three cotton
cloths preheated to 60 °C were given to the control group
patients for neck to feet coverage. The cloths were
exchanged two to three times during the patient’s stay at
the PACU. On average, each patient used eight pieces of
cotton cloth. A nonheated surgical, light green, covering
was also used over the cotton cloth for each patient to
maintain heat. The experimental group patients were given
a preheated (60 °C) thermal gown and a nonheated surgi-
cal covering. The thermal gown covered the patient from
neck to feet as well. Both a patient’s body temperature
and comfort level were measured until body temperature
and comfort level reached 36 °C and a level of 4, respec-
tively.
Research tools
Thermal gown
The newly designed thermal gown was used in this study
for the experimental group patients (Fig. 2). The design
concept is based on the Japanese kimono and the orthopae-
dic postsurgery wear for a patient’s comfort and the staff’s
convenience. The material of the gown is polyester,
designed specifically for comfort and warmth. This material
is also proven to be good insulation for safety. The gown
was heated to 60 °C before being placed on the patients.
There are two 35-cm-laced openings at each sleeve for the
ease of IV tube access and wound observation. There is also
another 40-cm-laced opening at the chest for electrocardi-
ography access, wound observation or tubing. The gown is
180 cm in length, covering the neck, trunk and limbs. This
ensures complete coverage.
Journal of Clinical Nursing, 24, 2779–2787
Original article
35 cm laced openings at
each sleeve for the ease of
IV tube access and wound
observation
Figure 2 Thermal gown.
Demographic data
Demographic data were collected from the patients’ medi-
cal records such as gender, age, height, weight, diagnosis,
surgical procedure, method of anaesthesia, preoperative
body temperature and duration of surgery.
Comfort assessment
The patients’ subjective comfort was assessed using a five-
point Likert scale. The scoring methods are: very cold (one
point), cold (two points), adequate (three points), warm
(four points) and very/too warm (five points). The patients
were asked to complete the comfort assessment when
admitted into the PACU (Leeth et al. 2010). When a
patient had undergone shivering or complained of feeling
cold, the comfort score appeared low.
Body temperature
Body temperatures were measured with an infrared ear
thermometer (OPUS 1000 ear thermometer). The range of
the thermometer is between 20–44 °C (0
2 °C). The ther-
mometers were calibrated once a month, prior and during
the study, by the hospital equipment technicians. The body
temperature of the patient was measured every 10 minutes,
beginning with admission to the recovery room until 36 °C
was reached. To avoid discrepancy in manual operations,
the two researchers had verified the consistency of the ear
thermometer operation two weeks prior to the commence-
ment of the study. The researchers verified their techniques
by measuring the temperatures of patients. Consensus
occurred when body temperature deviated <0
2 °C. The
researchers were able to obtain three temperature readings
with <0
2 °C in deviation.
© 2015 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.
Journal of Clinical Nursing, 24, 2779–2787
The newly designed thermal gown on hypothermic patients
40 cm laced opening at
the chest for
electrocardiography
access and wound
observation
Statistical analysis
The data were managed, stored and locked by the author.
The data were entered into a password protected computer
for safekeeping. The paper-based forms will be stored in a
locked file cabinet for five years after the completion of this
study, and will then be destroyed. The SPSS version 20.0
(IBM Corporation, Armonk, NY, USA) for Windows soft-
ware package was used to analyse data. The descriptive sta-
tistical analysis included categorical variable analysis
represented with frequency and percentage, and isometric
variable analysis represented as mean and standard devia-
tion. The inferential statistical analysis included independent
t test and chi-square test to determine the presence of signifi-
cant differences in demographic data among the patients.
Survival analysis represented on a log scale was used to
study a group for a period of time, and the probability of a
particular event occurring during this period (Lin 2008).
The cumulative percentage of patients who had reached
36 °C at each 10-minute interval was compared between
the two groups. The above assumptions used a two-tailed
test and a p-value of 0
05 as the significance threshold.
Results
Demographic data
There were a total of 100 subjects in this study, with 50
subjects in the control group and 50 subjects in the experi-
mental group. There were 49 males and 51 females. The
average age of the subjects was 53
36  10 years. The two
groups’ demographic data, which included gender, age,
height, weight, body mass index, surgical procedure, blood
loss volume and preoperative body temperature, were
2783
W-P Lee et al.

Table 1 Demographic data between the two groups (N = 100)

Groups

Cotton cloth (N = 50) Thermal gown (N = 50)

Item N (%) Mean Standard deviation N (%) Mean Standard deviation t/v2 p

Gender
Male 25 (50
0) 24 (48
0) 0
06 0
84
Female 25 (50
0) 26 (52
0)
Age 54
28 9
31 52
44 10
65 0
92 0
36
Height (cm) 161
50 7
73 161
44 9
57 0
57 0
97
Weight (kg) 69
18 10
16 67
64 11
28 0
72 0
48
Body mass index 26
59 3
93 25
94 3
64 0
39 0
86
Surgical procedure
Laminectomy 21 (42
0) 10 (20
0)
Postinstrumentation 18 (36
0) 29 (58
0)
with smartlac
Discectomy 7 (14
0) 9 (18
0)
TPS 4 (8
0) 2 (4
0)
Blood loss volume (ml)
0–500 33 (66
0) 39 (78
0) 3
39 0
16
501–1000 11 (22
0) 7 (14
0)
1001–1500 2 (4
0) 2 (4
0)
15001–2000 2 (4
0) 2 (4
0)
>2001 2 (4
0) 0 (0
0)
Surgery duration (minutes) 237
82 78
08 234
20 100
28 0
34 0
76
Preoperative body temperature (°C) 36
44 0
27 36
55 0
37 9
67 0
10

Table 2 The cumulative percentage of body temperature recovery methods for elevating hypothermic patients to body temperatures of
36 °C (N = 100)

Groups

Cotton cloth (N = 50) Thermal gown (N = 50)

>36
0 °C Number >36
0 °C Number

Total of individuals Percentage (%) Total of individuals Percentage (%) v2 p

10 minutes 50 0 0 50 2 4 2
04 0
153

20 minutes 50 0 0 48 13 26 12
91 <0
001
30 minutes 50 0 0 37 24 48 17
02 <0
001
40 minutes 50 0 0 26 29 58 10
29 <0
001
50 minutes 50 1 2 21 35 70 11
75 <0
001
60 minutes 49 6 12 15 45 90 20
40 <0
001
70 minutes 44 12 24 5 49 98 12
17 <0
001
80 minutes 38 19 38 1 50 100 3
98 0
046
90 minutes 31 31 62 0 50 100 NA NA
100 minutes 19 41 82 0 50 100 NA NA
>101 minutes 9 50 100 0 50 100 NA NA

shown by chi-square and t test to have no significant differ-
ences at the base (Table 1).
When the patients were first admitted into the PACU, the
body temperatures in the thermal gown group and the cot-
ton cloth group were 35
1  0
5 °C and 35
1  0
4 °C
(p = 0
05) respectively. The average length of time it took
for the thermal gown group patients to reach a body
temperature of 36 °C was 49
02 minutes (95% CI: 46
60–
51
43), with the median time being 50 minutes, while the
cotton cloth group took 93
09 minutes (95% CI: 91
33–
94
85), with the median time being 90 minutes. In compar-
ing the cumulative percentage of achieving standard core
body temperatures in postspinal surgery patients between
the two groups, the cumulative percentage for the thermal
gown group patients in reaching 36 °C during the first
20 minutes of admission was significantly higher than that

© 2015 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.
2784 Journal of Clinical Nursing, 24, 2779–2787
Original article The newly designed thermal gown on hypothermic patients

median time being 80 minutes. The cumulative comfort

percentage between the two body temperature recovery
methods indicated that (Table 3) the thermal gown group
individuals showed significantly higher comfort levels
(score = 4) at 10 minutes, when compared to the cotton
cloth group (v2 = 12
0, p < 0
001).
The average duration of a patient’s stay in the PACU for
the thermal gown group and the cotton cloth group was
71
53  6
63 and 99
45  17
27 minutes respectively. The
average duration of a patient’s stay in the PACU for the
thermal gown group was significantly lower than that of
the cotton cloth group.

Figure 3 The cumulative percentage of body temperatures below
36 °C for the two body temperature recovery methods.
of the cotton cloth group (v2 = 12
91, p < 0
001)
(Table 2). The 36 °C log rank survival analysis (Fig. 3)
showed a significant difference in the cumulative percentage
of a body temperature below 36 °C between the two
groups (v2 = 600
02, p < 0
001).
When the patients were first admitted into the PACU, the
comfort levels (at level 4) of the thermal gown group and
the cotton cloth group were 40 and 10% (v2 = 12
0,
p < 0
001) respectively. The average duration required for
the thermal gown group’s comfort level to reach 4 was
18
42 minutes (95% CI: 16
62–20
23), with the median
being 10 minutes. The average duration for the cotton cloth
group was 81
86 minutes (95% CI: 80
13–83
60), with the
Discussion
This study aimed to investigate the two different body tem-
perature recovery methods in providing hypothermia
improvements for postspinal surgery patients in the PACU,
where the end point of the study is comfort (score = 4) with
body temperatures of 36 °C. The results showed the thermal
gown group had a cumulative percentage significantly higher
than the cotton cloth group with patients reaching body tem-
peratures of 36 °C after 20 minutes in the PACU. The result
is similar to those conducted by Wagner et al. (2006), where
they investigated the difference between patient-controlled
heat blankets and conventional thermal blankets. That study
found that patients using the self-controlled thermal blanket
had much better warmth than those with conventional blan-
kets. Shih (2008) confirmed that the use of preoperative
warm air blower heating measures allowed the average body
temperature of experimental group patients to be 0
24 °C

Table 3 The cumulative percentage between the two body temperature recovery methods in providing comfort for hypothermic patients
(N = 100)

Groups

Cotton cloth (N = 50) Thermal gown (N = 50)

Comfortable Comfortable
Total (number of individuals) Percentage (%) Total (number of individuals) Percentage (%) v2 p

10 minutes 50
0 5
0 10
0 50
0 20
0 40
0 12
00 <0
001

20 minutes 45
0 8
0 16
0 30
0 33
0 66
0 14
42 <0
001
30 minutes 42
0 10
0 20
0 17
0 40
0 80
0 12
41 <0
001
40 minutes 40
0 13
0 26
0 10
0 46
0 92
0 14
94 <0
001
50 minutes 37
0 15
0 30
0 4
0 49
0 98
0 16
33 <0
001
60 minutes 35
0 20
0 40
0 1
0 50
0 100
0 5
14 0
023
70 minutes 30
0 33
0 66
0 0
0 50
0 100
0 NA NA
80 minutes 17
0 37
0 74
0 0
0 50
0 100
0 NA NA
90 minutes 13
0 42
0 84
0 0
0 50
0 100
0 NA NA
100 minutes 8
0 46
0 92
0 0
0 50
0 100
0 NA NA
>100 minutes 4
0 50
0 100
0 0
0 50
0 100
0 NA NA

Comfortable column indicated when a patient’s comfortable score reached 4.

© 2015 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.
Journal of Clinical Nursing, 24, 2779–2787 2785
W-P Lee et al.
higher than the control group in the PACU. In addition, Fa-
nelli et al. (2009) showed that newly developed carbon fibre
blankets can provide the same amount of heat in preventing
hypothermia as electrical heating blankets when placed
beneath the patient. In terms of comfort, the patients with
the thermal gowns showed a significantly higher percentage
of comfort than did the patients with the cotton cloth, after
10 minutes of being in the PACU.
Polyester synthetic fibres can provide both excellent
warmth and comfort (Teng 2004). The aforementioned
studies mainly used actively heating thermal gowns, electri-
cal heating blankets and warm air blowers. Although these
types of equipment have a good warming effect, they tend
to have higher operating costs, and if improperly used, may
cause burns to unconscious patients. Considering that the
current warm cloth material commonly used in hospitals is
cotton, this study designed and used a new polyester-based
thermal gown to provide warmth. By reducing the frequent
changing of warm cloths, the total cost for each patient was
reduced from $3
30–$1
10 (reduced 75%). As this gown is
economical and thermally safe, it will be introduced into
clinical care, to reduce heat loss from the skin surface and
reduce cold discomfort. The results showed that the newly
designed thermal gown group’s duration in the PACU was
significantly lower than the cotton cloth group’s duration.
The average duration of a patient’s stay in the PACU for the
thermal gown group and the cotton cloth group was
71
53  6
63 and 99
45  17
27 minutes respectively.
The unique findings of this study as compared to other
research in this area found that the patient’s comfort in the
experimental group was significantly higher than in the con-
trol group. When approaching the patients regarding this
newly designed thermal gown, patients responded by stating
that wearing the thermal gown made them feel like they were
wearing their own gown from home. The thermal cloth felt
more like just a covering over their body. With the thermal
cloth, they felt naked. Patients gave positive affirmation on
the thermal gown and strongly recommended continued use
in the future to benefit every patient in the PACU.
The study concluded that this newly designed thermal
gown when given to a patient after surgery can signifi-
cantly reduce the duration of their stay in the PACU,
thus reducing the cost of care. Therefore, this study can
provide references for the care of postoperative patients
recovering from anaesthesia in the PACU.
References
Chen TS & Wei FC (2011) Comparison of and electrical blankets in restoring nor-
the effectiveness between heater lamps mothermia and improving patients’ com-
© 2015 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.
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Conclusion and suggestions
Ideally, postsurgery warming equipment must be safe, fast,
reliable, have a predictable temperature and have no danger
of scalding the patients. Based on considerations of cost
and practicality, this study demonstrated the importance of
the development of the thermal gown. The use of the ther-
mal gown was shown to be superior to warm cotton cloth
in terms of increased patient comfort and the reduction in
the duration of a patient’s stay in the PACU. Therefore, in
clinical use, when the patient’s body temperature is <36 °C,
the thermal gown can be used to quickly recover the
patient’s temperature as well as provide comfort. We hope
that through further research, this newly designed thermal
gown can be widely used in other departments in the hospi-
tal in providing quality postoperative care.
Relevance to clinical practice
Maintaining a patient’s body temperature is a major task
for nurses working in the PACU. With the newly designed
thermal gown, the duration of a patient’s stay in the PACU
was shortened and a patient’s comfort was increased. In
addition, this newly designed thermal gown can be applied
to critical care unit patients as they are more vulnerable
and have many tubes attached to their bodies.
Limitations
The limitation of this study is that the subjects in this study
were spinal surgery patients who had undergone general
anaesthesia. The result from this study may not be applica-
ble for patients who underwent other types of surgery or
anaesthesia.
Disclosure
The authors have confirmed that all authors meet the
ICMJE criteria for authorship credit (http://www.icm-
je.ort/ethical_1author.html), as follows: (1) substantial
contributions to conception and design of, or acquisition
of data or analysis and interpretation of data, (2) drafting
the article or revising it critically for important intellec-
tual content and (3) final approval of the version to be
published.
fort after orthopedics surgery. Veterans
General Hospital Nursing 28, 258–265.
Journal of Clinical Nursing, 24, 2779–2787
Original article
Fanelli A, Danelli G, Ghisi D, Ortu A, Mos-
chini E & Fanelli G (2009) The efficacy
of a resistive heating under-patient blan-
ket versus a forced – air warming system:
a randomized controlled trial. Anesthe-
sia and Analgesia 108, 199–201.
Ford DA (2008) Preventing unplanned
hypothermia a key component to
patient safety. Operating Room
Nursing 2, 28–31.
Good KK, Verble JA, Secrest J & Nor-
wood BR (2006) Postoperative hypo-
thermia – the chilling consequences.
Association of Operating Room
Nurses Journal 83, 1054–1070.
Guyton AC & Hall JE (2000)Guyton: T/B
of Medical Physiology, 9th edn
(Translated by Lin YS & Yuan ZF).
Ho Chi, Taipei City (The original
work was published in 1995).
Harper CM, McNicholas T & Gowrie-
Mohan S (2003) Maintaining periop-
erative normothermia: a simple, safe,
and effective way of reducing compli-
cations of surgery. British Medical
Journal 326, 721–722.
Kiekkas P, Poulopoulou M, Papahatzi A &
Souleles P (2005) Effects of hypother-
mia and shivering on standard PACU
monitoring of patients. American
Association of Nurse Anesthetists
Journal 73, 47–53.
Lee FL, Shung YC, Ho HH & Guu SL
(2005) The effects of rewarming strat-
egy on patients receiving abdominal
surgery during intraoperative phase in
prevention core hypothermia and pos-
tanesthetic recovery. Tzu Chi Nursing
Journal 4, 42–50.
Leeth D, Mamaril M, Oman KS &
Krumbach B (2010) Normothermia
and patient comfort: a comparative
study in an outpatient surgery setting.
Journal of Perianesthesia Nursing 25,
146–151.
© 2015 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.
Journal of Clinical Nursing, 24, 2779–2787
The newly designed thermal gown on hypothermic patients
Lenhardt R, Marker E, Goll V, Tschernich
H, Kurz A, Sessler D, Narzt E &
Lackner F (1997) Mild intraoperative
hypothermia prolongs postanesthetic
recovery. Anesthesiology 87,
1318–1323.
Leslie K & Sessler DI (2003) Perioperative
hypothermia in the high – risk surgical
patient. Best Practice & Research.
Clinical Anaesthesiology 17, 485–498.
Lu SH & Dai YT (2006) Impact of aging
on the thermoregulation and febrile
response. Formosan Journal of Medi-
cine 10, 123–128.
Lin CF (2008) Survival Analysis. Yeh Yeh
Book Gallery, Taipei City.
Lin YS & Du MS (2006) Diagnosis of low
body temperature and treatment. Fam-
ily Medicine & Primary Medical Care
21, 139–144.
Lynch S, Dixon J & Leary D (2010)
Reducing the risk of unplanned peri-
operative hypothermia. Association of
Operating Room Nurses Journal 92,
553–562.
Macario A & Dexter F (2002) What are
the most important risk factors for a
patient’s developing intraoperative
hypothermia. Anesthesia and Analge-
sia 94, 215–220.
Mahoney CB & Odom J (1999) Maintain-
ing intraoperative normothermia: a
meta-analysis of outcomes with costs.
American Association of Nurse Anes-
thetists Journal 67, 155–164.
Moss R (1998) perioperative cardiac mor-
bidity. Anesthesiology 72, 153–184.
Paulikas CA (2008) Prevention of
unplanned perioperative hypothermia.
Association of Operating Room
Nurses Journal 88, 358–368.
Pikus E & Hooper VD (2010) Postopera-
tive rewarming: are there alternatives
to warm hospital blankets. Journal of
Perianesthesia Nursing 25, 11–23.
Sessler DI (2001) Complications and treat-
ment of mild hypothermia. Anesthesi-
ology 95, 531–543.
Shih CW (2008) The Effects of Pre –
Warming on Perioperative Hypother-
mia Prevention in Abdominal Surgery
Patients. Unpublished master’s thesis.
National Defense Medical Center, Tai-
pei City.
Shih CW, Lee YH & Wang KY (2010)
Nursing care of shivering related to
hypothermia following general anesthe-
sia. Chang Gung Nursing 21(3), 299–
305.
Teng LS (2004) Analysis of the status of
healthcare textiles market. Taiwan Tex-
tile Industries Newsletter 12, 5–28.
Torossian A (2008) Thermal management
during anesthesia and thermoregula-
tion standards for the prevention of
inadvertent perioperative hypothermia.
Best Practice & Research. Clinical
Anaesthesiology 22, 659–668.
Torrie JJ, Yip P & Robinson E (2005)
Comparison of forced – air warming
and radiant heating during transure-
thral prostatic resection under spinal
anesthesia. Anaesthesia and Intensive
Care 33, 733–738.
Tsao LI, Yu IC, Tsai LH, Wang YN, Hsu
HC, Sun SH & Lin HC (2009) New
Basic Nursing, 4th edn. New Wun
Ching, Taipei City.
Wagner D, Byrne M & Kolcaba K (2006)
Effects of comfort warming on preoper-
ative patients. Association of Operating
Room Nurses Journal 84, 427–448.
Wu YL, Wu CY, Jang YJ & Lou F (2006)
Operating Room Nursing. Farseeing,
Taipei City. New Wun Ching Devel-
opmental Publishing Co., Ltd.
Yan X (2010) Surgery patients nursing.
Medical-Surgical Nursing, 4th edn.
Totally revised by Liao Chang GL.
Yeong Dah, Taipei City.
2787