Development Of Intraoperative Hypothermia Risk Factors Assessment Scale For Adult Surgery Patients

Objective:By developing the intraoperative hypothermia risk factors assessment scale for adult surgical patients,to evaluate the risk of intraoperative hypothermia in time and accurately,to provide data support basis for operating room nurses to manage intraoperative hypothermia.Methods:Through Meta analysis method,searching PubMed,Embase,Cochrane Library,Web of Science,Wanfang and other databases by computer,the retrieval time is from the beginning of collection to April 2019.Document management was performed by using Note First 4.1 software.Document quality evaluation was performed by using the Newcastle-Ottawa Scale(NOS).Document heterogeneity testing,model analysis,sensitivity analysis,subgroup analysis and post bias test were performed by using RevMan 5.3 software.Based on the results of meta-analysis and clinical nursing practice,the intraoperative hypothermia risk factors entry-level assessment scale entry pool for adult surgical patients was established.To select and determine scale entries by Delphi method,using the method of purpose sampling,17 experts who have been engaged in operating room nursing for a long time in the tertiary class A general hospitals in China were selected for two rounds of consultation.The first round refers to the scale entry pool,and the second round is formed on the basis of the expert opinions in the first round.The data were recorded and analyzed by Epidate 3.1 and SPSS 24.0.Developing the initial scale according to the selected scale entries.To test the reliability and validity of the initial scale,random number table sampling method was used to extract 120 patients who underwent surgery in a tertiary class A general hospital in Changchun from November 2019 to December 2019 for clinical investigation.Epidate 3.1 and SPSS 24.0 were used to record and analyze the data.The scale was corrected to form a formal scale according to the analysis results.Results:A total of 36 intraoperative hypothermia risk factors were extracted through literature reading.24 risk factors related to intraoperative hypothermia were screened out combined with clinical nursing practice.19 intraoperative hypothermia risk factors were determined according to the results of meta analysis.The scale entry pool includes two dimensions of patients characteristics and iatrogenic factors,a total of 19 entries and 46 grade entries.After two rounds of expert correspondence,the effective recovery rates of the two rounds of questionnaires were 94.12% and 100%.The authoritative coefficient values of the two rounds of expert consultation were 0.87 and 0.89.In the first round,the variation coefficients of importance and accuracy were 6.78%～44.42% and 8.11%～34.52%.In the second round,the variation coefficients of importance and accuracy were 0.00%～10.87% and 8.11%～13.70%.Two rounds Kendalls W of importance and accuracy were tested and was statistically significant(P<0.05).A total of 6 entries and 20 grade entries were deleted,1 entry and 4 grade entries were modified.The final initial scale consists of 2 dimensions,13 entry and 26 grade entries.After the reliability and validity test and risk level analysis of the scale,significant difference between the entries of high group and low group(except the operating room temperature)by t-test(P<0.05)has been proved.The KMO value of all data was 0.664,the Bartlett spherical test had significant difference(P<0.0001),the common factor variance "extraction" value was 0.502～0.862,the cumulative variance contribution rate was 67.674%(>50%).The load value of each entry on its common factor was 0.416～0.907.Factor 3 and factor 4 belong to the patients’ characteristics,and factor 1、 factor 2 and factor 5 belong to the iatrogenic factors.The Cronbach′s α coefficient and half-reliability coefficient of the scale were 0.711 and 0.777.The risk index threshold was 15.31～17.78 points.The final scale consists of 2 dimensions,12 entries and 24 grade entries,and is divided into three levels(12 to 14 points for low risk,15 to 18 points for medium risk,19 to 24 points for high risk).Conclusions:One risk factors assessment scale of intraoperative hypothermia for adult surgical patients,which has good reliability and validity,providing a scientific and effective assessment tool for clinical practice,has been developed,through meta analysis,expert consultation by Delphi method and clinical investigation.