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Abbreviated PICO Framework and Search Strategy

Brief description of the problem or topic – clinical problem to be entered here:  You are a student nurse on clinical placement on the surgical ward at CQUniversity hospital. You are on the morning shift and have been assigned to care for 78-year-old Perla Daniel, who had a fall at home and fractured her right hip. Perla is scheduled to go to theatre at 11.00am.   She is very concerned and tells you that the last time she came out of theatre she was shivering badly, and this lasted a few hours.

The RN you are working with says that Perla’s post-operative shivering is most likely caused by perioperative hypothermia. The operating theatre is trialling different methods of reducing the effects of perioperative hypothermia. The RN says passive methods such as warmed cotton blankets and reflective blankets are often used but there is a trend to move to active warming using warmed fluids and forced-air warming blankets. The RN says she is unsure which is the most effective in preventing post-operative shivering.  The RN asks you to look at the research about these interventions to determine which method is best to stop Perla from shivering so much after her surgery.

Task 1 – PICO    Process

Keyword search terms

Alternative terms/synonyms



Perioperative Hypothermia

Fall in body temperature, chills, shivering



Warmed cotton blankets or Reflective Blankets

Warm comfort shields, radiating blankets



Warmed fluids and forced-air warming

Warm fluids, tense hot air warming



Reduction of post-operative shivering

Prevention of cold

Search terms with Boolean Operators and other symbols added

Perioperative hypothermia AND shivering; Reduction of shivering OR hypothermia; Warmed fluids NOT warmed cotton blankets; Warmed cotton blankets OR forced-air warming, Warm fluids in hypothermia OR Warm blankets in Hypothermia; Perioperative hypothemia AND post-operative shivering.

Write your clinical/research question

Is the use of warmed cotton blankets(I) more effective than the administration of warm fluids(c ) or air for reducing post operative shivering (o)in the disorder of perioperative hypothermia(p) ?

Identify databases used

PubMed, Cochrane, ProQuest, Medline

Identify search filters or limits used

Peer reviewed, Journal Articles, 2017 to present.


Madrid, E., Urrutia, G., i Figuls, M. R., Pardo?Hernandez, H., Campos, J. M., Paniagua, P., ... & Alonso?Coello, P. (2016). Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults. Cochrane Database of Systematic Reviews, (4).

Database used to source the article/academic resource: –  Cochrane Library

Type of study and level of evidence: Systematic Review, Level 1 Evidence

Ethical Approval: As the paper is a systematic review obtained from published literature, consent had been derived from all authors and ethical approval was not required.

Justification paragraph using the five components:  ARCOC - Authority, Relevance, Coverage, Objectivity, and Currency.

The research has been conducted after certain level of authoritativeness from the authors due to their enhanced qualifications. They have highlighted the subject of inadvertent perioperative hypothermia to be occuring as a result of temperature regulation, caused by anaesthesia, for prolonged exposures in operation rooms. The clinical complications have also been assessed while analysing the effeciveness of active body warming systems. It is quite relevant to the subject of the paper. This systematic review offers efficient coverage with the authors concluding on how there is proper evidence to utilize body warming systems to produce mechanical heat. It provides moderate coverage of the concerned topic as comparison between various modes of administering body warming systems have been discussed. The objectivity in the paper has been maintained due to the presence of a structured analysis of the study. The objectives have been fulfilled by proper integration of factual evidence obtained after reviewing subjects. The comparison of active body warming systems versus control for ethical and practical reasons explore future study options.The quality of evidence could be moderate in certain cases for complications of heart circulation and infections. The publication date is within the last 6 years and can be considered current enough for its time of publication, making the information contained in the study up-to date.


Haverkamp, F. J., Giesbrecht, G. G., & Tan, E. C. (2018). The prehospital management of hypothermia—an up-to-date overview. Injury, 49(2), 149-164.

Database used for this academic resource: PubMed

Type of Study and Level of Evidence: Systematic Review, level 1 Evidence

Ethical Approval: No consent had to be taken for this study as evidence had been taken from a published literature.

The researchers are evidenced to have experience in academics and clinical advancements. They possess adequate authority in this subject area. The literature has produced multiple articles out of which nearly 51 articles focused on active heating and passive insulation. The major effective insulation intervention has been deemed to be vapour barriers along with active external interventions concerning rewarming techniques. It is relevant to the concerned subject which aims to find suitable methods to stop preoperative shivering. The utilization of structured interventional methods to indicate non-shivering has been implemented to maintain objectivity in this study. The results have been gathered for intravenous fluids to be reliably warmed before infusion in patients. The study has been conducted within the time-frame of the last five years, as it has been published in 2018, which makes the evidence current. The author has based inferences according to systematic overview of currently prevalent treatment modalities for hypothermia management, which has coverage of the concerned topic, substantially.

Task 1 - PICO Process


Riley, C., & Andrzejowski, J. (2018). Inadvertent perioperative hypothermia. BJA education, 18(8), 227.

Database used for the academic resource: Medline

Type of Study and level of evidence: Evidence Summary, Level 3 evidence(non-experimental study),

Ethical Approval: Evidence has been acquired from published literature and no ethical consent was required to be derived.

The study is based on an evidenced summary, exploring the subject of ‘inadvertent perioperative hypothermia’ observed as a common consequence of general anaethesia in hospital settings. It has highlighted strategies that should be utilized for maintenance of normothermia, discussing risk factors like surgical site infections, coagulopathy, increased transfusions, metabolism and cardiac events. It has also analyzed the vitality of measuring temperature carefully by the use of appropriate devices. The paper is highly relevant to the topic. The authors of the paper belong to the Sheffield Teaching hospitals in the NHS foundation trust and maintain sufficient authority in this study. The article substantially covers the physiology of thermoregulation in anaesthetized children and adults, while describing the consequences and causes of preoperative hypothermia, along with the steps taken for its reduction in different stages of hypothermia. The objectivity in the paper has been presented in a structured format where authors have summarizes key points related to the literature of the effectiveness of various thermoregulatory methods including warm fluids and blankets. The information and inferences are placed moderately in the evidence pyramid, offering good quality. The publication date is within the time-frame of 5 years as it has been published in 2018, and is deemed to be current.


Quinn, C. S. (2018). Perioperative Hypothermia and the Impact of Forced-Air Prewarming (Doctoral dissertation, Grand Canyon University).

Database used for the academic resource: ProQuest

Type of Study and Level of Evidence: It is a primary study with a quantitative comparative approach. Level 1 evidence.

Ethical Approval: Consent was taken from participants who underwent surgical procedures in a hospital and were interrogated for the same. Their credentials have been considered while ensuring no harm or ambiguity of information is caused.

The study aimed at checking the differential effectiveness of utilizing continuous as well as intermittent forced air warming in the preoperative period. It also assesses the measures of outcomes of post operative hypothermia in various comorbidities in patients. It aims to analyze if the causes of higher incidence of unregulated hypothermia, which is excessively relevant with the subject matter. The student who has a Doctorate in Nursing Practice, and has submitted the dissertation through Proquest has moderate authoritativeness for not being a renowned author. The dissertation has efficiently covered all the topics included in the subject matter where perioperative hypothermia has been examined in the light of a complex anaesthesia based surgery where one’s temperature is bound to drop by a minimum of 36 C. The association of unfavourable circumstances has also been explicitly discussed for investigating the effectiveness of intermittent and contiunous air waming throughout the preoperative period. The paper has been written in a structured format wherein the quantitative evaluation has been correctly highlighted, while enhancing the objectivity of the paper. Improvement of quality imporvement committees have also been discussed. The paper is published within the time-frame of 5 years and can be referred to as current evidence.

The PICO framework has given a systematic analysis of the problem statement, to address the issue with necessary interventions. In my opinion, it is a very convenient way of formulating an effective research question, which would enhance the procedure of evaluating its correctness. The determination of the use of the components in the framework, i.e patient, intervention, comparison and outcomes creates effective search startgeies for aiding the quality of searching literature. Various database sites like PubMed, Cochrane, Medline and ProQuest were chosen for obtaining the scrutinized reference lists and obtaining citations on the studies. In this case, deciphering the ‘P’ component to be highlighting the patient or the problem was the question. It was a bit difficult to distinguish between the pertinent elements, to eradicate chances of ambiguity or errors.

The use of the PICO frameowork has helped in the streamlining of the search process, and helped me yield the best available evidences for essential clinical decisions to be integrated and explored. It made me understand alternative or complementary therapies available to the centralized problem. It has made me differentiate research from evidence based knowledge and practices to induce quality improvement measures. When the question appears in a clarified format, it is much easier to find out viable solutions in a clinical setting or otherwise. Interestingly, the framework does not just validate existing knowledge, but helps in the translation of existing evidence for easier application to clinical decision-making standards. Patient outcomes tend to improve substantially as healthcare is based on well-designed studies, instead of clinical expertise or traditions solely. I feel efficient performances can be generated as patient outcomes are enhanced. It is also crucial in a hospitals facing staffing issues.

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