Page 502 - Encyclopedia of Nursing Research

SImUlATIOn n 469

gradients was found to predict shivering in the biobehavioral interface of environmental
this population, presumed to reflect the dis- stimuli, biochemical and neurotransmitter
crepancy between hypothalamic set point activity, energy expenditure, physics of heat S
and peripheral temperatures that initiates exchange, and thermal comfort.
shivering. Sund-levander and Wahren (2000)
found that tympanic-to-toe temperature gra- Barbara J. Holtzclaw
dients predicted shivering in neurologically
injured patients during hypothermic surface
cooling and that patients were more likely to
shiver if cooled too quickly. This study sup- Simulation
ported the earlier contention of Abbey et al.
(1973) that shivering during surface cooling
could be reduced by modifying the rate of Simulations provide an innovative teaching
body heat loss. Studies confirm that little dif- method to enhance the learning of students
ference is found between pharmacological and professionals by engaging them in active
suppressants, warmed blankets, or reflective learning techniques which provide feed-
wraps in preventing shivering during peri- back and allow for reflection on practice and
operative rewarming (hershey, Valenciano, outcomes. A definition from the national
& Bookbinder, 1997); however, newer forced- Council of State Boards of nursing’s (nCSBn,
air warming units (e.g., Bair hugger) and 2005) policy statement describes simulations
radiant lamps have been found in medical broadly as “activities that mimic reality of
studies to maintain normothermia more a clinical environment and are designed to
effectively. extremity wraps were found to demonstrate procedures, decision-making
effectively reduce febrile shivering severity and critical thinking through techniques
and duration (see Fever/Febrile Response) in such as role-playing and the use of devices
immunosuppressed cancer patients and per- such as interactive videos or mannequins”
sons with hIV/AIDS (holtzclaw, 1990, 1998) (Jeffries, 2005; nCSBn, 2005). In using this
As scientific evidence grows about neu- innovative teaching method, faculty mem-
roregulatory and immunological factors bers and staff development personnel use
influencing shivering, new avenues of study patient-specific information to create mean-
emerge. little is known about how shivering ingful real-life scenarios that improves stu-
can be controlled in emergency situations dents’/nurses’ comprehension of the material
during rescue and evacuation. Few studies and situation. These scenarios vary in com-
have examined outcomes of shivering among plexity and expected learning objectives
children. Surgery, trauma, circulatory bypass, dependent upon the level of the learner, the
and hypothermia have all been linked in clinical situation they are being prepared for,
preliminary studies to acute phase reactions and the creativity of the developer. Clinical
that stimulate febrile shivering (phillips, nursing scenarios suspend disbelief of what
1999). Although shivering is estimated to is “real,” thus creating a hands-on opportu-
occur in about 10% of births during the last nity to practice patient monitoring and man-
stage of labor, it is more frequent following agement in a risk-free environment. A variety
epidural anesthesia (Arulkumaran, penne, & of professions benefit from the use of simu-
Rao, 2005, p. 58). however, little attention has lation activities and research demonstrates
been paid to its possible other proinflamma- enhanced learning and skill performance,
tory origins and management beyond con- increased communication, collaboration,
trolling warmth in the environment (Fallis and self-efficacy and improved patient
et al., 2006). Future directions in the study safety and outcomes (Bambini, Washburn, &
of shivering by nursing will likely address perkins, 2009; Kaakinen & Arwood, 2009;