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Nurse Researchers Conduct Blanket Study at Texas Health Presbyterian Hospital Dallas

DALLAS — Have you ever had surgery or a procedure and felt cold and anxious until a nurse covered you with a toasty warm blanket? By providing patients with a warm blanket, anxiety can decrease, and comfort levels can increase. Nurses at Texas Health Presbyterian Hospital Dallas want patients to have warm memories of their experiences in surgery and outpatient procedures — literally.

Mary Krogh (left) and Pat Kelly
Mary Krogh (left) and Pat Kelly, part of the research team, in front of the blanket warmer.
Click photo to download hi-res image

That’s why nurses questioned national guidelines that lowered the temperature settings of blanket warmer cabinets from 180 degrees Fahrenheit to 130 degrees Fahrenheit, a temperature which produces lukewarm blankets. The nurses at Texas Health Dallas challenged the guidelines by asking an important question, “What is the evidence for lowering the blanket warmer cabinet temperature?” To answer this question, nurse researchers conducted a study to demonstrate the safety and effectiveness of blankets warmed at the higher temperature settings, which had been used for decades.

“The study is a scientific approach to understanding the effects of warm dry cotton blankets on skin temperature and patients’ reports of thermal comfort” said Patricia Kelly, D.N.P., APRN, C.N.S., AOCN, a clinical nurse specialist/research and evidence-based practice facilitator for Texas Health Dallas. “We hope that the results from our study will encourage more nurses to ask questions, explore the literature, and use research to improve direct patient care.”

For years, hospitals around the country have used warming cabinets to bring blankets to patient-friendly temperatures but Texas Health Dallas nurse researchers say that because of the lower cabinet temperatures the blankets quickly lose their warmth and their effectiveness in making patients feel warm and comfortable before surgery.

“A patient having surgery or a procedure only wears a thin cotton hospital gown and often complain of being cold” said Mary Krogh, R.N., CPAN, a nurse in the post anesthesia care unit at Texas Health Dallas and nurse investigator of the hospital’s blanket study. “That’s why we thought this was an important issue to investigate.”

Texas Health Dallas nurse researchers teamed with Craig G. Crandall, Ph.D., director of the Thermoregulation Laboratory at the hospital’s Institute of Exercise and Environmental Medicine, to determine the effect of warm blankets (from different cabinet warmer temperatures) on skin temperatures and thermal comfort. The researchers asked volunteers to experience what it was like to be a patient — wear a hospital gown and receive a blanket warmed at one of two temperatures — 130 degrees and 200 degrees Fahrenheit. Skin temperatures were measured using a thermocouple device — the same device used to study skin temperatures in astronauts.

“Our findings show that participants prefer warmer blankets, and that warmer blankets are safe,” Krogh said.

Their findings challenge national recommendations for temperature settings, which say blanket warmer cabinets should not exceed 130 degrees Fahrenheit. Researchers found that blankets could be safely warmed to 200 degrees Fahrenheit. Researchers discovered there was little difference in skin temperature measurements from the two warming cabinet temperature settings, and none of the skin temperatures reached a level close to what has been reported to cause skin injury.

Of the 20 participants who received the warmer blanket, none of them rated the blanket as "too cold" after 10 minutes of contact; whereas 65 percent of participants revealed their cooler blankets — warmed at 130 degrees Fahrenheit — were “too cold” after 10 minutes, according to the research.

“It takes a few seconds to remove the blanket from the warming cabinet and it takes a few more seconds to get it to the patient,” Krogh said. “Then once the blanket has been unfolded and touches the patient’s skin, it’s lost some of its warmth. That’s all it takes to lose the ‘just right’ comfort level.”

Researchers anticipate a cost savings in using warmer blankets. “We can reduce the laundry costs and staff time spent replacing the blankets,” said Kelly, lead nurse investigator of the blanket study.

“It’s exciting when basic researchers collaborate with hospital nursing researchers,” said Crandall. “These efforts combine the strengths of both groups resulting in improved quality of care patients receive at our hospital.”

The study was sponsored by the Texas Health Dallas Nursing Research Committee. Other Texas Health Dallas nurse investigators for this study were Julie Balluck, M.S.N., R.N., CPAN, NEA-BC, director of surgical services; Susan Cooper, B.S.N, R.N., CPAN, nurse manager for the post anesthesia care unit; Terry Sands, B.S.N, R.N., CNOR, direct-care nurse in surgery; and Debby Rush, B.S.N., R.N., quality improvement coordinator.

“Dr. Kelly and this dedicated team of professional nurses are leading nursing research to better care for their patient’s needs and comfort levels,” said Cole Edmonson, D.N.P., R.N., FACHE, NEA-BC, chief nursing officer and vice president of patient care services at Texas Health Dallas. “What this group is doing to improve patient safety and patient satisfaction is both exceptional and elegantly simple. I am very proud to practice with these professional nurses, as they are challenging convention and tradition.”

About Texas Health Presbyterian Hospital Dallas
Texas Health Presbyterian Hospital Dallas is an 866-bed acute care hospital and recognized clinical program leader, having provided compassionate care to the residents of Dallas and surrounding communities since 1966. U.S. News and World Report has ranked Texas Health Dallas among the nation’s best hospitals in digestive disorders, orthopedics, and neurology and neurosurgery. An affiliate of the faith-based, nonprofit Texas Health Resources system, Texas Health Dallas has approximately 4,000 employees and an active medical staff of more than 1,000 physicians. For more information, call 1-877-THR-WELL, or visit

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