Nurses’ knowledge of and attitudes towards fever
and fever management in one Irish Children’s
Hospital.
Louise Greensmith
MSc., BSc (hons), RGN, RCN, RNT.
Background
• In most cases fever is a positive immunological
response in children.
• However, for more than thirty years research has
demonstrated that nurses and parents view fever
negatively and treat it aggressively, leading to less
than beneficial outcomes for febrile children.
2
Antipyretics
are not
necessary for
every child
with fever
Holtzclaw 2003
X
Watts 2003
X
Antipyretics can
lengthen
duration of
childhood illness
Doran 1989
X
Brandts 1997
X
Antipyretics are
ineffective in
preventing
febrile
convulsions
Uhari 1995
X
Van Stuijvenburg
1998
X
Sharber 1997
Woolard and Pitt
2003
Physical
antipyretics may
increase
children’s
discomfort and
induce shivering
Shivering can
lead to a febrile
convulsion
X
X
3
Clinical Guidelines
• The use of physical methods to reduce fever is not
recommended.
• The use of pharmacological antipyretics in children is
recommended only when the fever is associated with
evident discomfort.
• Preventative use of pharmacological antipyretics is
not recommended in relation to the prevention of
febrile convulsions in children
(NICE 2007 , Chiappini et al. 2009)
4
Research Design
• A descriptive, quantitative research design was
employed.
• Data was collected from a convenience sample.
– 119 nurses working in one children’s Hospital in Ireland
completed a self report questionnaire.
• Data was analysed using SPSS.
• Ethical approval was granted from the hospital where
the study took place and the University which the
researcher is affiliated with.
5
Findings- Knowledge
• Nurses’ mean knowledge score was 51% (n=119), which
was lower than expected.
• The current study found no statistically significant
difference in knowledge scores between nurses holding a
higher diploma in children’s nursing and those who did
not.
• The study found a small, positive, statistically significant
correlation between higher correct knowledge scores and
more years of experience in a children’s setting.
6
Findings -Knowledge
• Only 9.2% (n=11) of nurses in the current study
correctly answered that febrile convulsions commonly
occur in children with low grade fever.
• 65% (n=77) of nurses in the current study incorrectly
answered that febrile convulsions occur in more than
25% of children.
7
the principle danger of
fever.
8
Findings Attitudes
• 56% (n=66) of nurses agreed that temperature alone is an
indication for the administration for antipyretics.
• Almost all nurses in the current study (97%, n=115)
believe that doctors recommend the use of antipyretics to
reduce temperature in a febrile child.
• The study found that having a specialist qualification in
children’s nursing made no difference to nurses’ attitudes
towards fever.
9
Findings -Attitudes
10
Findings
• Findings from this study reveal nurses have low
knowledge levels of, and inappropriate attitudes towards
fever and fever management.
• This leads to inconsistent fever management practices.
• Nurses and health care providers are parents’ primary
source of fever management advice (Crocetti et al. 2001).
11
Interventions
• The pyrexia care plan has been updated to reflect
evidence based practice.
• Written discharge advice based on evidence based
practice has been developed, which is given to
parents of febrile children on discharge
• The University which trains student nurses in this
hospital has been informed of the findings.
• A second study with the aim of developing a nurse
led education intervention is underway.
12
References:
• Blumenthal I. (2000) Fever and the practice nurse: management and
treatment. Community Practioner 73, 519-521.
•
•
•
•
•
Brandts C.H., Ndjavi N., Graninger W. and Kremsner P.G. (1997) Effect of
paracetamol on parasite clearance time in plasmodium falciparum malaria. Lancet
350, 704-709.
Chiappini E., Principi N., Longhi R., Tovo P.A., Becherucci P., Bonsignori F.,
Esposito S., Festini F., Galli L., Lucchesi B., Mugelli A., and deMartino M. (2009)
Management of fever in children: Summary of the Italian Paediatric Society
Guidelines. Clinical Therapeutics 31(8), 1826-1843.
Crocceti M., Moghbeli N., and Serwint J. (2001) Fever phobia revisited: Have
parents misconceptions about fever changed in 20 years? Paediatrics 107(6), 12411246.
Doran T.F., De Angelis C., Baumgardner R.A. and Mellits E.D. (1989)
Acetaminophen: more harm than good for chickenpox? Journal of Pediatrics 114,
1045-1048.
Holtzcalw B.J. (2003) Use of thermoregulatory principles in patient care: Fever
management. CINAHL Information Systems, Clendale, California.
13
References
•
National Institute for Health and Clinical Excellence (2007) Feverish illness in
children; Assessment and initial management in children younger than 5 years.
Retrieved from http://guidance.nice.org.uk/nicemedia/live/11010/30523/30523.pdf
on 03 January 2011.
• Sarrell M., Cohen H.A. and Kahan E. (2002) Physicians’ nurses’ and
parents’ attitudes to and knowledge about fever in early childhood. Patient
Education and Counselling 46, 61-65.
•
•
•
Sharber J. (1997) The efficacy of tepid sponge bathing to reduce fever in young
children. American Journal of Emergency Nursing 15(2), 188-192.
Uhari M., Rantala L., Vainionpaa and Kurttila R. (1995) Effect of acetaminophen
and of low intermittent doses of diazepam on prevention of recurrence of febrile
seizures. Journal of Pediatrics 126(6), 991-995.
Van Stuijvenburg M., Derkson-Lubson G., SteyerbergE.W. Habbema J.D. and Holl
H.A. (1998) Randomised controlled trial of ibuprofen syrup administered during
febrile illnesses to prevent seizures. Pediatrics 102(5), 51-58.
14
References
•
•
•
Walsh A., Edwards H., Courtney M., Monaghan S. and Wilson, J. (2005) Fever
management: paediatric nurses’ knowledge, attitudes and influencing factors.
Journal of Advanced Nursing 49(5), 453-464.
Watts R., Robertson J. and Thomas G. (2003) Nursing management of fever in
children: A systematic review. International Journal of Nursing Practice 9, 51-58.
Woolard M. and Pitt K. (2003) Antipyretic pre-hospital therapy for febrile
convulsions: Does the treatment fit? A literature review. Health Education Journal
62(1), 23-28.
15
Any Questions?
16