Nurses’ knowledge of and attitudes towards fever and fever management in one Irish Children’s

Hospital.

Louise Greensmith

MSc., BSc (hons), RGN, RCN, RNT.

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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.

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Antipyretics are not necessary for every child with fever

Antipyretics can lengthen duration of childhood illness

Antipyretics are ineffective in preventing febrile convulsions

Physical antipyretics may increase children’s discomfort and induce shivering

Shivering can lead to a febrile convulsion

Holtzclaw 2003 X

Watts 2003 X

Doran 1989 X

Brandts 1997 X

Uhari 1995 X

Van Stuijvenburg 1998

X

Sharber 1997 X

Woolard and Pitt 2003

X

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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)

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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.

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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.

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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.

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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.

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Findings -Attitudes

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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).

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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.

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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), 1241-1246.

• 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.

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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.

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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.

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