Clinical management of fever by nurses: doing what works

Abstract

Aims The specific aims were to (1) define fever from the nurse’s perspective; (2) describe fever management decision-making by nurses and (3) describe barriers to evidence-based practice across various settings. Background Publication of practice guidelines, which address fever management, has not yielded improvements in nursing care. This may be related to differences in ways nurses define and approach fever. Method The collective case study approach was used to guide the process of data collection and analysis. Data were collected during 2006–7. Transcripts were coded using the constant comparative method until themes were identified. Cross-case comparison was conducted. The nursing process was used as an analytical filter for refinement and presentation of the findings. Findings Nurses across settings defined fever as a (single) elevated temperature that exceeded some established protocol. Regardless of practice setting, interventions chosen by nurses were frequently based on trial and error or individual conventions – ‘what works’– rather than evidence-based practice. Some nurses’ accounts indicated use of interventions that were clearly contraindicated by the literature. Participants working on dedicated neuroscience units articulated specific differences in patient care more than those working on mixed units. Conclusions By defining a set temperature for intervention, protocols may serve as a barrier to critical clinical judgment. We recommend that protocols be developed in an interdisciplinary manner to foster local adaptation of best practices. This could further best practice by encouraging individual nurses to think of protocols not as a recipe, but rather as a guide when individualizing patient care. There is value of specialty knowledge in narrowing the translational gap, offering institutions evidence for planning and structuring the organization of care.

Nursing Care to Pacients With High Body Temperature: An Integrative Review

“…As possíveis razões para esse fato são a produção de calafrios e a vasoconstrição causadas pelos métodos físicos, a falta de conhecimento da equipe sobre a eficácia dessa combinação no tratamento e a falta de tempo da equipe de enfermagem para a aplicação dos referidos métodos. 26 Na assistência de enfermagem a pacientes adultos com febre de foco neurológico, estudo 16 qualitativo realizado com 17 enfermeiros que trabalham em unidades neurológicas ou unidades mis-Verificou-se que o uso de compressas mornas apresenta efeito aditivo na redução da temperatura corporal de crianças, 29 contudo, há falta de evidência para apoiar a rotina. O uso de compressas é indicado apenas em situações de alta temperatura do ambiente ou quando a criança apresenta-se incapaz de transpirar.…”

“…É necessário rigoroso controle da temperatura corporal e avaliação de outros sinais e sintomas. 16 Em relato de experiência sobre a construção de um algoritmo com orientações para o tratamento da febre a pacientes oncológicos, são recomendados os seguintes cuidados de enfermagem: avaliação da temperatura; frequência cardíaca e respiratória, tremores, rubor e letargia; avaliação de exames de cultura; sinais de infecção; administração dos medicamentos de uso contínuo. 30…”

Fundamental care guided by the Careful Nursing Philosophy and Professional Practice Model©

“…At a practice level, fundamental care is also not given the attention it requires as nurses may carry it out in a ritualistic way, rather than an individualised relational way (Thompson & Kagan, ). Responsibilities completed efficiently in the name of quality and cost‐saving targets may be lacking in interpersonal attentiveness, for example assisting patients with eating and drinking, which are also social activities.…”

La fiebre en el niño: una mirada reflexiva a las prácticas de cuidado

“…La importancia del presente artículo radica en la posibilidad de identificar la problemática de la fiebrefobia para los profesionales de enfermería y la manera como ésta se relaciona con las prácticas actuales de cuidado al niño febril al convertirlas en prácticas que se alejan de la evidencia científi-ca (12)(13)(14), las cuales influyen negativamente en el estado de salud de los niños (15)(16)(17).…”