Clinical management of fever by nurses: doing what works

Factors contributing to healthcare professionals' adaptive capacity with hospital standardization: a scoping review

BACKGROUND

Certain factors contribute to healthcare professionals' adaptive capacities towards risks, challenges, and changes such as attitudes, stress, motivation, cognitive capacity, group norms, and teamwork. However, there is limited evidence as to factors that contribute to healthcare professionals' adaptive capacity towards hospital standardization. This scoping review aimed to identify and map the factors contributing to healthcare professionals' adaptive capacity with hospital standardization.

METHODS

Scoping review methodology was used. We searched six academic databases to September 2021 for peer-reviewed articles in English. We also reviewed grey literature sources and the reference lists of included studies. Quantitative and qualitative studies were included if they focused on factors influencing how healthcare professionals adapted towards hospital standardization such as guidelines, procedures, and strategies linked to clinical practice. Two researchers conducted a three-stage screening process and extracted data on study characteristics, hospital standardization practices and factors contributing to healthcare professionals' adaptive capacity. Study quality was not assessed.

RESULTS

A total of 57 studies were included. Factors contributing to healthcare professionals' adaptive capacity were identified in numerous standardization practices ranging from hand hygiene and personal protective equipment to clinical guidelines or protocols on for example asthma, pneumonia, antimicrobial prophylaxis, or cancer. The factors were grouped in eight categories: (1) psychological and emotional, (2) cognitive, (3) motivational, (4) knowledge and experience, (5) professional role, (6) risk management, (7) patient and family, and (8) work relationships. This combination of individual and group/social factors decided whether healthcare professionals complied with or adapted hospital standardization efforts. Contextual factors were identified related to guideline system, cultural norms, leadership support, physical environment, time, and workload.

CONCLUSION

The literature on healthcare professionals' adaptive capacity towards hospital standardization is varied and reflect different reasons for compliance or non-compliance to rules, guidelines, and protocols. The knowledge of individual and group/social factors and the role of contextual factors should be used by hospitals to improve standardization practices through educational efforts, individualised training and motivational support. The influence of patient and family factors on healthcare professionals' adaptive capacity should be investigated.

TRIAL REGISTRATION

Open Science Framework ( https://osf.io/ev7az ) https://doi.org/10.17605/OSF.IO/EV7AZ .

Nursing Management of Temperature in a Patient with Stroke

Fever is common in patients with stroke and is associated with worse outcomes. Studies in brain injury informed interventions commonly termed therapeutic temperature management (TTM) to improve the monitoring and management of fever. While the role and benefit of TTM in stroke patients has not been well studied, the nurse and healthcare team must extrapolate existing data to determine how to best monitor and apply TTM after stroke. Nurses should be knowledgeable about interventions to monitor and manage complications of TTM (eg, shivering), the studies underway to quantify the impact of fever treatment and emerging technology expected to improve TTM.

Holistic care of patients with diabetic foot ulcers during the COVID-19 era: integration of Henderson's Need Theory

The COVID-19 pandemic has inhibited the practice of diabetic foot ulcer care, particularly in the community. Comprehensive theory-based nursing care is needed to prevent further complications. Unfortunately, a study combining theory with nursing care in diabetic foot ulcer care has not been explored. When caring for patients with diabetic foot ulcers, who are also at increased risk of severe complications from COVID-19, it is important to take a holistic view of the patient and consider all of their needs and the factors affecting them. Henderson's Need Theory and the 14 basic needs contained within it was chosen to be integrated in the care of patients with diabetic foot ulcers during the pandemic, with the hope that the findings will help nurses to optimise care in both hospital-based and community practice.

An exploration into registered nurses' knowledge of adult fever in Scotland: A mixed method study

BACKGROUND

Fever may be a result of many causes, infective or non-infective. Nurses' fever management can be affected by their knowledge and beliefs and also by patients' beliefs. Consequently, an understanding of fever is vital in the diagnosis, treatment and follow-up of various ailments and diseases. Greater knowledge of fever will guide more accurate assessments of the epidemiology of fever and its management.

OBJECTIVES

This study explored nurses' knowledge in the context of fever and identified factors that affected this knowledge acquisition.

METHODS

A mixed methods approach was used with a validated questionnaire designed to gather information about nurses' knowledge of fever. This was followed up by semi-structured interviews to explore factors associated with the acquisition of fever knowledge. The online survey was distributed to registered nurses in Scotland.

RESULTS

A total of 177 questionnaires were completed. The questionnaires were scored with a correct answer 1 point, while a wrong answer -1 point. The mean total score in the knowledge section was 0.47. Only 49.2 % of participants scored above 0. The stepwise linear regression demonstrated working experience in critical care unit, acute care unit and the role of nurse practitioner together could predict 10 % of the total knowledge score (P < 0.05). Through analysis of associations and qualitative data, it was found that many factors had contributed to the nurses' knowledge about fever, specifically educational content, individual confidence and the Sepsis Six bundle.

CONCLUSIONS

Considerable misconceptions were found to exist in the nurses' understanding of fever. Only a few factors were found to be associated with the total knowledge score. It was highlighted that the due to the strong influence of the Sepsis Six bundle, participants often assumed a direct causal connection between fever and infectious disease or sepsis. The study result indicated a concern in nurses' acquisition of fever knowledge.

TWEETABLE ABSTRACT

Misconceptions from foundational learning were found in nurses' understanding of fever. However, the Sepsis 6 was found to impact their current knowledge of fever.

Impact of an Educational Program on Improving Nurses’ Management of Fever: An Experimental Study

Background: Despite a public information campaign “To Break the Myth of Fever”, nurses continued to overtreat fever. This study hypothesized that the campaign lacked the detailed rationale essential to alter nurses’ attitudes and behaviors. Aim: To evaluate the effect of the educational program on nurses’ knowledge, attitudes, and behaviors related to fever management. Design: A randomized experimental design using a time series analysis. Methods: A random sample of 58 medical/surgical nurses was evenly divided into an intervention and a control group. The intervention group received an educational program on fever and fever management. Both groups completed a pretest and four posttests using investigator-developed instruments: a questionnaire on knowledge and attitudes about fever management and a fever treatment checklist to audit charts. Results: The intervention group had markedly higher knowledge scores and reduced use of ice pillows at all four posttests, as well as lower use of antipyretics overall, except for the first posttest, despite no sustained change in attitude. Conclusions: An educational program for fever management can effectively improve clinical nurses’ knowledge and attitudes about fever management.

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

AIMS AND OBJECTIVES

To propose the Careful Nursing Philosophy and Professional Practice Model^© as a conceptual and practice solution to current fundamental nursing care erosion and deficits.

BACKGROUND

There is growing awareness of the crucial importance of fundamental care. Efforts are underway to heighten nurses' awareness of values that motivate fundamental care and thereby increase their attention to effective provision of fundamental care. However, there remains a need for nursing frameworks which motivate nurses to bring fundamental care values to life in their practice and strengthen their commitment to provide fundamental care.

DESIGN

This descriptive position paper builds on the Careful Nursing Philosophy and Professional Practice Model^© (Careful Nursing). Careful Nursing elaborates explicit nursing values and addresses both relational and pragmatic aspects of nursing practice, offering an ideal guide to provision of fundamental nursing care.

METHOD

A comparative alignment approach is used to review the capacity of Careful Nursing to address fundamentals of nursing care.

CONCLUSIONS

Careful Nursing provides a value-based comprehensive and practical framework which can strengthen clinical nurses' ability to articulate and control their practice and, thereby, more effectively fulfil their responsibility to provide fundamental care and measure its effectiveness.

RELEVANCE TO CLINICAL PRACTICE

This explicitly value-based nursing philosophy and professional practice model offers nurses a comprehensive, pragmatic and engaging framework designed to strengthen their control over their practice and ability to provide high-quality fundamental nursing care.

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

Objetivo: Realizar un análisis crítico-reflexivo de las prácticas rutinarias de los profesionales de enfermería y de los cuidadores familiares en el cuidado del niño con fiebre, a fin de incentivar un cuidado basado en evidencia científica que asegure el bienestar infantil.Síntesis de contenido: Se realizó una revisión bibliográfica de artículos científicos publicados entre los años 2007 y 2017, en las bases de datos ebscohost, ScienceDirect, medline, PubMed, cinahl, Web of Science y cuiden®, para lo cual se utilizaron los descriptores y sus combinaciones en español, portugués e inglés Fiebre; Cuidadores; Niño. Se elaboró un compendio de 45 artículos seleccionados y analizados que contenía las prácticas de cuidado con convergencias, divergencias y complementariedades.Los resultados se agruparon en los siguientes cinco temas: Concepción histórica de la fiebre; La fiebrefobia:una concepción en las actuales prácticas de cuidado; El baño de esponja:una práctica ancestral controvertida; El uso de antipiréticos: una rutina en contravía de la salud y la vidade los niños; La fiebre: en busca de una mirada desde su beneficio.Conclusiones: La concepción de la fiebre infantil centrada en el miedo y en el daño permanece. Las acciones de cuidado más comunes, como el baño de esponja y el uso/abuso de antipiréticos, son cuestionadas desde la evidencia científica, demostrando los efectos deletéreos que producen en la salud del niño. El cuidado del niño, después de una evaluación individualizada, deberá enfocarse en el confort, en un ambiente fresco y tranquilo y en el aumento de la ingesta de líquidos para evitar la deshidratación u otras complicaciones.

Nurses' knowledge of and attitudes towards fever and fever management in one Irish children's hospital

This study aims to describe nurses' knowledge of and attitudes towards the management of fever in one children's hospital in Ireland. A descriptive, quantitative research design was employed. One hundred and nineteen nurses working in one children's hospital completed a self-report questionnaire. Nurses' mean knowledge score about the physiology of fever, fever management and antipyretics was 51 per cent (n = 119), which was lower than expected. Nurses had both appropriate and inappropriate attitudes towards fever and fever management. Inconsistent attitudes between nurses were identified. Nurses who participated in this study are not expert managers of fever. Their lack of knowledge and inconsistent attitudes are affecting the care of febrile children, and may be fuelling parents' fever phobia. Further education is required to improve nurses' knowledge of fever and fever management. Inappropriate attitudes need to be challenged and addressed in an effort to promote evidence-based care for febrile children.