Childhood fever in well-child clinics: a focus group study among doctors and nurses

Discursive analysis of nursing care toward childhood fever and its contextual differences: An ethnomethodological study

Fever is the most common clinical sign during infancy. Nurses deal with fever in children most directly and it is an integral aspect of their role as pediatric nurses. The objective of this study is to analyze the perceptions, knowledge and attitudes toward childhood fever of nurses in three health contexts: pediatric hospitalization, pediatric emergency and primary care. To respond this objective, a qualitative study with ethnomethodological approach has been carried out. In-depth interviews were conducted and theoretical clinical cases were presented to nurses working in pediatrics in the three settings studied. After the analysis of the discourses, the codes were classified into three categories: static and number-centric knowledge, dependent nursing attitude, and unconscious model nurses. On the one hand, when we analyze and compare the perceptions, attitudes and knowledge of the nurses between the different contexts, we find differences that consist mainly of what the context requires of them. On the other hand, in general and regardless of the context, the nurses interviewed place themselves in a traditional framework when faced with the phenomenon of fever in children.

Advising parents when their child has a fever: a phenomenographic analysis of nurses' perceptions when working at a telephone helpline, at primary care or at a paediatric emergency department in Sweden

OBJECTIVES

To describe nurses' perceptions of advising parents when their child has a fever.

DESIGN/METHOD

Inductive, descriptive study with a qualitative, phenomenographic approach.

PARTICIPANTS AND SETTING

A purposive sampling was used. To be included, the 24 online interviewed nurses had to have experience advising parents of febrile children between birth and 5 years of age. They were recruited from three different parts of the healthcare system from four regions in the south of Sweden.

RESULTS

The nurses described advising parents when their child has a fever as four different kinds of balancing acts: balancing between the parents' story and objective assessment, balancing between listening and teaching, balancing between self-confidence and trust in the expert, and balancing between independence and having someone by one's side.

CONCLUSIONS

Giving advice to parents when their child has a fever is a process where the nurse needs to listen, assess and give advice based on the situation. This requires a correct assessment that depends on the parents' story. Creating a trusting relationship is perceived as necessary for parents to assimilate the advice that is provided. What dominates are the nurses' perceptions of the inner qualities required to achieve a balance in the process, for example, the importance of experience and security in their professional role, while it is also necessary to get support from colleagues.

Determining the fever-related knowledge and practices of mothers with children aged 1-5 years presenting to a child emergency service with fever complaints in Turkiye

PURPOSE

This study aimed to evaluate and determine the knowledge and practices of mothers with children aged between 1 and 5 years presenting to a pediatric emergency service with fever complaints regarding fever management.

DESIGN AND METHODS

This study was descriptive and correlational study was conducted between March and May 2019 with mothers over the age of 18 who brought their children aged 1-5 years to the XX State Hospital Pediatric Emergency Department with fever complaints. To evaluate the descriptive characteristics of the mothers and their practices when their children had a fever, data were collected with a questionnaire form consisting of 36 open-ended questions and the Parents' Fever Management Scale-Turkish Version (PFMS-TR). The data were analyzed using the SPSS 21 software with frequency, percentage, mean, standard deviation, min-max values, chi-squared, Cronbach's alpha, ANOVA, t-test, Kruskal- Wallis test, post hoc analysis with Bonferroni correction and correlation analysis, where p < 0.05, was considered statistically significant.

RESULTS

Of the mothers included in the study, 36.9% (n = 118) were between the ages of 33 and 39, 33.4% (n = 107) were graduates of higher education and 57.2% (n = 183) were homemakers. The mean number of people living at the homes of the participants was 4.26 ± 1.24 (min = 3, max = 8), the mean number of their children was 2.0 ±,97 (min = 1, max = 6), and the mean age of their children was 2.90 ± 1. 37 (min = 1, max = 5). The most common practices of the mothers when their children had fever were taking off their clothes and giving them antipyretic drugs. Moreover, the inappropriate practices of the mothers included rubbing the child with a vinegar and water mixture (11.9%) and cold application (8%). While 55.9% of the mothers were worried that the child would suffer post-fever convulsions 25.9% of them were worried that the child would suffer brain damage. A significant relationship was found between the mean scores of the mothers on PFMS-TR and their educational and economic statuses (p < 0.05).

CONCLUSIONS

Fears of fever are common in mothers, but their knowledge and practices about fever are inaccurate / incomplete.

PRACTICE IMPLICATIONS

Parents should be informed about fever with up-to-date information by nurses, and the appropriate attitude should be established on this issue. Efficient educational activities can reduce fears of mothers and prevent ill-advised practices.

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.

Fever in children: parents' search for urgent and emergency services

The study analyses the understanding of parents or guardians of children aged zero to five years old about fever, the conduct and care for this condition, carried out in the urgent and emergency service. The qualitative research, which used the thematic analysis technique, was carried out through interviews with 14 parents or guardians who sought an urgent and emergency Pediatric Service in a municipality in the countryside of São Paulo for this reason. The experiences of parents who seek these services are associated to three main topics: fear of fever; care for a febrile child; and the experience of care at the urgent and emergency services. It was identified that an exaggerated fear of fever predominates and that parents / guardians feel safe regarding the existing technology found in urgent and emergency services. The adopted precautions, however, are not always those recommended for the existing situation.

Development and evaluation of a hospital discharge information package to empower parents in caring for a child with a fever

OBJECTIVES

First, to explore parents' views on and experiences of managing their febrile child and to assess their behaviour and needs when in search of information about fever; second, to develop and evaluate a hospital discharge information package about fever in children.

DESIGN

Mixed methods: (A) qualitative study with semistructured interviews and a focus group discussion (FGD) and (B) quantitative survey.

SETTING

Emergency department, non-acute hospital setting and day nursery in Rotterdam, The Netherlands.

PARTICIPANTS

Parents of children <18 years (interviews, n=22) parents of children under 5 years (FGD (n=14), survey (n=38)).

INTERVENTION

Information package about fever in children (leaflet and website including videos).

OUTCOME MEASURES QUANTITATIVE SURVEY

Knowledge of fever and confidence in caring for a febrile child (Likert scale 0-5).

RESULTS

Parents found fever mostly alarming, especially high fever. Help-seeking behaviour was based on either specific symptoms or on an undefined intuition. When parents did not feel recognised in their concern or felt criticised, anxiety increased as well as the threshold to seek healthcare for future illnesses. Information was needed, especially for situations when the general practitioner or social network were less easily available. This information should be reliable, consistent, available in multiple formats and include advice on management of fever at home and precise referral to medical services. Parents reported improved knowledge about fever (p<0.05) and mentioned improved confidence in caring for a child with fever at home after consulting the information package.

CONCLUSION

Parents of children with a fever visiting the hospital are concerned about specific symptoms or based on an undefined intuition. Rather than telling parents that they should manage their child's illness at home, healthcare professionals should recognise parental intuition and provide clear information on alarming signs and potential diagnoses to empower parents in the management of their febrile child.

Optimising decision making on illness absenteeism due to fever and common infections within childcare centres: development of a multicomponent intervention and study protocol of a cluster randomised controlled trial

Background

Evidence has shown that children 0-4 year-old attending childcare are prone to acquire infections compared to children cared for at home, with fever being the most common symptom. Illness absenteeism due to fever and common infections is substantial and mostly driven by unrealistic concerns and negative attitude towards fever of both childcare staff and parents, resulting in illness absenteeism from childcare, work absenteeism among parents and healthcare service use. The objective of this study is to optimise decision making among childcare staff on illness absenteeism due to fever and common infections in childcare. Underlying determinants of behavioural change were targeted by means of a multicomponent intervention.

Methods

A multicomponent intervention was developed to improve decision making, using the stepwise approach of Intervention Mapping, and in close collaboration with stakeholders and experts. The intervention consisted of 1) a two-hour educational session on fever among childcare staff; 2) an online video for childcare staff and parents emphasising key information of the educational session; 3) a decision tool for childcare staff and parents in the format of a traffic light system to estimate the severity of illness and corresponding advices for childcare staff and parents; 4) an information booklet regarding childhood fever, common infections, and self-management strategies for childcare staff and parents.

The multicomponent intervention will be evaluated in a cluster randomised trial with a 12-week follow-up period and absenteeism due to illness (defined as the percentage of childcare days absent due to illness on the total of childcare days during a 12-week period) as primary outcome measure. Secondary outcome measures are: incidence rate and duration of illness episodes, knowledge, attitude, self-efficacy, and risk perception on fever and common infections of childcare staff and parents, healthcare service use in general and paracetamol use, and work absenteeism of parents.

Discussion

This study aims to develop a multicomponent intervention and to evaluate to what extent illness absenteeism due to fever and common infections can be affected by implementing a multicomponent intervention addressing decision making and underlying determinants among childcare staff and parents of children attending daycare.

Trial registration

NTR6402 (registered on 21-apr-2017).

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4602-3) contains supplementary material, which is available to authorized users.