Management of Fever in Children: Realities of Nursing Practice

Abstract

Nurses have a professional responsibility to promote and protect the safety and wellbeing of their patients. A key component of this is ensuring that patients receive effective and evidence-based care. Paediatric nurses play a crucial role in the management of fever in children, being both the firstresponder to the detection of patient fever in the inpatient setting, and an educator to families of evidence-based best practice for fever management. It is therefore important to understand how nurses currently manage fever, and what drives their decision-making. This study aims to describe the fever management practices of nurses within the inpatient setting, and explore influences on these practices. A mixed-methods research design was employed, utilising a quantitative survey and qualitative focus group interviews. One hundred and nine nurses working within New Zealand's only children's hospital participated in an online-based questionnaire investigating fever management attitudes, knowledge and practices. Eight nurses from within the same population then self-selected to participate in focus group interviews, where ideas related to current practice methods and influencing factors were discussed. The results of both components of this study were then integrated and analysed collectively. The study findings show that fever management is inconsistent both between nurses and across the hospital setting. These inconsistencies are related to nurses' tendencies to rely on their own, often overcomplicated, decision-making processes that determine their fever management practices. Nurses strive to manage fever in a way that reflects the value they place on patient comfort, and acknowledge the importance of evidence-based guidelines to delivering effective nursing care. However within the current realities of the clinical setting, a range of sociocultural factors such as ward culture and the influence of nurse colleagues, can override the attitudes of the nurse towards fever management, and create decisional conflict. This study extends previous research and contributes to understanding nurses' fever management practices in the inpatient setting. The findings of this study suggest a need to review nurse fever management practices with regard to nurse decision-making, and with a view to moving practice more towards standardised recommended best practice, in support of the optimisation of paediatric patient outcomes.