Louise Greensmith MSc., BSc (hons), RGN, RCN, RNT. Nurses’ knowledge of and attitudes towards fever and fever management in one Irish Children’s Hospital. Louise Greensmith MSc., BSc (hons), RGN, RCN, RNT.

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. Schmitt 1981

X 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 Doran 1989 Brandts 1997 Uhari 1995 Van Stuijvenburg 1998 Sharber 1997 Woolard and Pitt 2003 Two separate systematic reviews on fever agree, the administration of antipyretic drugs should not be assumed necessary for every child with a fever (Holtzclaw 2003, Watts et al. 2003). Antipyretics are ineffective in preventing febrile convulsions (Uhari et al. 1995, Van Stuijvenburg et al. 1998). Physical antipyretics may increase children’s discomfort (Sharber 1997) and induce shivering which can lead to a febrile convulsion (Woolard and Pitt 2003). The use of antipyretics can lengthen the duration of illness in children (Doran et al. 1989, Brandts et al. 1997).

The use of physical methods to reduce fever is not recommended. 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)

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.

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. These poor fever and fever management knowledge scores are supported by other international studies.

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.

What nurses believe is the principle danger of fever. A large prospective British study found no differences in intelligence, behaviour or academic performance in 381 children with febrile seizures compared with 12,981 children who had no evidence of febrile seizures (Verity et al. 1998).

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. However there was a small, statistically significant, positive correlation between nurses’ years of experience in the children’s setting and length of time as a registered nurse and total attitude scores.

Findings -Attitudes

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). This is a concern as nurses involved in the current study, care for febrile children on a daily basis. If nurses do not have comprehensive knowledge of fever, they cannot educate parents on evidence based fever management practice.

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.

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.

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.

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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