Nursing Care for Pediatric Fever Management

Evidence-Based Practice in Nursing

• Evidence-Based Practice (EBP) is an approach to healthcare integrating clinical expertise, current best evidence, and patient values to provide high-quality care.
• Knowledge is awareness of reality, gained through learning or investigation.
• Every individual collects, organizes, and arranges facts to form a knowledge base relevant to personal experiences.
• Traditional knowledge is passed down through generations and is part of nursing practice.
• Nurses often state "We've always done it this way" when questioned about the source of their practices.
• Authoritative knowledge comes from experts, whose expertise is perceived as truth.
• Scientific knowledge is obtained through the scientific method, which involves research.
• New ideas are systematically tested and measured using objective criteria.
• Critical appraisal of evidence involves evaluating the reliability and validity of scientific research, including accuracy of findings.
• Levels of evidence are ranked based on methodological quality and accuracy of study findings.

Steps of Evidence-Based Practice

• Step 1: Ask a clinical question. Focus the question to improve searching for evidence. Always consider patient care when forming the question. Clarify and question points that don't make sense. Example questions: "How long have you had pain?", "Can you describe your pain?". Utilizing the PICOT question format (Population, Intervention, Comparison, Outcome, Time) is helpful.

• Step 2: Collect the best evidence. Use scientific literature databases and resources from medical librarians, like CINAHL, MEDLINE, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, and National Guidelines Clearinghouse. Consider using Google Scholar.

• Step 3: Critically appraise the evidence. Carefully evaluate the information gathered. Ensure accuracy, reliability, and applicability to patients. Consider the source of the information, and question assumptions made. Ask: "Is this information accurate?", "Is it reliable?", and "Will it work for my patient?".

• Step 4: Integrate the evidence. Once the evidence is validated, apply it appropriately to patient care. Use the knowledge and resources acquired to enhance the plan of care. The EBP can be used in the nurses' daily work.

• Step 5: Evaluate the practice decision or change. After implementing the EBP change, evaluate the outcome to determine the intervention's effectiveness. Ask: "How does the intervention work?".

• Step 6: Share the outcomes. Communicate and share the outcomes of EBP changes with colleagues. Present results at professional conferences or meetings, scientific abstracts, or other presentations.

Barriers to Evidence-Based Practice in Nursing

• Lack of EBP skills or knowledge.
• Misperceptions or negative attitudes toward research and EBP.
• Lack of belief that EBP improves outcomes.
• Too much information in journals (information overload).
• Lack of time and resources to search and appraise evidence.
• Overwhelming patient loads.
• Organizational constraints and lack of administrative support.
• Lack of EBP mentors.
• Demands from the patients (for a particular type of treatment).
• Peer pressure to continue with traditional practice.
• Resistance to change.
• Lack of consequences for not implementing EBP.
• Lack of autonomy over practices and incentives.

Overcoming Barriers to EBP in Nursing

• Provide EBP training programs.
• Ensure administrative support.
• Encourage a culture of continuous improvement.

Future of Evidence-Based Practice in Nursing

• Integration of Artificial Intelligence (AI) in evidence appraisal.
• Focus on global health challenges.
• Enhancing patient participation in decision-making.

Conclusion

• Evidence-Based Practice is crucial for improving patient care, advancing nursing practice, and ensuring healthcare sustainability.

Case: Managing a Feverish Child

• An 8-year-old boy with a high fever (38.8°C), fatigue, loss of appetite, is brought to the clinic.
• Current treatment involves fluids, and cool compresses.
• Nurses need to evaluate the most effective treatment.

Simple Discussion Questions

• If you were the nurse, which intervention would you prioritize for the patient?
• What are the benefits and limitations of using cool compresses?
• Besides paracetamol, what other methods can be used to reduce fever?

Benefits and Limitations of Using Cold Compresses

• Benefits:*
• Fever reduction by increasing heat loss.
• Pain relief by reducing local inflammation.
• Swelling reduction after trauma.
• Easy and affordable.
• Limitations:*
• Temporary effect, doesn't address the root cause.
• Risk of incorrect application leading to tissue damage.
• Prolonged use causing hypothermia.
• Ineffective for the underlying infection.
• Discomfort for sensitive skin, especially in children.

Alternative Methods to Reduce Fever (Besides Paracetamol)

• Lukewarm Bath or Wiping: Reduces body temperature gently.
• Maintaining a Cool Environment: Regulate temperature (e.g., room temp).
• Ensuring Hydration: Increases fluid intake to counteract fever.
• Light Clothing: Avoid trapping heat; facilitating heat dissipation.

Alternative Methods to Reduce Fever (besides paracetamol) - continued methods

• Cold Compress or Damp Cloth: Apply to forehead, underarms, or groin.
• Proper Rest in the Right Position: Avoid excessive movement.
• Herbal Remedies: Use with caution; potential allergic reactions.
• Seeking Medical Advice: Seek professional help for prolonged or severe fever.

Additional Points

• The case study involves a clinical situation with an 8-year-old child, highlighting the EBP decision-making process.
• The provided case study and discussion questions are intended to demonstrate application of those steps.
• The case mentions data regarding different levels of evidence (i.e., level 1 systematic review).

This quiz assesses knowledge on the use of cold compresses and evidence-based practice in managing fever in children. It covers benefits, barriers to implementation, and levels of evidence in clinical decision-making. Test your understanding and refine your nursing skills.