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art & science literature review
Improving evidence-based care for patients with pyrexia
Scrase W, Tranter S (2011) Improving evidence-based care for patients with pyrexia. Nursing Standard. 25, 29, 37-41. Date of acceptance: December 29 2010.
Fever or pyrexia is a common clinical condition which nurses treat regularly. Fever and hyperpyrexia are defined in this article with a physiological explanation for this adaptive response. Suppression of temperature elevation prevents the production of antibodies and inhibits cell repair. The aim of this literature review is to encourage nurses to support patients with pyrexia by meeting their subjective needs, providing comfort and avoiding complications.
Wendy Scrase, nurse, Bryn Llifon nursing home, Bangor, and Siobhan Tranter, lecturer in nursing, School of Health Care Sciences, Bangor University. Email: email@example.com
Evidence based practice, fever, temperature measurement These keywords are based on subject headings from the British Nursing Index. All articles are subject to external double-blind peer review and checked for plagiarism using automated software. For author and research article guidelines visit the Nursing Standard home page at www.nursing-standard.co.uk. For related articles visit our online archive and search using the keywords.
THIS ARTICLE examines the delivery of care to a patient with fever (pyrexia) and evaluates the evidence base for the safe care of such patients. Current knowledge and understanding of the process of fever as an adaptive response has not resulted in changes to clinical guidelines or nursing interventions. Metabolic heat accelerates chemical reactions, which increases antibody production and assists the body’s cells to repair. Commonly prescribed antipyretics inhibit inflammatory action, reduce the temperature, mask the underlying signs of disease and impair the reparative process (Cuddy 2004). Nursing interventions associated with fever continue to be based on institutional habit or ritualistic practices and the belief that fever is harmful to the patient. Nursing care should aim to support the body’s normal physiological processes, provide comfort and avoid complications. The patient’s subjective needs during the stages of fever ought to be prioritised NURSING STANDARD
over routine tasks. In most circumstances finding out the cause is more important than curing the fever. Body temperature measurement is a core competency that nursing students learn early in their training because fever management is commonplace (Holtzclaw 2002). According to National Institute for Health and Clinical Excellence (NICE) (2007) guidelines, fever is an elevation of the body temperature above the normal daily variation. This fundamental sign of illness has traditionally had negative associations among nurses for patients’ wellbeing (Price and McGloin 2003, Thompson 2005). Over the past 20 years, research in immunology and neurophysiology has increased knowledge and understanding of the process of fever (Holtzclaw 2002, Thompson 2005). Although the perception of fever has changed from being part of an acute-phase reaction to an adaptive response, this awareness has yet to be incorporated into fever management practices or clinical guidelines (Holtzclaw 2002, Thompson 2005, Edwards et al 2007). Some literature suggests that there is confusion about the care that patients’ with fever should be receiving (Sarrell et al 2002, Thompson 2005, Walsh et al 2005).
A literature search was conducted using the TRIP Database, British Nursing Index, CINAHL, Cochrane Library and PubMed to clarify inconsistencies between established scientific facts about the purpose of fever and its management by nurses. Search terms included fever, pyrexia and nursing, and the purpose of the search was to identify or establish best practice. The search was...
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