Exploration into registered nurses' knowledge of adult fever and associated management decisions

Abstract

Introduction: This study explored nurse’s clinical decision making in the context of fever management. It aimed to understand how nurses use knowledge of fever in their decisions on pyrexia-related nursing interventions when managing adult patients’ fever. The management of fever has always been an enigma to health care professionals. Fever may be a result of many causes, infective or non-infective. Nurses’ fever management can be affected by knowledge, beliefs and patient’s needs. This research explored how knowledge acquisition influenced nurses’ decisions in the management of fever, and identified factors that affected this knowledge acquisition. Materials and Methods: A mixed methods approach was used with a validated questionnaire designed to gather information about nurses’ knowledge of fever and fever management. This was followed up by semi-structured interviews to explore the relationship between knowledge and management of fever. The survey was distributed through the Royal College of Nursing and NHS health boards to registered nurses in Scotland. The data was collected from January 2017 to September 2017. Results: A total of 177 questionnaires were completed. The questionnaires were scored with a correct answer 1 point, while a wrong answer -1 point. If the participants answered “not sure”, a score of 0 was given. The mean total score in the knowledge section was 0.47 in a potential range of ± 17. Only 49.2% of participants scored above 0 indicating more correct than incorrect answers. The majority of participants (94.4%) showed no clear understanding about what temperature is defined as fever and (75.1%) the degree of fever that could lead to physical damage to the individual. When managing fever, 146 participants would first choose to employ paracetamol. In the decision making process, 49.2% of participants used their independent nursing judgement to manage fever, while 15.8% followed the national guidelines as their primary rationale and 15.3% made their decisions based on medical direction. Factors relating fever knowledge to fever management were analysed. Use of the Sepsis Six bundle, confidence, intuition and fever phobia were significantly related to fever knowledge and fever management. The process of gaining fever knowledge was through analytic reasoning (explicit knowledge) and intuitive reasoning (tacit knowledge). The relationship between fever knowledge and management was not direct. Dual Process Theory was used to explore how such knowledge was employed in the decision-making processes of fever management. Dual Process Decision making explained fever management as an interplay of both intuitive decision-making and rational decision-making. Conclusions: This study showed that in the majority of situations fever management was based on intuitive decision making often related to routine clinical algorithms or practices that were not always appropriate to the situation. Most clinicians would choose to treat a fever even when there was no clear evidence of clinical benefit to support such an approach, resulting in overtreatment. A greater understanding of the appropriate use of analytic and intuitive reasoning in clinical decision making could improve practice in this context.