Fever education: does it reduce parent fever anxiety?

OBJECTIVE: The aims of the study were to determine the following: 1) if a fever education program (interactive or written) reduces parent fever anxiety; 2) if an interactive fever program was more effective as a teaching style than standard written material alone; and 3) if a fever program increases parent fever home management and reduces return emergency department (ED) visits. METHOD: A quasiexperimental, pretest and post-test pilot study examining parental fever anxiety was conducted at The Children's Hospital of Philadelphia. Eligible participants consisted of 87 parents and their children, aged 3 months to 5 years presenting with fever >38.4 degrees C, and without coexisting serious illness. RESULTS: Both the interactive fever education program and the standard written fever pamphlet were equally effective as teaching methods. Data revealed a 30% reduction in fever anxiety rated as moderate-severe on arrival to none-low post-fever education, increased parent fever home management skills with correct use of thermometer and antipyretics, and reduced unnecessary return ED visits. CONCLUSION: Parents in the acute and nonacute care setting may benefit from an interactive fever education program that includes the definition and benefit of fever, the correct use of a thermometer, fever home management skills, and appropriate fever telephone follow-up.

Instituting a disruptive conduct policy for medical staff.

A healthy work environment is one that promotes interaction and communication among all professionals, a positive and strong working relationship between the nurse manager and physician director, and activities such as joint patient care rounds, shared clinical protocols, and joint teaching of physicians and nurses. There are situations when a physician's unacceptable conduct leads to a disruptive environment for patients, staff, and fellow physicians. This article describes the steps taken in one institution to establish structures and systems to communicate behaviors that are unacceptable and a policy to be followed should disruptive behavior be encountered. Having systems and structures in place assists in promoting a healthy work environment.

Therapeutic relationships. Evolution of the Children's Hospital of Philadelphia model.

The evolution of family-centered pediatric care coupled with the increasing complexity of healthcare environments has had a tremendous impact on the nature of relationships between nursing staff and the children and families they serve. In order to address this, in 1988 the Nursing Department at the Children's Hospital of Philadelphia (CHOP) identified parameters for the development and maintenance of therapeutic relationships. A therapeutic relationship is an interactive relationship with a child and family that is caring, clear, boundaried, positive, and professional. It encompasses the philosophy of the institution, empowerment of the caregivers, and empowerment for families. Utilizing family-centered care as a framework for the delivery of care, this article describes the evolution of therapeutic relationships as a standard of practice including the articulation of principles, clinical examples, implications for practice, and strategies for assessment, management, and evaluation.

Research-based practice.

Research-based practice requires a practice setting that promotes the use of knowledge, access to current scientific knowledge, and the ability of the clinician to think critically about using the knowledge to positively affect patient outcomes. This article presents an overview of what is known about the research utilization process and describes a variety of approaches to facilitate research-based practice.

Research utilization in a metropolitan children's hospital.

A model of research utilization directing clinical practice has been described. Clinical practice is conceptualized as a pyramid, with research knowledge forming the base. Department and unit-level activities are designed to promote the identification of research-based practices for incorporation into practice. Practice Committee structures are designed to facilitate the dissemination and utilization of research-based practices. This model has evolved over the past 10 years, and current refinements include movement toward an interdisciplinary focus, support of unit level practice groups, and increased integration of the work of each practice committee.

Defining and implementing a standard for therapeutic relationships.

As family-centered care gradually became the norm in care of infants and children, relationships between staff, patients, and families became more complex. Because the complexity of these relationships was rarely, if ever, addressed, widely divergent, sometimes detrimental, behaviors evolved. Therapeutic relationships, which promote caring and define relationships with patients and families, are a positive and professional means to promote a family's control over their own child's health. This article describes assessment of nurse/patient/family relationships using family systems theory as a framework. The experience of implementing a culture shift toward therapeutic relationships is described.

A collaborative practice model for the clinical nurse specialist.

This article describes a model of advanced nursing practice, jointly funded through nursing and medicine. The model is based on a matrix reporting structure with the clinical nurse specialist reporting to both a physician and a director of nursing. The authors discuss how the various role components are enacted and the benefits of the model to the specialist, institution, physicians, staff, and patients and their families.

Implementing managed care in a pediatric setting.

A challenge in the current nursing environment is the ability to provide care cost-effectively and yet achieve desired patient outcomes. The managed care delivery system facilitates achievement of these goals. The system incorporates management of time, resources, and personnel so that patient outcomes are achieved within appropriate time frames. This article describes the design and implementation of a managed care delivery system in a children's hospital.

Perceptions and significance of patient deaths for pediatric critical care nurses.

This study provides nursing administrators with data regarding stressors of the pediatric critical care nurse in order of priority. Death of patients was the only item isolated and compared to the other stress categories. It is suggested that death of patients be compared to all other items on the audit. The authors recommend expanding this study by asking two additional questions: Does the amount of time spent caring for dying patients correlate with the nurses' estimate of patient deaths and is there a relationship between the time spent caring for patients who die and perception of death as a stressor? This information can be utilized at the unit level in the development of stress management activities. At the hospital administrator level, this information can assist in the expansion of retention and recruitment strategies.