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Fever care: Does nursing instruction make a difference?
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a r e n t s often visit the e m e r g e n c y d e p a r t m e n t w i t h c o n c e r n s a b o u t their child's fever. T h e y m a y b e a n x i o u s b e c a u s e of t h e fever itself, w h i c h t h e y often b e l i e v e is harmful, a n d b e c a u s e t h e y h a v e limited or i n c o r r e c t i n f o r m a t i o n a b o u t h o w to m a n a g e t h e child's fever at home. 1, 2 C h i l d r e n ' s Hospital of Philadelphia is c o n d u c t i n g a s t u d y to d e t e r m i n e w h e t h e r the followi n g m e a s u r e s are effective: (1) Does fever i n s t r u c t i o n (written material, d e m o n s t r a t i o n , d i s c u s s i o n ) help to d e c r e a s e p a r e n t a l a n x i e t y i n relation to fever h o m e m a n a g e m e n t ? (2) Does a fever e d u c a t i o n p r o g r a m increase p a r e n t a l p a r t i c i p a t i o n in fever h o m e m a n a g e ment, thereby reducing unnecessary physician and ED visits? (3) Is the u s e of pictorial t e a c h i n g m e t h o d s , d e m o n s t r a t i o n , a n d d i s c u s s i o n more effective t h a n w r i t t e n e d u c a t i o n a l i n f o r m a t i o n alone for pediatric fever h o m e m a n a g e m e n t ? Research has shown that parents have m a n y m i s c o n c e p t i o n s , m i s i n f o r m a t i o n , a n d limited skills reg a r d i n g fever a n d its m a n a g e m e n t , a n d t h a t m i s c o n c e p t i o n s are h a n d e d d o w n from one g e n e r a t i o n to the next. 3 O n e s t u d y i n d i c a t e d t h a t 67% of t h e m o t h e r s b e l i e v e d t h a t a doctor m u s t b e c o n s u l t e d for a n y fever. 4 M i s c o n c e p t i o n s a b o u t fever m a y b e p r e s e n t regardless of race, e d u c a t i o n , or s o c i o e c o n o m i c status.5, e M u c h (51%) of p a r e n t s ' k n o w l e d g e a b o u t Ms. Murphy is Nursing Education Chair, Emergency Department, The Children's Hospital of Philadelphia, and Pediatric Faculty Advisor, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania. Ms. Liebman is Trauma Clinical Nurse Specialist, Emergency Department, The Children's Hospital of Philadelphia.
Figure 1 The Saftytherm thermometer (S.M.B. Celsius Company, Inc., Plainview, N.Y.) has a large mercury reservoir (allowing rapid heat transfer). This feature makes the axillary site a convenient
fever is provided b y health care providers, s u c h as p h y s i c i a n s a n d n u r s e s , 2 a l t h o u g h c o n s i d e r a b l e knowle d g e a b o u t fever m a n a g e m e n t c o m e s from their o w n e x p e r i e n c e s or from relatives. 1 A n o t h e r problem, to w h i c h a n y ED n u r s e c a n attest, is t h a t m a n y p a r e n t s c a n n o t perform the b a s i c skill of r e a d i n g a t h e r m o m e t e r . A s t u d y b y Singhi a n d
To i m p r o v e f e v e r e d u c a t i o n for p a r e n t s in our emergency department, we began using a color-coded thermometer, along with a carefully c o o r d i n a t e d pamphlet with fever i n s t r u c t i o n s for p a r e n t s .
S i n g h 4 s h o w e d t h a t this w a s a more serious problem i n u r b a n i n n e r cities; a h i g h p e r c e n t a g e (97%) of For reprints, write Kathleen A. Murphy, RN, MSN, CEN, 924 Linda Vista Dr., West Chester, PA 19380. J EMERGNURS1995;21:461-3 Copyright 9 1995 by the Emergency Nurses Association. 0099-1767/95 $5.00 + 0 18/9/66280
and accurate locus for temperature determination in children and adults. The thermometer is color zoned for simplicity in judging "ranges of temperature." Used with permission.
October 1995
461
JOURNAL OF EMERGENCY NURSINGfMurphyand Liebman
Call your doctor or come to the emergency department if your child has a fever, and
1. Is 3 months old or younger. 2. Has a seizure (shaking or twitching of the arms and legs). 3. Has a temperature above 104~ F. 4. Has a fever that does not come down with antipyretics (acetaminophen) or sponging. 5. Has a fever that lasts longer than 3 days. 6. Has spots or a rash with the fever. 7. Is vomiting and cannot keep fluids down. 8. Refuses to drink fluids. 9. Is very irritable, sleepy, or hard to awaken. 10. Has difficulty breathing or is breathing fast. 11. Complains of neck pain or a stiff neck. Figure 2
Childhood fever concerns for caretakers. (From pamphlet available in emergency department.)
m o t h e r s i n a s u b u r b a n private practice were able to perform this task correctly. A l t h o u g h m o s t e m e r g e n c y d e p a r t m e n t s provide w r i t t e n fever m a n a g e m e n t i n s t r u c t i o n s for caretakers, there are often difficulties i n c o m m u n i c a t i n g t h e s e i n s t r u c t i o n s effectively. T i m e constraints, level of pare n t e d u c a t i o n , cultural c u s t o m s , a n d l a n g u a g e difficulties m a y all b e s i g n i f i c a n t barriers to e d u c a t i n g p a r e n t s a b o u t fever. 7 To i m p r o v e fever e d u c a t i o n for p a r e n t s i n our e m e r g e n c y d e p a r t m e n t , w e b e g a n u s i n g a colorc o d e d t h e r m o m e t e r (Figure 1), along w i t h a carefully c o o r d i n a t e d p a m p h l e t w i t h fever i n s t r u c t i o n s for pare n t s (Figure 2). We are in t h e process of d e t e r m i n i n g w h i c h fever e d u c a t i o n m e t h o d s are m o s t effective in reducing anxiety and improving parents' knowledge r e g a r d i n g fever m a n a g e m e n t . Our s t u d y is d e s i g n e d to i n c l u d e a c o n v e n i e n c e s a m p l e of 130 p a t i e n t s (ages 3 m o n t h s to 5 years) a n d their caretakers w h o c o m e to our e m e r g e n c y departm e n t w h e n t h e child h a s a t e m p e r a t u r e of 38.4 ~ C a n d w h o a g r e e to p a r t i c i p a t e i n the study. Children w i t h p r e e x i s t i n g c o m p l e x illnesses s u c h as h u m a n i m m u n o d e f i c i e n c y virus, cancer, sickle cell disease, or cardiac d i s e a s e are e x c l u d e d from the study. Before t h e p h y s i c i a n e x a m i n e s the child, w e u s e a 5-point Likert-type face scale to a s s e s s the caretakers' level of a n x i e t y r e g a r d i n g fever m a n a g e m e n t . Caretakers are t h e n a s k e d to read a p r e s e t t h e r m o m eter. E a c h caretaker is a s s i g n e d to one of two groups;
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Volume 21, Number 5
Table 1 Fever study protocol
All c a r e t a k e r s w h o p a r t i c i p a t e in t h e s t u d y will: 9 Be e s c o r t e d to a p r i v a t e r o o m in t h e e m e r g e n c y department.
9 Give v e r b a l c o n s e n t . 9 Discuss demographic information. 9 C o m p l e t e t h e p r e t e s t Likert F a c e A n x i e t y Scale. T h e Likert F a c e A n x i e t y Scale is a s i m p l e , 5-point f a c e s c a l e t h a t pictorially d e s c r i b e s t h e c a r e t a k e r s ' l e v e l of a n x i e t y . Similar f a c e s c a l e s h a v e b e e n s u c c e s s f u l l y u s e d to a s s e s s l e v e l s of p a i n in b o t h c h i l d r e n a n d a d u l t s . This f a c e s c a l e w a s a d a p t e d f r o m C r e a t i v e T h e r a p y A s s o c i a t e s , Ohio. Reliability validity is b e i n g o b t a i n e d b y a n e x p e r t p a n e l of ED p h y s i c i a n s , n u r s e s , social w o r k e r s , a n d psychologists. 9 Be r e q u i r e d to r e a d a p r e s e t t h e r m o m e t e r to
100.0~ F. 9 Be a s s i g n e d to o n e of t w o g r o u p s to p a r t i c i p a t e in a f e v e r e d u c a t i o n p r o g r a m . G r o u p I will c o n s i s t of p a r t i c i p a n t s w h o visit t h e e m e r g e n c y d e p a r t m e n t o n a n o d d day; t h e c a r e t a k e r w i l l r e c e i v e only t h e f e v e r e d u c a t i o n p a m p h l e t a n d w i l l b e i n s t r u c t e d to r e a d it in its e n t i r e t y d u r i n g a 1 0 - m i n u t e period. Group II w i l l c o n s i s t of c a r e t a k e r s w h o visit t h e e m e r g e n c y d e p a r t m e n t o n a n e v e n day. T h e caretaker will receive the fever education p a m p h l e t , a n d w i l l h e i n s t r u c t e d to r e a d it in its e n t i r e t y d u r i n g a 1 0 - m i n u t e period. T h e investigator will also review the pamphlet, discuss f e v e r care, a n d d e m o n s t r a t e t h e u s e of a thermometer. 9 Complete a posttest Likert F a c e A n x i e t y Scale. 9 Be informed of p h o n e f o l l o w - u p b y t h e i n v e s t i g a t o r s 2 w e e k s after a n d 2 m o n t h s after t h e d a t e of t h e i r s t u d y participation. 9 Be t h a n k e d for t h e i r p a r t i c i p a t i o n in t h e P a r e n t a l A n x i e t y a n d F e v e r P h o b i a Study, a n d r e c e i v e a free c o l o r - z o n e d t h e r m o m e t e r (S.M.B. C e l s i u s Co., Inc., P l a i n v i e w , N e w York).
o n e group receives w r i t t e n i n s t r u c t i o n s only, the other r e c e i v e s w r i t t e n i n f o r m a t i o n a n d is g i v e n verbal feedback, a d e m o n s t r a t i o n , a n d a n o p p o r t u n i t y to d i s c u s s fever care with the nurse. The caretakers' level of anxiety is t h e n reassessed. The protocol is listed in Table 1. T h e goals of this s t u d y are to d o c u m e n t the effects of our i n s t r u c t i o n a l m e t h o d s a n d to provide s o m e information a b o u t the u s e of the color-coded t h e r m o m e t e r i n fever a s s e s s m e n t . Nurses c a n play a n active role in e d u c a t i n g caretakers a b o u t appropriate h o m e m a n a g e m e n t for childhood fevers. To date, data h a v e b e e n o b t a i n e d on 60% of t h e s a m p l e population. Preliminary results s h o w that a c o m p r e h e n s i v e fever e d u c a t i o n p r o g r a m i n t h e ED s e t t i n g is successful i n r e d u c i n g p a r e n t a l fever anxiety. F u r t h e r m o r e the d a t a to d a t e s h o w that:
Murphy a n d Liebman/JOURNAL OF EMERGENCY NURSING
9 Both methods--teaching demonstration and discussion and written educational methods alone--are equally effective. 9 Caretakers are somewhat more successful in managing pediatric fever at home with correct a d m i n i s t r a t i o n of a n t i p y r e t i c s a n d skill i n corr e c t u s e a n d r e a d i n g of t h e r m o m e t e r s . 9 N i n e t y - s e v e n p e r c e n t of t h e c a r e t a k e r s h a d n o r e p e a t v i s i t s t o t h e e m e r g e n c y d e p a r t m e n t for f e v e r m a n a g e m e n t w i t h i n a 2 - w e e k p e r i o d aft e r t h e i n i t i a l F,D v i s i t s for fever; 4 2 % of t h e caretakers had routine follow-up with the clinic or l o c a l p e d i a t r i c i a n s ' o f f i c e s a s r e c o m m e n d e d , We t h a n k J a n e Barnsteiner, RN, PhD, for her m e n t o r s h i p a n d s u p p o r t w i t h t h e i n v e s t i g a t i o n of childhood fever.
References 1. Kilmon C. P a r e n t s ' k n o w l e d g e a n d p r a c t i c e s related to fever m a n a g e m e n t . J Pediatr Health Care 1987;i:173-9. 2. S c h m i t t B. Fever in childhood. Pediatrics 1984;Suppl: 929-36. 3. Casey R. Fever therapy: a n e d u c a t i o n a l i n t e r v e n t i o n for parents. Pediatrics 1984;73:600-5. 4. Singhi S, S i n g h S. M a t e r n a l k n o w l e d g e a n d a t t i t u d e s tow a r d s t r e a t m e n t p r a c t i c e s in a rural area. I n d i a n Pediatr 1990;27:1103-6. 5. Kramer M. Parental fever p h o b i a a n d its correlates. Pediatrics 1985;75:1110-3. 6. A n d e r s o n A. Parental p e r c e p t i o n a n d m a n a g e m e n t of school-age fevers. Nurse P r a c t 1988;13:8-18. 7. May A, B a u c h n e r H. Fever phobia: t h e p e d i a t r i c i a n ' s contribution. Pediatrics 1990;90:851-4.
FUTURE SITES AND DATES OF ENA ANNUAL MEETINGS A n n u a l Meeting 1996---Honolulu, HI Hilton H a w a i i a n Village General A s s e m b l y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Scientific A s s e m b l y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1997--Atlanta, GA A t l a n t a Marriott Marquis General A s s e m b l y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A t l a n t a Marriott Marquis Inforum Scientific A s s e m b l y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1998---Denver, CO Colorado Convention Center General A s s e m b l y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Scientific A s s e m b l y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1999--Washington, DC W a s h i n g t o n Convention Center General A s s e m b l y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Scientific A s s e m b l y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2000--Chicago, IL General A s s e m b l y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Navy Pier Scientific A s s e m b l y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Leadership Symposium 1996----Orlando, FL Marriott's Orlando World Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1997--New Orleans, LA N e w Orleans Marriott Hotel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
S e p t e m b e r 25-26 S e p t e m b e r 27-29 S e p t e m b e r 3-4 S e p t e m b e r 5-7 S e p t e m b e r 9-10 S e p t e m b e r 11-13 S e p t e m b e r 29-30 October 1-3 S e p t e m b e r 20-21 S e p t e m b e r 22-24
February 9-11 March 13-18
October 1995 4 6 3
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a r e n t s often visit the e m e r g e n c y d e p a r t m e n t w i t h c o n c e r n s a b o u t their child's fever. T h e y m a y b e a n x i o u s b e c a u s e of t h e fever itself, w h i c h t h e y often b e l i e v e is harmful, a n d b e c a u s e t h e y h a v e limited or i n c o r r e c t i n f o r m a t i o n a b o u t h o w to m a n a g e t h e child's fever at home. 1, 2 C h i l d r e n ' s Hospital of Philadelphia is c o n d u c t i n g a s t u d y to d e t e r m i n e w h e t h e r the followi n g m e a s u r e s are effective: (1) Does fever i n s t r u c t i o n (written material, d e m o n s t r a t i o n , d i s c u s s i o n ) help to d e c r e a s e p a r e n t a l a n x i e t y i n relation to fever h o m e m a n a g e m e n t ? (2) Does a fever e d u c a t i o n p r o g r a m increase p a r e n t a l p a r t i c i p a t i o n in fever h o m e m a n a g e ment, thereby reducing unnecessary physician and ED visits? (3) Is the u s e of pictorial t e a c h i n g m e t h o d s , d e m o n s t r a t i o n , a n d d i s c u s s i o n more effective t h a n w r i t t e n e d u c a t i o n a l i n f o r m a t i o n alone for pediatric fever h o m e m a n a g e m e n t ? Research has shown that parents have m a n y m i s c o n c e p t i o n s , m i s i n f o r m a t i o n , a n d limited skills reg a r d i n g fever a n d its m a n a g e m e n t , a n d t h a t m i s c o n c e p t i o n s are h a n d e d d o w n from one g e n e r a t i o n to the next. 3 O n e s t u d y i n d i c a t e d t h a t 67% of t h e m o t h e r s b e l i e v e d t h a t a doctor m u s t b e c o n s u l t e d for a n y fever. 4 M i s c o n c e p t i o n s a b o u t fever m a y b e p r e s e n t regardless of race, e d u c a t i o n , or s o c i o e c o n o m i c status.5, e M u c h (51%) of p a r e n t s ' k n o w l e d g e a b o u t Ms. Murphy is Nursing Education Chair, Emergency Department, The Children's Hospital of Philadelphia, and Pediatric Faculty Advisor, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania. Ms. Liebman is Trauma Clinical Nurse Specialist, Emergency Department, The Children's Hospital of Philadelphia.
Figure 1 The Saftytherm thermometer (S.M.B. Celsius Company, Inc., Plainview, N.Y.) has a large mercury reservoir (allowing rapid heat transfer). This feature makes the axillary site a convenient
fever is provided b y health care providers, s u c h as p h y s i c i a n s a n d n u r s e s , 2 a l t h o u g h c o n s i d e r a b l e knowle d g e a b o u t fever m a n a g e m e n t c o m e s from their o w n e x p e r i e n c e s or from relatives. 1 A n o t h e r problem, to w h i c h a n y ED n u r s e c a n attest, is t h a t m a n y p a r e n t s c a n n o t perform the b a s i c skill of r e a d i n g a t h e r m o m e t e r . A s t u d y b y Singhi a n d
To i m p r o v e f e v e r e d u c a t i o n for p a r e n t s in our emergency department, we began using a color-coded thermometer, along with a carefully c o o r d i n a t e d pamphlet with fever i n s t r u c t i o n s for p a r e n t s .
S i n g h 4 s h o w e d t h a t this w a s a more serious problem i n u r b a n i n n e r cities; a h i g h p e r c e n t a g e (97%) of For reprints, write Kathleen A. Murphy, RN, MSN, CEN, 924 Linda Vista Dr., West Chester, PA 19380. J EMERGNURS1995;21:461-3 Copyright 9 1995 by the Emergency Nurses Association. 0099-1767/95 $5.00 + 0 18/9/66280
and accurate locus for temperature determination in children and adults. The thermometer is color zoned for simplicity in judging "ranges of temperature." Used with permission.
October 1995
461
JOURNAL OF EMERGENCY NURSINGfMurphyand Liebman
Call your doctor or come to the emergency department if your child has a fever, and
1. Is 3 months old or younger. 2. Has a seizure (shaking or twitching of the arms and legs). 3. Has a temperature above 104~ F. 4. Has a fever that does not come down with antipyretics (acetaminophen) or sponging. 5. Has a fever that lasts longer than 3 days. 6. Has spots or a rash with the fever. 7. Is vomiting and cannot keep fluids down. 8. Refuses to drink fluids. 9. Is very irritable, sleepy, or hard to awaken. 10. Has difficulty breathing or is breathing fast. 11. Complains of neck pain or a stiff neck. Figure 2
Childhood fever concerns for caretakers. (From pamphlet available in emergency department.)
m o t h e r s i n a s u b u r b a n private practice were able to perform this task correctly. A l t h o u g h m o s t e m e r g e n c y d e p a r t m e n t s provide w r i t t e n fever m a n a g e m e n t i n s t r u c t i o n s for caretakers, there are often difficulties i n c o m m u n i c a t i n g t h e s e i n s t r u c t i o n s effectively. T i m e constraints, level of pare n t e d u c a t i o n , cultural c u s t o m s , a n d l a n g u a g e difficulties m a y all b e s i g n i f i c a n t barriers to e d u c a t i n g p a r e n t s a b o u t fever. 7 To i m p r o v e fever e d u c a t i o n for p a r e n t s i n our e m e r g e n c y d e p a r t m e n t , w e b e g a n u s i n g a colorc o d e d t h e r m o m e t e r (Figure 1), along w i t h a carefully c o o r d i n a t e d p a m p h l e t w i t h fever i n s t r u c t i o n s for pare n t s (Figure 2). We are in t h e process of d e t e r m i n i n g w h i c h fever e d u c a t i o n m e t h o d s are m o s t effective in reducing anxiety and improving parents' knowledge r e g a r d i n g fever m a n a g e m e n t . Our s t u d y is d e s i g n e d to i n c l u d e a c o n v e n i e n c e s a m p l e of 130 p a t i e n t s (ages 3 m o n t h s to 5 years) a n d their caretakers w h o c o m e to our e m e r g e n c y departm e n t w h e n t h e child h a s a t e m p e r a t u r e of 38.4 ~ C a n d w h o a g r e e to p a r t i c i p a t e i n the study. Children w i t h p r e e x i s t i n g c o m p l e x illnesses s u c h as h u m a n i m m u n o d e f i c i e n c y virus, cancer, sickle cell disease, or cardiac d i s e a s e are e x c l u d e d from the study. Before t h e p h y s i c i a n e x a m i n e s the child, w e u s e a 5-point Likert-type face scale to a s s e s s the caretakers' level of a n x i e t y r e g a r d i n g fever m a n a g e m e n t . Caretakers are t h e n a s k e d to read a p r e s e t t h e r m o m eter. E a c h caretaker is a s s i g n e d to one of two groups;
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Volume 21, Number 5
Table 1 Fever study protocol
All c a r e t a k e r s w h o p a r t i c i p a t e in t h e s t u d y will: 9 Be e s c o r t e d to a p r i v a t e r o o m in t h e e m e r g e n c y department.
9 Give v e r b a l c o n s e n t . 9 Discuss demographic information. 9 C o m p l e t e t h e p r e t e s t Likert F a c e A n x i e t y Scale. T h e Likert F a c e A n x i e t y Scale is a s i m p l e , 5-point f a c e s c a l e t h a t pictorially d e s c r i b e s t h e c a r e t a k e r s ' l e v e l of a n x i e t y . Similar f a c e s c a l e s h a v e b e e n s u c c e s s f u l l y u s e d to a s s e s s l e v e l s of p a i n in b o t h c h i l d r e n a n d a d u l t s . This f a c e s c a l e w a s a d a p t e d f r o m C r e a t i v e T h e r a p y A s s o c i a t e s , Ohio. Reliability validity is b e i n g o b t a i n e d b y a n e x p e r t p a n e l of ED p h y s i c i a n s , n u r s e s , social w o r k e r s , a n d psychologists. 9 Be r e q u i r e d to r e a d a p r e s e t t h e r m o m e t e r to
100.0~ F. 9 Be a s s i g n e d to o n e of t w o g r o u p s to p a r t i c i p a t e in a f e v e r e d u c a t i o n p r o g r a m . G r o u p I will c o n s i s t of p a r t i c i p a n t s w h o visit t h e e m e r g e n c y d e p a r t m e n t o n a n o d d day; t h e c a r e t a k e r w i l l r e c e i v e only t h e f e v e r e d u c a t i o n p a m p h l e t a n d w i l l b e i n s t r u c t e d to r e a d it in its e n t i r e t y d u r i n g a 1 0 - m i n u t e period. Group II w i l l c o n s i s t of c a r e t a k e r s w h o visit t h e e m e r g e n c y d e p a r t m e n t o n a n e v e n day. T h e caretaker will receive the fever education p a m p h l e t , a n d w i l l h e i n s t r u c t e d to r e a d it in its e n t i r e t y d u r i n g a 1 0 - m i n u t e period. T h e investigator will also review the pamphlet, discuss f e v e r care, a n d d e m o n s t r a t e t h e u s e of a thermometer. 9 Complete a posttest Likert F a c e A n x i e t y Scale. 9 Be informed of p h o n e f o l l o w - u p b y t h e i n v e s t i g a t o r s 2 w e e k s after a n d 2 m o n t h s after t h e d a t e of t h e i r s t u d y participation. 9 Be t h a n k e d for t h e i r p a r t i c i p a t i o n in t h e P a r e n t a l A n x i e t y a n d F e v e r P h o b i a Study, a n d r e c e i v e a free c o l o r - z o n e d t h e r m o m e t e r (S.M.B. C e l s i u s Co., Inc., P l a i n v i e w , N e w York).
o n e group receives w r i t t e n i n s t r u c t i o n s only, the other r e c e i v e s w r i t t e n i n f o r m a t i o n a n d is g i v e n verbal feedback, a d e m o n s t r a t i o n , a n d a n o p p o r t u n i t y to d i s c u s s fever care with the nurse. The caretakers' level of anxiety is t h e n reassessed. The protocol is listed in Table 1. T h e goals of this s t u d y are to d o c u m e n t the effects of our i n s t r u c t i o n a l m e t h o d s a n d to provide s o m e information a b o u t the u s e of the color-coded t h e r m o m e t e r i n fever a s s e s s m e n t . Nurses c a n play a n active role in e d u c a t i n g caretakers a b o u t appropriate h o m e m a n a g e m e n t for childhood fevers. To date, data h a v e b e e n o b t a i n e d on 60% of t h e s a m p l e population. Preliminary results s h o w that a c o m p r e h e n s i v e fever e d u c a t i o n p r o g r a m i n t h e ED s e t t i n g is successful i n r e d u c i n g p a r e n t a l fever anxiety. F u r t h e r m o r e the d a t a to d a t e s h o w that:
Murphy a n d Liebman/JOURNAL OF EMERGENCY NURSING
9 Both methods--teaching demonstration and discussion and written educational methods alone--are equally effective. 9 Caretakers are somewhat more successful in managing pediatric fever at home with correct a d m i n i s t r a t i o n of a n t i p y r e t i c s a n d skill i n corr e c t u s e a n d r e a d i n g of t h e r m o m e t e r s . 9 N i n e t y - s e v e n p e r c e n t of t h e c a r e t a k e r s h a d n o r e p e a t v i s i t s t o t h e e m e r g e n c y d e p a r t m e n t for f e v e r m a n a g e m e n t w i t h i n a 2 - w e e k p e r i o d aft e r t h e i n i t i a l F,D v i s i t s for fever; 4 2 % of t h e caretakers had routine follow-up with the clinic or l o c a l p e d i a t r i c i a n s ' o f f i c e s a s r e c o m m e n d e d , We t h a n k J a n e Barnsteiner, RN, PhD, for her m e n t o r s h i p a n d s u p p o r t w i t h t h e i n v e s t i g a t i o n of childhood fever.
References 1. Kilmon C. P a r e n t s ' k n o w l e d g e a n d p r a c t i c e s related to fever m a n a g e m e n t . J Pediatr Health Care 1987;i:173-9. 2. S c h m i t t B. Fever in childhood. Pediatrics 1984;Suppl: 929-36. 3. Casey R. Fever therapy: a n e d u c a t i o n a l i n t e r v e n t i o n for parents. Pediatrics 1984;73:600-5. 4. Singhi S, S i n g h S. M a t e r n a l k n o w l e d g e a n d a t t i t u d e s tow a r d s t r e a t m e n t p r a c t i c e s in a rural area. I n d i a n Pediatr 1990;27:1103-6. 5. Kramer M. Parental fever p h o b i a a n d its correlates. Pediatrics 1985;75:1110-3. 6. A n d e r s o n A. Parental p e r c e p t i o n a n d m a n a g e m e n t of school-age fevers. Nurse P r a c t 1988;13:8-18. 7. May A, B a u c h n e r H. Fever phobia: t h e p e d i a t r i c i a n ' s contribution. Pediatrics 1990;90:851-4.
FUTURE SITES AND DATES OF ENA ANNUAL MEETINGS A n n u a l Meeting 1996---Honolulu, HI Hilton H a w a i i a n Village General A s s e m b l y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Scientific A s s e m b l y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1997--Atlanta, GA A t l a n t a Marriott Marquis General A s s e m b l y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A t l a n t a Marriott Marquis Inforum Scientific A s s e m b l y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1998---Denver, CO Colorado Convention Center General A s s e m b l y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Scientific A s s e m b l y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1999--Washington, DC W a s h i n g t o n Convention Center General A s s e m b l y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Scientific A s s e m b l y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2000--Chicago, IL General A s s e m b l y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Navy Pier Scientific A s s e m b l y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Leadership Symposium 1996----Orlando, FL Marriott's Orlando World Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1997--New Orleans, LA N e w Orleans Marriott Hotel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
S e p t e m b e r 25-26 S e p t e m b e r 27-29 S e p t e m b e r 3-4 S e p t e m b e r 5-7 S e p t e m b e r 9-10 S e p t e m b e r 11-13 S e p t e m b e r 29-30 October 1-3 S e p t e m b e r 20-21 S e p t e m b e r 22-24
February 9-11 March 13-18
October 1995 4 6 3