1. Fever reduction in in pediatrics
Amy Douglas

2. Definition and Problem
Fever is a body temperature of 37.5 degrees C or 99.5 degrees F
One of the most common reasons parents seek medical attention for their children
60 million medical clinic visits
8 million ED visits
Estimated annual cost of $10 billion
Fever phobia
Education, education, education!
According to the National Institute for Health and Care Excellence (NICE), fever is a body temperature of over 37.5 C or 99.5 F and is actually part of the body’s natural immune system that has beneficial effects in fighting infections (NICE, 2013).
Fever can be a good thing, but to many parents of young children, fever is always a sign that their child is seriously ill. Understandably, parents worry when their child develops a fever and seek medical attention for their child almost immediately. Pyrexia, also known as fever, is one of the most common reasons children are taken to their general practitioner, pediatrician, urgent care facility, or hospital emergency room. In fact, each year in the United States, approximately 60 million medical clinic visits and 8 million emergency department visits, with an estimated annual cost of $10 billion, occur due to parents seeking medical help for their fevered children (Wallenstein, 2014).
Parental uninformed assessment of fever is often referred to as fever phobia. Dr. Barton Schmitt first described fever phobia in 1980 as a parent’s unrealistic concerns about fever resulting in unnecessary visits to clinics and emergency rooms for children (Sakai, Okumura, Marui, Niijima & Shimizu, 2012). Education can play an important role in improving a parent’s ability to effectively manage fever in children. Many children who present to healthcare facilities with fever can actually be safely managed at home. It is essential that parents and caretakers are provided with accurate and appropriate information about fever to enable them to distinguish between seeking medical help for potential serious illness and caring safely for their child at home (McDougall & Harrison, 2014).

3. Project Implementation
South Baldwin Urgent Care in Gulf Shores, AL
70 patients seen daily on average with 1/3 being pediatrics
Population: 6 months to 2 years of age with chief complaint of fever
Pre-test/Post-test design
Face-to-face interviews and phone calls
27 participants
A project was implemented at South Baldwin Urgent Care in Gulf Shores, Alabama to educate parents and caregivers of children presented with the main complaint of fever. This project topic was chosen due to the large number of children seeking medical treatment for fever that could be effectively treated at home without intervention from medical professionals. The clinical study was a pre-test/ post-test design with data collected through face-to-face interviews and telephone interviews. Inclusion criteria were children aged 6 months to 2 years of age presenting with the chief complaint of fever. The parents were given a brief history and description of the study and asked to sign a consent form for participation. There were 27 parents or caregivers who agreed to participate in the clinical project.

4. Project Implementation
Pre-test questions
Where did you get advice/information on how to control your child’s fever?
On a scale of 1-10, with 1 being no confidence at all and 10 being completely confident, how confident are you in controlling your child’s fever?
How many times in the past 6 months have you visited a health care facility because of fever in your child?
Results
On question 1, family and friends was the number one response at 70%.
Question 2 resulted in 60% of the caregivers rating themselves at or below 5 in being confident of controlling their child’s fever.
On question 3, 80% of the participants admitted to having at least 1 visit to a medical facility in the past 6 months.
The participants were asked the following questions on the pre-test:
Where did you get advice/information on how to control your child’s fever?
On a scale of 1-10, with 1 being no confidence at all and 10 being completely confident, how confident are you in controlling your child’s fever?
How many times in the past 6 months have you visited a health care facility because of fever in your child?
The results from the pre-test were as follows: On question 1, family and friends was the number one response at 70%. The other 30% named their pediatrician as being their main contributor to instructions on how to control their child’s fever. Other references were internet health websites, magazines, and acetaminophen and ibuprofen bottles. Question 2 resulted in 60% of the caregivers rating themselves at or below 5 in being confident of controlling their child’s fever. Two participants rated themselves at number 1 and one participant rated themselves at a 10. On question 3, 80% of the participants admitted to having at least 1 visit to a medical facility in the past 6 months. The highest number of visits to a health care facility for fever in the past six months was 4.

5. Project Implementation
Verbal instructions on fever, fever reducing techniques, symptoms to look for that would warrant a visit to a health care provider
Magnet containing pertinent fever control information
What is considered a fever
Appropriate interventions for fever control in children 6 months to 2 years of age
Weight based chart with acetaminophen and ibuprofen dosages
Parents and caregivers were given verbal instructions on fever, fever reducing techniques with the focus on proper dosages of fever reducing medications, and symptoms to look for that would warrant a visit to a health care provider rather than treatment at home. Parents were encouraged to ask any questions they had concerning fever control. Each caregiver was also given a magnet containing pertinent fever control information. The detailed information on the magnet included what is considered a fever, appropriate interventions for fever control in children 6 months to 2 years of age, and a weight based chart with acetaminophen and ibuprofen dosages. The magnet was chosen as the appropriate teaching tool because it can be placed in an easy accessible area such as a refrigerator in the family home.

6. Theorist Dorothea Orem’s Self-Care Theory
Family-centered care is based on the
assumptions that professionals alone cannot
and do not know what is best for clients, that
the family has significant influence on the
therapeutic regimens of individual clients,
and that the placement in the family constellation
affects the individuals’ ability for self care.
The theory used to guide teaching was the Self-Care Theory by Dorothea Orem.
Her concept of self-care is concerned with the practice of activities that adults initiate to maintain health, life, and well-being.
Orem’s theory encourages individuals to provide self-care at home to prevent having to go to hospitals and clinics for health care and teaches to be more in charge of their own well-being. Caregivers and parents provide care to those, like children, who are unable to care for themselves.

7. Project Evaluation Post-Test Questions
Did you use the fever control chart?
Did you notice that you were able to keep better control of your child’s fever?
Will you use the chart again?
Were you more confident in controlling your child’s fever?
Did you help someone else using this chart?
Did you have to go to the emergency room or see your primary care doctor during the past month due to your child’s illness?
After a period of one month, the participants were contacted by telephone to follow up with the post test. The results were then evaluated to discover if this type of education is sufficient in increasing parent’s confidence in controlling fever in children without unnecessary trips to health care facilities. The following questions were asked:
Did you use the fever control chart?
Did you notice that you were able to keep better control of your child’s fever?
Will you use the chart again?
Were you more confident in controlling your child’s fever?
Did you help someone else using this chart?
Did you have to go to the emergency room or see your primary care doctor during the past month due to your child’s illness?

8. Project Evaluation
All participants responded that they used the fever control magnet, with 90% stating that they were able to take better control of their child’s fever using the chart provided.
All participants stated that they would use the chart again and all respondents rated their confidence level at 7 or above, with 4 ranking their confidence level at 10.
90% of the parents stated that they shared their knowledge of fever control from the information on the magnet.
6 of the 20 participants returned to their pediatricians for a follow-up visit, but there were no emergency room or urgent care visits after receiving the magnet.
All participants responded that they used the fever control magnet, with 90% stating that they were able to take better control of their child’s fever using the chart provided. All participants stated that they would use the chart again and all respondents rated their confidence level at 7 or above, with 4 ranking their confidence level at 10. Ninety percent of the parents stated that they shared their knowledge of fever control from the information on the magnet. Six of the 20 participants returned to their pediatricians for a follow-up visit, but there were no emergency room or urgent care visits after receiving the magnet.

9. Limitations Inclusion criteria Follow-up Time
Inclusion criteria- Age of child should have been expanded to at least age 5.
A larger sample size is warranted with a longer amount of time and more follow-up to evaluate long-term effectiveness.- Some of the kids probably did not get sick within the one month time frame.

10. Conclusion
Education is an important factor in improving parents’ ability to provide quality care to their children experiencing fever. With simple, but specific instructions on how to control fever in children, parents can have more confidence in making the decision between treating their child at home and seeking professional medical interventions.
Education is an important factor in improving parents’ ability to provide quality care to their children experiencing fever. With simple, but specific instructions on how to control fever in children, parents can have more confidence in making the decision between treating their child at home and seeking professional medical interventions. Health care professionals should provide all parents and caregivers with safety net advice concerning fever to ensure that children can receive the treatment they need without inappropriate use of health care services. Providers should be proactive in educating parents about fever in an effort to increase parental self-efficacy while caring for their febrile child.

11. References
McDougall, P. & Harrison, M. (2014). Fever and feverish illness in children under five years. Nursing Standards, 28(30), Retrieved November 17, 2014 from ebscohost.com
Melelis, A. (2012). Theoretical nursing:  Development & progress (5th ed.). Philadelphia, PA: Lippincott, Williams, & Wilkins.
National Institute for Health and Care Excellence (2013). Feverish Illness in Children. Retrieved November 12, 2014 from
Sakai, R., Okumura, A., Marui, E., Niijima, S., & Shimizu, T. (2012). Does fever phobia cross borders? The case of Japan. Pediatrics International, 54(1), doi: /j X x
Wallenstein, M. (2012). What is a fever? Pediatrics for Parents, 28(11), Retrieved November 15, 2014 from ebscohost.com