Rockett Hannah, Thompson Hilaire J, Blissitt Patricia A
Hannah Rockett, MN ARNP CNRN, was an Adult-Gerontology Nurse Practitioner Student, University of Washington School of Nursing at the time of acceptance. She is now a Nurse Practitioner in the Regional Epilepsy Center at Harborview Medical Center, Seattle, WA. Questions or comments about this article may be directed to Hilaire J. Thompson, PhD RN CNRN ACNP-BC FAAN, at
J Neurosci Nurs. 2015 Apr;47(2):66-75. doi: 10.1097/JNN.0000000000000118.
Current evidence shows that fever and hyperthermia are especially detrimental to patients with neurologic injury, leading to higher rates of mortality, greater disability, and longer lengths of stay. Although clinical practice guidelines exist for ischemic stroke, subarachnoid hemorrhage, and traumatic brain injury, they lack specificity in their recommendations for fever management, making it difficult to formulate appropriate protocols for care. Using survey methods, the aims of this study were to (a) describe how nursing practices for fever management in this population have changed over the last several years, (b) assess if institutional protocols and nursing judgment follow published national guidelines for fever management in neuroscience patients, and (c) explore whether nurse or institutional characteristics influence decision making. Compared with the previous survey administered in 2007, there was a small increase (8%) in respondents reporting having an institutional fever protocol specific to neurologic patients. Temperatures to initiate treatment either based on protocols or nurse determination did not change from the previous survey. However, nurses with specialty certification and/or working in settings with institutional awards (e.g., Magnet status or Stroke Center Designation) initiated therapy at a lower temperature. Oral acetaminophen continues to be the primary choice for fever management, followed by ice packs and fans. This study encourages the development of a stepwise approach to neuro-specific protocols for fever management. Furthermore, it shows the continuing need to promote further education and specialty training among nurses and encourage collaboration with physicians to establish best practices.
目前的证据表明，发热和体温过高对神经损伤患者尤其有害，会导致更高的死亡率、更大的残疾率以及更长的住院时间。尽管针对缺血性中风、蛛网膜下腔出血和创伤性脑损伤有临床实践指南，但这些指南在发热管理建议方面缺乏特异性，难以制定合适的护理方案。本研究采用调查方法，旨在：(a) 描述过去几年该人群发热管理的护理实践有何变化；(b) 评估机构方案和护理判断是否遵循已发布的神经科学患者发热管理国家指南；(c) 探讨护士或机构特征是否影响决策制定。与2007年进行的上次调查相比，报告有针对神经科患者的机构发热方案的受访者略有增加（8%）。基于方案或护士判断开始治疗的温度与上次调查相比没有变化。然而，具有专业认证和/或在获得机构奖项的环境中工作（如磁体认证状态或卒中中心指定）的护士在较低温度下开始治疗。口服对乙酰氨基酚仍然是发热管理的主要选择，其次是冰袋和风扇。本研究鼓励制定针对神经科发热管理方案的逐步方法。此外，研究表明持续需要促进护士的进一步教育和专业培训，并鼓励与医生合作以建立最佳实践。
