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Childhood fever is a rather common condition. However, the parents of young patients recently discharged from the Emergency Room tend to overestimate this problem and bring the patients back to the facility. Due to the lack of sufficient information, parents do not understand the possibility of safe treatment of their child at home. Providing PO syringes and the necessary comprehensive-based information on antipyretic treatment for this type of fever is a possible solution. This intervention implemented during the patient consultation will help decrease the number of returns to the ER, as well as raise the patients awareness of the issue.
Change Model Overview
Johns Hopkins Nursing Evidence-Based Practice Process is an efficient method of solving problems related to nursing practice. It is based on three principal aspects: education, research, and practice. The process comprises three stages: practice question, evidence, and translation (Johns Hopkins Medicine, n.d., para. 1). The goal of this approach is to ensure that the latest findings are properly integrated into the nursing practice. Nurses are strongly recommended to apply this model, as it is relatively easy to use and conveniently divided into clearly defined steps. Employing this method will significantly facilitate the changes proposed below.
Practice Question
Step 1: Recruit Interprofessional Team
Since the intervention should aim at raising the parents awareness regarding the home treatment, the team of stakeholders will include several members in charge of different areas of medical service. The team will consist of a pharmacist, a pharmacy technician, a health services manager, a patient advocate, a charge nurse, and a physician.
Step 2: Develop and Refine the EBP Question
Children recently discharged from the ER often develop a fever at home, which can be easily managed by their parents. Brochures regarding the antipyretic treatment and PO syringes need to be distributed, and parents have to be provided with the proper guidelines. Ideally, this approach will help decrease the number of returns to the ER.
Step 3: Define the Scope of the EBP
According to Peetoom et al. (2016), the conducted qualitative research regarding the parents lack of knowledge and experience in childhood fever has demonstrated that proper education would minimize their concerns and improve their ability to treat children at home (p. 236). It was revealed that insufficient degree of self-management in parents constitutes a major problem for healthcare. The lack of knowledge regarding childhood fever coupled with an emotional approach of a concerned parent results in increased number of antibiotic prescriptions (De Bont et al., 2015, p. 9).
Steps 4 and 5: Determine Responsibility of Team Members
A physician and a charge nurse are crucial for the interprofessional team, as the physician will decide upon the necessary guidelines for the home treatment, and the charge nurse will explain the details to the patients parents. A pharmacist, prescribing the necessary medications and a pharmacy technician, assisting the parents with any further questions are also an important part of the team. A health services manager supervises the process of change implementation, and a patient advocate can always help the parents with any difficulties they might encounter.
Evidence
Steps 6 and 7: Conduct Internal/ External Search for Evidence and Appraisal of Evidence
The evidence was collected from three studies employing qualitative research method and one study with mixed research method. The selected studies provide high-quality evidence. The research was conducted for the purposes of establishing the connection between the level of self-managed healthcare, and the number of returns to the emergency care unit.
Steps 8 and 9: Summarize the Evidence
DeBont et al. (2016) have established that the major factors contributing to seeking professional medical help for childhood fever treatment are excessive cautiousness and improper balance between rational and emotional approach. The parental capacity of home fever treatment is determined by the level of knowledge, social and educational background, as well as by the degree of consistency and credibility of information on self-management provided by the health care facility (Peetoom et al., 2016). The role of maternal care and socio-cultural background is an aspect that should be considered when distributing the necessary self-management guidelines, as it is a major factor in the parental approach towards home treatment (Langer et al., 2013). Evidence suggests that parental interpretations of elevated fever vary significantly depending on the level of knowledge and experience, while the choice of treatment is often an impulsive and panic-driven decision (Walsh, Edwards, & Fraser, 2008).
Step 10: Develop Recommendations for Change Based on Evidence
Overall, all the mentioned studies have demonstrated that it is imperative to provide parents with the necessary information and guidelines concerning fever treatment at home. The information must be consistent and simple guidelines must be developed for the parents to follow in a home setting. Information should be adjusted to the parents expectations, as well as to their socio-cultural background.
Translation
Steps 11, 12, and 13, 14: Action Plan
The last step in the Johns Hopkins change model pertains to the process of implementation of the proposed project. This process will involve the following steps: selecting the necessary information, compiling the information in a manner that is suitable for a parent in a worried state, printing the brochures with the home treatment guidelines, and distribution of the brochures. The timeline for the project should be approximately 4-6 months, as the consistency and efficiency of the compiled information should be assessed on a regular basis.
Steps 15 and 16: Evaluating Outcomes and Reporting Outcomes
The decreased number of referrals with childhood fever is the desired outcome. The efficiency of the compiled information will be measured by the emergency room statistics, regarding the childhood fever cases. The preliminary results will be communicated to the key stakeholders in statistics reports, providing the achieved level of efficiency for childhood fever home treatment.
Steps 17: Identify Next Steps
When the guidelines are refined and adjusted to the parents needs so that the number of childhood fever referrals is significantly decreased, it will be possible to implement this project on a larger scale. Studies can be conducted regarding other areas of home treatment that are yet to be explained to the parents. In order to ensure that the implementation becomes permanent, it is necessary to assess the performance level consistently, draw the necessary conclusions for the information to be adjusted, and increase the project efficiency.
Step 18: Disseminate Findings
In order to communicate the results of the project throughout the health care facility, findings are to be communicated in the internal newsletter. Once the consistent results are obtained at the end of the implementation timeline, findings may be published in a professional journal. The findings should be published regardless of the projects degree of success.
Conclusion
To solve the problem of an excessive number of ER referrals with childhood fever a plan is implemented, addressing the crucial aspects of the problem based on the research evidence: the parents insufficient knowledge about childhood fever and its treatment, their excessively emotional approach, and the need for consistent self-management guidelines provided by medical professionals. The implementation plan includes selection of the necessary information and its adjustment to the parents needs, as well as compiling it into helpful guidelines for the home treatment. The implementation process will be measured using statistical tools and its efficiency will be communicated both on the internal and the external level.
References
De Bont, E. M., Loonen, N., Hendrix, D. S., Lepot, J. M., Dinant, G., & Cals, J. L. (2015). Childhood fever: A qualitative study on parents expectations and experiences during general practice out-of-hours care consultations. BMC Family Practice, 16(1), 1-9.
Johns Hopkins Medicine. (n.d.). Johns Hopkins nursing evidence-based practice model. Web.
Langer, T., Pfeifer, M., Soenmez, A., Kalitzkus, V., Wilm, S., & Schnepp, W. (2013). Activation of the maternal caregiving system by childhood fever a qualitative study of the experiences made by mothers with a German or a Turkish background in the care of their children. BMC Family Practice, 14(1), 35-43.
Peetoom, K. B., Ploum, L. L., Smits, J. M., Halbach, N. J., Dinant, G., & Cals, J. L. (2016). Childhood fever in well-child clinics: A focus group study among doctors and nurses. BMC Health Services Research, 16(1), 168-240.
Walsh, A., Edwards, H., & Fraser, J. (2008). Parents childhood fever management: Community survey and instrument development. Journal of Advanced Nursing, 63(4), 376-388.
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