Discursive Analysis of Pediatrician's Therapeutic Approach towards Childhood Fever and Its Contextual Differences: An Ethnomethodological Study.

Introduction: Fever stands out as the predominant clinical indicator in infancy. Pediatricians encounter fever routinely in their daily practice, playing a crucial role in their interactions with children and families. Objective: The aim is to examine pediatricians' viewpoints, understanding, and approaches regarding childhood fever in two healthcare settings: pediatric hospitalization (emergency and inpatient ward) and primary care. Methods: A qualitative study was conducted using an ethnomethodological approach. Pediatricians working in the specified pediatric settings participated in in-depth interviews where theoretical clinical cases were presented for analysis. Results: Following the examination of the discourses, the codes were organized into eight categories: Understanding of fever, Significance ascribed to fever, Therapeutic strategies, Engagement with the evidence, Family apprehensions regarding fever, Influence of the COVID-19 Pandemic, Inter- and intra-professional relationships, and Suggestions for change: Conclusions: Pediatricians acknowledge the importance of addressing discomfort in the treatment of fever, but express challenges in implementing these recommendations. Pediatricians in inpatient settings emphasize the need for enhanced parental education from primary care, while those in primary care recognize the potential for improvement. Inpatient pediatricians are open to implementing changes in their daily practices, particularly concerning the administration of antipyretics.

Discursive analysis of nursing care toward childhood fever and its contextual differences: An ethnomethodological study.

Fever is the most common clinical sign during infancy. Nurses deal with fever in children most directly and it is an integral aspect of their role as pediatric nurses. The objective of this study is to analyze the perceptions, knowledge and attitudes toward childhood fever of nurses in three health contexts: pediatric hospitalization, pediatric emergency and primary care. To respond this objective, a qualitative study with ethnomethodological approach has been carried out. In-depth interviews were conducted and theoretical clinical cases were presented to nurses working in pediatrics in the three settings studied. After the analysis of the discourses, the codes were classified into three categories: static and number-centric knowledge, dependent nursing attitude, and unconscious model nurses. On the one hand, when we analyze and compare the perceptions, attitudes and knowledge of the nurses between the different contexts, we find differences that consist mainly of what the context requires of them. On the other hand, in general and regardless of the context, the nurses interviewed place themselves in a traditional framework when faced with the phenomenon of fever in children.

Analysis of the perceptions, knowledge and attitudes of parents towards fever in children: A systematic review with a qualitative meta-synthesis.

Fever is the most common symptom in childhood. Despite its prevalence and decades of education and research, the treatment of fever and febrile illnesses continues to cause concern and anxiety in parents. The objective of this systematic review with meta-synthesis is to analyse parents' perceptions, knowledge and attitudes towards the febrile child and how they influence the construction of the concept of fever. The PRISMA international standards and PRISMA checklist, as well as the Cochrane recommendations, were followed. Articles with qualitative methodology have been selected that analyse what fever means to parents, what their concerns about this sign are, where they get their information and what their expectations are of healthcare professionals during treating their feverish child. Finally, 17 articles that met the inclusion criteria were added in the qualitative meta-synthesis. The concept of fever has been represented as a non-harmful sign in and of itself, an aspect that emerges in fathers and mothers' discourse. Meanwhile, the perceived need to lower the temperature still appears to be the main aim of their approach, with attitudes implying an emergency to reach normothermia, focusing on temperature as the primary indicator of severity.

Analysis of Nurses' and Physicians' Attitudes, Knowledge, and Perceptions toward Fever in Children: A Systematic Review with Meta-Analysis.

CONTEXT: Fever is a common symptom in children that nurses and pediatricians treat. Although it is a common sign in clinical practice, fever instills irrational fears in parents that health professionals share. OBJECTIVE: To investigate whether doctors' and nurses' knowledge, perceptions, and attitudes toward fever influence how this sign is managed. Furthermore, it intends to evaluate whether educational programs increase knowledge and change attitudes and/or perceptions of nurses about children's fever. DATA SOURCES: A systematic review with meta-analysis was conducted with PRISMA international standards and the Cochrane recommendations. STUDY SELECTION: Articles examining health professionals' (doctors and/or nurses) knowledge, perceptions, and/or attitudes toward fever in children and the use of antipyretics were selected for the study. DATA EXTRACTION: The qualitative analysis was carried out by classifying the articles according to the applied educational programs for nurses related to fever care for children that evaluated different outcomes to determine their efficacies. RESULTS: For the qualitative synthesis, 41 articles were included, and 5 of these were taken in meta-analysis, which measured the effectiveness of educational programs for fever management in nurses. LIMITATIONS: All of the included studies generally had a high risk of bias. CONCLUSION: According to the evidence reviewed, nurses' and physicians' perceptions and attitudes regarding fever management in children indicate an overtreatment of this sign. We can give a recommendation grade of D on the use of educational programs to modify attitudes, perceptions, and knowledge about fever in children and improve clinical practice in nurses.

Classification of Pressure Injury Stages and Skin Damage Photographs by RNs and Nursing Students in Spain: An Observational Comparison Study.

PURPOSE: The purpose of this study was to evaluate and classify pressure injuries (PIs) and other skin lesions according to the judgment of hospital-based RNs and nursing students who recently trained in wound care using photographs and comparing findings to those of wound care experts. DESIGN: Cross-sectional observational survey. SUBJECT AND SETTING: RNs working at Manacor Hospital, Mallorca, Spain, and third-year nursing students from the University of the Balearic Islands. Data were collected in June 2017. METHODS: The survey instrument was accompanied by a set of 24 photographs in 7 categories of skin lesions, such as PIs or moisture-associated skin damage, which the respondents were asked to classify. Descriptive analysis of the classifications was carried out, and levels of agreement using the chi-square test were compared with evaluations/classifications of a panel of experts. RESULTS: In total, 314 surveys (199 RNs and 115 students) were included in the analyses. Findings showed a wide variability among participants with levels of agreement, with expert opinion ranging from 91.4% to 15.61%. The levels of agreement were substantially lower for unstageable PIs (47.92%), those caused by moisture (53.50%), and mixed etiology (38.37%) than for stages 1-4 PIs. Of note, 62.12% of RNs had not received PI training or continuing education during the previous 2 years. This lack of education was statistically significantly associated with the accuracy of the classification made by the RNs for some of the photographs evaluated such as moisture-associated skin damage. CONCLUSIONS: We found discrepancies in the classification of PIs and other wounds/lesions among experts, RNs, and students. The regular provision of up-to-date information in training and continuing education programs is imperative to maintain nurses' abilities to identify and classify PIs and other skin-related damage.

Fiabilidad del uso de fotografías en la clasificación de heridas relacionadas con la dependencia / Reliability of the use of photographs for the classification of dependence-related lesions

Objetivo: Examinar la fiabilidad de la clasificación de lesiones relacionadas con la dependencia según su etiología mediante fotografías. Método: Se constituyó un panel de 5 expertas que evaluaron 24 fotografías de forma anónima, independiente y ciega, emitiendo un juicio para cada una de ellas. Las fotografías se enviaron por correo electrónico, junto con un cuestionario anónimo que se devolvió a un referente del grupo. Se propusieron 8 opciones de clasificación: úlceras por presión categorías I, II, III y IV, «sospecha de lesión de tejidos profundos», «lesión asociada a la humedad», etiología mixta presión-humedad y etiología multicausal. Se calculó el índice de acuerdo para cada fotografía y el coeficiente Kappa con técnica «jackknife» para cada imagen y cada categoría de clasificación, usando el paquete estadístico Epidat 4.2. Resultados: Los índices de acuerdo observado fueron variables, entre 0,4 y 1 dependiendo de la fotografía. En 6 ocasiones se obtuvo un 100% de acuerdo observado. El coeficiente Kappa global resultó moderado: 0,5202 (IC95%: 0,3850- 0,6542). El coeficiente de concordancia intraclase resultó moderado en 4 de las categorías y bajo en 3 de ellas, siendo alto solamente en úlceras por presión categoría II (Kappa 0,8924. IC 95%: 0,7388-1,0456). La concordancia entre observadoras resultó 0,6602 (IC 95%: 0,4969-0,8081). Conclusiones: La fiabilidad del uso de fotografías para la categorización de lesiones relacionadas con la dependencia resulta moderada, siendo mayor en úlceras por presión categoría II y baja en lesiones de mayor complejidad. Este método, debe ser usado con cautela en la categorización de lesiones crónicas, siendo necesario impulsar acciones formativas

Objective: To examine the reliability of the classification of dependence-related lesions using photography. Method: A panel of 5 experts carried out a blind, anonymous and independent assessment of 24 photographs. Images were sent by electronic mail, together with an anonymous questionnaire that was sent back to a referee of the research group. We suggested 8 options for classification: pressure ulcer (categories I, II, III, IV, or ‘suspect of deep-tissue damage’), moisture-associated damage, pressure-moisture combined aetiology and multifactorial lesion. Concordance index was calculated for every photography. Cohen‘s Kappa index with 'jackknife' technique were calculated for every photograph and category. We used the statistical programme Epidat 4.2. Results: Observed agreement was variable, between 4 and 1 depending on the photography. A consensus of 100% was observed in 6 images. Global Kappa resulted as moderate: 0.5202 (IC95%: 0.3850- 0.6542). Intra-group concordance resulted moderate in 4 categories, low in 3, and high only for pressure ulcer category II (Kappa 0.8924. IC 95%: 0.7388-1.0456). Inter-observer concordance was 0.6602 (IC 95%: 0.4969-0.8081). Conclusions: The reliability of the use of photographs for the categorization of dependence-related lesions is moderate, being higher for category II pressure ulcers and low for more complex wounds. This method must be used with care, and education on the subject is required

Reliability of the use of photographs for the classification of dependence-related lesions. / Fiabilidad del uso de fotografías en la clasificación de heridas relacionadas con la dependencia.

OBJECTIVE: To examine the reliability of the classification of dependence-related lesions using photography. METHOD: A panel of 5 experts carried out a blind, anonymous and independent assessment of 24 photographs. Images were sent by electronic mail, together with an anonymous questionnaire that was sent back to a referee of the research group. We suggested 8 options for classification: pressure ulcer (categories I, II, III, IV, or 'suspect of deep-tissue damage'), moisture-associated damage, pressure-moisture combined aetiology and multifactorial lesion. Concordance index was calculated for every photography. Cohen's Kappa index with 'jackknife' technique were calculated for every photograph and category. We used the statistical programme Epidat 4.2. RESULTS: Observed agreement was variable, between 4 and 1 depending on the photography. A consensus of 100% was observed in 6 images. Global Kappa resulted as moderate: 0.5202 (IC95%: 0.3850- 0.6542). Intra-group concordance resulted moderate in 4 categories, low in 3, and high only for pressure ulcer category II (Kappa 0.8924. IC 95%: 0.7388-1.0456). Inter-observer concordance was 0.6602 (IC 95%: 0.4969-0.8081). CONCLUSIONS: The reliability of the use of photographs for the categorization of dependence-related lesions is moderate, being higher for category II pressure ulcers and low for more complex wounds. This method must be used with care, and education on the subject is required.

Genealogy as a critical toolbox: deconstructing the professional identity of nurses.

AIM: To discuss the Foucauldian concept of genealogy as a framework for understanding and transforming nurses' professional identity. BACKGROUND: The professional identity of nurses has primarily been defined by personal and interpersonal attributes and by the intradisciplinary dimensions of nursing, leading to its conceptualization as a universal, monolithic phenomenon. The Foucauldian genealogical perspective offers a critical lens to examine what constitutes this professional identity; Spanish nursing offers a historical case study of an active effort to impose an identity that fits the monolithic ideal. DATA SOURCES: Five of the 33 professional conduct manuals for nurses' training published from 1956-1976 during the Franco dictatorship in Spain and six interviews with nursing instructors or students at the time were analysed using a theoretical framework drawn from Foucault's writing. DISCUSSION: Foucault's genealogical framework considers practices of normalization and resistance as a means of understanding knowledge continuities and discontinuities, clarifying practices that constitute nurses' professional identity in a particular way in specific contexts and analysing the implications of this theoretical frame. IMPLICATIONS FOR NURSING: The genealogy concept offers valuable tools to determine how professional identities are constituted, questions assumptions about the profession and its professionals and envisions alternative approaches. This theoretical approach helps both scholars and practitioners understand, question and transform their practices as needed. CONCLUSION: The genealogical approach prioritizes analysis of the phenomenon over its description and challenges many unknown, forgotten, excluded and/or unquestioned aspects of identity from a position of diversity and complexity.

[Ethical conflicts over verbal statements regarding last wishes]. / Conflictos éticos ante la manifestación verbal de las últimas voluntades.

Within our socio-professional framework, there are few occasions in which there is sincere communication between health care teams and patients and their families that allows questions to be raised about decisions made during the process of an illness i.e., whether an intervention, or its omission in certain cases, would be accepted. Decisions regarding representation or living wills are merely an extension of the inclusion of the patients' moral autonomy in clinical decision making. Nevertheless, the best way to make patients' rights effective is not by focussing on these documents, but rather by achieving the development of integral processes that promote patient participation and decision making. On the basis of a discussion in which a number of ethical conflicts that concern patients' last wishes are intertwined, we present the following clinical case that allows reflection on the most effective kind of intervention, the nature of its duration and intensity and the way health care professionals must be faithful to patients' and families' desires and expressions in these cases.

Conflictos éticos ante la manifestación verbal de las últimas voluntades / Ethical conflicts over verbal statements regarding last wishes

En nuestra realidad socioprofesional en pocas ocasiones tiene lugar una comunicación sincera del equipo con el paciente y su familia que permita cuestionar, ante un proceso de enfermedad, cuál es su decisión al respecto, es decir, si aceptaría o no una intervención. Las decisiones de representación y los testamentos vitales no son más que una prolongación de la incorporación de la autonomía moral de los pacientes en la toma de decisiones clínicas. Sin embargo, la manera más adecuada de hacer efectivo el derecho de los pacientes no es centrarse en estos documentos, sino conseguir desarrollar procesos integrales que fomenten su participación y toma de decisiones. Partiendo de una discusión en la que se entrelazan varios conflictos éticos que conciernen a las últimas voluntades del paciente, planteamos el siguiente caso clínico, que nos permite reflexionar acerca del tipo de intervención más eficaz, cuál debe ser su duración y su intensidad y cómo debemos ser fieles a los deseos y las expresiones del paciente y la familia en estos casos (AU)

Within our socio-professional framework, there are few occasions in which there is sincere communication between health care teams and patients and their families that allows questions to be raised about decisions made during the process of an illness i.e., whether an intervention, or its omission in certain cases, would be accepted. Decisions regarding representation or living wills are merely an extension of the inclusion of the patients’ moral autonomy in clinical decision making. Nevertheless, the best way to make patients’ rights effective is not by focussing on these documents, but rather by achieving the development of integral processes that promote patient participation and decision making. On the basis of a discussion in which a number of ethical conflicts that concern patients’ last wishes are intertwined, we present the following clinical case that allows reflection on the most effective kind of intervention, the nature of its duration and intensity and the way health care professionals must be faithful to patients’ and families’ desires and expressions in these cases (AU)

[Follow-up of a case by the hospital-at-home service: a new alternative]. / Seguimiento de un caso clínico en hospitalización a domicilio: una nueva alternativa.

The present article is a continuation of two previously published articles in Enfermería Clínica that describe the clinical course of María, a 26-year-old woman with Down syndrome. The first article described the patient's admission to the intensive care unit (ICU) with a diagnosis of atypical pneumonia. During admission, the patient was completely dependent. The second article described the weaning process when the patient showed anxiety, which was favorably resolved. Maria was discharged to a conventional ward with a nursing discharge report that contained the nursing care performed during her stay in the ICU. The present article describes the patient's follow-up by the hospital-at-home team. The specialized team suggested to María that she continue admission with the possibility of being at home until she could be discharged and followed-up by primary care. The evaluations were performed in 2 phases: a first evaluation before the patient's return to home, in which the suitability of domiciliary care was evaluated, and a second evaluation in which care was planned with María and her family. A hygiene deficit and ineffective management of the family therapeutic regimen were identified. Both problems were approached by the specialized healthcare team within the context of domiciliary care, in which work with the family is essential.

Ansiedad durante el proceso de destete. Estudio de un caso / Anxiety during the weaning process. Study of a case

María es una mujer de 26 años, con síndrome de Down, obesidad mórbida y antecedentes de problemas cardíacos, ingresada en una unidad de cuidados intensivos (UCI) a causa de una neumonía atípica, y en el momento de la valoración estaba sedada y conectada a un ventilador. Este artículo presenta la continuación de un caso clínico publicado con anterioridad en Enfermería Clínica, en el que se describe la evolución clínica y la planificación de los cuidados enfermeros de los nuevos problemas que presentó María durante el proceso de destete del ventilador hasta que fue dada de alta de la UCI. Los diagnósticos enfermeros presentados durante este proceso fueron: ansiedad, que se solucionó a los 3 días de la implementación del plan de cuidados, y suplencia parcial en la necesidad de evitar peligros, causada por la agitación al disminuir la sedación farmacológica. Después de afrontar el proceso de destete satisfactoriamente, se planificaron los cuidados recomendados al alta en la UCI incluidos en el informe de continuidad de cuidados

María is a 26-year-old woman with Down syndrome, morbid obesity and a history of heart abnormalities, was admitted to an intensive care unit due to atypical pneumonia. At evaluation, she was sedated and connected to a ventilator. We present the continuation of a case previously reported in Enfermería Clínica. The clinical course and nursing care planning of new problems presented by María during the process of ventilator weaning until discharge from the intensive care unit (ICU) are described. The nursing diagnoses formulated during this process were: anxiety which was resolved 3 days after implementing a nursing care plan and providing assistance in the need to avoid danger, caused by agitation on reducing sedation. After the patient was satisfactorily weaned from the ventilator, the care recommended on discharge from the ICU included in the continuity of care report was planned

Planificación enfermera ante una persona con falta de autonomía. Estudio de un caso / Nursing care planning in a patient lacking autonomy. A case study

Este trabajo muestra, a través de un caso clínico con datos reales, la integración del modelo de Virginia Henderson en la práctica asistencial. Se expone la valoración de una mujer de 26 años ingresada en una unidad de cuidados intensivos, así como la situación de su familia. Se formulan los problemas detectados y se realiza la planificación de los cuidados de enfermería. En el momento de la valoración, al día siguiente del ingreso, María Climent está sedada y de momento no puede modificar conducta alguna, por lo que no se plantean problemas para la independencia. Tiene una falta total de capacidad física y psíquica para hacer por sí misma las acciones apropiadas para satisfacer las necesidades básicas, por lo que se identifican 4 problemas de autonomía relacionados con la higiene y la protección de la piel: la eliminación, moverse y mantener la postura adecuada, así como el mantenimiento de la temperatura corporal

Through a case study with real data, this study shows the integration of Virginia Henderson's model in nursing practice. The evaluation of a 26-year-old woman admitted to the intensive care unit and the family situation are described. The problems detected were formulated and the nursing care plan was drawn up. At evaluation, the day after admission, María Climent was sedated and was unable to modify any form of behavior. Therefore programs of independence were not considered. The patient presented a complete lack of physical and mental capacity to satisfy her basic needs and consequently four problems of autonomy related to hygiene and skin protection, excretion, movement and maintenance of appropriate posture, and body temperature were identified

[The nursing field in education]. / La docencia enfermera. Convergencia hacia las nuevas technologías.

"Campus Extens" is a new correspondence course/open university educational project which makes use of new technologies in communication such as the Internet or videoconferences for the diffusion of its course content. This program commenced in 1997 as a provisional experimental program at the University of the Balearic Islands; at present, after six years up and running, this program is an established program. Classes in nursing were introduced as part of this program, due to a request by the Nursing Department, in an experimental provisional format since the academic year 2001-02 hoping to integrate new educational technologies and bring these closer to students in the Balearic Isles who find it difficult to attend traditional classes which are taught on the Palma campus and at the same time to make future correspondence courses possible. Taking the pedagogical materials which correspond to the Nursing Fundamentals course as an example, the authors describe the characteristics of this system, the educational model implemented, the didactic strategies which are used in this virtual classroom environment, as well as the methodological arrangement and the didactic materials which have been developed for this program. Finally, the authors want to point out that the participation of Nursing in this program has enabled the Nursing Department to respond to the educational and professional demands of the University of the Balearic Islands, to reflect critically about teaching methodology, to bring the School of Nursing and Physiotherapy closer to our university community and to design new projects for future correspondence/open university courses.

La docencia enfermera. Convergencia hacia las nuevas tecnologías / The nursing field in education

Campus Extens es un nuevo proyecto de educación a distancia que utiliza para su difusión las nuevas tecnologías de la comunicación como Internet o videoconferencias. Se inició en el año 1997 de manera experimental en la "Universitat de les Illes Balears" (U.I.B) y actualmente, después de seis años en funcionamiento, es un proyecto consolidado. Los estudios de enfermería entran, a petición propia, a formar parte de él de forma experimental y progresiva desde el curso 2001-2002 con la pretensión de acercar e integrar las nuevas tecnologías educativas a los estudiantes de Baleares con dificultades para acudir a las clases tradicionales que se imparten en el Campus de Palma y posibilitar futuras opciones docentes a distancia. Utilizando como ejemplo los materiales educativos de la asignatura de Fundamentos de Enfermería se exponen las características del sistema, el modelo de formación implementado, las estrategias didácticas que utilizamos en este entorno virtual de formación, así como el dispositivo metodológico y los materiales educativos que se han desarrollado. Para concluir señalamos que la participación de los estudios de Enfermería en este proyecto ha permitido responder a la demanda formativa y profesional de las Islas Baleares, hacer una reflexión crítica sobre la metodología docente, acercar la Escuela de Enfermería y Fisioterapia a nuestra Comunidad Universitaria y diseñar nuevos proyectos a distancia para el futuro (AU)