This study applied exploratory mixed method which included 3 stages: developing a fever management plan in infants and teaching this educational plan to nursing students, interviewing with students and parents regarding fever management, and designing a questionnaire and evaluating the opinions of students regarding the fever management plan. The present study is approved by ethics committee of Shahrekord University of Medical Sciences. Participants included nursing students in who were attending in pediatric internship course and parents of febrile children hospitalized in pediatrics ward. The study protocol contained three stage which is described as below (Fig. 1).
First stage: in this stage, a fever management plan in pediatric patients developed and taught to nursing students. This educational plan developed based on textbooks and evidences regarding pediatric fever management, using 6 steps of Kern’s educational planning model (Fig. 2). Participants in this stage included 100 students in fifth semester of Bachelor of Nursing who were willingness to participate in the study. Informed consent form obtained from each participants. The developed fever management plan taught to participants through two sessions of theoretical education and six sessions of practical training. Theoretical education included following topics: 1. Definition of fever, 2. Purposes of fever management in pediatric patients, 3. Steps of implementing fever management plan in pediatrics, 4. Keywords and abbreviations related to fever management in pediatrics, 5. Responsibility for providing fever management in children and 6. Interventions for fever management in pediatrics. The first three topics were educated in first session and the next three topics educated in the second session. Each session lasted one hour. After completion of these two theoretical educational sessions, participants practiced components of the fever management plan during apprenticeship course in pediatrics ward of Hajar hospital of Shahrekord city. This apprenticeship course included six sessions and 8–10 students participated in each course. In this course, participants learned how to apply the educated fever management plan in clinical settings. It is important to note that, the fever management plan included giving information to and teaching parents regarding fever and the key role that parents have in fever management process. The apprenticeship course was held by the corresponding author, who has PhD in nursing and is associate professor in pediatrics nursing group in Shahrekord University of Medical Sciences. In the first three sessions of apprenticeship, participants practiced fever management plan with the supervision of their educator, their questions were answered and their errors or misunderstandings was resolved by the master. In the next three session, participants were asked to apply the fever management plan independently and report their works to the educator. Goal, Objectives and learning domains of this fever management educated to nursing students is shown in Table 1.
Second stage: in this stage, experiences of nursing students and parents of infants regarding fever management was evaluated. Inclusion criteria was students who were completed the mentioned apprenticeship course, and parents of feverish infants, they selected using purposive sampling method. Exclusion criteria was unwillingness to continue participating in the study for mothers and students, and absenting more than one session in the fever management program for students. Informed consent form obtained from each participant. Data collected using individual interviews in Hajar hospital of Shahrekord or nursing faculty of Shahrekord University of Medical Sciences, based on preferences of participants. Mean time of interviews was 45 minutes. Interviews started with the open question: “please tell about your experiences regarding fever management in infants” for nursing students and “please tell about your experiences regarding lowering your child’s fever” for parents, and continued with probing questions. Data collection continued until the researcher felt that data saturation has occurred. Data saturation occurred after 20 interviews. All interview recorded on tape. Data were analyzed based on conventional content analysis method. This method is used for description of a phenomenon or when theoretical models and researches regarding a phenomenon or topic is limited (18). Generally, process of analyzing data included open coding, classification and abstraction. For analyzing qualitative data, the researcher listened to all interviews several times to drown in data and obtain a general overview to interviews and their contents. All interviews typed word by word for highlighting keywords representing main themes and extracting codes. After extracting codes and concepts from important sentences and paragraphs, they were classified into categories based on similarities and differences. Then, these categories combined into main categories based on their relationships (19). To ensure trustworthiness, the four Guba and Lincoln criteria were used to ensure the trustworthiness of the research (17).The researcher's long-term involvement, the researcher's contact and communication with the research environment and relevant authorities and participants helped to gain the participants' trust and also helped the researcher to understand the research environment. Participants' review was used to confirm the accuracy of the extracted data and codes. To review the observers, the text of some of the interviews, the codes, and the extracted categories were reviewed by two faculty members in addition to the researchers, and there was 90% agreement among the extracted results. The researcher also shared the findings with some of the parents and students who did not participate in the study, and they confirmed the appropriateness of the findings.
Table 1
details of fever management plan educated to nursing students
Goal | Objectives | Learning domains |
Cognitive | affective | Psychomotor |
Orientation to fever management plan in pediatrics | 1. Students can describe hyperthermia (fever) | knowledge | - | - |
2. Students can describe mechanism of fever | knowledge | - | - |
3. Students know the difference between hypothermia and hyperthermia | Comprehension | - | - |
4. Students can describe required interventions for fever management | Comprehension | - | - |
5. Students perform fever management plan with the help and supervision of the teacher | - | - | Guided response |
6. Students discuss about the importance of fever management in pediatrics | - | Valuing | - |
7. Students role-play teaching fever management methods to putative parents | - | - | Independent performance |
8. Students teach fever management methods to parents of febrile children | Analysis | - | - |
9. Students discuss about objectives of fever management | Synthesis | - | - |
10. Design and present a fever management plan in pediatrics based on 5 steps of nursing process | - | - | Independent performance |
Third stage: after analyzing qualitative data, a questionnaire developed with the aim of evaluating opinions of participants regarding the educated fever management plan. This questionnaire included 4 items: 1. in the fever management plan, enough attention is paid to parents’ needs, 2: the fever management plan leads to modification of students and parent practices regarding fever management, 3. The fever management plan leads to behavioral changes in students and parents and 4. Generally, the fever management plan was satisfactory. The scoring was based on 5-point Likert scale including completely disagree, disagree, have no idea, agree and completely agree. Content validity of the questionnaire was approved by opinions of faculty members of Nursing School of Shahrekord University of Medical sciences, and content validity index reported to be 0.86. The reliability of the questionnaire evaluated by calculating Cronbach’s Alpha, which was 0.92. This questionnaire provided to nursing students who had participated in the educational fever management plan. Exclusion criteria was absence in more than one of the educational sessions and unwillingness to continue participating in the study. Data obtained in this stage were analyzed using SPSS software version 22 via descriptive statistics.
Ethical Considerations
This study was the result of a research project approved by ethics committee of Shahrekord University of Medical Sciences (ethics code: IR.SKUMS.REC.140.189). Parents and students interested in participating in the study were interviewed after obtaining their informed written consent. They were informed about the objectives of the study and told that they could leave the study at any time. In addition to obtaining permission to record audio, they were assured of the confidentiality of the information.