醫師與護理師發燒概念與退燒藥物處置知識、態度與行為之探討

Physicians’ and nurses’ knowledge, attitudes and practices about fever and antipyretic management

邱旅揚(Lu-Yang Chiu)

指導教授 ： 戴玉慈教授

國立臺灣大學/醫學院/護理學研究所/碩士(2012年)

https://doi.org/10.6342/NTU.2012.01884

摘要

退燒處置為臨床常見且重要的護理處置，近年來許多研究已逐漸形成共識，認為發燒為人體對抗感染之自然防禦機轉，發燒症狀的處理應以增進舒適為主，非以降低體溫為目標，然而此觀念的轉變並未著實改變目前臨床準則與護理措施。故本研究目的為了解醫護人員對發燒概念與退燒藥物處置的知識、態度與行為，以及比較醫護間知識、態度與處置之異同。
研究設計採橫斷、描述性研究，以立意取樣方式針對北部某醫學中心醫師與護理師為對象，使用自擬結構式問卷收集人口學資料及發燒與退燒藥物處置相關資料。本研究收案期間為2012年2月至4月，共收案78位醫師、251位護理師，總共329位醫護人員。
研究結果發現，本研究醫師發燒知識題總分答對率達80.09%，護理師為67.02%。醫護人員對發燒認知與退燒藥物處置的自信程度最高，醫護人員視發燒定義與開始給退燒藥的體溫中位數皆為38℃，其中以acetaminophen類使用頻率最高。醫護人員認為退燒目的是預防病患無法負荷體溫升高引起的身體代謝率的增加，而認為發燒會導致熱痙攣及腦部受損的擔憂雖然較低，但仍持續存在。
在影響因素方面，醫師的進階層級越高，工作年資越久，對自己的發燒認知與退燒藥物處置信心越高，而資淺醫師的退燒藥物處置易受同事與家屬要求所影響；以及認為不用退燒藥的高燒，會使病患出現腦部受損的比率較資深醫師高。而護理師的進階層級越高、越資深，其發燒知識總分越高，對發燒認知與退燒處置的信心越高，對發燒反應的焦慮感越低，會待病患發燒溫度較高時才給予解熱劑處置；且認為退燒目的是為緩解病患與家屬的焦慮、預防病患無法負荷身體代謝率的增加，較少為了避免造成腦部或重要器官細胞受損；並且資深護理師依實證文獻為給藥依據的頻率較高，及較少受同事壓力影響。
而與護理師相較下，醫師的發燒知識較高，對退燒藥物處置的自信較高、對發燒反應的焦慮感較低、對面對病患家屬之外在壓力感受較低；且認為退燒目的主要為預防病患無法負荷身體代謝率的增加，與緩解家屬與病患的焦慮不安較護理師高，而預防體溫再上升與降溫為退燒目的比率較護理師低。此外，醫師依實證文獻結果與同事壓力而給藥的頻率較護理師高。
因此醫護人員對發燒的態度雖已較過去的研究結果更接近實證研究的建議，認為發燒對病人可能有益，且認為退燒主要目的在於增進病人舒適而非降溫，但對發燒與熱痙攣、腦部受損的關係仍感到擔憂，尤以進階層級低、資淺人員對發燒處置較沒有信心，退燒藥物處置較易受外在壓力所影響。且本研究發現醫師與護理師於發燒知識、態度與行為有差異，故此結果可做為未來主管規劃醫護共同繼續教育、發燒個案討論，以及研擬發燒處置準則之參考，強化醫護人員對發燒處置的共識，讓發燒病人得到最適當的處置。

關鍵字

發燒 ； 醫師 ； 護理師 ； 退燒藥物處置 ； 解熱劑

並列摘要

Fever management through antipyretic therapy is a common clinical nursing practice. More and more studies have reached the consensus that fever is a part of the body’s natural defense mechanism against infectious disease. The main purpose of managing the symptoms of fever is to comfort patients, not lower their body temperature. However, this change in viewpoint has not been incorporated into common antipyretic practices and clinical guidelines. The objective of this study is to investigate the different knowledge, attitudes and practices of physicians and nurses in fever and antipyretic management.
A cross-sectional, descriptive design was used to purposively sample physicians and nurses to collect data on demographics, fever knowledeg, and antipyretic management. A total of 329 self-developed, structured questionnaires were collected from 78 physicians and 251 nurses in medical centers in northern Taiwan from February to April 2012.
The results showed that eighty percent (80%) of the knowledge items were correctly answered by physicians, and sixty-seven percent (67%) by nurses. Physicians and nurses were most confident in fever knowledeg and antipyretic management and the median temperature they considered to be a fever and at which they administered antipyretics was 38℃. Acetaminophen was the primary antipyretic used by the health care providers surveyed, with the purpose of antipyretic therapy being to help patients tolerate the increased metabolic demands caused by fever. The concern among health care providers that fever would cause febrile seizure and brain damage continued to exist, but less than in previous studies.
Physicians practicing at a more advanced level and with more experience were more confident in their beliefs about fever and antipyretic management, while less experienced physicians were more influenced by colleagues and parents. In addition, less experienced physicians believed that an untreated high fever would lead to brain damage more often than did experienced physicians. Similarly, nurses practicing at a more advanced level and with more experience also were more knowledgeable and confident in their beliefs about fever and antipyretic management, and less anxious about fever response. The more advanced level and experience of the nurse, the more often they administered antipyretics in higher fever. They considered the purpose of antipyretic therapy to be to reduce the anxiety of patients and families, and to help patients tolerate the metabolic burden caused by fever, rather than to prevent damage to the brain and organs’ cells. Furthermore, the use of antipyretic management by experienced nurses was more evidence-based, and less dependent on peer pressure.
Compared with nurses, physicians were more knowledgeable about fever and antipyretic management, more confident in antipyretic management, less anxious about fever response, and less influenced by patients and parents. They were more likely to consider the purpose of antipyretic therapy to be helping patients tolerate the metabolic burden caused by fever, and reducing the anxiety of patients and families. Finally, in comparison with nurses, their antipyretic management was more evidence-based and more dependent on peer pressure.
In conclusion, this study shows that health care providers’ attitudes toward fever are more positive than they have been in the past. They consider fever to be beneficial to a host’s defenses and use antipyretic therapy to comfort patients, rather than to lower body temperature. Nevertheless, novices and less experienced health care providers continue to worry about febrile seizure and brain damage, and their antipyretic managements are more easily influenced by the concern of others. Given the differences between physicians and nurses in their knowledge, attitudes and practices of fever and antipyretic management, the results of this study can serve as reference data in the design of febrile case conferences and continuing education for health care providers, and in the establishment of guidelines for antipyretic management. Physicians and nurses must have agreement on antipyretic management so that patients would receive appropriate care.

並列關鍵字

febrile ； fever ； physicians ； nurses ； antipyretic management ； antipyretic

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