Temperature - Royal College of Nursing

Temperature Assessment as a
Therapeutic Nursing Intervention
By Natalie Porter
Student Nurse
The importance of temperature
assessment
An assessment of temperature should be carried on admission and then at
regular intervals dependant on the child's clinical need
(RCN 2011)
Temperature assessment is included in the early warning score (EWS)
(Coyne et al 2010)
Temperature can impact the reading of other vital signs, such as heart rate
(Dawson et al 2012)
Death can occur as a result of extremely high temperatures above 42 C or
even low temperatures below 27 C
(Roberts 1986)
Therapeutic relationships
Muetzel’s PIR model
Partnership
By working together developing trust and a mutual respect, patients are more likely to feel empowered
(Reed 2011).
Nurses should work with patients and “recognise and respect the contribution that people make to their own
care and wellbeing” (NMC 2008 p3).
Intimacy
The presence of the nurse and the engagement that they have with their patients.
Allows effective communication to take place as the nurse has time to show their care and compassion to the
patient through listening and befriending them (Williams 2001).
Reciprocity
Reciprocity relates to a mutual exchange between patients and their nurse allowing close emotional
relationships to develop (Williams 2001).
Patients often disclose personal information at a time when they are at their most vulnerable (Griffith and
Tengnah 2013). This in itself highlights the importance of therapeutic relationships overcoming barriers allowing
patients to feel comfortable and at ease with the individuals caring for them.
Evidence supporting
therapeutic relationships
Patient-focused rounding
• It has been hoped that the scheme will enhance communication between patients
and staff allowing the nurse-patient relationship to develop (Fitzsimons et al
2011).
• Criticism of the scheme believing it to be more paper work rather than being a
beneficial activity (Moore and Waters 2012).
The six C’s campaign
• "care, compassion, competence, communication, courage and commitment" (DH
2012 p4).
• Healthcare is changing into a shared partnership between professionals and
patients however the basics of care and compassion remain (Lintern 2013).
• These values can help establish therapeutic relationships by targeting partnership,
intimacy and reciprocity and become key factors in maximising the potential of
patients recovering quicker.
Research into temperature assessment
A child’s natural temperature ranges between 36.5 C and 37.5 C however this can vary
as a result of age, illness and environment. Different routes that allow for
temperature assessment including: axilla, tympanic, oral and rectal
(Coyne et al 2010).
Table 1: Methods of temperature taking in under 5s
Electronic Chemical dot
Infra-red
thermometer thermometer
tympanic
axilla
axilla
thermometer
< 4 weeks
4 weeks – 5
years






Source: National Institute for Health and Clinical Excellence (NICE) (2007)
Oral
Rectal




Controversies surrounding
temperature assessment
Touch alone cannot be a reliable temperature assessment
Glass mercury thermometers
Accuracy of tools and human error
Therapeutic Nursing and
Temperature Assessment
Partnership
• Involving parents in temperature assessment is useful in order to develop a complete relationship with the family
and child.
• Gaining consent is vital before carrying out nursing interventions (Corkin et al 2012).
• Children, who can understand, should be informed of the importance of taking their temperature and told how it
is carried out.
Intimacy
• All nurse-patient contact is important in developing a therapeutic relationship (McMahon 1998).
• Patients may be at their most vulnerable and taking their temperature may be a time they want to discuss other
issues (Griffith and Tengnah 2013).
• When taking a patients temperature the nurse is temporarily entering their personal space.
• The therapeutic use of touch can often be calming (Trigg and Mohammed 2010).
• Families and children may be worried whilst in hospital however the nurse can develop a trusting relationship
with them to help reduce anxieties (Coyne et al 2010).
Reciprocity
Nurse benefits
• Receive clarification regarding the wellbeing of the patient (Macqueen et al 2012).
• The nurse can observe other vital signs whilst taking the patients temperature
Patient benefits
• They are aware that the nurse is monitoring their condition and is doing their best to promote their health
• Recovery can happen as quickly as possible.
References
•
•
•
•
•
•
•
•
•
•
•
Aprahamian, N., Shannon, M., Hummel, D., Johnston, P. and Kimia, A. (2009). Glass Thermometer Injuries: It Is Not Just
About the Mercury, Pediatric Emergency Care, 25(10), 645-647.
Barton, SJ., Gaffney, R., Chase, T., Rayens, MK. and Piyabanditkul, L. (2003). Pediatric Temperature Measurement and
Child/Parent/Nurse Preference Using Three Temperature Measurement Instruments: Journal of Pediatric Nursing, 18(5),
314-320.
Corkin, D., Clarke, S. and Liggett, L. (2012). Care Planning in Children and Young People's Nursing. West Sussex;
Blackwell Publishing Ltd.
Coyne, I., Neill, F. and Timmins, F. (2010). Clinical Skills in Children's Nursing. New York: Oxford University Press.
Dawson, P., Cook, L., Holliday, LJ. and Reddy, H. (2012). Oxford handbook of clinical skills for children's and young
people's nursing. xford: Oxford University Press.
Department of Health (DH). (2012). Developing the culture of compassionate care: Creating a new vision for nurses,
midwives and care-givers [pdf document]. Available from <http://www.england.nhs.uk/wp-content/uploads/2012/10/nursingvision.pdf> [Accessed 06.05.13].
Erickson, RS., Meyer, LT. and Woo, TM. (1996). Accuracy of Chemical Dot Thermometers in Critically Ill Adults and Young
Children: Journal of Nursing Scholarship, 28(1), 23-28.
Fitzsimons, B., Bartley, A. and Cornwell, J. (2011). Intentional rounding: its role in supporting essential care [online].
Available from <http://www.nursingtimes.net/nursing-practice/clinical-zones/management/intentional-rounding-its-role-insupporting-essential-care/5032316.article> [Accessed 08.05.13].
Griffith, R. and Tengnah, C. (2013). Maintaining professional boundaries: keep your distance: British Journal of Community
Nursing, 18(1) 43-46.
Lintern, S. (2013). CNO reveals plans to make 6Cs a reality [online]. Available from <http://www.nursingtimes.net/nursingpractice/clinical-zones/management/cno-reveals-plans-to-make-6cs-a-reality/5056215.article> [Accessed 08.05.13].
Macqueen, S., Bruce, EA. and Gibson, F. (2012). The Great Ormond Street Hospital Manual of Children's Nursing Practices.
West Sussex: Wiley-Blackwell. in nursing: Journal of Advanced Nursing, 33(5), 660-667.
References (2)
•McMahon, R. (1998). Therapeutic nursing: theory, issues and practice. In McMahon, R. and Pearson, A. (eds.) Nursing as
Therapy. Cheltenham: Stanley Thornes.
•Moore, A. and Waters, A. (2012). All eyes on the patient [online]. Available from
<http://nursingstandard.rcnpublhing.co.uk/campaigns/care-campaign/features/all-eyes-on-the-patient> [Accessed 08.05.13]. Is
•National Institute for Health and Clinical Excellence (NICE). (2007). Feverish illness in children: Assessment and initial
management in children younger than 5 years. Clinical guideline 47. London: National Institute for Health and Clinical
Excellence.
•Nursing and Midwifery Council. (2008). The NMC Code of Professional Conduct: Standards for Conduct, Performance and
Ethics. London: Nursing & Midwifery Council.
•Reed, A. (2011). Nursing in Partnership with Patients and Carers. Exeter: Learning Matters Ltd.
•Roberts, MBV. (1986). Biology: a functional approach. 4th edition. Cheltenham: Thomas Nelson and Sons Ltd.
•Royal College of Nursing (RCN). (2011). Standards for assessing, measuring and monitoring vital signs in infants, children and
young people. London: Royal College of Nursing.
•Trigg, E. and Mohammed, TA. (2010). Practices in Children's Nursing: Guidelines for Hospital and Community. 3rd edition.
Edinburgh: Elsevier Limited.
•Whybrew, K., Murray, M. and Morley, C. (1998). Diagnosing fever by touch: observational study: British Medical Journal,
317(7154), 321.
•Williams, A. (2001). A literature review on the concept of intimacy

Download Report