Fever, Frustration and Fortitude: A Qualitative Exploration of Nursing Practice in Paediatric Settings

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BACKGROUND: Fever is one of the most common symptoms in children and a leading cause of their hospitalisation. Nurses, as primary caregivers in paediatric wards, play a pivotal role in the assessment and management of children with fever. However, nurses' perceptions and experiences of fever management are influenced by cultural contexts, psychological and social factors, as well as prevailing health system policies. AIM: The aim of the study was to explore nurses' perceptions influencing their management of childhood fever, including barriers and facilitators to evidence-based practice. DESIGN: A qualitative descriptive design using a conventional content analysis approach. METHODS: Nineteen nurses working in paediatric wards participated in individual semi-structured interviews conducted between March 20, 2024 and May 20, 2025. Purposive sampling was used to recruit participants with direct experience in managing fever in children. Data were audio-recorded, transcribed verbatim and analysed inductively using qualitative content analysis as described by Graneheim and Lundman. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. RESULTS: Data analysis resulted in the extraction of one main theme titled 'Navigating Uncertainty and Psychological Strain in Pediatric Fever Management' and five main categories. Nurses described challenges related to the absence of locally adapted clinical guidelines, lack of continuous education, hierarchical dependence on physicians, fever phobia and misconceptions, which led to non-evidence-based decision-making and unnecessary interventions. CONCLUSION: The findings underscore the need for developing culturally appropriate local clinical guidelines, implementing evidence-based continuous educational programmes, enhancing nurses' professional autonomy and providing effective family education. These interventions can improve care quality, reduce nurses' occupational anxiety and ultimately enhance child health outcomes. IMPLICATIONS FOR PROFESSION AND/OR PATIENT CARE: Understanding nurses' experiences and challenges may inform the development of educational interventions, localised clinical guidelines and organisational strategies to improve the quality and consistency of fever management in children. IMPACT: What problem did the study address? ◦The study addressed the gap between evidence-based fever management guidelines and actual nursing practice in paediatric settings. What were the main findings? ◦Nurses' clinical decision-making was influenced by fear of complications, parental expectations, organisational factors and contextual factors. Where and on whom will the research have an impact on? ◦The findings may impact paediatric nurses, healthcare administrators and policymakers by informing strategies to support evidence-based fever management in hospital settings. REPORTING METHOD: This study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution: Patients or members of the public were not involved in the design, conduct, reporting or dissemination plans of this research, as the study focused on nurses' professional experiences.