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Evidence-based nursing research: evidence based nursing online offers a selection of articles from the health-related literature reporting studies and reviews that warrant immediate attention by nurses attempting to keep pace with important advances in their profession.

Available evidence does not support routine administration of antipyretics to reduce duration of fever or illness


Anne Walsh, School of Nursing and Midwifery, Queensland University of Technology, Brisbane

Fever is a common occurrence in adults and children in community and healthcare settings. Despite this, it does not seem to be common knowledge that fever is a natural response to an invading organism and that most fevers are associated with self-limiting viral illnesses.

Many health professionals and the general public see fever as an illness in itself not as a highly-coordinated protective response. Illness sometimes results in the body thermostat being set higher than normal, and hence fever is a physiological measure, which may result in shivering, for example, in order to initially raise the body temperature to an elevated set point, and then sweating to return it to normal.

Being febrile may be unpleasant, and the literature abounds with reports of health professionals' and parents' actions to reduce fever and maintain temperature within normal limits, during febrile illnesses. Active cooling methods include tepid sponging, cooling blankets and intermittent or regular oral or intravenous antipyretics (e.g. paracetamol). Adults may overdose using, for example, paracetamol and a cold/flu medication that also includes paracetamol (for pain management).

Furthermore, parents might provide incorrect doses at incorrect frequencies, and use antipyretics in combination in their quest to normalise temperature. As fever is a natural response to illness, which is thought to support the body's response to illness, then treating it might delay recovery; hence it is important to evaluate the necessity of reducing fever and the effect of reducing fever on illness duration, morbidity and mortality. content/14/2/58.full

Limited good-quality evidence available on earwax removal methods; softeners more effective than no treatment, but evidence for irrigation or mechanical removal is equivocal


Yehudah Roth,Yahav Oron, Abraham Goldfarb, Department of Otolaryngology --Head and Neck Surgery, The Edith Wolfson Medical Center, Holon, Israel


Cerumen impaction is common and saliently affects well-being. Cerumen excreted from the skin of the external ear canal provides a protective oily layer, entraps foreign materials and has antibacterial properties. It is produced by special glands and is usually degraded in parallel, so in most people there is no wax accumulation. If a large quantity of wax is retained, it blocks the ear canal and severely interferes with hearing. Such blockage can easily be removed to resume previous hearing.


Impaction is caused by ear 'cleaning' with Q-tips, which often creates a piston mechanism that pushes the wax inside the canal towards the tympanic membrane.

This is one of the reasons why regular wax removal or 'cleaning' is not recommended. Some populations tend to develop frequent cerumen impaction, which is reflected as reversible, profound, hearing loss. Other symptoms include tinnitus, itching, cough, dizziness or pain. Reasons for higher prevalence include drier secretions, metabolic changes and genetics. content/14/2/60.full

Expansion of nursing role in general practice: studies suggest patients think nurses can manage simple conditions but have some concerns about knowledge and competence in some areas


Elizabeth J. Halcomb, Family and Community Health Research Group, University of Western Sydney, Penrith

The increasing burden of chronic disease and an ageing population in the developed world has led to a shift towards primary care to manage chronic and complex disease. This has prompted a growing interest in the nursing role within general practice. Various models of substitution, delegation and supplementation have been proposed in the literature.

The impact of these models on patient outcomes and service delivery has only recently begun to receive attention. This article sought to review the recent evidence about the benefits and limitations of the role expansion of nurses in UK general practice.

An integrative review method was used to identify and synthesise the literature published since 2004 that investigated the role of nurses in UK general practice. The search of nine electronic databases identified 164 articles, of which eight met the inclusion criteria and were included in the review.

The outcomes from the included studies could be clustered under three themes: impact on patients; nurse competence; and National Health Service policy. From these outcomes, the author also identifies that the nursing role has been driven by the general practitioner contract and that current models of delegation remove consumer choice about the health professional that they see.

The article concludes there is limited literature about the expanding nursing role in general practice, as well as identifying a need for additional nurse training around consultation and inclusion of patients' views.

Patient-to-nurse ratio in neonatal ICU associated with daily weight gain, but not other clinical outcomes in moderately pre-term infants

Janet Tucker, University of Aberdeen, Aberdeen, Scotland

Reports from critical care settings more than a decade ago suggested poorer clinical outcomes were associated with lower nurse staffing, but subsequent findings from studies in neonatal intensive care units (NICUs) have been more equivocal.

The research examined outcomes for a prospective cohort of 850 moderately pre-term infants (gestational age of 30-34 6/7 weeks) in relation to registered nurses on shift in 10 NICUs. The measure of nursing provision used was the patient-nurse ratio (PNR). This was the average number of registered nurses (calculated over a 24-hr period of shifts, including partial nurse shifts) and occupancy in terms of NICU census of midnight the previous day.

In addition to testing some infrequent clinical outcomes for this particular patient group and sample size (eg. intraventricular haemorrhage and chronic lung disease), nosocomial infection and further proxy-outcome indicators were also tested. These indicators may be judged relevant and more sensitive indicators of nursing process and quality. Further follow-up information for the cohort was also available about subsequent acute emergency visits or re-hospitalisation in the three months post-discharge.

A rudimentary comparison between smaller units and larger units revealed the following: the PNRs in large units were higher; their infants had longer stays and later gestational age at discharge, higher daily weight gain, more days of respiratory support and lower rates of any breast milk at discharge.

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Publication:The Lamp
Geographic Code:4EUUK
Date:Oct 1, 2011
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