Page 223 - Encyclopedia of Nursing Research

190 n FITZPATrICK’S rHyTHM MOdEL

emergency room and randomly assigned to study of fever and its management, there
acetaminophen alone or acetaminophen with remains a persistent lag in the application
F sponge bathing (Sharber, 1997). Although the of what is already known (Thompson, 2005).
sponge-bathed children cooled faster during One potential for improving application is
the first hour, rapid cooling evoked higher seen in research efforts of nurses in neuro-
distress and no significant temperature dif- science, an area in which fever management
ference between groups over the 2-hour is critical, to assess fever management prac-
study period. There is evidence that a grad- tices (Thompson, Kirkness, & Mitchell, 2007;
ual, less drastic reduction in body tempera- Thompson, Kirkness, Mitchell, & Webb, 2007;
ture evokes fewer adverse responses during Thompson, Tkacs, Saatman, raghupathi, &
aggressive fever treatment with cooling McIntosh, 2003). As in many specialty orga-
blankets. Warmer settings effectively lower nizations in nursing, the consciousness-
body temperature as well as cooler levels, raising dissemination of evidence-based
without inducing shivering (Caruso, Hadley, practical knowledge may be effective in fever
Shukla, Frame, & Khoury, 1992). Two studies management.
demonstrate that in comparisons of sponge
baths, hypothermia cooling blankets, and Barbara J. Holtzclaw
acetaminophen (Morgan, 1990) and of cool-
ing blankets versus acetaminophen (Henker
et al., 2001), no temperature-lowering advan-
tage was seen in the physical cooling treat- Fitzpatrick’s rhythm
ment, which required more nursing time,
caused shivering, and was distressful. model
Today’s nurse scientist is prepared
to investigate many of the questions that
remain unanswered in fever care. As inves- Fitzpatrick (1989) presented a rhythm model
tigators acquire skills and resources for these for the field of inquiry for nursing. Meaning
biological measurements, they can be used to is viewed as the central component of the
quantify and qualify the effects of fever and human experience and is necessary to
results of intervention. research is needed enhance and maintain life. Fitzpatrick incor-
to demonstrate the effects of elevated body porated rogers’s (1983) postulated correlates
temperature, cooling interventions, and of human development as the basis for dif-
measures to support natural temperature- ferentiating, organizing, and ordering life’s
stabilizing mechanisms. Fever may provide reality. rogers’s correlates of shorter, higher
study variables, with body temperature, frequency waves that manifest shorter
cytokines, and biochemical correlates being rhythms and approach a seemingly contin-
the outcome of interest. The febrile episode uous pattern serve as Fitzpatrick’s foci for
itself may be the context of other questions for hypothesizing the existence of rhythmic
study. Psychoneuroimmunological factors patterns.
surrounding sleep, irritability, and tolerance Occurring within the context of rhyth-
of febrile symptoms remain untapped top- mical person/environment interaction,
ics. Likewise, the metabolic toll of fever on Fitzpatrick identified indices of holistic
nutritional variables, effects of intravenous human functioning as temporal, motion,
fluid on endogenous antipyresis, and mea- con sciousness, and perceptual patterns.
sures of energy expenditure are important, Fitzpatrick has asserted that the four indi-
but relatively untouched, areas of research ces of human functioning are intricately
for nursing. In contrast with the increasing related to health patterns throughout the
opportunities for nursing research in the life span, and these indices are rhythmic in