full2010.pdf - page 578

540
of clinical practice guideline of Australian National Health and Medical Research Council (1998). The search
strategy sought evidence-based practice. The 15 empirical studies were chosen, including 2 systematic reviews; 5
randomized controlled trials; 5 quasi-experimental studies; 2 retrospective cohort studies and 1 descriptive study,
synthesized yielding the CNPG. The content and feasibility of developed CNPG was approved by three experts
and corrected following their suggestion. Finally, achieving appropriate content of CNPG for fever management
in patients with TBI composed of five steps: (1) definition of fever, (2) assessment body temperature, (3) fever
reduction including antipyretics and external cooling interventions, (4) assessment and management of shivering,
and (5) reassessment body temperature.
The recommendations for nursing practice were mentioned. The CNPG should include a pilot study in
order to evaluate the process and outcomes of this CNPG. The application into practice should be integrated in
continuous quality improvement and using outcome research.
Keywords: Clinical nursing practice guideline, Fever, Patients with traumatic brain injury
‡ÎµœÎµ
„µ¦š¸É ¤°ŠÅ—o¦´µ—Á‹È ¦»œÂ¦Š¤¸ Á¨º°—‡´ÉŠnŠŸ¨Ä®oÁ„·—‡ªµ¤—´ œÄœ„³Ã®¨„«¸¦¬³¼Š ‹œ°µ‹šÎµÄ®o ¤°Š
¼Á¸¥®œoµš¸ÉĜ„µ¦‡ª‡»¤°»–®£¼¤·¦nµŠ„µ¥Â¨³Á„·—£µª³Å o ¼Š (neurogenic fever) ‹µ„Šµœª·‹´¥˜nµŠž¦³Áš«¡ªn µ
£µª³Å oÁž}œž{®µš¸É ¡Å—on°¥£µ¥ÄœnªŠ 72 ´É ªÃ¤ŠÂ¦„®¨´Š‹µ„Ÿ¼o žiª¥Å—o¦´µ—Á‹È¤°Š ×¥ÁŒ¡µ³°¥nµŠ¥·ÉŠ
Ÿ¼ožiª¥Å—o¦´µ—Á‹È ¤°Š¦·Áª–nªœ®œoµ Ÿ¼ožiª¥¤¸Á¨º°—°°„ĘoÁ¥ºÉ°®»o ¤¤°Š´ÊœÄœ ®¦º°Ÿ¼o žiª¥¤¸„µ¦Œ¸„ µ—®¦º°—¹ Š¦´ÊŠ
°ŠÁoœž¦³µš (diffuse axon injury) ¤¸Ã°„µÁ„·—Å o ¼ŠÅ—o¤µ„„ªnµ¦o°¥¨³ 50 (Rabinstein and Sandhu, 2007)
£µª³Å o ¼ Š¤¸Ÿ¨„¦³š˜n°£µª³»£µ¡ °ŠŸ¼ožiª¥µ—Á‹È¤°Šš´Ê Š—oµœ¦nµŠ„µ¥ Á«¦¬“„· ‹Â¨³´Š‡¤ ×¥
šÎ µÄ®o¤¸„µ¦šÎµ¨µ¥¤°Š¤µ„ ¹Êœ£µ¥®¨´ ŠŸ¼o žiª¥Å—o¦´µ—Á‹È¤°Š ÁœºÉ°Š‹µ„¤¸ °´˜¦µ„µ¦ÁŸµŸ¨µ°°„Ž· Á‹œÄœ¤°Š
Á¡·É¤ ¹Êœ ‡ªµ¤—´ œÄœ®¨°—Á¨º°——Š¨—¨Š (Kiekkas et al., 2007) ‡ªµ¤—´œÄœ„³Ã®¨„«¸ ¦¬³¼Š ¹Êœ (Cairns and
Andrews, 2002) Ÿ¼oži ª¥‹¹Š¤¸ ¦³—´‡ªµ¤¦¼o ¹„˜´ª¨—¨Š ˜o °Š¡¹ÉŠ¡µŸ¼o°ºÉœ ˜o°Š¦´„¬µ˜´ªÄœÃ¦Š¡¥µµ¨œµœ ¹Êœ ¨³´¤¡´ œ›r
„´°´˜¦µ„µ¦Á¸¥¸ª·˜¤µ„„ªnµŸ¼ožiª¥š¸ÉŤn¤¸£µª³Å o (Diringer, Reaven, Funk and Uman, 2004; Greer et al., 2008)
„µ¦š¸É¤¸ Ÿ¨„¦³šÁ„·— ¹Êœ‹µ„£µª³Å oĜŸ¼o žiª¥µ—Á‹È¤°Š ¦ª¤š´Ê Š‹µ„„µ¦ššªœª¦¦–„¦¦¤Äœ
˜nµŠž¦³Áš«¡ªnµ „µ¦‹´ —„µ¦„´£µª³Å oĜŸ¼oži ª¥µ—Á‹È¤°Š¥´ŠÅ¤n ¤¸ž¦³·š›·£µ¡Á¡¸¥Š¡° ¤¸Á¡¸¥Š¦o°¥¨³ 31 °Š
Ÿ¼ožiª¥Å—o¦´„µ¦¨—Å o ¨³¦o°¥¨³ 13 °ŠŸ¼ožiª¥š¸É¤¸°»–®£¼¤·„µ¥¼Š Á„· œ 40 °Š«µÁŽ¨ÁŽ¸¥ ŗo¦´„µ¦—¼ ¨¦´„¬µ˜ÉÎ µ„ªnµ
š¸É ‡ª¦Áž}œ (Thomson, Kirkness and Mitchell, 2007) š´ÊŠœ¸ÊÁœºÉ°Š‹µ„µŠ®œn ª¥Šµœ¥´ŠÅ¤n¤¸Âœªž’·´˜·šµŠ„µ¦¡¥µµ¨
š¸É Áž}œ¤µ˜¦“µœ šÎµÄ®o¤¸ „µ¦‹´—„µ¦„´£µª³Å oš¸É ®¨µ„®¨µ¥ n ŠŸ¨Ä®o£µª³Å o‡ŠÁž}œž{®µš¸É¡Å—on °¥ÄœŸ¼oži ª¥
µ—Á‹È ¤°Š¦³¥³ª·„§˜ Ÿ¼o«¹„¬µÁ®È œ™¹Š‡ªµ¤Îµ‡´Äœ„µ¦¡´•œµÂœªž’·´ ˜·„µ¦¡¥µµ¨Äœ„µ¦‹´—„µ¦£µª³Å o °Š
Ÿ¼oži ª¥µ—Á‹È¤°Š ץčoª·›¸„µ¦ššªœª¦¦–„¦¦¤°¥nµŠÁž}œ¦³‹µ„®¨´„“µœÁ· Šž¦³‹´„¬r£µ¥Ä˜o „¦°Âœª
šµŠ„µ¦¡´ •œµÂœªž’·´˜·šµŠ‡¨·œ· „ °Š£µ„µ¦ª·‹´¥„µ¦Â¡š¥r¨³»£µ¡Â®n Šµ˜·ž¦³Áš«°°Á˜¦Á¨¸¥ (National
Health and Medical Research Council, [NHMRC], 1998) Á¡ºÉ °œÎµ¤µÄoĜ„µ¦ž’·´˜·„µ¦¡¥µµ¨Ž¹ÉŠÁž}œ„µ¦¼¦–µ
„µ¦Ÿ¨Šµœª·‹´¥Á oµ„´‡ªµ¤ÎµœµšµŠ‡¨·œ· „ °Š¡¥µµ¨š¸É °—‡¨o °Š„´‡ªµ¤˜o°Š„µ¦ °ŠŸ¼ožiª¥Â¨³Á®¤µ³¤„´