Nursing management decisions in fever: a mixed-methods approach to understanding.

Background: Fever is a common symptom among hospitalized patients and often triggers nursing interventions. Although clinical guidelines recommend the use of antipyretics primarily to alleviate patient discomfort rather than to normalize temperature, both pharmacological and non-pharmacological treatments remain routinely employed. However, the rationale behind these interventions in adult care settings remains poorly understood. Aim: This study aims to explore how nurses manage fever in adult patients and examine the rationale underpinning their clinical decisions in fever management. Methods: A sequential explanatory mixed-methods design was employed. Quantitative data on nurses' fever management and decision-making for patients with fever were collected via an online survey of 177 registered nurses in Scotland. Qualitative data on nurses' rationale and experience in managing fever were obtained through open-text responses in the online survey and five follow-up interviews. Thematic analysis and descriptive statistics were integrated to interpret findings. Results: Independent nursing judgement was the most frequently cited rationale for fever intervention (49.2 %). However, according to the qualitative finding, clinical decisions were predominantly influenced by habitual routines, institutional norms, and risk-averse thinking. Participants frequently initiated interventions as part of the Sepsis Six protocol, even in the absence of confirmed infection. Fever phobia, defined as exaggerated perceptions of fever-related harm, was evident in both interview and questionnaire data. Comfort was commonly cited as a justification for treatment, yet few participants reassessed patient comfort after administering interventions. Conclusion: Nurses' fever management is influenced more by embedded routines and clinical culture than by formal knowledge or guideline adherence. Fever phobia and Sepsis Six pressures can contribute to unnecessary intervention, highlighting the need for reflective education and systems-level support for evidence-based practice.The result of this study illustrated the potential for overtreatment in fever care and provides actionable insights to support evidence-informed decision-making in nursing practice. Future initiatives should focus on challenging fever phobia, supporting critical reflection, and aligning practice with current evidence through targeted educational strategies.