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	Artículo de revisión
Avances en Enfermería [av.enferm. -Col-] 2017 sep-dic; 35(3): 333-344 Recibido: 21/12/2015 Aceptado: 12/07/2017	La fiebre en el niño: una mirada reflexiva a las prácticas de cuidado Ana Ligia Escobar Tobón Candidata a Doctora en Enfermería. Profesora Asociada, Universidad de Antioquia. Medellín, Colombia. E-mail: ana.escobar@udea.edu.co *La revisión de la literatura se derivó de la tesis doctoral Los significados que construyen los cuidadores formales e informales sobre al cuidado al niño con fiebre.

Resumen

Objetivo: Realizar un análisis crítico- reflexivo de las prácticas rutinarias de los profesionales de enfermería y de los cuidadores familiares en el cuidado del niño con fiebre, a fin de incentivar un cuidado basado en evidencia científica que asegure el bienestar infantil. Síntesis de contenido: Se realizó una revisión bibliográfica de artículos científicos publicados entre los años 2007 y 2017, en las bases de datos ebscohost, ScienceDirect, medline, PubMed, cinahl, Web of Science y cuiden®, para lo cual se utilizaron los descriptores y sus combinaciones en español, portugués e inglés Fiebre; Cuidadores; Niño. Se elaboró un compendio de 45 artículos seleccionados y analizados que contenía las prácticas de cuidado con convergencias, divergencias y complementariedades. Los resultados se agruparon en los siguientes cinco temas: Concepción histórica de la fiebre; La fiebrefobia: una concepción en las actuales prácticas de cuidado; El baño de esponja: una práctica ancestral controvertida; El uso de antipiréticos: una rutina en contravía de la salud y la vida de los niños; La fiebre: en busca de una mirada desde su beneficio. Conclusiones: La concepción de la fiebre infantil centrada en el miedo y en el daño permanece. Las acciones de cuidado más comunes, como el baño de esponja y el uso/abuso de antipiréticos, son cuestionadas desde la evidencia científica, demostrando los efectos deletéreos que producen en la salud del niño. El cuidado del niño, después de una evaluación individualizada, deberá enfocarse en el confort, en un ambiente fresco y tranquilo y en el aumento de la ingesta de líquidos para evitar la deshidratación u otras complicaciones.
Palabras clave: Fiebre/ Niño/ Cuidadores/ Enfermería Basada en la Evidencia/ Cuidado del Niño.
 

Resumo
Febre em crianças: um olhar reflexivo sobre as práticas de cuidados

Objetivo: Realizar uma análise crítico-reflexiva das práticas de rotina por profissionais de enfermagem e cuidadores familiares, em cuidados para a criança com febre, que permita promover a busca de cuidados baseados em evidências científicas que garanta o bem-estar das crianças. Síntese do conteúdo: Uma revisão da literatura foi feita a partir de artigos científicos escritos entre 2007 e 2017 em bancos de dados ebscohost, ScienceDirect, medline, PubMed, cinahl, Web of Science e cuiden®. Foram utilizados os descritores Febre; Cuidadores; Criança e suas combinações em espanhol, português e inglês. Foi preparado um compêndio e análise dos 45 artigos selecionados que continha as práticas de cuidado com as convergências, divergências e complementaridades. Os resultados foram agrupados em cinco temas: Concepção histórica da febre; Febrefobia: uma concepção nas atuais práticas de cuidado; O banho de esponja: uma prática ancestral controvertida; O uso de antipiréticos: uma rotina em contramão da saúde e a vida dos meninos; A febre: em procura de uma mirada desde seu benefício. Conclusões: A concepção de febre na criança centrada sobre o medo e os danos, permanece. As ações de cuidados mais comuns tais como banho de esponja e o uso e abuso de antipiréticos são questionados a partir da evidência, mostrando os efeitos deletérios produzidos sobre a saúde das crianças. Cuidar de crianças, após um enfoque individualizado na avaliação, deve procurar conforto, um ambiente fresco e tranquilo, e aumentar a ingestão de líquidos para evitar a desidratação ou outras complicações.
Palavras chave: Febre/ Criança/ Cuidadores/ Enfermagem Baseada em Evidências/ Cuidado da Criança.
 

Abstract
Fever in children: a critical view of caring practices

Objective: To carry out a critical and reflexive analysis of nursing professionals and family caregivers routine practices in feverish child caring, in order to promote the caring based on scientific evidence that assures child well-being. Content synthesis: A literature review of scientific articles published between 2007 and 2017 was conducted in following databases: ebscohost, ScienceDirect, medline, PubMed, cinahl, Web of Science, and cuiden®, for which descriptors, and their combinations in Spanish, Portuguese and English Fever; Caregivers; and Child were used. A compendium of 45 selected and analyzed articles was elaborated containing the caring practices with convergences, divergences and complementarities. Results were pooled into five topics, as follows: Historical conception of fever; Fever phobia: a conception in current caring practices; Sponge bath: a controversial ancestral practice; The use of antipyretics: a routine contrary to the health and children's life; Fever: in pursuit of a benefits perspective. Conclusions: The conception of fever in children by focusing on the fear and the damage still remains. The most common caring actions, such as sponge bath and antipyretics use and abuse, have been questioned from the scientific evidence, showing the deleterious effects that they produce on the children's health. After a case-bycase assessment, child caring should focus on comfort, on a cool and quiet environment, and on increase in fluid intake to avoid dehydration and other complications.
Key-words: Fever/ Child/ Caregivers/ Evidence-Based Nursing/ Child Care.
  

Bibliografía

(1) Argente HA, Álvarez ME. Semiología médica. Fisiopatología, semiotecnia y propedéutica: enseñanza basada en el paciente. 2a ed. Buenos Aires: Médica Panamericana; 2013.
(2) Rojas MW, Anaya JM, Aristizábal B, Cano LE, Gómez LM, Lopera D. Inmunología de Rojas. 16a ed. Medellín: Corporación para Investigaciones Biológicas (cib); 2012.
(3) Ministerio de la Protección Social. Análisis de la situación de salud en Colombia 2002-2007. Tomo 7 [informe en Internet]. Bogotá D.C.: Ministerio de la Protección Social/Universidad de Antioquia, Facultad Nacional de Salud Pública; 2010 [acceso: 03 feb 2013]. Disponible en: https://Publicaciones/ASIS-TomoVII--SituaciondeSaludenColombia2002-2007-Resumen.pdf
(4) Gómez C, Flórez ID, Morales O, Bermúdez M, Aguilar J, López L. Correlación entre la fiebre y la frecuencia respiratoria en menores de 5 años. Rev Chil Pediatr [revista en Internet]. 2013 [acceso: 03 feb 2014];84(4):409-416. Disponible en: DOI: https://dx.doi.org/10.4067/S0370-41062013000400007
(5) National Institute for Health and Care Excellence (nice). Fever in under 5s: assessment and initial management [guideline on the Internet]. London: National Institute for Health and Care Excellence (nice); 2013 [access: 2014 Feb 10]. Available from: https://www.nice.org.uk/guidance/cg160/resources/fever-in-under-5s-assessment-and-initial-management-pdf-35109685049029
(6) Rupe A, Ahlers-Schmidt CR, Wittler R. A comparison of perceptions of fever and fever phobia by ethnicity. Clin Pediatr (Phila) [serial on the Internet]. 2010 [access: 2013 Jun 15];49(2):172-176. Available from: doi: https://dx.doi.org/10.1177/0009922809336208
(7) Kwak YH, Kim DK, Jang HY, Kim JJ, Ryu JM, Oh SB et al. Fever phobia in Korean caregivers and its clinical implications. J Korean Med Sci [serial on the Internet]. 2013 [access: 2014 Mar 20];28(11):1639-1644. Available from: doi: https://dx.doi.org/10.3346/jkms.2013.28.11.1639
(8) Chang MC, Chen YC, Chang SC, Smith GD. Knowledge of using acetaminophen syrup and comprehension of written medication instruction among caregivers with febrile children. J Clin Nurs [serial on the Internet]. 2012 [access: 2014 May 09];21(1-2):42-51. Available from: doi: https://dx.doi.org/10.1111/j.1365-2702.2010.03668.x
(9) Ravanipour M, Akaberian S, Hatami G. Mothers' perceptions of fever in children. J Educ Health Promot [serial on the Internet]. 2014 [access: 2015 Mar 2];3:97. Available from: doi: https://dx.doi.org/10.4103/2277-9531.139679
(10) Kiekkas P, Konstantinou E, Psychogiou KS, Tsampoula I, Stefanopoulos N, Bakalis N. Nursing personnel's attitudes towards fever and antipyre-sis of adult patients: cross-sectional survey. J Clin Nurs [serial on the Internet]. 2014 [access: 2015 Mar 02];23(19-20):2949-2957. Available from: doi: https://dx.doi.org/10.1111/jocn.12551
(11) Purssell E. Fever in children: a concept analysis. J Clin Nurs [serial on the Internet]. 2014 [access: 2015 Mar 02];23(23-24):3575-3582. Available from: doi: https://dx.doi.org/10.1111/jocn.12347
(12) Poirier MP, Collins EP, McGuire E. Fever phobia: a survey of caregivers of children seen in a pediatric emergency department. Clin Pediatr (Phila) [serial on the Internet]. 2010 [access: 2014 Apr 10];49(6):530-534. Available from: doi: https://dx.doi.org/10.1177/0009922809355312
(13) Bertille N, Fournier-Charrière E, Pons G, Chalumeau M. Managing fever in children: a national survey of parents' knowledge and practices in France. PLoS One [serial on the Internet]. 2013 [access: 2014 Apr 10];8(12):e83469. Available from: doi: https://dx.doi.org/10.1371/journal.pone.0083469
(14) Lava SA, Simonetti GD, Ramelli GP, Tschumi S, Bianchetti MG. Symptomatic management of fever by Swiss board-certified pediatricians: results from a cross-sectional, Web-based survey. Clin Ther [serial on the Internet]. 2012 [access: 2013 Jul 05];34(1):250- 256. Available from: doi: https://dx.doi.org/10.1016/j.clinthera.2011.12.002
(15) Pereira GL, Tavares NU, Mengue SS, Pizzol TD. Therapeutic procedures and use of alternating antipyretic drugs for fever management in children. J Pediatr (Rio J) [serial on the Internet]. 2013 [access: 2014 May 14];89(1):25-32. Available from: doi: https://dx.doi.org/10.1016/j.jped.2013.02.005
(16) Maguire S, Ranmal R, Komulainen S, Pearse S, Maconochie I, Lakhanpaul M et al. Which urgent care services do febrile children use and why? Arch Dis Child [serial on the Internet]. 2011 [access: 2013 Aug 18];96(9):810-816 Available from: doi: https://dx.doi.org/10.1136/adc.2010.210096
(17) Thompson HJ, Kagan SH. Clinical management of fever by nurses: doing what works. J Adv Nurs [serial on the Internet]. 2011 [access: 2014 May 04];67(2):359-370. Available from: doi: https://dx.doi.org/10.1111/j.1365-2648.2010.05506.x
(18) Cannon JG. Perspective on fever: the basic science and conventional medicine. Complement Ther Med [serial on the Internet]. 2013 [access: 2014 Mar 10];21(Suppl 1):54-60. Available from: doi: https://dx.doi.org/10.1016/j.ctim.2011.08.002
(19) Young PJ, Saxena MK, Beasley RW. Fever and antipyresis in infection. Med J Aust [serial on the Internet]. 2011 [access: 2014 Mar 10];195(8):458-459. Available from: doi: https://dx.doi.org/10.5694/mja11.10502
(20) Álpizar LB, Medina EE. Fisiopatología de la fiebre. Rev Cubana Med Milit [revista en Internet]. 1999 [acceso: 05 jun 2013];28(1);49-54. Disponible en: https://bvs.sld.cu/revistas/mil/vol28_1_99/mil08199.pdf
(21) Hipócrates. Tratados hipocráticos I. Madrid: Gredos; 1983.
(22) Hench PS, Slocumb SH, Popp WC. Fever therapy: results for gonorrheal arthritis, chronic infectious (atrophic) arthritis, and other forms of "rheumatism". J Am Med Assoc [serial on the Internet]. 1935 [access: 2013 May 03];104(20):1779-1790. Available from: doi: https://dx.doi.org/10.1001/jama.1935.02760200001001
(23) Durán MM. La renovación del conocimiento y la práctica [Editorial]. Aquichán [revista en Internet]. 2014 [acceso: 10 ago 2015];14(1):5-6. Disponible en: https://aquichan.unisabana.edu.co/index.php/aquichan/article/view/3930/3381
(24) Schmitt BD. Fever phobia: misconceptions of parents about fevers. Am J Dis Child [serial on the Internet]. 1980 [access: 2013 Feb 8];134(2):176-181. Available from: doi: https://dx.doi.org10.1001/archpedi.1980.02130140050015
(25) Gunduz S, Usak E, Koksal T, Canbal M. Why fever phobia is still common? Iran Red Crescent Med J [serial on the Internet]. 2016 [access: 2017 Jul 05];18(8):e23827. Available from: doi: https://dx.doi.org/10.5812/ircmj.23827
(26) Enarson MC, Ali S, Vandermeer B, Wright RB, Klassen TP, Spiers JA. Beliefs and expectations of Canadian parents who bring febrile children for medical care. Pediatrics [serial on the Internet]. 2012 [access: 2014 Mar 16];130(4):e905-e912. Available from: doi: https://dx.doi.org/10.1542/peds.2011-2140
(27) Patricia C. Evidence-based management of childhood fever: what pediatric nurses need to know. J Pediatr Nurs [serial on the Internet]. 2014 [access: 2015 Nov 16];29(4):372-375. Available from: doi: https://dx.doi. org/10.1016/j.pedn.2014.02.007
(28) Chiappini E, Parretti A, Becherucci P, Pierattelli M, Bonsignori F, Galli L et al. Parental and medical knowledge and management of fever in Italian preschool children. BMC Pediatr [serial on the Internet]. 2012 [access: 2013 Oct 15];12:97. Available from: doi: https://dx.doi.org/10.1186/1471-2431-12-97
(29) Saettini F, Bettinelli A. Fever phobia among Italian caregivers: a survey in a pediatric emergency department. Minerva Pediatr [serial on the Internet]. 2014 [access: 2015 May 13];66(4):261-266. Available from: doi: https://dx.doi.org/10.1177/0009922809355312
(30) Sakai R, Okumura A, Marui E, Niijima S, Shimizu T. Does fever phobia cross borders? The case of Japan. Pediatr Int [serial on the Internet]. 2012 [access: 2014 May 08];54(1):39-44. Available from: doi: https://dx.doi.org/10.1111/j.1442-200X.2011.03449.x
(31) Purssell E, Collin J. Fever phobia: the impact of time and mortality: a systematic review and meta- analysis. Int J Nurs Stud [serial on the Internet]. 2016 [access: 2017 Jan 05];56:81-89. Available from: doi: https://dx.doi.org/10.1016/j.ijnurstu.2015.11.001
(32) Polat M, Kara SS, Tezer H, Tapýsýz A, Derinöz O, Dolgun A. A current analysis of caregivers' approaches to fever and antipyretic usage. J Infect Dev Ctries [serial on the Internet]. 2014 [access: 2017 Jan 05];8(3):365-371. Available from: doi: https://dx.doi.org/10.3855/jidc.3904
(33) Monsma J, Richerson J, Sloand E. Empowering parents for evidence-based fever management: an integrative review. J Am Assoc Nurse Pract [serial on the Internet]. 2015 [access: 2016 May 05];27(4):222-229. Available from: doi: https://dx.doi.org/10.1002/2327-6924.12152
(34) Fieldston ES, Nadel FM, Alpern ER, Fiks AG, Shea JA, Alessandrini EA. Effects of an education and training intervention on caregiver knowledge of nonurgent pediatric complaints and on child health services utilization. Pediatr Emerg Care [serial on the Internet]. 2013 [access: 2014 Jun 03];29(3):331-336. Available from: doi: https://dx.doi.org/10.1097/PEC.0b013e31828512c7
(35) Elkon-Tamir E, Rimon A, Scolnik D, Glatstein M. Fever phobia as a reason for pediatric emergency department visits: does the primary care physician make a difference? Rambam Maimonides Med J [serial on the Internet]. 2017 [access: 2017 Jul 06];8(1):1-6. Available from: doi: https://dx.doi.org/10.5041/RMMJ.10282
(36) Wallenstein MB, Schroeder AR, Hole MK, Ryan C, Fijalkowski N, Alvarez E et al. Fever literacy and fever phobia. Clin Pediatr (Phila) [serial on the Internet]. 2013 [access: 2014 May 20];52(3):254-259. Available from: doi: https://dx.doi.org/10.1177/0009922812472252
(37) Banks T, Paul SP, Wall M. Managing fever in children with a single antipyretic. Nurs Times [serial on the Internet]. 2013 [access: 2013 Jul 04];109(7):24-25. Available from: https://www.nursingtimes.net/Journals/2013/02/15/r/c/h/190213-Managing-fever-in-childrenwith-a-single-antipyretic.pdf
(38) Kiekkas P. Fever treatment in critical care: when available evidence does not support traditional practice. Nurs Crit Care [serial on the Internet]. 2012 [access: 2014 May 09];17(1):7-8. Available from: doi: https://dx.doi.org/10.1111/j.1478-5153.2011.00483.x
(39) Alqudah M, Johnson M, Cowin L, George A. An innovative fever management education program for parents, caregivers, and emergency nurses. Adv Emerg Nurs J [serial on the Internet]. 2014 [access: 2014 Oct 13];36(1):52-61. Available from: doi: https://dx.doi.org/10.1097/TME.0000000000000004
(40) Cinar ND, Altun Ý, Altýnkaynak S, Walsh A. Turkish parents' management of childhood fever: a cross-sectional survey using the pfms-tr. Australas Emerg Nurs J [serial on the Internet]. 2014 [access: 2015 Feb 20];17(1):3-10. Available from: doi: https://dx.doi.org/10.1016/j.aenj.2013.10.002
(41) Greensmith L. Nurses' knowledge of and attitudes towards fever and fever management in one Irish children's hospital. J Child Heal Care [serial on the Internet]. 2013 [access: 2014 Feb 20];17(3):305-316. Available from: doi: https://dx.doi.org/10.1177/1367493512461457
(42) Kelly M, Sahm LJ, Shiely F, O'Sullivan R, McGillicuddy A, McCarthy S. Parental knowledge, attitudes and beliefs regarding fever in children: an interview study. bmc Public Health [serial on the Internet]. 2016 [access: 2017 Jul 07];16:540-546. Available from: doi: https://doi.org/10.1186/s12889-016-3224-5
(43) Carey JV. Literature review: should antipyretic therapies routinely be administered to patients with [corrected] fever? J Clin Nurs [serial on the Internet]. 2010 [access: 2014 May 04];19(17-18):2377-2393. Available from: doi: https://doi.org/10.1111/j.1365-2702.2010.03258.x
(44) Rueda FA, Cáceres P. Estado actual del manejo de la fiebre en niños. Medunab [revista en Internet]. 2010 [acceso: 03 mar 2013];13(3):146-158. Disponible en: https://132.248.9.34/hevila/Medunab/2010/vol13/no3/4.pdf
(45) Kamel MC. Tratamiento de la fiebre en la infancia. Informed [revista en Internet]. 2012 [acceso: 07 jun 2013];14(7):327-331. Disponible en: https://saber.ucv.ve/ojs/index.php/rev_im/article/view/6209/5983
(46) Shivbalan S, Sathiyasekeran M, Thomas K. Therapeutic misadventure with paracetamol in children. Indian J Pharmacol [serial on the Internet]. 2010 [access: 2013 Feb 08];42(6):412-415. Available from: doi: https://doi.org/10.4103/0253-7613.71894
(47) de Bont EG, Brand PL, Dinant GJ, van Well GT, Cals J. Risks and benefits of paracetamol in children with fever. Ned Tijdschr Geneeskd [serial on the Internet]. 2014 [access: 2015 Jul 20];158(2):A6636. Available from: https://europepmc.org/abstract/med/24405896
(48) Demir F, Sekreter O. Knowledge, attitudes and misconceptions of primary care physicians regarding fever in children: a cross sectional study. Ital J Pediatr [serial on the Internet]. 2012 [access: 2013 Ago 16];38:40- 47. Available from: doi: https://doi.org/10.1186/1824-7288-38-40
(49) Sahm LJ, Kelly M, McCarthy S, O'Sullivan R, Shiely F, Rømsing J. Knowledge, attitudes and beliefs of parents regarding fever in children: a Danish interview study. Acta Paediatr [serial on the Internet]. 2016 [access: 2017 Feb 15];105(1):69-73. Available from: doi: https://doi.org/10.1111/apa.13152
(50) Davies A. Fever in children. Nurs Stand [serial on the Internet]. 2014 [access: 2016 Feb 15];29(1):61. Available from: doi: https://doi.org/10.7748/ns.29.1.61.s51
(51) Purssell E. Antipyretic use in children : more than just temperature. J Pediatr (Rio J) [serial on the Internet]. 2013 [access: 2015 Feb 08];89(1):1-3. Available from: doi: https://doi.org/10.1016/j.jped.2013.02.001
(52) Lubrano R, Paoli S, Bonci M, Di Ruzza L, Cecchetti C, Falsaperla R et al. Acetaminophen administration in pediatric age: an observational prospective cross-sectional study. Ital J Pediatr [serial on the Internet]. 2016 [access: 2017 Feb 15];42(1):20-25. Available from: doi: https://doi.org/10.1186/s13052-016-0219-x
(53) Rajanayagam J, Bishop JR, Lewindon PJ, Evans HM. Paracetamol-associated acute liver failure in Australian and New Zealand children: high rate of medication errors. Arch Dis Child [serial on the Internet]. 2015 [access: 2016 May 20];100(1):77-80. Available from: doi: https://doi.org/10.1136/archdischild-2013-304902
(54) Teagle AR, Powell CV. Is fever phobia driving inappropriate use of antipyretics? Arch Dis Child [serial on the Internet]. 2014 [access: 2015 May 20];99(7):701- 702. Available from: doi: https://doi.org/10.1136/archdischild-2013-305853
(55) Blieden M, Paramore LC, Shah D, Ben-Joseph R. A perspective on the epidemiology of acetaminophen exposure and toxicity in the United States. Expert Rev Clin Pharmacol [serial on the Internet]. 2014 [access: 2015 May 20];7(3):341-348. Available from: doi: https://doi.org/10.1586/17512433.2014.904744
(56) Mund ME, Quarcoo D, Gyo C, Brüggmann D, Groneberg DA. Paracetamol as a toxic substance for children: aspects of legislation in selected countries. J Occup Med Toxicol [serial on the Internet]. 2015 [access: 2016 Mar 18];10:43-49. Available from: doi: https://doi.org/10.1186/s12995-015-0084-3
(57) Muthukrishnan L, Raman R. Analysis of acetaminophen toxicity in children in a tertiary care setting. Indian J Trauma Emerg Pediatr [serial on the Internet]. 2013 [access: 2016 Mar 18];5(1):5-8. Available from: https://www.rfppl.co.in/subscription/upload_pdf/Article%201_1234.pdf
(58) Rosenbloom E, Finkelstein Y, Adams-Webber T, Kozer E. Do antipyretics prevent the recurrence of febrile seizures in children? A systematic review of randomized controlled trials and meta-analysis. Eur J Paediatr Neurol [serial on the Internet]. 2013 [access: 2014 Oct 10];17(6):585-588. Available from: doi: https://doi.org/10.1016/j.ejpn.2013.04.008
(59) Sherman JM, Sood SK. Current challenges in the diagnosis and management of fever. Curr Opin Pediatr [serial on the Internet]. 2012 [access: 2013 Nov10]; 24(3):400-406. Available from: doi: https://doi.org/10.1097/MOP.0b013e32835333e3
(60) Sullivan JE, Farrar HC. Section on Clinical Pharmacology and Therapeutics, Committee on Drugs. Fever and antipyretic use in children. Pediatrics [serial on the Internet]. 2011 [access: 2014 May 09];127(3):580-587. Available from: doi: https://doi.org/10.1542/peds.2010-3852
(61) Gardner J. Is fever after infection part of the illness or the cure? Emerg Nurse [serial on the Internet]. 2012 [access: 2013 Nov 15];19(10):20-25. Available from: doi: https://doi.org/10.7748/en2012.03.19.10.20.c8992
(62) El-Radhi SM. Fever management: evidence vs current practice. World J Clin Pediatr [serial on the Internet]. 2012 [access: 2013 Oct 19];1(4):29-33. Available from: doi: https://doi.org/10.5409/wjcp.v1.i4.29
(63) McDougall P, Harrison M. Fever and feverish illness in children under five years. Nurs Stand [serial on the Internet]. 2014 [access: 2015 Mar 10];28(30):49- 59. Available from: doi: https://doi.org/10.7748/ns2014.03.28.30.49.e8410
(64) Evans SS, Repasky EA, Fisher DT. Fever and the thermal regulation of immunity: the immune system feels the heat. Nat Rev Immunol [serial on the Internet]. 2015 [access: 2016 Feb 10];15(6):335-349. Available from: doi: https://doi.org/10.1038/nri3843
(65) Reed P, Crawford NB. Nursing knowledge and theory innovation: advancing the science of practice. New York: Springer Publishing Company; 2011.
(66) Moreno-Ferguson ME. Evidencia científica y autonomía [Editorial]. Aquichan [revista en Internet]. 2014 [acceso: 13 may 2014];14(2):136-137. Disponible en: https://aquichan.unisabana.edu.co/index.php/aquichan/article/view/4365/3475
(67) Pineda-Perdomo R. Teoría, práctica e investigación en enfermería: Marie-Luise Friedmann en conversación con Rafael Pineda Perdomo. Invest Educ Enferm [revista en Internet]. 2010 [acceso: 13 jun 2013];28(2):282- 285. Disponible en: https://www.scielo.org.co/pdf/iee/v28n2/v28n2a16.pdf