A febrile seizure sometimes called a fever fit or febrile convulsion, is a type of seizure accompanied by a high body temperature but no major underlying medical condition. They most frequently affect kids between the ages of 6 months and five years. Most convulsions last less than five minutes, and after the incident, the youngster is fully normal within an hour. Simple febrile seizures and complicated febrile convulsions are the two forms. A child with simple febrile convulsions has at most one tonic-clonic seizure lasting less than 15 minutes in 24 hours and is otherwise healthy. Complex febrile convulsions are febrile seizures that last longer than 15 minutes, including specific symptoms, or happen more than once in 24 hours. 80% of convulsions are considered to be simple febrile convulsions [1].

Whether or not the febrile seizure is simple versus complex affects the signs and symptoms. The child’s temperature is typically higher than 38 \({}^{\circ}C\) (100.4 \({}^{\circ}F\)), while most have fevers of at least 39\({}^{\circ}C\) (102.2\({}^{\circ}F\)). The first 24 hours after acquiring a fever are when most febrile seizures will occur. The infant may appear pale or blue (cyanotic), lose consciousness, open eyes that may be deviated or look in one direction, have erratic breathing, produce more secretions than usual, or foam at the mouth. They might vomit as well as become incontinent (wet or urinate on themselves). Children who suffer focal or lateralized FS, prolonged (especially lasting more than an hour), partial-onset, or recurrent seizures within 24 hours are more dangerous [2].

Although febrile seizures are common among all races, they are more common among Asian people (5-10% of Indian children, 6-9% of Japanese children, and up to 14% of Guamese children). In youngsters, the disorder is more prevalent. They have a lower socioeconomic status, probably due to limited access to health care. Researchers have seen variations in the frequency of febrile seizures by season and day in Finland, Japan, and the United States. In general, febrile seizures are more common in the winter and in the afternoon [3].

The Royal College of Physicians describes Ambulatory emergency care as "clinical care that can be provided across the primary/secondary care interface four and may include diagnosis, observation, treatment, and rehabilitation, not provided within the traditional hospital bed base or the traditional outpatient services [4].

When caring for children, pediatric nurses frequently experience febrile convulsions. In addition, pediatric nurses provide mothers with information on caring for their children’s health to lessen the frequency of febrile convulsions and learn to cope with symptoms. They organize educational events, distribute flyers, carry out health checks, and administer medication. The objectives of pediatric nursing are to protect, promote, and maintain the health of children experiencing febrile convulsions. Promoting a healthy lifestyle, preventing health issues, providing direct care spiritual care, educating mothers about managing chronic diseases like febrile convulsions, making healthy decisions, and conducting research to advance healthcare are all fundamental aspects that pediatric nursing incorporates [1].

In Iraq , 77% of infants and children under the age of five report having febrile convulsions; roughly 5% of feverish illnesses might lead to febrile convulsions. The ambulatory nurse should watch the seizure to see how it behaves and how long it lasts. As respiratory distress and cyanosis can happen at this time, it is crucial to keep an eye on your breathing and airways. Equipment for oxygen, suctioning, and CPR should be available throughout this time. If IV access is already available, diazepam can be given rectally or intravenously to halt the seizure, depending on the local hospital’s protocols [5].

This study aim to assess ambulatory nursing care for young children suffering from febrile convulsions through:

1. determine ambulatory nurse’s knowledge about febrile convulsions
2. determine ambulatory nurses practice to deal with attack of febrile convulsion.

1. Is there relation between demographic characteristics and ambulatory nurse’s knowledge about febrile convulsions?
2. Is there relation between demographic characteristics and ambulatory nurses reported practice about how to deal with attack of febrile convulsions?

Technical design

The technical design includes research design, setting, subject and tools for data collection.

Research design

A descriptive study design will be used to conduct the study

Setting

The study will be conducted in all outpatient clinics at central children’s hospital , Al-zahrawi ( Ibn Al-Baladi.) Teaching hospital and Welfare children teaching hospital

Sampling

Convenience sample for all ambulatory nurses they were 100 nurses (47 nurses in central children’s hospital , 21 nurses in Al-zahrawi ( Ibn Al-Baladi.) Teaching hospital and 32 nurses in Welfare children teaching hospital

Tools of data Collection

Two tools of data collection were used to carry out the current study namely, A Structural interviewing questionnaire and observation check list.

Tool I:

A Structural interviewing questionnaire: This tool was developed by investigator after reviewing the national and international related literature. It will consist of two parts:

First part:

Nurses demographic characteristics such as : age, level of education, and years of experience and training programs about febrile convulsions.

Second part:

Ambulatory nurse knowledge about febrile convulsions about meaning of febrile convulsions, factors that help the occurrence of febrile convulsions, symptoms appear on the child, relationship between the elevated child’s temperature and the occurrence of febrile convulsions, child’s temperature rise or not before convulsions or opposite, febrile convulsions have an effect on the brain and affect the degree of perception, relationship between febrile convulsions and epilepsy, how to manage in case of convulsions of the child, steps of the child’s ambulance and during the febrile convulsions put in consideration.

Scoring system:

For knowledge items it included 10 questions; a correct answer was scored (two points), while incorrect answer was scored (one point) and I don’t know was given (Zero), according to ambulatory nurses answers.

The total score of knowledge =20 score which be divided as the following:

• satisfactory knowledge \(\leq\) 50% (\(\leq\) 10 scores),
• unsatisfactory knowledge >50 %( \(\geq\) 10 scores).

Tool II:

observation check list assess of ambulatory nurse practice . The scale is constituted of 3 procedures such as Nurses practice the right way to measure body temperature, such as washing hands, Preparation the equipment (mercurial thermometer - piece gauze), explaining the procedure to the patient, maintaining the patient’s privacy, cleaning the thermometer from the top of the bowl with alcohol, hold the thermometer by controlling thumb and index finger and move it vigorously until the mercury line reaches 35\({}^{\circ}C\), hold the thermometer and place it at the level of view to be readable.

Nurses practice the right way to make tap compresses, including reviewing the doctor’s order with the patient’s papers, explaining the procedure to the patient, washing hands, preparing the tools, dipping the compresses into a basin filled with tap water, putting a towel over the tarpaulin and place them under the part to be worked as compresses, squeeze the compresses well and then put on the affected part, record the time when the compresses are placed, the compresses are changed every 12 minutes and the compresses should not exceed 30 minutes, Nurse practice about the right way to give oxygen therapy includes washing hands, preparing the instruments (oxygen source, wall or cylinder tubes, oxygen flow meter, humidification device, patient connections, o2 mask or nasal cannula, medical jelly, patient Preparation: Know the patient why oxygen is given - how it will help - how it will be given and how to help it during giving, place the warning sign in a prominent place, put the patient in the sitting position or half sitting, check the integrity of the oxygen cylinder in the absence of central oxygen, open the oxygen.

Scoring system

Each statement was assigned a score according to ambulatory nurse responses were "Done", "Not done", "Don’t know" and were scored 3, 2 and 1 respectively.

The scores of the items were summed up and were converted into a percentage score It was Classified into 3 categories:

• done practice < 25 %(< 24 score),
• not done practice 25- 50 %( 24:48 score),
• don’t know practice < 25 %(< 24 score).

Validity

The revision of the tools for clarity, relevance, comprehensiveness, understanding and applicability was done by a panel of five experts from pediatric nursing specialty Dhi Qar university of Nasiriyah to measure the content validity of the tools and the necessary modification will be done accordingly through add some question to assess the ambulatory care nurses knowledge and practice about febrile convulsions.

Tools reliability

To assess reliability, the study tools were tested by using calculating Cranach’s Alpha which was 0.89 for knowledge and 0.76 for practice.

Ethical consideration

An official permission to conduct the proposed study was be obtained from the Scientific Research Ethics Committee. Participation in the study is voluntary and subjects was be given complete full information about the study and their role before signing the informed consent. The ethical considerations were including explaining the purpose and nature of the study, stating the possibility to withdraw at any time, confidentiality of the information were been guaranteed. Ethics, values, culture and beliefs were be respected.

Pilot study

Pilot study has been conducted to test the clarity, applicability and understandability of the tool. It has been conducted on 10% (10) of nurses. They have been selected from settings similar to those chosen for the study. The results of the pilot helped in refining the interview questionnaire and to schedule the time framework. The participants of the pilot were included in the main study sample.

Statistical items

The collected data were categorized, tabulated, analyzed and statistically analyzed using the SPSS software (statistical package for social sciences) for quantitative data, the range, mean and standard deviation. For qualitative data which describe categorical set of date by frequency and percentage or proportion of each category. Pearson’s, spearman and Kendall’s correlation coefficient (R) was applied between variables. A significant level value was considered when p.<0.001.

Figure 1 illustrated that 65% of nurses satisfactory knowledge, 35% of them unsatisfactory knowledge regarding febrile convulsions.

Figure 2 illustrated that 70% of nurses done practice, and 25.0% of them not done practice and 5% of them don’t know regarding measurement child body temperature under axillary.

Figure 3 illustrated that 65% of nurses done practice, and 20.0% of them not done practice and 15% of them don’t know regarding the right way to make tap compresses.

Figure 4 illustrated that, 70.0% of nurses done practice , and 20.0% of them not done practice and 10% of them do not know regarding the right way to give oxygen therapy.

It was observed from this Table 2 that there was statistical significant relation between, age, level of education, years of experience and training program about febrile convulsions p= 0.001*, and Total knowledge about febrile convulsions

Table 3 illustrated that, there was positive relation between nurses total knowledge and total practice regarding right way to measure body temperature, measurement young children temperature under axillary and right way to give oxygen therapy with statistical significance difference between nurses knowledge and practice regarding febrile convulsions \((p<0.001)\).

A febrile seizure occurs due to a sudden increase in body temperature, defined as a fever exceeding \(38^{\circ}C (100.4^{\circ}F)\), without any underlying conditions or illnesses that could induce seizures, such as infections of the central nervous system (CNS), electrolyte imbalances, drug withdrawal, trauma, genetic predisposition, or known epilepsy. There are two types of febrile seizures: simple and complex. It is crucial to differentiate between mild and complex febrile seizures because each necessitates specific treatment and evaluation [6].

Regarding the demographic characteristics of ambulatory nurses, the current study revealed that more than half of the nurses studied were between 21 and 23 years old, with a mean age of \(22.42\pm9.04\). The majority of them hold a diploma, while more than two-thirds have 3 to 5 years of experience. Additionally, the majority do not participate in training programs related to febrile convulsions. This finding aligns with [7], which examined "Do All Children Who Present With a Complex Febrile Seizure Need a Lumbar Puncture?" and found that 52.0% of the nurses were between 21 and 23 years old, with a mean age of \(22.99\pm8.24\). Furthermore, 83.0% of them hold a diploma, and 70.50% have 3 to 6 years of experience. Moreover, 90.0% of them do not engage in training programs on febrile convulsions.

Concerning the knowledge of ambulatory nurses about febrile convulsions, the current study indicated that more than two-thirds of them possess accurate knowledge regarding the definition of febrile convulsions, the contributing factors, the symptoms in a child, and the correlation between the child’s elevated temperature and convulsions. This finding coincides with [2], which studied "Risk Factors, Recurrence, Treatment, and Prognosis" and found that 55.0% of nurses had accurate knowledge about the meaning of febrile convulsions, contributing factors, symptoms in children, and the correlation between a child’s elevated temperature and convulsions. From the researcher’s perspective, the nurses’ knowledge appeared to be satisfactory due to their extensive experience in dealing with children during febrile convulsions.

The current study also revealed that more than half of the nurses have incorrect knowledge regarding whether a child’s temperature rises before convulsions, the impact of febrile convulsions on the brain and perception, the association between febrile convulsions and epilepsy, how to manage convulsions in a child, the necessary steps during a child’s ambulance transport, and the considerations during febrile convulsions. This result is consistent with [8], the study "Clinical Update: Assessment and Management of Febrile Children," which found that 55.0% of nurses had incorrect knowledge regarding these aspects. From the researcher’s viewpoint, most nurses would benefit from attending workshops and training courses to enhance their understanding of febrile convulsions.

In the context of ambulatory nurses’ knowledge about febrile convulsions, the current study revealed that more than two-thirds of them possessed accurate knowledge concerning the meaning of febrile convulsions, the contributing factors, the symptoms in a child, and the correlation between elevated body temperature and these convulsions. This finding aligns with [2], who studied "Risk Factors, Recurrence, Treatment, and Prognosis," revealing that 55.0% of nurses had correct knowledge in these areas. From the investigator’s perspective, the nurses exhibited good knowledge, likely due to their extensive experience in caring for children during febrile convulsions.

However, more than half of the nurses demonstrated incorrect knowledge regarding whether a child’s temperature rises before convulsions or vice versa, the impact of febrile convulsions on the brain and perception, the relationship between these convulsions and epilepsy, appropriate management during convulsions, and proper ambulance procedures for the child. This finding aligns with [8], in their study "Clinical Update: Assessment and Management of Febrile Children," indicating that 55.0% of nurses had inadequate knowledge in these aspects. In the investigator’s view, most nurses would benefit from workshops and training courses to enhance their understanding of febrile convulsions.

Concerning the nurses’ overall knowledge and practice regarding febrile convulsions, the study revealed that more than two-thirds of them had satisfactory knowledge, while one-third had unsatisfactory knowledge. This result corresponds to [9], who explored "Parents of Children with Febrile Convulsions: Multidisciplinary Quality Development of Information and Documentation," indicating that 65% of nurses had satisfactory knowledge, while 35% had unsatisfactory knowledge about febrile convulsions.

Regarding the nurses’ practices in measuring body temperature under the axilla, the study revealed that most nurses adhered to washing hands before the procedure, waiting three minutes with the thermometer in the armpit, and recording the temperature. However, over two-thirds of the nurses did not explain the procedure to the patient, and less than two-thirds did not wash their hands after the procedure. Additionally, a minority lacked awareness of patient confidentiality protocols. This outcome resonates with [10], indicating that while 70.0% of nurses washed hands before the procedure and waited three minutes for temperature readings, 65.0% did not explain the procedure to the patient, and 60.0% did not wash hands afterward. From the investigator’s perspective, many nurses would benefit from workshops to improve their axillary temperature measuring practices.

Regarding the measurement of young children’s body temperature under the axilla, the study revealed that more than two-thirds of nurses had practiced this technique, while a quarter had not and a minority was unfamiliar with it. This finding aligns with [11], who explored "Complex Febrile Seizures, Lumbar Puncture, and Central Nervous System Infections," indicating that 70% practiced this measurement, 25.0% did not, and 5% were unaware of the process.

Concerning the nurses’ practices in applying tap compresses correctly, the majority had experience submerging the compresses in water, applying them after squeezing, and reviewing patient paperwork and doctor’s orders. However, over two-thirds did not explain the procedure to the patient or note indicators of poor circulation, while a quarter did not change the compresses regularly. This result aligns with [10], indicating that 80.0% to 75.0% of nurses correctly submerged the compresses, applied them after squeezing, and reviewed paperwork. However, 70.0% did not explain the procedure, and 15.0% were unaware of certain steps. From the investigator’s perspective, workshops are necessary to improve nurses’ practices in applying tap compresses correctly.

In terms of administering oxygen therapy correctly, most nurses were proficient in turning on oxygen, checking cylinder integrity, adjusting masks, and applying lubricant on the catheter. However, more than two-thirds did not inform the patient about oxygen benefits or adjust the oxygen flow appropriately, while a quarter did not visualize the catheter tip. This finding corresponds to [12], indicating that while 80.0% to 75.0% of nurses correctly performed several steps, 70.0% did not inform the patient, and 20.0% did not visualize the catheter tip. From the investigator’s perspective, workshops could enhance nurses’ proficiency in administering oxygen therapy correctly.

Concerning the correlation between nurses’ total knowledge and demographic characteristics, a statistically significant relation was found between age, level of education, years of experience, training programs about febrile convulsions, and overall knowledge about febrile convulsions. This finding corresponds to [13], indicating a statistically significant relation between these factors and total knowledge about febrile convulsions.

Regarding the correlation between total knowledge and total practice, the study found a positive relation between nurses’ total knowledge and their practices in measuring body temperature, measuring young children’s temperature under the axilla, and administering oxygen therapy. These findings align with [13], demonstrating a positive correlation between nurses’ total knowledge and practices in these areas. From the investigator’s perspective, an increase in nurses’ knowledge translates into an improvement in their practical skills.

Based on the present study and research question, it can be concluded that more than two-thirds of nurses have satisfactory knowledge, while one-third of them exhibit unsatisfactory knowledge regarding febrile convulsions. Additionally, more than two-thirds of nurses have practiced, while one quarter of them have not, and a minority are unsure about measuring a child’s body temperature under the axilla. Moreover, more than two-thirds of nurses have practiced the right way to make tap compresses, while one-fourth have not, and another quarter are uncertain about this procedure. Similarly, more than two-thirds of nurses have practiced the proper method for administering oxygen therapy, while one-fourth have not, and a minority are unaware of the correct approach. The study also reflects a highly statistically significant relationship between the total knowledge score and the total practice score for nurses (\(p \leq 0.01\)).

Based on the findings of the present study, the following recommendations are suggested:

1. continuous health education and training programs for the nurses about febrile convulsions,
2. disseminating health educations booklets to increase the nurses knowledge and practice about febrile convulsions,
3. future studies needed to be conducted with different variables, subjects, and different settings to provide strong evidence about preventive and control of febrile convulsions.

The authors declare no conflicts of interest.

All authors contributed equally to this paper. They have all read and approved the final version.

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