A survey of the oral care practices of intensive care nurses

Oral care of intubated patients, challenging task of ICU nurses: a survey of knowledge, attitudes and practices

INTRODUCTION

Patients' health outcomes can be positively affected by the oral care provided by intensive care unit (ICU) nurses. Providing effective oral care for intubated patients is a challenging task. The purpose of this study was to examine the knowledge, attitudes, and practices(KAP) of oral care among ICU nurses for intubated patients, as well as the underlying factors that influence these behaviors.

METHOD

This cross-sectional survey was conducted on 200 nurses from adult ICUs in referral hospitals located in the central eighth area of healthcare management in Iran. The timeframe for data collection was April to June in 2023. Data were collected by questionnaires which consisted of four sections: demographic information, knowledge, attitudes and practices of oral care for intubated patients. The Pearson Correlation Coefficient was employed to determine the correlation between KAP and its main variables, which were distributed normally.

RESULTS

The result showed that nurses were 32.19 ± 6.23 years old, with an average total work experience of 8.91 ± 5.54 years and an average ICU work experience of 5.89 ± 4.31 years. The mean KAP score were17.66 ± 3.04, 15.46 ± 4.23, and 7.57 ± 2.21, respectively. The knowledge of nurses was significantly impacted by their level of education (p = 0.04), and an increase in work experience each year was associated with improved attitudes among nurses (p = 0.04). A significant association was found between the nurses' oral care practice, knowledge (p = 0.03), and attitude (p = 0.04).

CONCLUSION

This study revealed that ICU nurses possess a moderate level of knowledge, a higher-than-average level of practice, and they have a favorable attitude towards giving oral care to intubated patients. Therefore, providing continuous education about oral care is essential for ICU nurses.

Impaired oral health: a required companion of bacterial aspiration pneumonia

Laryngotracheal aspiration has a widely-held reputation as a primary cause of lower respiratory infections, such as pneumonia, and is a major concern of care providers of the seriously ill orelderly frail patient. Laryngeal mechanical inefficiency resulting in aspiration into the lower respiratory tract, by itself, is not the cause of pneumonia. It is but one of several factors that must be present simultaneously for pneumonia to develop. Aspiration of oral and gastric contentsoccurs often in healthy people of all ages and without significant pulmonary consequences. Inthe seriously ill or elderly frail patient, higher concentrations of pathogens in the contents of theaspirate are the primary catalyst for pulmonary infection development if in an immunocompromised lower respiratory system. The oral cavity is a complex and ever changing eco-environment striving to maintain homogeneity among the numerous microbial communities inhabiting its surfaces. Poor maintenance of these surfaces to prevent infection can result inpathogenic changes to these microbial communities and, with subsequent proliferation, can altermicrobial communities in the tracheal and bronchial passages. Higher bacterial pathogen concentrations mixing with oral secretions, or with foods, when aspirated into an immunecompromised lower respiratory complex, may result in bacterial aspiration pneumonia development, or other respiratory or systemic diseases. A large volume of clinical evidence makes it clear that oral cleaning regimens, when used in caring for ill or frail patients in hospitals and long-term care facilities, drastically reduce the incidence of respiratory infection and death. The purpose of this narrative review is to examine oral health as a required causative companionin bacterial aspiration pneumonia development, and the effectiveness of oral infection control inthe prevention of this disease.

Assessment of Knowledge, Attitude, and Practice (KAP) Among Nurses on Oral Care for Intensive Care Unit Patients in Riyadh, Saudi Arabia: A Cross-Sectional Study

BACKGROUND

Oral care of intensive care unit (ICU) bound individuals is essential for overall health outcomes and to prevent complications. Nurses, who are the primary caregivers, should possess adequate knowledge, attitude, and practice (KAP) in this regard to provide optimal care to these patients. There are no standardized guidelines existing at present in this regard, making the practice of oral care more challenging. There is a diversified representation of nurses who practice in this region of the world and have not been analyzed in the past. This study would like to address this paucity of data. Hence, the aim of the present study was to evaluate the knowledge, attitude, and practice of nurses regarding oral health care in ICU patients along with analyzing any existing hospital-based policies related to oral care.

MATERIALS AND METHODS

A cross-sectional study was conducted among 230 nurses practicing at ICU of the National Guard Health Affairs (NGHAs) Hospital, King Abdulaziz Medical City, in Riyadh City, Saudi Arabia. Nurses responded to 22 closed-ended questionnaires, which were adopted after content validation and reliability assessment. Descriptive statistics, chi-square analysis, and multinomial logistic regression were carried out using the Statistical Package for the Social Sciences (SPSS, Version 20, 2011; IBM Corp., Armonk, USA).

RESULTS

A total of 230 (51.1%) nurses responded. The mean working experience of 12.6 (±7.5) years and ICU experience of 10.6 (±6.7) years were observed. Seventy-four (32.2%) nurses mentioned they received oral care training for ICU patients as part of their degree. A significant variation (p=0.03) in response was observed based on qualification concerning the knowledge of nurses if improper oral care among ICU patients could cause systemic complications. Nurses with less than five years' experience were more likely to provide oral care only once per day compared to nurses with higher experience (>10 years) (OR: 2.97, p=0.00, 95% CI: 2.40-12.2).

CONCLUSION

There were certain knowledge, attitude, and practice-based questions that elicited significant differences in responses based on the qualifications and experience of the nurses. Overall, the nurses did possess fair knowledge and favorable attitudes towards oral care in these patients.

Oral care knowledge, attitude and practice among nursing staff in acute hospital settings in Hong Kong

Investigating the oral care delivered by nursing staff in acute hospital setting is having a remarkable shortage within the current literature. This was provoked due to lack of previous performed investigation in the acute hospital setting besides inconsistent existence of a standardized and comprehensive oral care knowledge, attitude and practice (KAP) instrumentation. Therefore, the purpose of this study is to assess the oral care KAP level for inpatients among nursing staff; to identify possible barriers to the provision of oral care; and to identify training preferences to improve the oral care of inpatients, in acute hospital settings in Hong Kong; and to provide standardized comprehensive KAP based assessment tool that would benefit and guide other future studies. In this study, a cross-sectional survey was conducted after a 55-item self-administered structured questionnaire was developed. A modified KAP tool was developed. The tool includes 4 domains: oral care knowledge, attitude, practice, and experience. Nursing staff was recruited from July 2018 to April 2019 via convenience sampling. Either online or printed questionnaires were completed. Proportions of nursing staff with good KAP, as defined by having 60% of the total score in the respective domain, were estimated with 95% confidence intervals (CI). Analysis of covariance was used to compare the mean scores of KAP among different independent variables and identify the factors associated with good KAP. 404 nursing staff were recruited. Approximately 29.5%, 33.7% and 14.9% of the respondents had good oral care knowledge, attitude and practice, respectively, and 53.2% of the respondents had unpleasant oral care experience. Better oral care practice was associated with higher levels of oral care knowledge (β = 0.1) and oral care attitude (β = 0.3). To conclude: nursing staff in acute hospital settings reported low levels of oral care KAP with variations between the RN, EN and HCA. This study adds to the literature the association between oral care unpleasant experiences and the oral care practice, as well as oral care knowledge and attitude which also in turns associated with practice. The developed standardised tool could be applied for future studies. Recommendations on the future research, training and practices were made.

Oral Care Practice, Perception, and Attitude of Nurses in Intensive Care Units in Korea: A Questionnaire Survey

Background: This cross-sectional study investigated the factors influencing oral care in patients in intensive care units (ICUs) by identifying the current oral care practice status, perceptions, and attitudes of ICU nurses in Korea. Methods: This study surveyed 240 nurses with work experience in the ICU using a self-report questionnaire consisting of 22 items on the status, perception, and attitude towards oral care in the ICU. Results: A total of 227 questionnaires were analyzed. The average age of the participants was 29.79 ± 5.92 years, and the medical ICU was the most type of ICU. The factors affecting the attitude towards oral care and its importance in ICU patients were the experience of working as a nurse (r = 0.336, p < 0.01), ICU work experience (r = 0.218, p < 0.01), and oral care practice frequency (r = 0.167 p < 0.05); these were found to be statistically significant. Conclusions: In this study, the interest of the nurses in oral care practice and education was high, but professional education and the regular implementation of oral care practices were insufficient. To address these problems, it will be necessary to improve oral care practices through dental intervention and education about oral care methods focused on ICU patients.

Interventions to promote oral care regimen adherence in the critical care setting: A systematic review

BACKGROUND

Oral care is a fundamental nurse-led intervention in the critical care setting that provides patient comfort and prevents adverse outcomes in critically ill patients. To date, there has been minimal focus on nurse-focused interventions to improve adherence to oral care regimens in the adult intensive care unit setting.

OBJECTIVES

The objectives of this study were to (i) identify types and characteristics of interventions to improve oral care adherence amongst critical care nurses and intervention core components, (ii) evaluate the effectiveness of interventions to improve adherence of oral care regimens, and (iii) identify the types of outcome measures used to assess oral care regimen adherence.

DESIGN

This is a systematic review in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

DATA SOURCES

Key bibliographic databases and platforms, including Scopus, Cochrane, MEDLINE, CINAHL, Embase, PsycINFO, ProQuest, and Web of Science, were searched for studies published before July 2020. The Joanna Briggs Institute's quality appraisal tool was used to assess risk of bias in included studies.

RESULTS

A total of 21 original research studies were identified, of which 18 studies used multifaceted interventions. In accordance with the Joanna Briggs Institute's quality appraisal tools, four of the 20 quasi-experimental studies were rated as high quality. The one randomised control trial was of moderate quality. Outcome measures included oral care adherence behaviours, oral care knowledge, self-reported adherence, and documentation. Improved effectiveness in oral care adherence was reported in 20 studies.

CONCLUSIONS

Review findings confirm interventions to change behaviours improve oral care adherence. The most effective interventional approach could not be determined owing to heterogeneity in intervention design and outcome measures. Oral care in the intensive care unit is a vital, nurse-led activity that reduces the risk of hospital-acquired infection. It is recommended that future research adopt implementation science methods to ensure stakeholder engagement and feasibility.

SYSTEMATIC REVIEW REGISTRATION NUMBER

This review was submitted and subsequently registered on PROSPERO, the International Perspective Register of Systematic Reviews PROSPERO 2019 CRD42019123142.

Nurses' practices and obstacles to oral care quality in intensive care units in Upper Egypt

BACKGROUND

Oral care is one of the fundamental nursing care procedures used to decrease oral colonization, dental plaque, respiratory infections, and patient stay and cost.

AIMS

This study aimed to identify intensive care unit (ICU) nurses' self-assessment of oral care frequency, skill competency, documentation, oral care tools, and obstacles to oral care quality. In addition, it proposed exploring associations between nurses' attitudes about the importance of oral care and the priority of other interventions.

STUDY DESIGN AND SETTING

A cross-sectional descriptive study was conducted in two ICUs (trauma and general) in the main teaching hospital in Upper Egypt. Of 105 nurses selected using convenience sampling, 91 completed the questionnaire.

RESULTS

About 60.4% of ICU nurses did not attend any oral care training programme, 40.7% reported performing oral care four times per shift in intubated patients, 62.6% reported that their skills needed improvement, 37.4% saw themselves as competent, and 86.8% documented oral care in patients' records. Significant positive correlations were found, indicating that nurses' attitudes towards the importance of oral care showed the same tendency as the priority given to other interventions, such as eye care, bowel care, documentation, hygiene, catheters, feeding, and wound care (correlation coefficient [r] = 0.290, 0.511, 0.333, 0.425, 0.431, 0.345, and 0.337, respectively). Furthermore, a toothbrush (84.6%) was often used, while chlorhexidine was not used (90.1%). The major obstacles to the provision of oral care as perceived by the nurses were the fear of aspiration and life-threatening interventions (95.6%), inadequate nurse-patient ratios (94.5%), irregular competency evaluations (92.3%), unavailability of oral care guidelines (92.3%), and shortage of time (84.6%).

CONCLUSION

The participating nurses were mindful of the importance and priority of oral care. Many of them did not attend oral care training programmes and considered that their skills needed improvement. Moreover, ICU nurses reported many obstacles hindering oral care quality.

RELEVANCE TO CLINICAL PRACTICE

This research identifies the importance of developing in-service oral care training programmes to improve ICU nurses' skill competency. High-quality oral care can be provided by focusing on and overcoming obstacles that hinder nurses' oral care practice.

Linguistic-cultural validation of the oral health assessment tool (OHAT) for the Italian context

BACKGROUND

The increase in the ageing population and the consequent establishment of a network of adequate structures to respond effectively to the welfare needs of institutionalized elderly people have stimulated the discussion by healthcare professionals on the subject of oral hygiene.Literature data show that the same attention has not been paid to oral health care compared to other health needs. Many studies have demonstrated that oral health has a significant impact on the quality of life, especially for older people. Poor oral health also has a considerable role on the physical condition of the elderly because it affects their ability to eat, feed themselves, forcing them to have unbalanced diets. The consequence of this condition is dehydration, malnutrition and impairment of communication skills. The essential nursing activity for oral care is the assessment of the state of oral health, an activity that should be conducted by means of valid tools. To date there are no tools for assessing the health of the oral cavity validated for the Italian linguistic-cultural context. The aim of this study is to conduct a linguistic-cultural validation for the Italian context, of the original Australian version of the Oral Health Assessment Tool (OHAT) scale.

METHODS

Study design: Linguistic-cultural validation and adaptation of a tool for the assessment of oral health. The Beaton and Sousa & Rojjanasrirat (2011) models were used to conduct the linguistic-cultural validation and adaptation process. This validation involved 368 inmates/patients aged over 65 years with cognitive deficit.

RESULTS

The face validity was confirmed by a score for each item related to clarity equal to or greater than 80%. The content validity was confirmed by an content validity index for items (I-CVI) score equal to or greater than 0.8 for each item and an content validity index for scales (S-CVI) of 0.93 for the entire tool. For the reliability of the internal consistency the Cronbach alpha was calculated, which was found to be 0.82. The test-retest was calculated by means of the Pearson coefficient correlation which turned out to be 0.5.

CONCLUSIONS

The Italian version of the OHAT is a tool that can help to consider oral health at the same level as other health needs aimed at increasing the quality of nursing care provided. This tool can be used by nurses to assess the health of the oral cavity in elderly subjects also with cognitive deficit.

Factors influencing oral care in intubated intensive care patients

BACKGROUND

The practice of oral care in intensive care settings remains inconsistent among intubated patients, yet these patients are at high risk of developing ventilator-associated pneumonia. Therefore, it is important to adopt safe professional behaviour based on clinical practice guidelines. This study was based on Ajzen's (1985) theory of planned behavior, a conceptual framework that allows a better understanding of how internal and external factors influence behaviour adoption.

AIMS AND OBJECTIVES

To study influential factors in how nurses practice oral care with intubated clients in intensive care settings, referring to the theory of planned behavior (TPB) constructs.

DESIGN

A cross-sectional descriptive correlational design was conducted through a provincial postal survey in Quebec, Canada.

METHODS

A questionnaire was completed by 375 nurses working in intensive care units (ICUs).

RESULTS

Perceived behavioural control and attitude were the most important determinants in the level of intention to engage in oral care. Knowledge, available human and material resources, and number of years of experience in critical care nursing also seemed to be significant influencing factors.

CONCLUSIONS

This study improved our understanding of the factors influencing the practice of oral care in intubated patients in the ICU, relying on TPB as an explanatory framework. It would be important to continue to study this professional behaviour and to work in collaboration with health care facilities to promote the importance of oral care as an imperative for the safety and quality of health care.

RELEVANCE TO CLINICAL PRACTICE

The results of this study represent a solid foundation for advancing continuing education programmes and intensive care orientation programmes tailored to the needs of nurses.

Awareness among intensive care nurses regarding oral care in critically ill patients

Background:

Oral health and general health are interdependent which influence each other through biological, psychological, emotional, and developmental factors. As patients in Intensive Care Unit (ICU) are completely dependent on the caregivers, the knowledge, attitude, and practices of the nurses influence the recovery of patients to a greater extent.

Objectives:

Unfortunately, oral health problems are usually overshadowed by other serious needs in critically ill patients. In addition, nursing staff appear to perceive oral health as the most difficult part of their work, hence been a low-priority intervention. Therefore, the aim of the study was to assess the knowledge, attitude, and practices of ICU nurses on oral care in critically ill patients.

Materials and Methods:

A total of 200 nurses working in 21 different hospitals in Mysore, Karnataka, participated in the cross-sectional survey. The survey instrument included the demographic details, knowledge, attitude, and practice of oral care, complications in ICU due to lack of oral care, and educative programs attended.

Results:

Among the 200 ICU nurses, 67% had ICU experience of more than 5 years. About 94% were diploma candidates, 5% were graduates, and only 2% were postgraduates with a mean age of 27.5 years. All the participants were aware of the concept of focal infection theory and 93% knew about the potential complications associated with poor oral hygiene in ICU. About 95.5% of the nurses performed oral care after every shift change and used gauze soaked in chlorhexidine routinely. Nearly 76.5% of the participants stated mechanical obstruction as a main barrier toward oral care.

Conclusion:

A variety of oral care practices exist for ventilated patients but, the majority of nurses used chlorhexidine with gauze. They failed to adhere to the latest evidence-based practice despite ranking oral care as a high priority. They need to be educated to improve clinical outcomes thereby reducing the hospital mortality and stay in ICU.

Impact of an education program on the performance of nurses in providing oral care for mechanically ventilated children

BACKGROUND

Mechanically ventilated children are prone to pneumonia due to immobilization and lack of laryngeal (cough) reflex and swallowing. Nurses are directly responsible for many clinical approaches used to prevent ventilator-associated pneumonia.

OBJECTIVE

The research objective is to determine the effectiveness of the nurse education program on the performance of nurses in providing oral care for mechanically ventilated children.

METHODS

This quasi-experimental pretest-posttest design was conducted on 100 nurses (50 in each of the control and intervention groups) in pediatric intensive care units (PICU) in Tehran, 2015. The research tools included a demographic form and three checklists for evaluation of performance according to the clinical practice guidelines for the oral health status of children in PICU. Before intervention, the performance of nurses in both groups was observed at three stages and three different shifts, using an observational checklist. After one month, their performance was observed again with the same checklist at three stages and three different shifts in the PICU. The training was done in four 40-50 minute sessions in a workshop with a 4-week follow-up. The Chi-square test, Fisher's exact test, paired t-test, independent t-test, and regression analysis comprised the tools used to analyze the data.

FINDINGS

The mean performance scores of nurses before the education program in the intervention and control groups were 42.8 (±18.5) and 48.7 (±15.7), respectively. These scores improved to 68.6 (±31.4) and 48.6 (±15.4) four weeks after the intervention (p < 0.001).

CONCLUSION

The performance of nurses in providing oral care for mechanically ventilated children improved after the intervention. It is recommended to implement this program for all nurses, regardless of their ward or specialty, based on the clinical practice guidelines. The periodic refreshing in-service training program should be provided to nurses in PICU in order to enhance their performance in providing oral care.

Survey of Extent of Translation of Oral Healthcare Guidelines for ICU Patients into Clinical Practice by Nursing Staff

Nosocomial infections in critically ill/ventilated patients result from bacterial load in oropharyngeal regions. Oral decontamination serves as the easiest effective means of controlling infections. Knowledge, attitude, and practices followed by healthcare personnel in intensive care settings need to be assessed to implement concrete measures in health-care. Survey questionnaire was constructed and implemented following its validation on seventy nursing and paramedical staff working in government and private intensive care units throughout Lucknow city. 21-item questionnaire consisted of three parts of seven questions each. 78% of respondents had knowledge regarding oral care and its importance in critical settings but 44% of respondents considered it to be unpleasant task. 36% of respondents claimed to have provided oral care to all patients in ICU. Uniform guidelines for translation of oral healthcare in ICU settings are not being implemented. Previous studies in literature from various geographic diverse regions also point out to similar lacunae. Based on present survey, most respondents were aware of importance of oral care with protocols covered in academic curriculum. Attitude towards oral care is positive but respondents feel a need for specialised training. Practice for oral care is not sufficient and needs improvement and proper implementation.

Oral Care Effect on Intubated Patient with 0.2 per cent Chlorhexidine Gluconate and Tooth Brushing in Intensive Care Unit

Aims and Objectives:

Ventilator-associated pneumonia is associated with increased morbidity and mortality. The aim of this pilot study was to determine the effectiveness of oral care with both tooth brushing and 0.2 per cent chlor-hexidine gluconate compared to 0.2 per cent chlorhexidine gluconate alone for the intubated patient in an intensive care unit (ICU).

Materials and Methods:

Patient screening was done over a period of two months. After taking informed consent, those ICU patients were divided into two groups. Only nine subjects were enrolled. During the study, the experimental group (N = 4) got oral care that consisted of both tooth brushing and 0.2 per cent chlorhexidine gluconate thrice a day. The control group got oral care with 0.2 per cent chlorhexidine gluconate alone thrice a day. The data were analysed by IBM statistical software SPPS, version 24.

Results:

Preliminary results suggest that the risk of ventilator-associated pneumonia in intubated patients can be reduced by maintaining thrice-daily oral care involving both tooth brushing and 0.2 per cent chlorhexidine gluconate.

Conclusion:

Thrice-daily oral care consisted of both tooth brushing and 0.2 per cent chlorhexidine gluconate might be a promise as a ventilator-associated pneumonia-reduction strategy in ICU. Furthermore, more studies are required for its application widely.

Comprehensive oral-health assessment of individuals with acquired brain-injury in neuro-rehabilitation setting

PRIMARY OBJECTIVE

To perform a detailed clinical oral health assessment and oral-health-related social and behavioural aspect assessment in individuals with acquired brain injury (ABI).

RESEARCH DESIGN

Prospective observational study.

METHODS AND PROCEDURES

Thirteen individuals with ABI were recruited. Individual's social and behavioural history, bed-side oral examination score (BOE), tooth condition and periodontal status (bleeding, plaque and clinical attachment loss) were thoroughly examined. The entire examination took up to 60 minutes, using proper dental armamentarium.

MAIN OUTCOMES AND RESULTS

All evaluated individuals were diagnosed with chronic generalized periodontitis. A relationship between active periodontal disease and severe BOE score was observed (p = 0.01). Significant interaction between severe BOE scores (≥ 15 or ≥ 14) and periodontal disease severity of ≥ 2 mm (p = 0.01) was observed. The same interaction was seen between severe BOE scores and the combination of 75% extent and 2 mm severity (p = 0.01). Severity and activity of periodontitis showed dependence on individual brushing frequency (p = 0.03 and p = 0.05, respectively).

CONCLUSIONS

Individuals with ABI had a poor status across a range of oral-, dental- and periodontal-related parameters. Further structured studies are required to define evidence-based assessment approaches for such clinical reality.

Oral care for intubated patients: a survey of intensive care unit nurses

AIMS

This study aimed to determine attitudes and practices of intensive care unit (ICU) nurses towards provision of oral care for intubated patients.

BACKGROUND

Oral care is as an essential nursing intervention for intubated patients to maintain patient comfort and prevent colonization of dental plaque by respiratory pathogens.

DESIGN

This was a cross-sectional study.

METHODS

Data were collected from 93 ICU nurses of a teaching hospital in the East Coast of Peninsular Malaysia using a self-administered questionnaire.

RESULTS

Some nurses agreed that oral cavity of intubated patients was difficult (40·8%) and unpleasant (16·2%) to clean, but all of them realized the importance of oral care and the majority (97·9%) would like to learn more about it. Most nurses reported providing oral care at least two times daily using various methods and products such as suction toothbrush (90·4%), manual toothbrush (49·5%), cotton swab (91·5%) and foam swab (65·7%). Chlorhexidine gluconate oral rinse was the preferred mouthwash (97·8%) and swabs (93·5%) solution although few used non-optimal products such as sodium bicarbonate (14·0%), tap water (4·3%) and hydrogen peroxide (3·2%) to wash their patients' mouths. While the majority of nurses agreed that oral care supplies and equipments were available (93·6%) and suitable (88·2%), most of them also thought they need better hospital support (88·2%).

CONCLUSIONS

The nurses' attitudes towards oral care were generally positive and most oral care methods were appropriate. However, some methods and products used were inconsistent with the current recommendations and they have mixed views about the suitability of oral care supplies and equipment provided by the hospital.

RELEVANCE TO CLINICAL PRACTICE

Recommendations were made for providing standard oral care protocols for intubated patients and oral care training programs for ICU nurses to support delivery of quality patient care.

Factors influencing intensive care nurses' knowledge and attitudes regarding ventilator-associated pneumonia and oral care practice in intubated patients in Croatia

Adequate oral care in intubated patients may reduce occurrence of ventilator-associated pneumonia. The purpose of this study was to explore knowledge, attitudes, and oral care practice in Croatian intensive care units and influencing factors. Nurses' knowledge is insufficient; however, most of them reported positive attitude toward the importance of oral care. Performed oral hygiene measures are mostly inappropriate. There is a need to improve the knowledge of ventilator-associated pneumonia and oral care.

Turkish Nurses' Attitudes and Practices Regarding Oral Care

PURPOSE

This study was conducted to determine the attitudes and practices of nurses working in intensive care units of four different hospitals regarding oral care.

METHODS

One hundred eighty-five nurses who worked in adult intensive care units comprised the sample of this cross-sectional descriptive study.

CONCLUSION

It can be said that intensive care nurses perform oral care without an oral care protocol and assessment guideline, and that the methods and frequency of oral care and solutions and tools used for oral care differ from one institution to another.

IMPLICATIONS FOR NURSING PRACTICE

The results emphasized the need for continuing training in this area.

Oral Care in Trauma Patients Admitted to the ICU: Viewpoints of ICU Nurses

Background:

Many patients with severe traumatic injuries are admitted to intensive care units (ICU). These patients usually require prolonged mechanical ventilation. These interventions require oral intubation and leave the mouth open which consequently impairs the natural antimicrobial activity in the mouth and airways. These patients are also prone to ventilator-associated pneumonia (VAP). Evidence shows that paying attention to oral hygiene in patients under mechanical ventilation is important in helping to prevent VAP.

Objectives:

The present study was conducted to assess the viewpoints and performance of ICU nurses at Birjand hospitals towards oral care of patients under mechanical ventilation.

Patients and Methods:

A cross-sectional study was conducted at ICUs of Imam-Reza and Vali-Asr hospitals, Birjand, Iran. Sampling was done through a census in which 53 ICU nurses participated. Descriptive statistics, Kolmogorov-Smirnov test, Mann-Whitney U tests and Kendall's correlation coefficient were used to analyze the data.

Results:

A total of 53 nurses participated in this study. Most of the nurses had been trained to provide oral care during their university education. According to the participants' opinions, oral care with an average score of 5.72 ranked second among the 10 nursing care domains. The most frequent oral care provided was oral suctioning, normal saline irrigation, and chlorhexidine rinse with 95%, 90%, and 81.3% frequency, respectively.

Conclusions:

Nurses participating in this study considered oral care to be of prime importance. Most of the participants although trained in this area felt the need for continuing training courses.

[Methods for endotracheal tube fixation. Results of a survey of intensive care nurses]

There are a wide variety of strategies and methods used in securing and managing the oral endotracheal tube and mouth and oral care in German clinical intensive care nursing for mechanically ventilated patients. There are no nationally recognized guidelines or recommendations on this topic. A survey among intensive care nurses identified the most widely used nursing strategies and methods. Regarding the results of the survey and international literature findings, the commonly used strategies and methods are discussed. Following these discussions, there are recommendations for improving nursing care of orally intubated patients in intensive care, including the aspects of evidence identified, currently used methods and patient needs. Also included are aspects of patient safety, potential complications and quality-orientated nursing care within a system having limited overall nursing care resources.

Intensive care nurses' opinions and practice for oral care of mechanically ventilated patients

Context:

Oral care is an essential aspect of critical care nursing. However, no study has been published on oral care practice of Iranian and Asian nurses. The majority of published studies were conducted in western and European countries.

Aims:

This study aimed to evaluate the nurses’ opinions and practice about oral care in patients under mechanical ventilation.

Settings and Design:

A cross-sectional study was conducted on 130 intensive care nurses from 6 intensive care units in the university hospitals of Iran.

Materials and Methods:

A questionnaire was used to gather the data and charts of 45 patients were evaluated.

Statistical analysis:

Descriptive statistical analysis are presented.

Results:

Oral care obtained the 7^th rank in prority and a mean score of 5.7 on a scale of 1-10. More than 21% of subjects did not perform oral care in their usual duties. High load of writing tasks and personnel shortages were the major barriers to oral care. Only 20% of the patients’ charts contained a report on oral care.

Conclusions:

Nurses did not consider oral care in intensive care patients as a high priority. This result highlights the need to continue education programs on oral care for improving the knowledge and attitude of intensive care nurses with respect to oral care.

Toothbrushing for critically ill mechanically ventilated patients: a systematic review and meta-analysis of randomized trials evaluating ventilator-associated pneumonia

BACKGROUND

Oral care may decrease ventilator-associated pneumonia in the ICU. The objective of this review was to summarize and critically appraise randomized trials in mechanically ventilated patients in the ICU testing the effect of oral care strategies involving toothbrushing on ventilator-associated pneumonia.

SEARCH METHODS

We searched EMBASE, MEDLINE, and the Cochrane Controlled Trials Register and Database of Systematic Reviews from 1980 until March 2012, independently and in duplicate, as well as personal files and reference lists. In duplicate, articles were selected if they were randomized trials, enrolled adult critically ill patients, compared any kind of oral care involving toothbrushing with any other kind of oral care or control with or without toothbrushing, and examined ventilator-associated pneumonia. In duplicate, we abstracted trial characteristics and quality using the Cochrane risk of bias tool. The results were combined using a random effects model.

RESULTS

We included six trials enrolling 1,408 patients, five of which compared toothbrushing to usual oral care and one of which compared electric with manual toothbrushing. In four trials, there was a trend toward lower ventilator-associated pneumonia rates (risk ratio, 0.77; 95% confidence interval, 0.50-1.21; p = 0.26). This trend was also observed in one trial reporting fewer cases of ventilator-associated pneumonia per 1,000 ventilator days (20.68 vs. 25.89; p = 0.53) in patients receiving toothbrushing vs. no toothbrushing. The only trial with low risk of bias suggested that toothbrushing significantly reduced ventilator-associated pneumonia (risk ratio, 0.26; 95% confidence interval, 0.10-0.67; p = 0.006). Use of chlorhexidine antisepsis seems to attenuate the effect of toothbrushing on ventilator-associated pneumonia (p for the interaction = 0.02). One trial comparing electric vs. manual toothbrushing showed no difference in ventilator-associated pneumonia rates (risk ratio, 0.96; 95% confidence interval, 0.47-1.96; p = 0.91). Toothbrushing did not impact on length of ICU stay, or ICU or hospital mortality.

CONCLUSIONS

In intubated, mechanically ventilated critically ill patients, toothbrushing did not significantly reduce the risk of ventilator-associated pneumonia overall. Toothbrushing has no effect on mortality or length of stay. Electric and manual toothbrushing seem to have similar effects. More research is needed on this aspect of oral care to evaluate its potential to decrease ventilator-associated pneumonia.

Critical care nurses' knowledge of, adherence to and barriers towards evidence-based guidelines for the prevention of ventilator-associated pneumonia--a survey study

OBJECTIVES

To explore critical care nurses' knowledge of, adherence to and barriers towards evidence-based guidelines for prevention of ventilator-associated pneumonia.

DESIGN

A quantitative cross-sectional survey.

METHODS

Two multiple-choice questionnaires were distributed to critical care nurses (n=101) in a single academic centre in Finland in the autumn of 2010. An independent-samples t-test was used to compare critical care nurses' knowledge and adherence within different groups. The principles of inductive content analysis were used to analyse the barriers towards evidence-based guidelines for prevention of ventilator-associated pneumonia.

RESULTS

The mean score in the knowledge test was 59.9%. More experienced nurses performed significantly better than their less-experienced colleagues (p=0.029). The overall, self-reported adherence was 84.0%. The main self-reported barriers towards evidence-based guidelines were inadequate resources and disagreement with the results as well as lack of time, skills, knowledge and guidance.

CONCLUSION

There is an ongoing need for improvements in education and effective implementation strategies.

CLINICAL IMPLICATIONS

The results could be used to inform local practice and stimulate debate on measures to prevent ventilator-associated pneumonia. Education, guidelines as well as ventilator bundles and instruments should be developed and updated to improve infection control.

Assessment of oral care needs of patients treated at the intensive care unit

AIMS AND OBJECTIVES

To assess the oral hygiene needs and the status of the oral mucus membranes of patients being treated in an intensive care unit and to determine the personal- or treatment-related variables associated with oral hygiene and the status of the oral mucus membranes of patients.

BACKGROUND

Oral hygiene has an impact on the clinical outcomes and well-being of critically ill patients.

DESIGN

A descriptive, cross-sectional design was used.

METHOD

The study was conducted in the intensive care unit of a private hospital located in Istanbul. The study sample consisted of 60 patients treated in the intensive care unit for five consecutive days. Oral assessments were conducted once per day every morning for five days. The oral assessments were performed using the Oral Assessment Tool and Oral Assessment Checklist.

RESULTS

The oral hygiene status and the health of the oral mucus membranes improved over the consecutive five-day assessments, and the routine oral care provided by nurses in the intensive care unit was effective in preventing oral mucus membrane-related complications.

CONCLUSIONS

The frequency of oral care and oral moistening should be determined according to the patient's condition and the presence of risk factors for oral complications. Oral mucus membranes should be assessed closely and systematically in all critically ill patients who are mechanically ventilated, are receiving oxygen therapy, are undergoing invasive procedures, have a history of chronic health problems or are receiving enteral or parenteral nutrition.

RELEVANCE TO CLINICAL PRACTICE

To prevent infections or complications during intensive care treatment, it is important for nurses working in critical care units to develop and implement oral care assessments and evidence-based oral care protocols.

Oral care practices of intensive care nurses: a descriptive study

The aim of this study was to investigate intensive care unit (ICU) nurses' views and practices on oral care and to define the factors related to oral care measures. A study was carried out in eight ICUs of a teaching hospital in 2008. One hundred one nurses constituted the study sample. The data were collected using 'Oral Care Practices Survey' which included demographic characteristics (5 items) and current oral care practices (13 items). Oral care was given the highest priority by nearly 60% of the nurses. The most commonly used solution was sodium bicarbonate (79.2%), and the most frequently used equipment was foam swab (82.2%). Oral care was carried out less than every 4 h per day by 44.5% of the nurses. The oral care products and solutions were reported to be different in almost every unit. The relationship between the use of toothpaste and the place of employment was statistically significant (x(2) = 24.566, d.f. = 6, P = 0.000). There was a statistical significance between the clinics and frequency of oral care (x(2) = 81.486, d.f. = 42, P = 0.000). This study suggests that there is a wide variety of type and frequency of oral care measures among ICU nurses. Optimal oral care supported by evidence is an effective prevention method for eliminating oral complications.

Preventing Ventilator-Associated Pneumonia Through Oral Care, Product Selection, and Application Method

Objective:

Review the literature to identify the most effective method of oral hygiene to reduce the incidence of ventilator-associated pneumonia (VAP).

Background:

Ventilator-associated pneumonia is the most common nosocomial infection in patients being treated with mechanical ventilation.

Method:

This study is a systematic literature review. The databases searched included Web of Science, Cumulative Index to Nursing and Allied Health Literature, Ovid, and MEDLINE.

Results:

Implementation of oral care protocols and nurse education programs reduced VAP. Although chlorhexidine was the most popular oral care product, no consensus emerged on concentration or protocols for oral care.

Conclusion:

No consensus on best practice for oral hygiene in patients being treated with mechanical ventilation was found. Chlorhexidine was the most popular oral care product. Implementation of an oral care protocol, ongoing nurse education, and evaluation were important in reducing the incidence of VAP. Future research should analyze chlorhexidine concentration, application techniques, and frequency of oral care, to optimize VAP prevention.

Mouth care for orally intubated patients: a critical ethnographic review of the nursing literature

OBJECTIVES

The aim of this critical ethnographic literature review was to explore the evolution of nursing discourse in oral hygiene for intubated and mechanically ventilated patients.

METHODS

The online databases CINAHL and MEDLINE were searched for nurse-authored English language articles published between 1960 and 2011 in peer-reviewed journals. Articles that did not discuss oral problems or related care for intubated adult patients were excluded. Articles that met the inclusion criteria were chronologically reviewed to trace changes in language and focus over time.

RESULTS

A total of 469 articles were identified, and 84 papers met all of the inclusion criteria. These articles presented an increasingly scientific and evaluative nursing discourse. Oral care originally focused on patient comfort within the literature; now it is emphasized as an infection control practice for the prevention of ventilator-associated pneumonia (VAP). Despite concern for its neglected application, the literature does not sufficiently address mouth care's practical accomplishment.

CONCLUSIONS

Mouth care for orally intubated patients is both a science and practice. However, the nursing literature now emphasises a scientific discourse of infection prevention. Inattention to the social and technical complexities of practice may inhibit how nurses learn, discuss and effectively perform this critical aspect of patient care.

The effect of oral care on intracranial pressure: a review of the literature

Neuroscience intensive care unit nurses routinely perform oral care on patients with intracranial pressure (ICP) monitoring. When the ICP is elevated or rises in response to oral care, this intervention may be withheld despite the lack of evidence linking the two. To appraise the best evidence for providing oral care to patients with ICP monitoring, articles published in English from 1978 to 2009 and indexed in CINHAL, PubMed/MEDLINE, Cochran Library, and BioSys were searched using the key terms ICP monitoring, intracranial hypertension, oral care, mouth care, hygiene, nursing interventions, nursing care, intensive care, and critical care. Reference lists of retrieved articles were reviewed for articles missed during the initial search. The search yielded 65 articles: 16 experimental or quasi-experimental studies, 24 descriptive studies, and 25 review articles. Of these, only four specifically tested or described the effect of oral care on ICP. There is a need for more knowledge about the effect of oral care on ICP so that evidence-based oral care practices in this patient population can be defined.

Critical care nurses' knowledge, attitudes and practices of oral care for patients with oral endotracheal intubation: a questionnaire survey

AIM

This study investigated intensive care unit nurses' knowledge, attitudes and practices of oral care for intubated patients together with the associated factors of the same.

BACKGROUND

Effective oral care improves patient comfort and prevents oral infection. Although oral care is a common requirement of nursing practice, providing intubated patients with oral care is a challenging task.

DESIGN

A descriptive, cross-sectional design.

METHODS

This study applied purposive sampling method at 12 adult intensive care units in one medical centre in northern Taiwan. Two hundred and five nurses were recruited. Data were collected by structured questionnaires which consisted of four sections: knowledge, attitudes and practices of oral care for intubated patients and demographic information for the nurses.

RESULTS

The average percentages indicating the intensive care unit nurses' oral care knowledge, attitudes and practices were 58·8, 79·4 and 49·8%, respectively. Higher scores on oral care knowledge were associated with nurses performing oral care more frequently. Nurses learning about oral care from reading related studies and materials of their own accord may increase the frequency with which they provide oral care to intubated patients. The nurses' age and the type of intensive care unit they work in were significant factors related to the frequency of performing practices related to oral care.

CONCLUSION

Findings show that nurses who have more resources for learning about oral care have greater knowledge about it and provide oral care to intubated patients more frequently.

RELEVANCE TO CLINICAL PRACTICE

Encouraging nurses to learn more about oral care using diverse educational resources will enhance their knowledge and improve their practice. Nursing administrators are encouraged to establish policies and procedures for oral care of intubated patients based on the type of patients cared for, in addition to holding in-service training, with a view to enhancing the quality of oral care for critically ill patients.

Supportive care of a critically ill child

The goal of pediatric intensive care is early identification, severity assessment and resuscitation of critical patients by utilizing standardized protocols. The primary or precipitating disorder should be the focus of attention and specific intervention. But in order to provide holistic care to a patient, due attention should also be rendered to supportive care. Monitoring of sick children in PICU is an essential part of management. Various monitoring technologies add to the clinical monitoring but cannot replace clinical monitoring. The treating team should follow a checklist to ensure all aspects of supportive care are taken care of in every patient. Due attention should be paid to glucose control, skin and eye care, oral hygiene, prevention of stress ulcer, care of various lines and catheters and prevention of nosocomial infections.

The impact of hospitalization on oral health: a systematic review

BACKGROUND

Poor oral health of hospitalized patients is associated with an increased risk of hospital-acquired infections and reduced life quality.

OBJECTIVES

To systematically review the evidence on oral health changes during hospitalization.

DATA SOURCES

Cochrane library, Medline, OldMedline, Embase and CINAHL without language restrictions.

STUDY ELIGIBILITY CRITERIA

Observational longitudinal studies.

DATA APPRAISAL AND SYNTHESIS METHODS

Two independent reviewers screened studies for inclusion, assessed the risk of bias and extracted data. Risk of bias was assessed using the Newcastle-Ottawa assessment scale. A narrative synthesis was conducted.

RESULTS

Five before and after studies were included. The data suggest a deterioration in oral health following hospitalization with an increase in dental plaque accumulation and gingival inflammation and a deterioration in mucosal health.

LIMITATIONS

While before and after studies are at a general risk of bias, other specific study characteristics were judged to have a low risk of bias. However, methodological issues such as unvalidated outcome measures and the lack of assessor training limit the strength of the evidence.

CONCLUSION

Hospitalization is associated with a deterioration in oral health, particularly in intubated patients.

Oral care practices among critical care nurses in Singapore: a questionnaire survey

BACKGROUND

Oral hygiene has an important role in maintaining the health and well-being of critically ill patients. Although a number of studies have examined nurses' oral hygiene practices, few were conducted among nurses caring for critically ill patients or involved Asian nurses.

OBJECTIVES

The study aims to assess local nurses' knowledge, attitudes, and practices regarding oral care for critically ill patients.

METHODS

A descriptive cross-sectional design was used. We developed a 31-item questionnaire based on the literature, existing questionnaires, and focus group discussion. The tool covers three domains: beliefs and attitudes, prevailing practices, and knowledge. We sampled all nurses who worked in five intensive care units and high dependency during a 2-week period. We summarized data using descriptive statistics and explored the association between the nurses' knowledge of oral practices and ward specialty, job function, nurses' education level, and work shift. We used exploratory factor analysis to investigate factorial validity of the beliefs and attitudes domain.

RESULTS

A total of 244 nurses (97%) returned the surveys. More than 80% of the respondents believed that good oral care has a significant impact on the patients' clinical outcomes. However, practices varied with regard to the frequency, requisites, and methods used for oral care. Only 66.3% perceived that they have adequate oral care training. Nurses' oral health knowledge varied with education level (p = .019). Nurses' knowledge did not differ statistically across different specialities, job functions, and type of shift work. Factor analysis on the beliefs and attitudes domain revealed three factors, which we labeled as task efficacy, knowledge need, and task salience.

CONCLUSIONS

The survey provided useful insights on the oral hygiene knowledge and practices of nurses caring for critically ill patients. The findings indicated that local nurses lacked adequate knowledge related to oral health and generally were ill equipped to deliver proper oral hygiene for critically ill patients. The large majority of the nurses' oral care knowledge was learned during their basic nursing education. This knowledge is inadequate to prepare them for the challenge of caring for the oral hygiene needs of critically ill patients. The results emphasized the need for continuing training in this area.

An exploration of factors affecting Hong Kong ICU nurses in providing oral care

AIM AND OBJECTIVES

This paper aims to explore the factors that affect Hong Kong intensive care unit nurses in providing oral care.

BACKGROUND

The literature shows that evidence-based oral care prevents ventilator-associated pneumonia. Nevertheless, not all intensive care unit nurses provide such care. Although several studies have been undertaken to identify factors that affecting the provision of oral care, none of these studies looked at the situation in Hong Kong.

DESIGN

An exploratory qualitative design was adopted, with audio-taped interviews.

METHODS

A convenience sample of 10 registered nurses with 3-14 years of intensive care unit working experience was recruited from the intensive care unit of one regional hospital in Hong Kong. Transcribed interviews were analysed by means of content analysis.

RESULTS

The participants' descriptions of their oral care practices covered oral health assessment, cleansing the oral cavity and care of the surrounding areas. Findings revealed the following significant factors that influenced intensive care unit nurses in providing oral care: their perceptions of the purpose of oral care; their fears about providing it; the priority of oral care; and inadequate support for oral care.

CONCLUSIONS

The findings indicate that nurses' oral care practices were not evidence based. Factors that affected the provision of oral care were consistent with those found in previous studies.

RELEVANCE TO CLINICAL PRACTICE

Study findings indicate that present oral care training should be revised. The findings also highlight the influence of ward culture on nurses' priorities in providing oral care. Appropriate materials, adequate staffing levels and the establishment of an evidence-based oral care protocol may facilitate the provision of oral care in the intensive care unit.

[Prevention of mechanical ventilator-associated pneumonia: a comparison of two different oral hygiene methods]

INTRODUCTION

Oral hygiene (OH) forms a part of the patient's safety in the prevention of mechanical ventilator-associated pneumonia (VAP). The dental plaque index (DP) is considered as a quality marker for OH.

HYPOTHESIS

The association of electric toothbrush and conventional OH in intubated patients decreases the DP and incidence of VAP.

OBJECTIVE

To verify the reduction of DP in patients receiving OH and electric toothbrush and its association with to the decrease of VAP incidence.

MATERIALS AND METHODS

A 3-year long randomized, single blind and prospective study conducted in a 14-bed polyvalent intensive care unit. Patients were included when there was more than 48hours of mechanical ventilation and no expected respiratory infection. Patients were randomized into two groups: Standard (OH with chlorhexidine) (GS) and Raspall (Standard OH with electric dental brush) (GR). The VAP was identified following clinical, medical and microbiological criteria. The DP and halitosis were observed daily. Oral and pharyngeal swabs were collected during the first 5 days.

RESULTS

147 patients were included. Mean age was 53.9±17.5. No significant differences were found in the VAP incidence between the two groups (OR=0.78; 95% IC, 0.36-1.68; p=0.56). The relation between halitosis and DP was p=0.7. The dental plaque index on the 5th day was 1.98 (n=60) in GR and 2.04 (n=57) in GS (p=0.3). The dental plaque index on the 10th day was 1.68 (n=29) in GR and 1.91 (n=32) in GS (p=0.7).

CONCLUSIONS

There is a tendency towards a decrease in the DP which is clearing in the GR group and no relation between VAP and greater DP or halitosis.

Oral care and bacteremia risk in mechanically ventilated adults

OBJECTIVE

Transient bacteremia occurs in healthy populations from toothbrushing. With the high incidence of bacteremia in the intensive care unit and toothbrushing as an oral care method, this study examined the incidence and clinical significance of transient bacteremia from toothbrushing in mechanically ventilated adults.

METHODS

Prospective pre- and post-test with all subjects (N = 30) receiving a toothbrushing intervention twice per day (up to 48 hours). The planned microbial analysis used DNA typing to identify organisms from oral and blood cultures collected immediately before, 1 minute, and 30 minutes after the interventions.

RESULTS

Seventeen percent of subjects had oral cultures that were positive for selected pathogens before the first toothbrushing intervention. None of the subjects had evidence of transient bacteremia by positive quantitative blood cultures before or after the toothbrushing interventions. Patient characteristics were not statistically significant predictors for systemic inflammatory response syndrome, length of hospital stay, or length of intubation.

CONCLUSION

The toothbrushing intervention did not induce transient bacteremia in this patient population.

Oral care practices for orally intubated critically ill adults

BACKGROUND

Ventilator-associated pneumonia is a major threat to patients receiving mechanical ventilation in hospitals. Oral care is a nursing intervention that may help prevent ventilator-associated pneumonia.

OBJECTIVES

To describe oral care practices performed by critical care nurses for orally intubated critically ill patients and compare these practices with recommendations for oral care in the 2005 AACN Procedure Manual for Critical Care and the guidelines from the Centers for Disease Control and Prevention.

METHODS

A descriptive, cross-sectional design with a 31-item Web-based survey was used to describe oral care practices reported by 347 randomly selected members of the American Association of Critical-Care Nurses.

RESULTS

Oral care was performed every 2 (50%) or 4 (42%) hours, usually with foam swabs (97%). Oral care was reported as a high priority (47%). Nurses with 7 years or more of critical care experience performed oral care more often (P=.008) than did less experienced nurses. Nurses with a bachelor's degree in nursing used foam swabs (P=.001), suctioned the mouth before the endotracheal tube (P=.02), and suctioned after oral care (P<.001) more often than other nurses. Nurses whose units had an oral care policy (72%) reported that the policy indicated using a toothbrush (63%), using toothpaste (40%), brushing with a foam swab (90%), using chlorhexidine gluconate oral rinse (49%), suctioning the oral cavity (84%), and assessing the oral cavity (73%). Oral care practices and policies differed for all those items.

CONCLUSIONS

Survey results indicate that discrepancies exist between reported practices and policies. Oral care policies appear to be present, but not well used.

Validity and reliability of an oral care practice survey for the orally intubated adult critically ill patient

BACKGROUND

Oral care is proposed as key to preventing ventilator-associated pneumonia, yet little work has been done to measure reliably current oral care practices nationwide. Five critical care oral care surveys are described in the literature; however, their usefulness is diminished because of insufficient validity or reliability measures and sampling limitations that limit generalizability.

OBJECTIVES

The aim of this study was to present a survey instrument for oral care practices for the orally intubated adult critically ill patient and the attendant psychometric properties.

METHODS

The oral care survey items were designed to elucidate information on the type and frequency of each specific task for oral care (toothbrushes, foam swabs, suctioning, and chlorhexidine gluconate oral rinse). The oral care survey was evaluated for face validity, content validity, and stability reliability psychometric properties.

RESULTS

Face validity was established by an expert panel. Content validity was assessed using content validity index (CVI) and pairwise comparison. The overall CVI score was 97.5% agreement. A pairwise comparison for the three raters was computed. The strongest rating agreements were between Rater 1 and Rater 2 (.86) and Rater 1 and Rater 3 (.83). Given these interrater reliability scores and the overall 97.5% CVI score, minor revisions were made for survey items as recommended by the reviewers' comments. Test-retest reliability (.82-.86) showed a less than 10% difference between all items from Time 1 and Time 2.

IMPLICATIONS

This survey, tested for validity and reliability, can be used in future critical care settings as an audit tool for oral care practices performed by nurses.

ICU nurses' oral-care practices and the current best evidence

PURPOSE

The purpose of this study was to describe the oral-care practices of ICU nurses, to compare those practices with current evidence-based practice, and to determine if the use of evidence-based practice was associated with personal demographic or professional characteristics.

DESIGN

A national survey of oral-care practices of ICU nurses was conducted using a convenience sample of 218 practicing ICU nurses in 2004-05. The survey instrument included questions about demographic and professional characteristics and a checklist of oral-care practices. Nurses rated their perceived level of priority concerning oral care on a scale from 0 to 100. A score was computed representing the sum of 14 items related to equipment, solutions, assessments, and techniques associated with the current best evidence. This score was then statistically analyzed using ANOVA to determine differences of EBP based on demographic and professional characteristics.

FINDINGS

The most commonly used equipment was gauze pads (84%), followed by tongue depressors (55%), and toothbrushes (34%). Chlorhexidine was the most common solution used (75%). Less than half (44%) reported brushing their patients' teeth. The majority performed an oral assessment before beginning oral care (71%); however, none could describe what assessment tool was used. Only 57% of nurses reported documenting their oral care. Nurses rated oral care of intubated patients with a priority of 67+/-27.1. Wide variations were noted within and between units in terms of which techniques, equipment, and solutions were used. No significant relationships were found between the use of an evidence-based protocol and demographic and professional characteristics or with the priority given to oral care.

CONCLUSIONS

While nurses ranked oral care a high priority, many did not implement the latest evidence into their current practice. The level of research utilization was not related to personal or professional characteristics. Therefore attempts should be made to encourage all ICU nurses to introduce and use evidence-based, oral-care protocols.

CLINICAL RELEVANCE

Practicing ICU nurses in this survey were often not adhering to the latest evidence-based practice and therefore need to be educated and encouraged to do so in order to improve patient care.

Brush up on oral assessment and care

Lack of proper oral care can lead to serious complications in critically ill patients. Learn what you need to know about oral assessment and care to keep your patient safe.

Perceptions of registered and enrolled nurses on thirst in mechanically ventilated adult patients in intensive care units-a phenomenographic study

BACKGROUND

Thirst is a commonly experienced source of discomfort among patients receiving mechanical ventilation during intensive care. Dehydration, endotracheal tubes, electrolyte disturbances and the use of various medicines can contribute to the feeling of thirst. At present, the knowledge of nurses' perceptions of the feelings of thirst in mechanically ventilated patients are limited.

PURPOSE

The purpose of this study was to describe registered and enrolled intensive care nurses' perceptions of the feelings of thirst in mechanically ventilated adult patients and to investigate the interventions to reduce thirst.

METHOD

Ten registered intensive care nurses and 10 enrolled nurses, aged 32-59 years, were interviewed. They all had at least one year's experience in caring for adult, mechanically ventilated patients. The data were analysed using a phenomenographic methodology.

FINDINGS

Four categories of perceptions among registered and enrolled nurses, regarding thirst in mechanically ventilated patients were identified: reasons for thirst, signs of thirst, preventing or reducing thirst and the perception that patients had no feelings of thirst.

CONCLUSIONS

Registered and enrolled nurses wish to reduce sources of discomfort among their patients but they do not always realise that patients feel thirst and therefore relieving it has a low priority among staff. Relieving thirst is a human need that must be recognised in nursing education and on intensive care units.