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BaHammam F, Durham J, Abdulmohsen B, Wassall R, McCracken GI. Oral health decline in patients after stroke: a qualitative study. Br Dent J 2023; 235:881-885. [PMID: 38066151 DOI: 10.1038/s41415-023-6558-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 12/18/2023]
Abstract
Introduction To develop and implement effective oral care interventions for patients after stroke, there is a need to understand the causes behind the decline in their oral health. This qualitative study was, therefore, undertaken to explore experiences and views of health service providers about the causes of oral health decline in this group of patients.Methods A purposively selected sample of healthcare service providers who work in two NHS Trusts in the North of England were interviewed utilising a semi-structured interview technique. Interviews were conducted with the assistance of a topic guide and continued until data saturation (n = 30) was reached. The constant comparative approach was used to analyse the data.Results Two major factors, perceived by the participants, were thought to cause oral health decline in patients after stroke. Post-stroke neurological deficits resulting in oral-related functional disturbances was the first. The second was the barriers leading to difficulties in performing or receiving daily oral care. These barriers were related to the patients, their service providers, or the environment in which care is being delivered.Conclusions This study described the major factors affecting the oral health of patients after stroke, which can offer a starting point for developing effective oral care interventions for them.
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Affiliation(s)
- Fahad BaHammam
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Centre, National Guard Health Affairs, Riyadh, Saudi Arabia.
| | - Justin Durham
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Bana Abdulmohsen
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rebecca Wassall
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Giles I McCracken
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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Tsui PK, Chau PH, Wong JYH, Wang MP, Gao X, Lam OLT, Leung KCM, Lo ECM, Tiwari A. Oral care knowledge, attitude and practice among nursing staff in acute hospital settings in Hong Kong. PLoS One 2023; 18:e0289953. [PMID: 37582111 PMCID: PMC10427009 DOI: 10.1371/journal.pone.0289953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 07/17/2023] [Indexed: 08/17/2023] Open
Abstract
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.
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Affiliation(s)
- Pui Ki Tsui
- School of Nursing, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- Department of Childcare, Elderly and Community Services, Hong Kong Institute of Vocational Education (Sha Tin), Hong Kong Special Administrative Region, Hong Kong, China
| | - Pui Hing Chau
- School of Nursing, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Janet Yuen Ha Wong
- School of Nursing, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- School of Nursing & Health Studies, Hong Kong Metropolitan University, Hong Kong Special Administrative Region, Hong Kong, China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Xiaoli Gao
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Otto Lok Tao Lam
- George & Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Katherine Chiu Man Leung
- Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Edward Chin Man Lo
- Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Agnes Tiwari
- School of Nursing, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- School of Nursing, Hong Kong Sanatorium & Hospital Limited, Hong Kong Special Administrative Region, Hong Kong, China
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Interventions to promote oral care regimen adherence in the critical care setting: A systematic review. Aust Crit Care 2022; 35:583-594. [PMID: 34764003 DOI: 10.1016/j.aucc.2021.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 08/04/2021] [Accepted: 08/31/2021] [Indexed: 11/20/2022] Open
Abstract
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.
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Madhuvu A, Endacott R, Plummer V, Morphet J. Healthcare professional views on barriers to implementation of evidence-based practice in prevention of ventilator-associated events: A qualitative descriptive study. Intensive Crit Care Nurs 2021; 68:103133. [PMID: 34756476 DOI: 10.1016/j.iccn.2021.103133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/26/2021] [Accepted: 08/09/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To explore health professional views of barriers to the use of evidence-based practice to prevent ventilator-associated events in intensive care units. DESIGN A qualitative descriptive study was conducted with nurses and doctors with more than six months experience caring for mechanically ventilated patients. SETTING The study was conducted in two intensive care units, in large metropolitan health services in Victoria, Australia. METHODS Individual semi-structured interviews were undertaken with 20 participants (16 nurses and 4 doctors) in 2019. Purposive sampling method was used until data saturation was reached. The interviews were held at the hospital in a private room away from their place of employment. The interview data were analysed using thematic analysis. FINDINGS Four major themes were inductively identified from nine subthemes: i) prioritising specific situations, ii) inadequate use of evidence to underpin practice, iii) perception of inadequate staffing and equipment and, iv) inadequate training and knowledge of evidence-based guidelines. CONCLUSIONS These themes helped to explain previously reported deficits in nurses' knowledge of and adherence to evidence-based practice in intensive care. Findings suggest the need for a well-established policy to underpin practice. The barriers faced by nurses and doctors in preventing ventilator associated events need to be addressed to optimise quality of patient care in intensive care units.
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Affiliation(s)
- Auxillia Madhuvu
- School of Nursing and Midwifery, Monash University, McMahons Road, Frankston, Victoria, Australia; Monash Health, Dandenong Hospital, 135 David Street, Dandenong, Victoria, Australia. https://twitter.com/@AuxilliaMadhuvu
| | - Ruth Endacott
- School of Nursing and Midwifery, Monash University, McMahons Road, Frankston, Victoria, Australia; Plymouth University/Royal Devon and Exeter Hospital Clinical School, Drake Circus, Plymouth, Devon PL4 8AA, United Kingdom
| | - Virginia Plummer
- School of Nursing and Midwifery, Monash University, McMahons Road, Frankston, Victoria, Australia; School of Nursing and Healthcare Professions, Federation University Australia, Australia
| | - Julia Morphet
- School of Nursing and Midwifery, Monash University, McMahons Road, Frankston, Victoria, Australia; Monash Health, Dandenong Hospital, 135 David Street, Dandenong, Victoria, Australia
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Teimoori F, Haghighat A, Mohammadi I, Tahani B. Knowledge, attitude, and expertise of nurses in intensive care unit regarding oral and dental care in hospitalized patients. Dent Res J (Isfahan) 2021. [DOI: 10.4103/1735-3327.328751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Andersson M, Wilde-Larsson B, Persenius M. Oral care - identifying quality improvement areas. Int J Health Care Qual Assur 2020; 32:45-58. [PMID: 32421268 DOI: 10.1108/ijhcqa-09-2017-0176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to describe and compare nurses' and healthcare assistants' oral care quality perceptions, including perceived reality (PR) and subjective importance (SI), to identify improvement areas in intensive care and short-term care, and to explore potential nursing satisfaction predictors regarding oral care. DESIGN/METHODOLOGY/APPROACH Swedish staff, 154 within intensive care and 278 within short-term care responded to a modified quality of care from a patient perspective questionnaire. Descriptive and analytical statistics were used. FINDINGS Staff scored oral care quality both high and low in relation to PR and SI. Improvement areas were identified, despite high satisfaction values regarding oral care. Setting, SI and PR explained 51.5 percent of the variance in staff satisfaction regarding oral care quality. PRACTICAL IMPLICATIONS Quality improvements could guide oral care development. ORIGINALITY/VALUE This study describes oral care by comparing nurse perceptions of how important they perceive different oral care aspects and to what extent these oral care aspects are performed.
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Affiliation(s)
- Maria Andersson
- Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Bodil Wilde-Larsson
- Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Mona Persenius
- Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
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Atashi V, Yousefi H, Mahjobipoor H, Yazdannik A. The barriers to the prevention of ventilator-associated pneumonia from the perspective of critical care nurses: A qualitative descriptive study. J Clin Nurs 2018; 27:e1161-e1170. [PMID: 29215801 DOI: 10.1111/jocn.14216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2017] [Indexed: 12/29/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to explore the perspectives of Iranian critical care nurses on the barriers to ventilator-associated pneumonia prevention in intensive care units. BACKGROUND Most patients hospitalized in intensive care units need mechanical ventilation. One of the most prevalent and serious complications of mechanical ventilation is ventilator-associated pneumonia. There are different barriers to the prevention of this kind of pneumonia. DESIGN Qualitative descriptive design was used. METHODS In this qualitative study, 23 critical care nurses were recruited via purposive sampling. Semi-structured interviews were done for data collection. The interviews were recorded digitally, transcribed word by word, and analyzed using the inductive content analysis approach. RESULTS The barriers to the prevention of ventilator-associated pneumonia fell into three main categories, namely nurses' limited professional competence, unfavorable environmental conditions, and passive human resource management. The 10 subcategories of these main categories were unfavorable professional attitude, limited professional knowledge, low job motivation, limited professional accountability, non-standard physical structure, inadequate or inappropriate equipment, heavy workload, staff shortage, inadequate staff training, and ineffective supervision. CONCLUSION The barriers to the prevention of ventilator-associated pneumonia in intensive care units are very diverse and complex and include a wide range of interrelated personal, environmental, and organizational barriers. RELEVANCE TO CLINICAL PRACTICE This study created a better understanding of the barriers to ventilator-associated pneumonia prevention. Moreover, highlighted the importance of sufficient resources, adequate staffing level, and contextually-appropriate evidence-based guidelines for effective ventilator-associated pneumonia prevention.
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Affiliation(s)
- Vajihe Atashi
- Student Research Committee, Faculty of Nursing and Midwifery School, Isfahan University of Medical Science, Isfahan, Iran
| | - Hojatollah Yousefi
- Ulcer Repair Research Center, School of Nursing and Midwifery, Isfahan University of Medical Science, Isfahan, Iran
| | - Hosein Mahjobipoor
- Department of Anesthesiology and Critical Care Medicine, Critical care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmadreza Yazdannik
- Critical Care Nursing Department, Nursing and Midwifery School, Nursing and Midwifery Care Research Center, Isfahan University of Medical Science, Isfahan, Iran
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Yazdannik A, Atashi V, Ghafari S. Performance of ICU Nurses in Providing Respiratory Care. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2018; 23:178-182. [PMID: 29861754 PMCID: PMC5954637 DOI: 10.4103/ijnmr.ijnmr_205_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Failure to provide proper respiratory care leads to incidence of certain complications such as ventilator-associated pneumonia. Nurses have a crucial role in providing this care. The aim of this study is to assess the performance of ICU (Intensive Care Unit) nurses in providing respiratory care. MATERIALS AND METHODS The present descriptive cross-sectional study recruited 120 nurses working in selected hospitals affiliated to Isfahan University of Medical Sciences from March to August 2016. The questionnaire used included demographic and employment details and performance observation checklist (containing 39 items in four care domains) based on recommendations in clinical guidelines. The performance of each nurse during a working shift was observed. Data were analyzed by SPSS 18, using tables of frequency, mean, and standard deviation. RESULTS According to the results obtained, mean (SD) total performance score of nurses in providing respiratory care was 15.46 (2.16). The highest score was obtained in preventing contamination of respiratory equipment 5 (0), and the lowest score was in oral care 0.68 (0.73). CONCLUSIONS Considering that respiratory care is one of the main pillars of patient care in ICU and that nurses scored poorly in this area, it is imperative to pay greater attention to this area. It is essential to provide necessary training to nurses and adequate facilities for improving the quality of clinical care.
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Affiliation(s)
- Ahmadreza Yazdannik
- Department of Critical Care Nursing, School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vajihe Atashi
- Student Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Somayeh Ghafari
- Department of Critical Care Nursing, School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Survey of Extent of Translation of Oral Healthcare Guidelines for ICU Patients into Clinical Practice by Nursing Staff. Crit Care Res Pract 2017; 2017:1348372. [PMID: 29181195 PMCID: PMC5664266 DOI: 10.1155/2017/1348372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 09/17/2017] [Indexed: 11/30/2022] Open
Abstract
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.
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Nobahar M, Razavi MR, Malek F, Ghorbani R. Effects of hydrogen peroxide mouthwash on preventing ventilator-associated pneumonia in patients admitted to the intensive care unit. Braz J Infect Dis 2016; 20:444-50. [PMID: 27471125 PMCID: PMC9425535 DOI: 10.1016/j.bjid.2016.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 06/23/2016] [Accepted: 06/27/2016] [Indexed: 02/05/2023] Open
Abstract
AIMS The aim of the study was to determine the effect of hydrogen peroxide (HP) mouthwash on the incidence of ventilator associated pneumonia (VAP) in patients admitted to the intensive care unit (ICU). METHODS This was a randomized clinical trial conducted on 68 patients. The intervention group used 3% HP as mouthwash and the control group used mouthwashes with 0.9% normal saline (NS) twice a day. Data were collected using a questionnaire and the Modified Clinical Pulmonary Infection Score (MCPIS). MCPIS includes five items, body temperature: white blood cell count, pulmonary secretions, the ratio of pressure of arterial oxygen (PaO2) to fraction of inspired oxygen (FiO2), and the chest X-ray. Each of these items scored 0-2. Scores ≥6 were considered as VAP signs. The SPSS-20 software was employed to analyze the data. RESULTS In total, 14.7% patients of the HP group and 38.2% patients of the NS group contracted VAP. The risk of VAP in the NS group was 2.60 times greater than that in the HP group (RR=2.60, 95% CI: 1.04-6.49, p=0.0279). The mean±SD MCPIS was calculated as 3.91±1.35 in the HP group and 4.65±1.55 in the NS group, a difference statistically significant (p=0.042). There were no significant differences in the risk factors for VAP between the two groups. CONCLUSION HP mouthwash was found more effective than NS in reducing VAP. HP mouthwash can therefore be used in routine nursing care for reducing VAP.
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Affiliation(s)
- Monir Nobahar
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Nursing, Faculty of Nursing and Allied Health, Semnan University of Medical Sciences, Semnan, Iran.
| | - Mohammad Reza Razavi
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Farhad Malek
- Kowsar Hospital, Semnan University of Medical Sciences, Semnan, Iran
| | - Raheb Ghorbani
- Research Center for Social Determinants of Health and Research Center of Physiology, Department of Community Medicine, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
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Alotaibi AK, Alotaibi SK, Alshayiqi M, Ramalingam S. Knowledge and attitudes of Saudi intensive care unit nurses regarding oral care delivery to mechanically ventilated patients with the effect of healthcare quality accreditation. Saudi J Anaesth 2016; 10:208-12. [PMID: 27051375 PMCID: PMC4799616 DOI: 10.4103/1658-354x.177417] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Ventilator-associated pneumonia is a major morbid outcome among intensive care unit (ICU) patients. Providing oral care for intubated patients is an important task by the ICU nursing staff in reducing the mortality and morbidity. The objectives of this study were to evaluate the attitudes and knowledge of ICU nurses regarding oral care delivery to critically ill patients in Saudi Arabian ICUs. The findings were further correlated to the presence of healthcare quality accreditation of the institution. Materials and Methods: The nurses’ knowledge, attitudes, and healthcare quality accreditation status of the hospital were recorded. Two hundred fifteen nurses conveniently selected from 10 random hospitals were included in this study from Riyadh city, Saudi Arabia. This is a cross-sectional study in the form of a questionnaire. Results: When comparing the knowledge of the participants to their level of education, there was no statistically significant difference between the two groups of nurses. The majority of the nurses agreed that the oral cavity is difficult to clean and that oral care delivery is a high priority for mechanically ventilated patients. Furthermore, there was no statistically significant difference in the attitudes between nurses working in accredited and nonaccredited hospitals. Conclusion: The presence of healthcare quality accreditation did not reflect any significance in attitudes or knowledge of the ICU nurses in regard to mechanically ventilated patients. Factors affecting oral care delivery should be evaluated on the personal and institutional level to achieve better understanding of them.
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Affiliation(s)
- A K Alotaibi
- Department of Restorative Dentistry, Prince Sultan Medical Military City, Riyadh, Kingdom of Saudi Arabia
| | - S K Alotaibi
- Department of Emergency Medicine, Prince Sultan Medical Military City, Riyadh, Kingdom of Saudi Arabia
| | - M Alshayiqi
- Department of Restorative Dentistry, Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia
| | - S Ramalingam
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Abstract
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.
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Affiliation(s)
- Hüsna Özveren
- Nursing Department, Faculty of Health Sciences, Kirikkale University, Kirikkale, Turkey
| | - Dilek Özden
- Nursing Department, Faculty of Health Sciences, Dokuz Eylül University, Izmir, Turkey
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Özden D, Türk G, Düger C, Güler EK, Tok F, Gülsoy Z. Effects of oral care solutions on mucous membrane integrity and bacterial colonization. Nurs Crit Care 2013; 19:78-86. [PMID: 24354738 DOI: 10.1111/nicc.12057] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 07/12/2013] [Accepted: 09/16/2013] [Indexed: 11/27/2022]
Abstract
AIM This research was conducted with the aim of determining the influence of three different oral care solutions on oral mucous membrane integrity in critically ill patients. BACKGROUND Oral care is a basic part of nursing care in intensive care units. DESIGN A randomized controlled trial was conducted. METHOD A total of 60 patients (20 patients in each group) comprised the study sample of the research. Patients were randomly allocated to three groups. Patients in groups 1, 2 and 3 were administered mouth care three times a day using 5% sodium bicarbonate, 0·2% chlorhexidine and saline solution, respectively. Data were collected by means of a 'Descriptive characteristics form' and an 'oral assessment tool'. RESULTS Mean scores of oral assessment tool increased according to days in all groups, however, this increase was found to be statistically insignificant (p > 0·05). Mean scores of the patients in saline solution group were seen to be lower than those of the other groups. When inter-group comparison of days was done, the difference between oral assessment scores was found to be statistically significant (p = 0·000). CONCLUSION It was found that there was no difference between patient groups receiving saline solution, sodium bicarbonate and 0·2% chlorhexidine for mouth care in terms of oral mucous membrane integrity; oral mucosa of all patients was found to be mildly dysfunctioning. RELEVANCE TO CLINICAL PRACTICE It is thought that standardized protocols for oral hygiene developed in the light of the findings of randomized controlled trials may improve the oral health in critically ill patients.
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Affiliation(s)
- Dilek Özden
- D Özden, PhD, RN, Assistant Professor, Fundamentals of Nursing Department, Cumhuriyet University, Health Sciences Faculty, Sivas, Turkey
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A brief report: a mere toothbrush or a brilliant lifesaver? Dimens Crit Care Nurs 2013; 32:33-5. [PMID: 23222227 DOI: 10.1097/dcc.0b013e31827682ce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This article presents the results of a project conducted by senior nursing students to determine if oral care could reduce the number of complications suffered by patients in critical-care units. The students also helped develop an evidence-based policy for oral care.
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Parish CL, Singer R, Abel S, Metsch LR. Addressing the oral healthcare needs of special needs children: pediatric nurses’ self-perceived effectiveness. SPECIAL CARE IN DENTISTRY 2013; 34:88-95. [DOI: 10.1111/scd.12035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Carrigan L. Parish
- Senior Project Director; Department of Sociomedical Sciences; Columbia University Mailman School of Public Health; New York NY
| | - Richard Singer
- Doctoral Graduate Student; University of Miami Miller School of Medicine; Department of Epidemiology and Public Health, Miami, FL; Assistant Professor; Nova Southeastern College of Dental Medicine; Department of Orthodontics; Fort Lauderdale FL
| | - Stephen Abel
- Associate Dean for Community and Professional Initiatives; University at Buffalo School of Dental Medicine; Buffalo NY
| | - Lisa R. Metsch
- Chair Sociomedical Sciences; Stephen Smith Professor of; Sociomedical Sciences; Columbia University Mailman School of Public Health, New York, NY; Volunteer Faculty; University of Miami Miller School of Medicine; Department of Epidemiology and Public Health; Miami FL
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Toothbrushing for critically ill mechanically ventilated patients: a systematic review and meta-analysis of randomized trials evaluating ventilator-associated pneumonia. Crit Care Med 2013; 41:646-55. [PMID: 23263588 DOI: 10.1097/ccm.0b013e3182742d45] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Batiha AMM, Bashaireh I, Albashtawy M, Shennaq S. Exploring the competency of the Jordanian intensive care nurses towards endotracheal tube and oral care practices for mechanically ventilated patients: an observational study. Glob J Health Sci 2012; 5:203-13. [PMID: 23283054 PMCID: PMC4776978 DOI: 10.5539/gjhs.v5n1p203] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 11/27/2012] [Indexed: 11/12/2022] Open
Abstract
Oral care is an important feature of nursing; it is known that oropharynx is considered the main reservoir of bacterial colonization, so the removal of oral infection is a major duty of all health care providers, particularly nurses. We performed this study to explore endotracheal tube and oral care practices for mechanically ventilated patients of Jordanian intensive care nurses, and to study Jordanian intensive care nurses' practices during, prior to, and post endotracheal tube and oral care for mechanically ventilated patients. Endotracheal tube and oral care of Jordanian intensive care nurses for mechanically ventilated patients was compared with recommendations for endotracheal tube and oral care of American Association of Critical Care Nurses and guidelines of Centers for Disease Control and Prevention. Non- participant structured observational design was conducted using a 24 -item structured observational schedule. The findings show that nurses different in their oral care practices; did not follow American Association of Critical Care Nurses recommendations; and therefore delivered lower-quality oral care than predictable. Important inconsistencies were observed in the nurses' hyperoxygenation, respiratory assessment techniques and infection control practices.
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Dale C, Angus JE, Sinuff T, Mykhalovskiy E. Mouth care for orally intubated patients: a critical ethnographic review of the nursing literature. Intensive Crit Care Nurs 2012; 29:266-74. [PMID: 23092851 DOI: 10.1016/j.iccn.2012.09.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 09/11/2012] [Accepted: 09/22/2012] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Craig Dale
- Trauma, Emergency and Critical Care Program, Sunnybrook Health Sciences Centre, B508 - 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5.
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