Effects of simulation education on oral care practices - a randomized controlled trial

Virtual reality-based simulation learning on geriatric oral health care for nursing students: a pilot study

BACKGROUND

There is a great need for training and education in the nursing curriculum to improve nurses' knowledge and skills to provide oral health care.

METHODS

A pilot study was conducted to evaluate the use of a virtual reality (VR)-based Oral Health Care Learning System to train geriatric oral health care among nursing students. Fifty undergraduate nursing students were randomly assigned to experimental (n = 25) and control (n = 25) groups. The experimental group received the VR-based simulation training on geriatric oral health care and the training was implemented twice at two weeks apart from March to November 2021. The control group did not receive the training intervention. Knowledge, attitude, and self-efficacy of geriatric oral health care as well as the intention to assist oral health care for older adults were assessed at the beginning, second, and fourth weeks. Generalized estimating equations were used to analyze the effectiveness of the VR-based simulation training.

RESULTS

After the first round of training, students in the experimental group had significantly greater improvements in knowledge and self-efficacy of geriatric oral health care than in the control group. After the second round of training, students in the experimental group had significantly greater improvements in knowledge, attitude, and self-efficacy of geriatric oral health care as well as the intention to assist oral health care for older adult than in the control group.

CONCLUSIONS

The VR-based simulation training was effective to improve undergraduate nursing students' knowledge, attitudes and self-efficacy of geriatric oral health as well as the intention to assist oral health care for older adults. The VR-based simulation learning system is an effective tool to provide practice experiences to build confidence and skills and to bridge the gap of understudied geriatric oral health content in entry-level nursing curricula.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT05248542; registration date 21/02/2022).

Development and evaluation of simulation-based scenario education program for professional oral hygiene care in intubated patient

PURPOSE

This study was conducted to develop a professional oral hygiene care (POHC) simulation education program for intubated patients and to evaluate the suitability of education by evaluating the performance confidence (PC), critical thinking disposition (CT), and learning satisfaction (LS) of dental hygiene students.

METHODS

This study developed a POHC simulation education program (theory, skill training, scenario education, and debriefing) for intubated patients through expert validation and consisted of a single-group pre- and postexperiment design. The subjects were 3rd and 4th year students at the Department of Dental Hygiene in Wonju City, and a total of 30 people were enrolled. The collected data were analyzed using the PASW Statistics version 23.0. The content validity test was measured by the CVI (Content validity index) value, and the PC, CT, and LS of the subjects before and after participating in the program were analyzed using a paired t-test. The significance level (α) was based on .05.

RESULTS

After the program, the PC improved from 4.29 ± 0.43 to 4.54 ± 0.44, and there was a significant difference (p = .004). CT improved from 3.73 ± 0.36 to 3.84 ± 0.36, but there was no significant difference (p = .062), and prudence improved from 4.21 ± 0.33 to 4.43 ± 0.27, and there was significant difference. (p = .001). LS increased from 4.66 ± 0.36 to 4.90 ± 0.16 after education, and there was a significant difference (p = .002).

CONCLUSION(S)

Simulation education program improved dental hygiene students' POHC performance confidence. Various scenarios will need to be developed in the future, and it is necessary to evaluate simulation education within the dental hygiene curriculum and identify areas for improvement.

Simulation-based training program on patient safety management: A quasi-experimental study among new intensive care unit nurses

BACKGROUND

Patient safety is an essential responsibility of nurses. However, newly graduated nurses experience patient safety incidents due to a lack of patient safety competency. In particular, intensive care unit nurses provide care to critical patients, making it difficult for new nurses to maintain patient safety. Therefore, it is necessary to improve the patient safety competency of newly graduated nurses working in the intensive care unit.

OBJECTIVES

To analyze the effects of a simulation-based training program on patient safety management on the patient safety competency, patient safety management activity, communication self-efficacy, and teamwork of newly graduated nurses working in an intensive care unit.

DESIGN

A quasi-experimental study.

SETTINGS

The study was conducted at a university in Korea.

PARTICIPANTS

A total of 44 newly graduated nurses working in the intensive care unit of a university hospital.

METHODS

A simulation-based training program on patient safety management was applied to the experimental group (n = 22), while only the usual hospital training program was used for the control group (n = 22). A structured questionnaire survey comprising Patient Safety Competency Self-Evaluation, Patient Safety Management Activities, the Korean version of the self-efficacy questionnaire, and K-self assessment of teamwork was conducted at baseline test (T1), post test (T2), and follow-up test (T3). Data were analyzed using a repeated measures ANOVA.

RESULTS

The experimental group showed significantly higher patient safety competency, patient safety knowledge, and patient safety skills, along with higher communication self-efficacy scores than the control group (p < .05) after the intervention and at four weeks after the intervention.

CONCLUSIONS

The simulation-based training program on patient safety management effectively improved the patient safety competency, patient safety knowledge, and patient safety skills as well as communication self-efficacy of newly graduated nurses working in an intensive care unit.

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.

A systematic review of measurement instruments for oral health assessment of older adults in long-term care facilities by nondental professionals

BACKGROUND

Regular oral health assessment of older adults living in Long-term Care Facilities (LTCF) can improve their oral health.

AIMS

This study aimed to systematically review studies describing the development of instruments employed by nondental professionals to assess the oral health of older adults in LTCF and to evaluate their measurement properties.

MATERIAL & METHODS

Electronic searches were conducted in the MEDLINE (PubMed), Embase, Web of Science, Scopus, and LILACS databases. Measurement properties of the identified instruments were evaluated using the Consensus-based Standards to select health Measurement Instruments (COSMIN) checklist. Studies assessing at least one measurement property (validity, reliability, or responsiveness) of instruments used to assess oral health of older adults living in LTCF by nondental professionals were considered. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) checklist was used to evaluate the quality of evidence.

RESULTS

Fifteen studies reporting measurement properties of seven instruments were selected. The ohr-interRAI and the OHAT were considered to have sufficient content validity, with high and moderate evidence quality, respectively. OHAT, BOHSE, and DHI showed acceptable results on reliability but with very low quality of evidence. DHI and OHSTNP also showed acceptable results for criterion validity, but, with low quality of evidence, insufficient or unclear results were observed for the remaining measurement properties. Studies evaluating the validity criteria of BOHSE and hypotheses testing of ohr-MDS were considered to have high evidence quality.

DISCUSSION AND CONCLUSION

The ohr-interRAI can be provisionally recommended for use until further evidence is provided. Further methodologically rigorous studies are needed to assess the measurement properties of the existing instruments.

Mouth care training and practice: a survey of nursing staff working in National Health Service hospitals in England

Background

This study investigated the training and mouth care practice of nursing staff in hospital Trusts across England. Oral health has been found to deteriorate during hospital admission, mouth care standards have been found to be poor.

Aims

The objectives of the study were to assess if and what the barriers are to supporting inpatients' mouth care, and to assess how confident nursing staff are in carrying out mouth care assessments and mouth care and see if this is related to previous training.

Methods

A cross-sectional descriptive survey was conducted in 33 Trusts in England with 1576 members of the nursing team including nurses and nursing assistants. Nursing staff were asked to complete a questionnaire on previous oral health training and their current practice.

Results

Nursing staff reported that they had limited training in mouth care. The main barriers to mouth care were time and patient compliance. Confidence in recognising oral cancer was low.

Conclusions

Nursing staff would benefit from mouth care training targeted at assessing the mouth and providing mouth care for all inpatients.

The role of simulation-based training in healthcare-associated infection (HAI) prevention

Objectives:

To perform a review of the literature on the role of simulation-based training (SBT) in healthcare-associated infection (HAI) prevention and to highlight the importance of SBT as an educational tool in infection prevention.

Methods:

We reviewed English language publications from PubMed to select original articles that utilized SBT as the primary mode of education for infection prevention efforts in acute-care hospitals.

Results:

Overall, 27 publications utilized SBT as primary mode of education for HAI prevention in acute-care hospitals. Training included the following: hand hygiene in 3 studies (11%), standard precaution in 1 study (4%), disaster preparedness in 4 studies (15%), central-line–associated blood stream infection (CLABSI) prevention in 14 studies (52%), catheter-associated urinary tract infection (CAUTI) prevention in 2 studies (7%), surgical site infection prevention in 2 studies (7%), and ventilatory associated pneumonia prevention in 1 study (4%). SBT improved learner’s sense of competence and confidence, increased knowledge and compliance in infection prevention measures, decreased HAI rates, and reduced healthcare costs.

Conclusion:

SBT can function as a teaching tool in day-to-day infection prevention efforts as well as in disaster preparedness. SBT is underutilized in infection prevention but can serve as a crucial educational tool.

Hospital Dentistry for Intensive Care Unit Patients: A Comprehensive Review

This study aimed to review the oral hygiene status, oral care guidelines, and outcomes of oral care in intensive care unit (ICU) patients from a dental perspective for effective oral care. A literature search using the keywords "Hospital dentistry" OR "Oral care" OR "Intensive care unit" OR "Hospital inpatient" OR "Hospitalization" OR "Emergency service" AND "Oral health" OR "Oral hygiene" OR "Dental plaque" was conducted in PubMed, Medline, and Google Scholar to identify publications reporting on the oral care of the patients admitted to ICUs. A total of 17,400 articles were initially identified. Of these, 58 were selected and classified into three categories for critical review. Seven of these studies evaluated the oral status of ICU patients, and most of the studies indicated that ICU patients had poor oral hygiene or required active dental treatment. Thirty-three of these studies evaluated oral care methods for ICU patients, and in general, oral care methods using chlorhexidine as adjuncts along with tooth brushing were recommended. However, there were insufficient studies to evaluate oral hygiene through effective assessment tools from a dental perspective. In 36 studies on the outcomes of oral care in ICU patients, interventions by dental professionals showed effective results in preventing hospital-acquired infection. This review highlights the importance of establishing guidelines for the evaluation of oral status in ICU patients and summarizes data that may be useful for future studies. Further studies on maintaining good oral hygiene among ICU patients are needed.

Assessment of oral health in older adults by non-dental professional caregivers-development and validation of a photograph-supported oral health-related section for the interRAI suite of instruments

OBJECTIVES

An optimized oral health-related section and a video training were developed and validated for the interRAI suite of instruments. The latter is completed by professional non-dental caregivers and used in more than 40 countries to assess care needs of older adults.

METHODS

The optimized oral health-related section (ohr-interRAI) consists of nine items and a video training that were developed in consecutive phases. To evaluate psychometric properties, a study was conducted in 260 long-term care residents. Each resident was assessed by a dentist and by four caregivers (two who received the video training, two who did not).

RESULTS

Mean kappa values and percent agreement between caregivers and dentist ranged between κ = 0.60 (80.2%) for dry mouth and κ = 0.13 (54.0%) for oral hygiene. The highest inter-caregiver agreement was found for dry mouth with κ = 0.63 [95% CI: 0.56-0.70] (81.6%), while for the item palate/lips/cheeks only κ = 0.27 [95% CI: 0.18-0.36] (76.7%) was achieved. Intra-caregiver agreement ranged between κ = 0.93 [95% CI: 0.79-1.00] (96.4%) for dry mouth and κ = 0.45 [95% CI: 0.06-0.84] (82.8%) for gums. Logistic regression analysis showed only small differences between caregivers who watched the video training and those who did not.

CONCLUSIONS

Psychometric properties of the optimized ohr-interRAI section were improved compared to previous versions. Nevertheless, particularly the items based on inspection of the mouth require further refinement and caregiver training needs to be improved.

CLINICAL RELEVANCE

Valid assessment of oral health by professional caregivers is essential due to the impaired accessibility of regular dental care for care-dependent older adults.

Development of the Second Prototype of an Oral Care Simulator

Oral care is crucial to preventing diseases and maintaining the quality of life of elderly people. To create an effective training environment for nursing students, we developed a second prototype of an oral care simulator that can guide and record oral care practices. The simulator has three components: (1) a dentition model with pressure sensors, (2) a microcomputer to record signals, and (3) software for visualization. We proposed a novel mechanism to detect brushing behavior using pressure sensors and developed software to visualize the records of oral care practice. We calibrated the system to estimate the weights applied in the dentition model using a brush and verified that the calibration increased the accuracy of the estimation.

Development of an intensive care oral care frequency assessment scale

BACKGROUND

Oral care and frequency of oral care is important for intensive care patients in order to prevent the risk of ventilator-associated pneumonia. However, there are no scales to assess the frequency of oral care specific to intensive care units (ICUs).

AIMS AND OBJECTIVES

This study aimed to develop a valid and reliable tool, "Intensive Care Oral Care Frequency Assessment Scale (ICOCFAS)", for assessing the frequency of nurses' oral care in critical ill patients.

DESIGN

This was an instrument development study.

METHODS

The validity and reliability of the ICOCFAS, which consists of nine items, were tested using content validity (five expert opinions), construct validity (factor analysis), item analysis, and internal consistency analysis methods. The population of the research consisted of inpatients at the ICU of a hospital in Sakarya, Turkey. The research was conducted with 73 patients in the ICU.

RESULTS

Expert opinions on the content validity indicated that the scale was admissible. The Kaiser-Meyer-Olkin (KMO) coefficient was calculated at 0.800, and the Chi-square value of the Bartlett test was considerably significant (χ² = 270.539; P < .001). Using a path diagram in confirmatory factor analysis, Chi-square/df ratio values were calculated as 1.49, standardized root mean square residual as 0.077, comparative fit index as 0.97, and root mean square error of approximation as 0.082. Cronbach's alpha was 0.851. The correlations between the items and total scores were 0.455 to 0.835 and were statistically significant (P < .001).

CONCLUSIONS

The ICOCFAS is an efficient tool with high validity and reliability for assessing oral care frequency in the ICU.

RELEVANCE TO CLINICAL PRACTICE

The ICOCFAS is a valid and reliable tool for Turkish society for assessing the frequency of oral care of patients in the ICU. It is recommended for various national and international studies with different patients in ICUs.

The utilization of debriefing for simulation in healthcare: A literature review

The aim of this review was to examine how debriefings have been conducted in healthcare simulations. Using keywords, our search yielded 962 studies through databases. After removing duplicates, we found 20 studies that met inclusion and exclusion criteria. Through ancestry searches, we found two more studies. A total of 22 studies were reviewed. From each study, detailed information about debriefing was extracted based on six criteria, namely, timing, facilitator, place of occurrence, method, length, and structure. Various types of debriefings were available according to learning objectives, learners' abilities, availability of resources, and context of simulations. We found that peer-led debriefing might be more appropriate for experienced healthcare professionals than unlicensed students due to a gap in knowledge and problem-solving skills between them. In addition, we found that tele-debriefing was feasible in some studies. Although types of individual debriefing varied across the studies, a substantial number of debriefings closely aligned to the standards for high-quality debriefing.

Clinical simulation in nursing education in intensive therapy: an integrative review

OBJECTIVE

to analyze the publications on clinical simulation practices for education in Nursing in Intensive Care.

METHOD

an integrative review carried out through LILACS, PubMed, Cochrane Library, CINAHL and SciELO databases, of articles published from 2008 to 2017.

RESULTS

29 articles were selected, of which 76% discuss the use of simulation in continuing education of nursing professionals, while the others describe their use for student education. There is a higher prevalence of studies with a level of evidence 6 (17), with 28 international publications. There was an increase in scientific production, with 16 articles published in the last three years.

CONCLUSION

variables after simulation use, such as confidence, communication skills, efficiency in the identification of clinical worsening of patients, development of technical skills, teamwork and clinical decision-making, presented a significant improvement, demonstrating that this tool is effective in qualifying care for critical patients.

Improving Student's Self-Efficacy and Perceived Susceptibility Toward Oral and Dental Health: A Randomized Controlled Trial

Objectives

We sought to assess the impact of educational intervention on female junior high school students' perceived susceptibility and self-efficacy regarding oral and dental health.

Methods

We recruited 100 female junior high school students (50 in intervention and 50 in control group) from Falavarjan city using multistage random sampling. A self-administered questionnaire was used to gather data about study variables. Students in the intervention group attended five 90-minute sessions designed to teach the students about dental hygiene.

Results

We found no significant difference between the two groups with respect to the preintervention mean scores of knowledge, perceived susceptibility, and self-efficacy (p > 0.050). The postintervention mean scores in the intervention group were significantly higher than those in the control group (p < 0.050).

Conclusions

Training plans with particular behavioral goals and good instructional strategies can be useful in empowering students toward dental health.

The practice of dentistry in intensive care units in Brazil

Objective

To evaluate the practice of dentistry in intensive care units.

Methods

An observational survey study was conducted in which questionnaires were sent via the online platform for collaboration in intensive care research in Brazil (AMIBnet). The study was carried out from June to October 2017. The questionnaires, which contained 26 closed questions about hospitals and dentistry practices in the intensive care units, were sent to 4,569 professionals from different specialties practicing in the units.

Results

In total, 203 questionnaires were returned, resulting in a response rate of 4.44%. Most of the responses were from intensive care units in the Southeast region of the country (46.8%). Public hospitals (37.9%) and private hospitals (36.4%) had similar participation rates. Of the respondents, 55% indicated that a bedside dentistry service was present, and they were provided in different ways.

Conclusion

The presence of dentistry services and oral health service delivery training and protocols were correlated. The oral care methods varied greatly among the intensive care units surveyed.

Compliance of Nurses and Hospitals With Ventilator-Associated Pneumonia Prevention Guidelines: A Middle Eastern Survey

This study was a self-reported cross-sectional survey that investigated nurses' and hospitals' compliance with ventilator-associated pneumonia prevention guidelines and the barriers and factors that affect their level of compliance. A questionnaire was completed by 471 intensive care unit nurses from 16 medical centers in 3 Middle Eastern countries: Jordan, Egypt, and Saudi Arabia. The results show that both nurses and hospitals have insufficient compliance. Previous education, experience, and academic degree were all found to affect nurses' compliance.