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Ribeiro Bersaneti MD, Lobo RD, Brandão TB, Silva Souza RC, Poveda VDB. Oral hygiene in critically ill patients at a tertiary hospital in São Paulo, Brazil: a best practice implementation project. JBI Evid Implement 2024:02205615-990000000-00084. [PMID: 38505992 DOI: 10.1097/xeb.0000000000000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVES This project aimed to promote evidence-based practices relat. ed to the oral health of critically ill patients in an intensive care unit in Brazil. INTRODUCTION The oral hygiene of patients on mechanical ventilation is an essential component of nursing care quality, and well-defined guidelines ensure appropriate care. Mechanical ventilation is associated with the risk of ventilator-associated pneumonia, which can increase mortality, length of stay, time on mechanical ventilation, and hospital costs. METHODS This project was guided by the JBI Evidence Implementation Framework, which consists of seven stages: (1) identification of the area of practice to be changed, (2) involvement of change agents, (3) context assessment and readiness for change, (4) review of practices against evidence-based audit criteria, (5) implementation of practice changes, (6) reassessment of practices using a follow-up audit and (7) consideration of the sustainability of changes in practice. RESULTS Four audit criteria were developed to evaluate compliance with best practices. In the follow-up audit, Criteria 1, 2, and 3 obtained compliance of ≥ 80%. Thus, for Criterion 1, all the patients on mechanical ventilation for more than 24 hours were evaluated by the oral medicine team, resulting in 100% compliance. For Criterion 2 on appropriate oral hygiene measures, a compliance rate of 80% was achieved. For Criterion 3, 39 professionals (90.7%) participated in educational activities related to the oral health protocol for critically ill patients, obtaining 90.7% compliance. For Criterion 4 regarding patients being evaluated before receiving any oral health care, improvement was low (only 50%), revealing the need for further improvement. CONCLUSION This best practice project improved the professional practice of nursing staff and increased compliance with best practices for the oral health of critically ill patients. SPANISH ABSTRACT http://links.lww.com/IJEBH/A175.
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Affiliation(s)
| | | | | | | | - Vanessa de Brito Poveda
- Brazilian Centre for Evidence-based Healthcare: A JBI Centre of Excellence, School of Nursing of the University of São Paulo, São Paulo, Brazil
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Iyer K, AlKhalifah K, Alshahrani BN, Ibrahim Alghamdi SS, Albishi S, A Alsheraihi AA, Al Sudairy N. 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. Cureus 2023; 15:e50682. [PMID: 38229773 PMCID: PMC10791100 DOI: 10.7759/cureus.50682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 01/18/2024] Open
Abstract
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.
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Affiliation(s)
- Kiran Iyer
- Dental Public Health, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Khalifah AlKhalifah
- College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Bader Nashir Alshahrani
- College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, Ministry of National Guard Health Affairs, Riyadh, SAU
| | | | - Sultan Albishi
- College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, Ministry of National Guard Health Affairs, Riyadh, SAU
| | | | - Nawaf Al Sudairy
- College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, Ministry of National Guard Health Affairs, Riyadh, SAU
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Marquès-Pellejà G, Roqueta-Vall-Llosera M, Cámara-Liebana D, Mantas-Jiménez S, Gelabert-Vilella S, Baltasar-Bagué A, Reig-Garcia G. Assessing the Student Nurses' Knowledge of Oral Health Care. NURSING REPORTS 2023; 13:1126-1137. [PMID: 37606465 PMCID: PMC10443348 DOI: 10.3390/nursrep13030097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/23/2023] Open
Abstract
Oral health is crucial for the overall well-being and quality of life, and nurses play a significant role in promoting it. This study assessed the oral health knowledge of fourth-grade nursing degree students. Seventy-two students completed a questionnaire covering sociodemographic variables, oral health-related factors, knowledge about oral health, and perceptions of its importance and learning experiences. The results showed that 83.3% of students attended regular dental check-ups for preventive purposes, and 55.6% had visited a dentist during the last year. Most of the students reported experiencing cavities (66.7%) and undergoing orthodontic treatment (54.2%). The average knowledge score in oral health was 6.4 out of 10, and students recognized the importance of oral health in the nursing role. However, their knowledge acquired during their nursing degree scored relatively low, being 2.5 out of 5. Notably, students who valued problem-based learning achieved higher knowledge scores (p < 0.05). Overall, fourth-grade nursing students demonstrated a moderate level of oral health knowledge. Improving oral health education within nursing curricula, particularly through problem-based learning, is essential to enhance their preparedness in addressing oral health issues effectively. This study was not registered.
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Affiliation(s)
| | - Marta Roqueta-Vall-Llosera
- Department of Nursing, Faculty of Nursing, University of Girona, C/Emili Grahit, 77, 17003 Girona, Spain
- Health Gender and Aging Research Group, University of Girona, 17003 Girona, Spain
| | - David Cámara-Liebana
- Department of Nursing, Faculty of Nursing, University of Girona, C/Emili Grahit, 77, 17003 Girona, Spain
- Quality of Life Institute Research Group, University of Girona, 17003 Girona, Spain
| | - Susana Mantas-Jiménez
- Department of Nursing, Faculty of Nursing, University of Girona, C/Emili Grahit, 77, 17003 Girona, Spain
| | - Sandra Gelabert-Vilella
- Department of Nursing, Faculty of Nursing, University of Girona, C/Emili Grahit, 77, 17003 Girona, Spain
- Health and Health Care Research Group, University of Girona, 17003 Girona, Spain
| | - Alícia Baltasar-Bagué
- Department of Nursing, Faculty of Nursing, University of Girona, C/Emili Grahit, 77, 17003 Girona, Spain
| | - Glòria Reig-Garcia
- Department of Nursing, Faculty of Nursing, University of Girona, C/Emili Grahit, 77, 17003 Girona, Spain
- Health and Health Care Research Group, University of Girona, 17003 Girona, Spain
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Bestwick C, Yates C, Carter V. Developing an oral healthcare assessment strategy to enhance patient care. Nurs Stand 2023; 38:41-47. [PMID: 36872892 DOI: 10.7748/ns.2023.e12000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 03/07/2023]
Abstract
The promotion of oral healthcare is an integral part of nursing care. However, research has shown that staff in hospitals and community care settings often lack oral healthcare skills. This article details a quality improvement project in which a scoping exercise was undertaken in one NHS trust to assess whether ward-based oral healthcare provision was adequate. The scoping exercise identified that there was a need to address the lack of oral healthcare provision in the trust. Subsequently, a multidisciplinary working group developed an oral healthcare assessment tool and rolled this out across the trust. The authors also provided online training for nurses in the trust to assist them in using the new tool. At the same time, an audit of the oral healthcare products used in the trust, and their appropriateness, was undertaken.
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Affiliation(s)
| | - Caroline Yates
- The Royal Wolverhampton NHS Trust, Wolverhampton, England
| | - Vanda Carter
- The Royal Wolverhampton NHS Trust, Wolverhampton, England
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Knowledge, attitudes and practices of nurses regarding oral hygiene of dependent inpatients. ENFERMERIA CLINICA (ENGLISH EDITION) 2023; 33:22-29. [PMID: 35680116 DOI: 10.1016/j.enfcle.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/16/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Assess nurses' knowledge, attitudes and practices towards oral hygiene of dependent inpatients. METHODS Quantitative, descriptive, and cross-sectional study. Data were collected through a self-administered questionnaire applied to 100 nurses from internal medicine wards of two hospitals in Northern Portugal, which assessed three dimensions: knowledge, attitudes, and practices regarding oral hygiene. Knowledge, attitudes, and practices in oral care were summarized in statistical descriptions including percentages, frequencies, means, and standard deviations using SPSS version 23 for data analysis. RESULTS The mean total knowledge score was 13.98 out of 22 and the participants' mean score of the attitudes towards oral care was 48.35 out of 60 points. All participants acknowledge the importance of oral care for inpatients, with 96% associating poor oral hygiene with systemic disease. As for practices, 90% of participants assess the need for oral care of inpatients in the first 24 h, and 61% document the result of this assessment. CONCLUSION The results show that although participants are aware of the importance of oral care, knowledge and practices are not consistent. Concerning oral health practices, it is urgent to narrow the gap between evidence and practice and promote oral care standardization.
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Stark P, McKenna G, Wilson CB, Tsakos G, Brocklehurst P, Lappin C, Quinn B, Mitchell G. Interventions supporting community nurses in the provision of Oral healthcare to people living at home: a scoping review. BMC Nurs 2022; 21:269. [PMID: 36199087 PMCID: PMC9533519 DOI: 10.1186/s12912-022-01051-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Oral health is a critical issue for public health and poor oral health is associated with significant chronic health conditions and lower quality of life. There has been little focus on providing oral health care to people who receive care in their own homes, despite the high risk of poor oral health in older people. Nurses practicing in the community are well placed to deliver this care, but little is known about how to build this capability through education or training interventions. Methods A scoping review methodology was employed to find and review studies of oral health interventions involving populations of people receiving care in their own home or those nurses who deliver this care. The research question asked what previous research tells us about oral health interventions delivered by nurses in the community. Data was extracted for four areas: setting and type of intervention, patient outcomes, changes to nursing practice and implementation and process evaluations of interventions. Results Two thousand eighty papers were found from the searches, and only nine were ultimately deemed eligible for inclusion in the review. Included studies spanned community nursing for older people (n = 3) and health visiting or community nursing for children and infants (n = 6). Patient outcomes were generally positive, but this is based on a low level of evidence. Changes to practice including increased oral health care administered by nurses were found, but this required professional support to be sustainable. Conclusions This review has found that there is a clear gap in the research around interventions designed to be used by community nurses to improve oral health care for people receiving care in their own homes. The results also suggest that any future intervention must make use of a participatory, co-design approach and consider the complex setting of nursing practice in the community and the barriers to delivering this care, such as time pressure and lack of prior experience.
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Affiliation(s)
- Patrick Stark
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
| | - Gerry McKenna
- Centre for Public Health, Belfast, Queen's University Belfast, Belfast, Northern Ireland
| | | | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | | | - Caroline Lappin
- Department of Health, Castle Buildings, Stormont, Belfast, Northern Ireland
| | - Barry Quinn
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
| | - Gary Mitchell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland.
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Wei X, Jing M, Zhang X, Li C, Li L. Nurses' practice and educational needs in oral care for postoperative patients with oral cancer in ICUs: a multicenter cross-sectional study. BMC Oral Health 2022; 22:389. [PMID: 36071441 PMCID: PMC9454168 DOI: 10.1186/s12903-022-02426-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/30/2022] [Indexed: 12/24/2022] Open
Abstract
Background Surgical incision, endotracheal intubation, structural changes in the oral cavity, and other factors lead to a divergence in oral care between patients after oral surgery and ordinary inpatients. High-quality oral care can reduce the incidence of incision infection and ventilator-associated pneumonia. However, there is a lack of guidelines or expert consensus on oral care after oral cancer surgery. Therefore, the aim of this study was to assess the practicing situation of nurses in the intensive care unit (ICU) for postoperative patients with oral cancer and their need for training. Methods A multicenter cross-sectional study design was conducted in 19 ICUs of 11 tertiary hospitals from Henan province in China. Data were collected from 173 nurses and 19 head nurses online using a structured questionnaire. Mann–Whitney U and Kruskal–Wallis H tests were performed to analyze the data using SPSS (Version 25.0). Results Seven ICUs (36.8%) developed evaluation regulations for the oral care of postoperative patients with oral cancer, and eight ICUs (42.1%) described the operating standards. A total of 173 nurses completed the questionnaire, and the median score was 75 (68, 78). Almost all of the examined nurses (91.2%) assessed patients’ oral hygiene at a fixed time, while in 52.0% and 28.3% of nurses, the first oral care and frequency of oral care after surgery was determined based on the individual patient’s situation. More than half of the nurses (55.5%) spent approximately 5–10 min conducting oral care for patients. Physiological saline solution (82.7%), swabbing (91.9%), and oral care package with cotton ball (86.1%) were the most popular oral care mouthwash, method, and tool, respectively. Nurses sought help from senior nurses (87.3%) and doctors (83.8%), mostly to solve difficulties of oral care. Moreover, 76.9% of the nurses believed that the lack of knowledge and skills surrounding oral care was the main barrier for nurses to implement oral care. The majority of participants (69.4%) had never received continuing education or training in oral care for postoperative patients with oral cancer, and almost all (98.8%) of the respondents stated their preference to receive training in standardized oral care skills. Indications and contraindications (84.4%), tools (81.5%), and mouthwash (80.9%) of oral care were the items that the respondents were most eager to learn about. Approximately three quarters of nurses preferred scenario simulation practice as the training method. Conclusion Although the participants had high oral care scores for postoperative patients with oral cancer, there was great diversity in the practice. The lack of oral care knowledge was deemed the main barrier in delivering quality oral care, and the educational need was stated by almost all participants. We suggest that a standard protocol or clinical practice guidelines for oral care for postoperative patients with oral cancer should be developed, and nurses should be educated to equip them with professional knowledge and skills.
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Affiliation(s)
- XiaoJing Wei
- Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou, Henan, China
| | - MengJuan Jing
- Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou, Henan, China
| | - XianXian Zhang
- Department of Infectious Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou, Henan, China
| | - ChunPeng Li
- Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou, Henan, China
| | - LiMing Li
- Department of Nursing, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou, Henan, China.
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Andrade-Leite DB, Martins-Santos SC, Marques-Gomes SM, Oliveira IDJ. Conocimientos, actitudes y prácticas enfermeros en materia de higiene bucal de los pacientes hospitalizados dependientes. ENFERMERIA CLINICA 2022. [DOI: 10.1016/j.enfcli.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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