Ethnographic Investigation of Oral Care in the Intensive Care Unit

Dale, Craig; Angus, Jan; Sinuff, Tasnim; Rose, Louise

doi:10.4037/ajcc2016795

Cited by 19 publications

(20 citation statements)

References 53 publications

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“…In this first video and photographic elicitation study of difficulty accessing the mouths of intubated and mechanically ventilated adults for oral care, a key finding identified by participants was the observation of substantial procedural pain during oral care interventions. Similar to prior research, we found oral crowding with tubes and aversive patient responses to result in insufficient oral care (Dale, Angus, Sinuff, & Rose, ; Jongerden et al, ). Findings include important differences in ICU and non‐ICU health professional oral health language and training (Hein et al, ).…”

Section: Discussionsupporting

confidence: 88%

Exploration of difficulty accessing the mouths of intubated and mechanically ventilated adults for oral care: A video and photographic elicitation study

Dale

Angus

Sutherland

et al. 2019

Journal of Clinical Nursing

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Aim:To explore descriptors of difficulty accessing the mouths of intubated and mechanically ventilated adults for oral care, consequences, modifiable antecedents and recommendations for improving care delivery.Background: Nurses report oral access and care delivery difficulty in most mechanically ventilated patients. Design:A prospective qualitative descriptive design.Methods: Data were collected using video and photographic elicitation interviews focused on delivery of oral care. Directed content analysis was used to explore descriptive categories. Reporting used the SRQR guidelines. Setting and participants:A university-affiliated hospital in Toronto, Canada.Participants included clinicians experienced in accessing the oral space of adults representing nursing, medicine, dentistry and allied health professionals.Findings: We recruited 18 participants; 9 representing critical care and 9 other specialties frequently accessing the mouth, that is dentistry. Descriptors for observed difficulty accessing the oral cavity were "oral crowding with tubes" and "aversive patient responses", which were considered to result in insufficient oral care.Participants perceived aversive patient responses (e.g. biting, turning head side to side, gagging, coughing) as a consequence of forced introduction of instruments inside a crowded mouth. A key finding identified by participants was the observation of substantial procedural pain during oral care interventions. Potentially modifiable antecedents to difficult oral care delivery identified were procedural pain, oral health deterioration (e.g. xerostomia) and lack of interprofessional team problem-solving.Recommendations to address these antecedents included patient preparation for oral care through verbal and nonverbal cueing, pharmacological and nonpharmacological strategies, and ICU interprofessional education. Conclusions:Oral care in mechanically ventilated adults is complex and painful. Visual research methods offer important advantages for oral care exploration including its | 1921 DALE Et AL.

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Section: Discussionsupporting

confidence: 88%

Exploration of difficulty accessing the mouths of intubated and mechanically ventilated adults for oral care: A video and photographic elicitation study

Dale

Angus

Sutherland

et al. 2019

Journal of Clinical Nursing

View full text Add to dashboard Cite

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“…This is in line with a recent multicenter study demonstrating that oral care was the most frequently missed hygienic activity in hospitals across 12 countries . The reason could be lower priority given to the core principles of nursing, including oral hygiene in today's complex and time‐pressured healthcare environment . The obvious solution to the lack of adequate time could be to delegate the task to a dental hygienist.…”

Section: Discussionsupporting

confidence: 77%

“…35 The reason could be lower priority given to the core principles of nursing, including oral hygiene in today's complex and time-pressured healthcare environment. 36 The obvious solution to the lack of adequate time could be to delegate the task to a dental hygienist.…”

Section: Attitudes Towards Hospital Supplies Equipment and Timementioning

confidence: 99%

Survey of oral nursing care attitudes, knowledge and practices in a neurorehabilitation setting

Odgaard¹,

Kothari

2019

J of Oral Rehabilitation

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The provision of oral care is an important fundamental nursing activity. The purpose of the study was to gain knowledge on nursing care professionals´ attitude, belief, knowledge and practice towards oral care in a neurorehabilitation setting. Nursing care professionals (n = 260, response rate: 60%) at neurorehabilitation hospital took part in cross‐sectional web‐based 59‐items survey. Attitudes were cross‐tabulated and compared using Fisher's exact test. Oral care product frequencies were compared between patients with/without eating difficulties using McNemar's test. Most professionals agreed that oral health impacts general health (93%) and poor oral health can cause pneumonia (85%). 41% professionals found it difficult to clean the oral cavity and 12% found it unpleasant. 40% indicated that time allocated for oral hygiene was insufficient, 27% indicated a need for broader range of oral care supplies and >80% would like continuing oral care education. Manual toothbrush and toothpaste were used more than once per shift by >75% in all patients. Swabs, premixed mouth rinse, carbonated water and lip moisturiser were more frequently used in patients with eating difficulties compared to with no eating difficulties. Oral care is perceived as an essential component of care in neurorehabilitation. However, professionals indicated lack of time, need for better supplies and oral care training. The differentiated use of oral care products shows that professionals were aware that patients with eating difficulties have different requirements; however, some oral care practices were inappropriate. The results should be considered while designing oral care guidelines and training.

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“…[3] CHX was also proven to be an essential mouthwash among patients hospitalized in ICU through numerous studies. [17,20,21] Normal saline was used by the majority (89%) of participants working in the ICU. However, a study revealed normal saline has a drying effect on the oral mucosa and not recommended; [16] and therefore would exacerbate an already dry mouth in a ventilated patient.…”

Section: Knowledge Of Comprehensive Oral Carementioning

confidence: 99%

“…A comprehensive oral care protocol and attendant compliance can significantly reduce VAP rates. [21,27] Similarly, a study in Sudan showed not having a protocol influenced nurses' practice. [11] Furthermore, the presence of service delivery protocol rendered bedside dentistry services delivery more organized on the unit.…”

Section: In-service Trainingmentioning

confidence: 99%

Oral care practices of nurses on ventilated patients in Kigali Intensive Care Unit

Rumagihwa¹,

Bhengu²

2018

Rwanda Journal of Medicine and Health Sciences

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Background Oral care in the Intensive Care Unit (ICU) is an essential intervention proven to prevent Ventilator Associated Pneumonia (VAP). VAP results in increased morbidity and mortality, with excess hospital stay and cost. Oral care is a critical intervention that controls the accumulation of oral pathogens; however, it is viewed as a comfort measure and not a critical life-saving intervention. Objective To assess the oral care provided to ICU ventilated patients by nurses at a referral hospital in Kigali. Methods This cross-sectional design used a convenience sample of 47 nurses at a referral hospital in Kigali. Descriptive statistics were used for data analysis. Results The majority of nurses (89.4%) used normal saline for comprehensive mouth care on ICU patients. The majority reported they never used a toothbrush (53.2%) toothpaste (63.8%), or Chlorhexidine solution (89.4%), which are the recommendation. One third (34%) do not perform the oral assessment on admission. There is no ICU oral care protocol, and oral hygiene supplies are limited. Conclusion Oral care is critical care in VAP prevention. ICU nurses reported a low level of oral care practice. We recommend an oral care protocol and in-service training to improve the quality of oral care to ICU ventilated patients.

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Ethnographic Investigation of Oral Care in the Intensive Care Unit

Cited by 19 publications

References 53 publications

Exploration of difficulty accessing the mouths of intubated and mechanically ventilated adults for oral care: A video and photographic elicitation study

Exploration of difficulty accessing the mouths of intubated and mechanically ventilated adults for oral care: A video and photographic elicitation study

Survey of oral nursing care attitudes, knowledge and practices in a neurorehabilitation setting

Oral care practices of nurses on ventilated patients in Kigali Intensive Care Unit

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