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

Abstract

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.

Recall of pain and discomfort during oral procedures experienced by intubated critically ill patients in the intensive care unit: A qualitative elicitation study

“…Our results align with findings from recent video and photographic elicitation research identifying unmet patient needs for comfort, guidance, and empathy during routine oral interventions. 8 This finding was also supported by Rose and colleagues, who described ICU nurses’ recognition of patient behaviors such as the inability to follow commands, gagging/coughing, and pulling at oral tubes as indicative of pain less than 50% of the time. 33 Recent research demonstrates that lack of pain appraisal or treatment before oral interventions independently predicts responsive patient behaviors (e.g., grimacing, biting, turning the head side to side, gagging).…”

“…This qualitative study was embedded in a larger research project studying the prevalence of adult ICU patient behaviors during oral care. 8 In this article, we report on the procedural oral pain recollections of intubated and mechanically ventilated patients, what it is like to experience such pain, and their recommendations for practice improvement.…”

“…7 Recent developments in pain inquiry include examination of procedures involving the mouth and throat, such as oral suctioning of secretions and preventative oral hygiene. 8 A constellation of dehydrating oral stressors during ICU treatment contribute to reduced salivary flow and xerostomia (i.e., severe dryness). 9 Loss of buffering, lubricating, and antimicrobial properties of saliva result in reduced oral pH, inflammation, and infection.…”

Comparison Elicitation Techniques in Furniture Manufacture Requirement

“…Requirement elicitation is the process of collecting, exploring, finding and studying the needs of customers, users and stakeholders, so that the application developed can help solve problems and meet customer needs [7][8]. The requirement elicitation process is expected to determine user expectations and obtain the essential requirements for the program's success [9][10]. The application of requirement elicitation in the manufacturing industry can help understand the problems that arise by translating inappropriate or incomplete needs and desires from users to obtain complete and precise specifications [11][12].…”

Fundamentals of care: Methodologies, metrics and mobilisation

“…Well, I would say we continue to refine our observational studies and aggregate them to help us understand the attitudinal, behavioural, cultural and systemic issues we need to unravel in order to understand how to develop and test robust fundamental care interventions. We have examples of novel methodologies in this special issue such as the use of videos and photography in both identifying patient care needs (Dale, Angus, Sutherland, Dev, & Rose, 2019) as well as generating ways to improve inter‐rater reliability in measurement testing and refinement (van Ingen Schenau‐Veldman, Niemeijer, Lamberts, & Nieuwenhuis, 2019).…”