Nurses’ practice and educational needs in oral care for postoperative patients with oral cancer in ICUs: a multicenter cross-sectional study

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.

Assessment of Nursing Staff\'s Knowledge, Attitude and Practice Regarding Oral Hygiene Care in Intensive Care Unit Patients: A Multicenter Cross-sectional Study

“…Most of the participants in our study agreed that plain saline is the best substance to use when maintaining oral hygiene in ICU patients which was in accordance with studies by Adib-Hajbaghery M et al and Wei et al in which 69.2 and 82.7% of individuals used regular saline as their primary mouthwash, respectively. 17 , 18 In contrast the findings of a few recent meta-analyses revealed that using mouthwashes containing povidone-iodine and chlorhexidine rather than saline effectively reduced the incidence of VAP in ICU patients. 19 – 21 These findings support the need for greater dissemination of oral health knowledge and for improvement of Indian nurses’ capacity for evidence-based nursing.…”

Impact of oral health management by nurses and dental professionals on oral health status in inpatients eligible for the Nutrition Support Team: A longitudinal study

“…[22][23][24] Therefore, proper training in oral health management is an unmet need in this profession. 20,21,25 A previous study reported that oral health management provided by nurses, based on a simple protocol including twice-daily tooth brushing and mouthwash after lunch, improved the oral health of patients with subacute stroke in a short period of time. 32 In addition, oral health management based on oral health management guidelines provided by nurses under the supervision of dental hygienists could improve the oral hygiene of older adult residents in a facility.…”

“…Furthermore, it is clear that the curricula used for training nurses do not provide sufficient education in oral health management 22–24 . Therefore, proper training in oral health management is an unmet need in this profession 20,21,25 . A previous study reported that oral health management provided by nurses, based on a simple protocol including twice‐daily tooth brushing and mouthwash after lunch, improved the oral health of patients with subacute stroke in a short period of time 32 .…”

“…[22][23][24] Thus, many nurses may need the instruction from dental professionals to properly conduct oral health management. 20,21,25 From the viewpoint of standardisation and equalisation of health care, dental professionals should instruct nurses on oral health management. However, the effectiveness of oral health management provided by nurses instructed on oral health management by dental professionals and that provided by dental professionals for patients eligible for NST remains undetermined.…”

“…In fact, it has been reported that there is a lack of content related to oral health in nursing education programs 22–24 . Thus, many nurses may need the instruction from dental professionals to properly conduct oral health management 20,21,25 . From the viewpoint of standardisation and equalisation of health care, dental professionals should instruct nurses on oral health management.…”