Nurses' practices and obstacles to oral care quality in intensive care units in Upper Egypt

Abstract

Background: Oral care is one of the fundamental nursing care procedures used to decrease oral colonization, dental plaque, respiratory infections, and patient stay and cost.Aims: This study aimed to identify intensive care unit (ICU) nurses' self-assessment of oral care frequency, skill competency, documentation, oral care tools, and obstacles to oral care quality. In addition, it proposed exploring associations between nurses' attitudes about the importance of oral care and the priority of other interventions. Study design and setting:A cross-sectional descriptive study was conducted in two ICUs (trauma and general) in the main teaching hospital in Upper Egypt. Of 105 nurses selected using convenience sampling, 91 completed the questionnaire.Results: About 60.4% of ICU nurses did not attend any oral care training programme, 40.7% reported performing oral care four times per shift in intubated patients, 62.6% reported that their skills needed improvement, 37.4% saw themselves as competent, and 86.8% documented oral care in patients' records. Significant positive correlations were found, indicating that nurses' attitudes towards the importance of oral care showed the same tendency as the priority given to other interventions, such as eye care, bowel care, documentation, hygiene, catheters, feeding, and wound care (correlation coefficient [r] = 0.290, 0.511, 0.333, 0.425, 0.431, 0.345, and 0.337, respectively). Furthermore, a toothbrush (84.6%) was often used, while chlorhexidine was not used (90.1%). The major obstacles to the provision of oral care as perceived by the nurses were the fear of aspiration and life-threatening interventions (95.6%), inadequate nurse-patient ratios (94.5%), irregular competency evaluations (92.3%), unavailability of oral care guidelines (92.3%), and shortage of time (84.6%). Conclusion:The participating nurses were mindful of the importance and priority of oral care. Many of them did not attend oral care training programmes and considered that their skills needed improvement. Moreover, ICU nurses reported many obstacles hindering oral care quality.Relevance to clinical practice: This research identifies the importance of developing in-service oral care training programmes to improve ICU nurses' skill competency.High-quality oral care can be provided by focusing on and overcoming obstacles that hinder nurses' oral care practice.

Spotlight on simulation and tool assessment and development

“…Other papers in this issue analyse nurses' knowledge and practices related to oral care 12 and central line‐associated bloodstream infections 13 ; the demand on and efficacy of critical care outreach service during the COVID‐19 pandemic 14 ; and the development and implementation of a family‐centred transition intervention programme led by an intensive care unit liaison nurse 15 …”

“…This issue also includes a set of methodological papers focusing on the development and and/or evaluation of instruments that support critical care practice or research. Chen et al 6 assessed the predictive validity of the Jackson-Cubbin scale for pressure ulcers through a systematic review and meta-analysis, do Nascimento et al 7 Other papers in this issue analyse nurses' knowledge and practices related to oral care 12 and central line-associated bloodstream infections 13 ; the demand on and efficacy of critical care outreach service during the COVID-19 pandemic 14 ; and the development and implementation of a family-centred transition intervention programme led by an intensive care unit liaison nurse. 15 The issue concludes with two paediatric and neonatal care papers: a case study of the postoperative care provided to an infant who underwent pulmonary artery tracheal transposition with slide tracheobronchial keratoplasty 16 and a systematic review with meta-analysis on the effects of the mother's voice on painful procedures among pre-term and full-term infants.…”