Intensive care nurses' knowledge, attitudes and practices of oral care for patients with oral endotracheal intubation
Date
2016-11-03
Authors
Tembo, Esther
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Abstract
Oral hygiene is the basic nursing care activity that promotes health, comfort and pleasant
environment that everyone needs. Studies have shown that oral care is not only influenced
by knowledge but also the characteristics of the environment. Providing effective oral
hygiene in ICU can be challenging due to patient’s medical conditions, treatment,
equipment and consciousness level of these critically ill patients. Oral care that is evidence
based has proved to overrule this challenge. Studies have shown that the mouth of
critically ill patients become colonized with bacteria within 48 hours of admission (Garcia
et al. 2009; Grap et al. 2009; Sole et al. 2002). Evidence-based oral care interventions can
assist in the prevention of colonization of the mouth by bacteria capable of causing serious
and often fatal respiratory infections, such as ventilator associated pneumonia.
The purpose of this study was to investigate ICU nurses knowledge, attitudes and practices
related to oral care for intubated patients with the associated factors of the same. The
intention of the study was also to make recommendations for clinical practice and
education of ICU nurses.
A non-experimental, quantitative, descriptive and cross-sectional design was used to
evaluate ICU nurses knowledge, attitudes and practices regarding evidence-based
guidelines and recommendations about oral care for intubated critically ill patients. Data
were collected from ICU nurses who were purposively selected using a validated
questionnaire (Lin, Chang, Chang and Lou, 2011) to obtain the quantitative results on their
knowledge, attitudes and practices of oral care for intubated patients. Data analysis was
done by means of descriptive and inferential statistics using graphs, frequency
distributions, means and standard deviations and Spearman’s rank order correlation
coefficient (rho) and Kruskahl Wallis H test. Testing was done at the 0.05 level of
significance.
The knowledge, attitudes and practices of 81 nurses working in 5 adult ICUs from one
university-affiliated, public sector hospital and tertiary level institution in Johannesburg
was tested using the data collection instrument. Knowledge, attitude and practices of
trained ICU nurses working in the ICUs were found to be lacking in the evidence-based
practice guidelines and recommendations. Of the 81 participants, the mean score for
knowledge, attitudes and practices were 31.84%, 60.02% and 52.25%, respectively. A
higher level of qualification and years of intensive care experience were not significant
factors related to knowledge and the frequency of performing oral care. Although, ICU
nurses learning from multiple sources about oral care will improve knowledge and
increase the frequency with which they provide oral care for patients. In this study, the
correlation coefficients were small; therefore the implications of these findings should be
viewed with caution. Overall the findings show that ICU nurses lack knowledge on best
practice in the implementation of oral care for patients with endotracheal intubation.
Recommendations to address this lack of knowledge were made for ICU nurses to learn
more about oral care using a combination of different educational strategies, which will
enhance knowledge and improve their practice.
Description
A research report submitted to the
Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
in partial fulfilment the requirements for the degree
of
Master of Science in Nursing
Johannesburg, 2016