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This is the first clinically focused nursing study published from the United Arab Emirates. It could be the first research presentation from the country at an international event. However, it is simple reflecting the beginning nature of the author. Trained Nurses’ Knowledge and Reported Practice of Mouth Care on Three Wards in Acute Care Hospital in Abu Dhabi, UAE. by Belal M Hijji, Department of Nursing Mafraq Hospital, Abu Dhabi, United Arab Emirates Prepared for The Centennial Nursing Conference, Beirut, June 30 – July 2, 2005 Published in the Online Journal of Brazilian Nursing www.uff.br/nepae/objn203hijji.htm 2 DEFINITION OF RESEARCH • “Research is a means of understanding, assessing and evaluating what we do as nurses” (1). 1. BURNARD, P. & MORRISON, P. Nursing research in action: developing basic skills. London, Macmillan, 1990. 3 BACKGROUND Mouth care, an essential nursing procedure, helps to maintain a comfortable, clean, moist and infection free mouth. Poor knowledge has the potential to compromise the quality of patient care and result in unsafe practice. Therefore, it is crucial for nurses to have up-to date knowledge and skills of oral care. In the UAE, there is no evidence of nurses‘ knowledge and practice and,thus, no baseline data on which improvement efforts may proceed. 4 AIMS OF THE STUDY • Investigate nurses’ knowledge and reported practice of oral care. • Identify nurses' perceived barriers to good practice. • Establish an association, if any, between nurses’ knowledge and practice and their demographics. 5 METHOD Cross-sectional exploratory survey. All 58 nurses on three wards in a general hospital represented the target population.The questionnaire generated information about personal data, education and level of knowledge and practice of mouth care. Nurses were supervised during questionnaire completion. 6 RESULTS 46 nurses (79%) participated in the study. Multiple factors interact culminating in poor oral care. 1. Knowledge deficits: • Importance of oral assessment (Graph 1) • Indicators of healthy mouth (Slide 13, Graph 2) • Drug effects on mouth health (Table 1, Slide 22) 7 RESULTS • • 2. • • Frequency of mouth care (Table 2) Materials ideal for mouth care (Table 3) Practice deficits: Deficient reported oral assessments (Graph 3) Limited categories of patients reported to be assessed (Table 4) 8 RESULTS • • • Limited use of brush and paste (Table 5A&5B) Use of materials that are ineffective or could be potentially harmful (Table 5A & 5B) Lack of oral assessment guide 9 NURSES’ PERCEIVED BARRIERS TO GOOD MOUTH CARE • • • • • • • Lack of materials (n=19) Lack of time (n=17) staff shortages (n= 15) Uncooperative patients (n= 16) Lack of assignment system (n= 4) 17 nurses identified one barrier 19 nurses identified more than one barrier 10 INFLUENCE OF DEMOGRAPHICS ON KNOWLEDGE AND PRACTICE At 95% CI, no statistically significant differences were detected among groups due to small numbers of nurses having certain demographic characteristics 11 CONCLUSION AND RECOMMENDATIONS • Individual results of the study were communicated to participating wards • Nurses urged not to use Hydrogen Peroxide 3% • Regular supply of paste and brush provided • Resource material on oral hygiene provided to nurses 12 Graph (1) Important Not important Nurses responses 13 Indicators of Healthy Mouth • • • • • • • Clean teeth No infection Pink mucosa Pink tongue Moist tongue No dentures debris Normal swallow Moist mucosa Smooth lips Pink lips Moist lips Watery saliva Voice 14 Graph (2) Number of indicators identified by nurses Indicators Nurses 15 Table (1) Drug Steroids N 6 Nurses % 23% Antibiotics 5 19% Radiotherapy 4 15% Chemotherapy 4 15% Immunosuppressants 4 15% Epaneutin 3 12% Iron 3 12% Other drugs 6 23% 16 Table (2) Patient condition Frequency of care/hr & number of nurses stating each frequency 1-6 >6-12 >12-18 >18 Dehydrated 36 7 -- 2 Oxygenated 32 13 1 -- Has oral infection 39 5 -- -- Unconscious 32 13 -- 1 As a preventive measure 13 26 -- 3 17 Table (3) Nurses response N of ideal equipment % Nurses response of ideal solution N % Oral care set 19 41.3 Toothpaste 18 38.1 Toothbrush Tongue depressor & gauze Other equipment 18 7 38.1 Hydrogen per 3% 16 15.2 Normal saline 15 34.8 32.6 4 8.7 Antiseptic wash 7 15.2 Betadine 4 8.7 Other solutions 8 17 18 Graph (3) YES NO Reported Assessments 19 Table (4) SN Patient condition Nurses Responses N % 1 Bedridden 11 42 2 Unconscious 9 35 3 Stroke 9 35 4 Oral problems 3 35 20 Table (5A) Materials names No. of nurses citing materials used N % Equipment Oral care set Tongue depressor & gauze 22 17 48.8 37.8 Toothbrush Dressing set 17 4 37.8 9 Other equipment 5 11 21 Table (5B) Materials Used Solutions Hydrogen Peroxide Normal Saline Toothpaste Betadine Water Other solutions No. of nurses citing materials use N % 28 24 17 4 4 6 62 53 38 9 9 13 22 DRUGS AFFECTING MOUTH HEALTH • • • • • • • Antibiotics Oxygen therapy Cytotoxic drugs Steroids Antidepressants Antihistamines Antihypertensives • • • • • • Anticholinergics Antipsychotic Anorectics Anticonvulsants Duiretics Sympathmimetics 24