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
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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