Validity and reliability of an oral care practice survey for the orally intubated adult critically ill patient.

BACKGROUND

Oral care is proposed as key to preventing ventilator-associated pneumonia, yet little work has been done to measure reliably current oral care practices nationwide. Five critical care oral care surveys are described in the literature; however, their usefulness is diminished because of insufficient validity or reliability measures and sampling limitations that limit generalizability.

OBJECTIVES

The aim of this study was to present a survey instrument for oral care practices for the orally intubated adult critically ill patient and the attendant psychometric properties.

METHODS

The oral care survey items were designed to elucidate information on the type and frequency of each specific task for oral care (toothbrushes, foam swabs, suctioning, and chlorhexidine gluconate oral rinse). The oral care survey was evaluated for face validity, content validity, and stability reliability psychometric properties.

RESULTS

Face validity was established by an expert panel. Content validity was assessed using content validity index (CVI) and pairwise comparison. The overall CVI score was 97.5% agreement. A pairwise comparison for the three raters was computed. The strongest rating agreements were between Rater 1 and Rater 2 (.86) and Rater 1 and Rater 3 (.83). Given these interrater reliability scores and the overall 97.5% CVI score, minor revisions were made for survey items as recommended by the reviewers' comments. Test-retest reliability (.82-.86) showed a less than 10% difference between all items from Time 1 and Time 2.

IMPLICATIONS

This survey, tested for validity and reliability, can be used in future critical care settings as an audit tool for oral care practices performed by nurses.