Centre for Oral Health Outcomes, Research & Translation (COHORT), Liverpool 1871, Australia; School of Nursing & Midwifery, Western Sydney University, Penrith 2751, Australia; Western Sydney Nursing & Midwifery Research Centre, Western Sydney University & Western Sydney Local Health District, Australia; Ingham Institute for Applied Medical Research, Liverpool 1871, Australia.
Centre for Oral Health Outcomes, Research & Translation (COHORT), Liverpool 1871, Australia; School of Nursing & Midwifery, Western Sydney University, Penrith 2751, Australia; Ingham Institute for Applied Medical Research, Liverpool 1871, Australia; South Western Sydney Local Health District, NSW, Australia; School of Dentistry, University of Sydney, Camperdown 2050, Australia.
Aust Crit Care. 2022 Sep;35(5):583-594. doi: 10.1016/j.aucc.2021.08.010. Epub 2021 Nov 9.
Oral care is a fundamental nurse-led intervention in the critical care setting that provides patient comfort and prevents adverse outcomes in critically ill patients. To date, there has been minimal focus on nurse-focused interventions to improve adherence to oral care regimens in the adult intensive care unit setting.
The objectives of this study were to (i) identify types and characteristics of interventions to improve oral care adherence amongst critical care nurses and intervention core components, (ii) evaluate the effectiveness of interventions to improve adherence of oral care regimens, and (iii) identify the types of outcome measures used to assess oral care regimen adherence.
This is a systematic review in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
Key bibliographic databases and platforms, including Scopus, Cochrane, MEDLINE, CINAHL, Embase, PsycINFO, ProQuest, and Web of Science, were searched for studies published before July 2020. The Joanna Briggs Institute's quality appraisal tool was used to assess risk of bias in included studies.
A total of 21 original research studies were identified, of which 18 studies used multifaceted interventions. In accordance with the Joanna Briggs Institute's quality appraisal tools, four of the 20 quasi-experimental studies were rated as high quality. The one randomised control trial was of moderate quality. Outcome measures included oral care adherence behaviours, oral care knowledge, self-reported adherence, and documentation. Improved effectiveness in oral care adherence was reported in 20 studies.
Review findings confirm interventions to change behaviours improve oral care adherence. The most effective interventional approach could not be determined owing to heterogeneity in intervention design and outcome measures. Oral care in the intensive care unit is a vital, nurse-led activity that reduces the risk of hospital-acquired infection. It is recommended that future research adopt implementation science methods to ensure stakeholder engagement and feasibility.
This review was submitted and subsequently registered on PROSPERO, the International Perspective Register of Systematic Reviews PROSPERO 2019 CRD42019123142.
口腔护理是重症监护环境中基本的护士主导干预措施，可为重症患者提供舒适感并预防不良后果。迄今为止，人们对以护士为重点的干预措施关注甚少，无法改善成人重症监护病房的口腔护理方案的依从性。
本研究的目的是：(i) 确定提高重症监护护士口腔护理依从性的干预措施类型和特征以及干预核心组成部分；(ii) 评估提高口腔护理方案依从性的干预措施的有效性；(iii) 确定用于评估口腔护理方案依从性的结果测量类型。
这是一项与系统评价和荟萃分析报告的首选项目一致的系统评价。
在 2020 年 7 月之前，对 Scopus、Cochrane、MEDLINE、CINAHL、Embase、PsycINFO、ProQuest 和 Web of Science 等主要书目数据库和平台进行了搜索，以查找已发表的研究。采用乔安娜·布里格斯研究所的质量评估工具评估纳入研究的偏倚风险。
共确定了 21 项原始研究，其中 18 项研究使用了多方面的干预措施。根据乔安娜·布里格斯研究所的质量评估工具，20 项准实验研究中有 4 项被评为高质量。唯一的一项随机对照试验为中等质量。结果测量包括口腔护理依从性行为、口腔护理知识、自我报告的依从性和记录。20 项研究报告称口腔护理依从性得到了改善。
综述结果证实，改变行为的干预措施可提高口腔护理的依从性。由于干预设计和结果测量的异质性，无法确定最有效的干预方法。重症监护病房的口腔护理是一项重要的、由护士主导的活动，可降低医院获得性感染的风险。建议未来的研究采用实施科学方法，确保利益相关者的参与和可行性。
本综述已提交，并随后在 PROSPERO（国际系统评价注册平台）上注册，注册号为 PROSPERO 2019 CRD42019123142。
