Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou, Henan, China.
Department of Infectious Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou, Henan, China.
BMC Oral Health. 2022 Sep 7;22(1):389. doi: 10.1186/s12903-022-02426-5.
Surgical incision, endotracheal intubation, structural changes in the oral cavity, and other factors lead to a divergence in oral care between patients after oral surgery and ordinary inpatients. High-quality oral care can reduce the incidence of incision infection and ventilator-associated pneumonia. However, there is a lack of guidelines or expert consensus on oral care after oral cancer surgery. Therefore, the aim of this study was to assess the practicing situation of nurses in the intensive care unit (ICU) for postoperative patients with oral cancer and their need for training.
A multicenter cross-sectional study design was conducted in 19 ICUs of 11 tertiary hospitals from Henan province in China. Data were collected from 173 nurses and 19 head nurses online using a structured questionnaire. Mann-Whitney U and Kruskal-Wallis H tests were performed to analyze the data using SPSS (Version 25.0).
Seven ICUs (36.8%) developed evaluation regulations for the oral care of postoperative patients with oral cancer, and eight ICUs (42.1%) described the operating standards. A total of 173 nurses completed the questionnaire, and the median score was 75 (68, 78). Almost all of the examined nurses (91.2%) assessed patients' oral hygiene at a fixed time, while in 52.0% and 28.3% of nurses, the first oral care and frequency of oral care after surgery was determined based on the individual patient's situation. More than half of the nurses (55.5%) spent approximately 5-10 min conducting oral care for patients. Physiological saline solution (82.7%), swabbing (91.9%), and oral care package with cotton ball (86.1%) were the most popular oral care mouthwash, method, and tool, respectively. Nurses sought help from senior nurses (87.3%) and doctors (83.8%), mostly to solve difficulties of oral care. Moreover, 76.9% of the nurses believed that the lack of knowledge and skills surrounding oral care was the main barrier for nurses to implement oral care. The majority of participants (69.4%) had never received continuing education or training in oral care for postoperative patients with oral cancer, and almost all (98.8%) of the respondents stated their preference to receive training in standardized oral care skills. Indications and contraindications (84.4%), tools (81.5%), and mouthwash (80.9%) of oral care were the items that the respondents were most eager to learn about. Approximately three quarters of nurses preferred scenario simulation practice as the training method.
Although the participants had high oral care scores for postoperative patients with oral cancer, there was great diversity in the practice. The lack of oral care knowledge was deemed the main barrier in delivering quality oral care, and the educational need was stated by almost all participants. We suggest that a standard protocol or clinical practice guidelines for oral care for postoperative patients with oral cancer should be developed, and nurses should be educated to equip them with professional knowledge and skills.
手术切口、气管插管、口腔结构改变等因素导致口腔手术后患者的口腔护理与普通住院患者存在差异。高质量的口腔护理可以降低切口感染和呼吸机相关性肺炎的发生率。然而，目前缺乏口腔癌手术后口腔护理的指南或专家共识。因此，本研究旨在评估口腔癌术后患者在重症监护病房（ICU）护士的实践情况及其培训需求。
采用多中心横断面研究设计，在中国河南省 11 家三级医院的 19 个 ICU 中进行。通过在线问卷调查收集 173 名护士和 19 名护士长的数据。采用 Mann-Whitney U 和 Kruskal-Wallis H 检验对 SPSS（版本 25.0）进行数据分析。
7 个 ICU（36.8%）制定了口腔癌术后患者口腔护理评估规范，8 个 ICU（42.1%）描述了操作标准。共有 173 名护士完成了问卷，中位数评分为 75（68，78）。几乎所有接受检查的护士（91.2%）都会在固定时间评估患者的口腔卫生情况，而在 52.0%和 28.3%的护士中，第一次口腔护理和术后口腔护理的频率则根据患者的个体情况而定。超过一半的护士（55.5%）花费大约 5-10 分钟为患者进行口腔护理。生理盐水（82.7%）、擦拭（91.9%）和带棉球的口腔护理包（86.1%）是最受欢迎的口腔护理漱口水、方法和工具。护士主要向高年资护士（87.3%）和医生（83.8%）寻求帮助，以解决口腔护理方面的困难。此外，76.9%的护士认为缺乏口腔护理知识和技能是阻碍护士实施口腔护理的主要因素。大多数参与者（69.4%）从未接受过口腔癌术后患者口腔护理的继续教育或培训，几乎所有（98.8%）的受访者表示希望接受标准化口腔护理技能培训。口腔护理的适应证和禁忌证（84.4%）、工具（81.5%）和漱口水（80.9%）是受访者最希望了解的项目。大约四分之三的护士更喜欢情景模拟练习作为培训方法。
尽管参与者对口腔癌术后患者的口腔护理评分较高，但实践情况存在很大差异。缺乏口腔护理知识被认为是提供高质量口腔护理的主要障碍，几乎所有参与者都表示有教育需求。我们建议制定口腔癌术后患者口腔护理的标准方案或临床实践指南，并对护士进行教育，使他们具备专业知识和技能。
