Department of Internal Medicine, Section Nursing Science, Erasmus University Medical Centre, Rotterdam, the Netherlands.
Department of Biostatistics, Erasmus University Medical Centre, Rotterdam, the Netherlands.
Int J Dent Hyg. 2024 Aug;22(3):661-671. doi: 10.1111/idh.12748. Epub 2023 Sep 18.
Providing oral care is an essential part of basic nursing care but receives little priority in daily practice, with a risk of adverse events. Also, nurses report many barriers to adequate provision of oral care, such as time restraints, insufficient materials, fear of causing pain, lack of knowledge and a negative attitude towards providing oral care.
We performed a cluster-randomized, stepped-wedge study to explore the effect of the the implementation of a new nursing evidence-based oral care protocol on nurses' knowledge, attitude and protocol adherence. The study population included both nursing students, graduated nurses and patients in selected wards. The implementation strategy included oral and written information, instruction videos and reminders. Nurses' knowledge and attitude towards oral care were assessed at baseline and after the implementation of the protocol with a validated 47-item questionnaire with a score range of 0-100. Secondarily, nurses' protocol adherence to teeth brushing, measured in Activities of Daily Living (ADL) dependent patients, was evaluated. The Standards for Reporting Implementation Studies (StaRI) Statement was used.
At baseline, the questionnaire was completed by 226 nurses; after implementation by 283. Knowledge had significantly improved from 68.8 to 72.3. Nurses' attitude improved not significantly. Protocol adherence was assessed in 73 ADL-dependent patients at baseline, in 51 after implementation. Adherence to teeth brushing significantly decreased in patients with permanent teeth. Also, adherence to both teeth brushing and usage of soap decreased in patients with (partial) dentures.
Nurses' knowledge and attitude of oral care increased somewhat after the implementation of a new nursing evidence-based protocol. After implementation, there was an unexplained decreased adherence to oral care in ADL-dependent patients.
提供口腔护理是基础护理的重要组成部分，但在日常实践中却很少受到重视，存在不良事件的风险。此外，护士报告说，他们在提供口腔护理方面存在许多障碍，例如时间限制、材料不足、担心引起疼痛、缺乏知识以及对提供口腔护理的负面态度。
我们进行了一项集群随机、逐步楔形研究，以探讨实施新的护理循证口腔护理方案对护士知识、态度和方案依从性的影响。研究人群包括选定病房的护理学生、毕业护士和患者。实施策略包括口头和书面信息、教学视频和提醒。在实施方案前后，使用经过验证的 47 项问卷评估护士对口腔护理的知识和态度，得分范围为 0-100。其次，评估了依赖日常生活活动（ADL）的患者中护士对刷牙的方案依从性。使用报告实施研究的标准（StaRI 声明）。
基线时，226 名护士完成了问卷；实施后，283 名护士完成了问卷。知识从 68.8 分显著提高到 72.3 分。护士的态度虽有改善，但无统计学意义。在基线时，73 名 ADL 依赖患者接受了刷牙方案依从性评估，实施后 51 名患者接受了评估。永久性牙齿患者的刷牙依从性显著下降。此外，全口义齿和局部义齿患者的刷牙和使用肥皂的依从性也下降。
实施新的护理循证方案后，护士对口腔护理的知识和态度略有提高。实施后，ADL 依赖患者的口腔护理依从性出现了无法解释的下降。
