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Exploration of difficulty accessing the mouths of intubated and mechanically ventilated adults for oral care: A video and photographic elicitation study.

Authors
  • Dale, Craig M1, 2
  • Angus, Jan E1
  • Sutherland, Susan3
  • Dev, Shelly4, 5
  • Rose, Louise6, 7, 8
  • 1 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada. , (Canada)
  • 2 Sunnybrook Health Sciences Centre, Toronto, ON, Canada. , (Canada)
  • 3 Department of Dentistry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. , (Canada)
  • 4 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. , (Canada)
  • 5 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. , (Canada)
  • 6 Lawrence S. Bloomberg Faculty of Nursing and Faculty of Medicine, University of Toronto, Toronto, ON, Canada. , (Canada)
  • 7 Department of Critical Care Medicine, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. , (Canada)
  • 8 Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, London, UK.
Type
Published Article
Journal
Journal of Clinical Nursing
Publisher
Wiley (Blackwell Publishing)
Publication Date
Jun 01, 2020
Volume
29
Issue
11-12
Pages
1920–1932
Identifiers
DOI: 10.1111/jocn.15014
PMID: 31342565
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To explore descriptors of difficulty accessing the mouths of intubated and mechanically ventilated adults for oral care, consequences, modifiable antecedents and recommendations for improving care delivery. Nurses report oral access and care delivery difficulty in most mechanically ventilated patients. A prospective qualitative descriptive design. Data were collected using video and photographic elicitation interviews focused on delivery of oral care. Directed content analysis was used to explore descriptive categories. Reporting used the SRQR guidelines. A university-affiliated hospital in Toronto, Canada. Participants included clinicians experienced in accessing the oral space of adults representing nursing, medicine, dentistry and allied health professionals. We recruited 18 participants; 9 representing critical care and 9 other specialties frequently accessing the mouth, that is dentistry. Descriptors for observed difficulty accessing the oral cavity were "oral crowding with tubes" and "aversive patient responses", which were considered to result in insufficient oral care. Participants perceived aversive patient responses (e.g. biting, turning head side to side, gagging, coughing) as a consequence of forced introduction of instruments inside a crowded mouth. A key finding identified by participants was the observation of substantial procedural pain during oral care interventions. Potentially modifiable antecedents to difficult oral care delivery identified were procedural pain, oral health deterioration (e.g. xerostomia) and lack of interprofessional team problem-solving. Recommendations to address these antecedents included patient preparation for oral care through verbal and nonverbal cueing, pharmacological and nonpharmacological strategies, and ICU interprofessional education. Oral care in mechanically ventilated adults is complex and painful. Visual research methods offer important advantages for oral care exploration including its ability to reveal less visible aspects of the nurse-patient encounter, thereby enabling novel insights and care. Interprofessional education and training in oral health and care interventions tailored to mechanically ventilated patients are recommended. © 2019 John Wiley & Sons Ltd.

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