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Background Maintaining oral hygiene is a key component of preventing ventilator-associated pneumonia; however, practices are inconsistent. Objectives To explore how characteristics of institutional guidelines for oral hygiene influence nurses' oral hygiene practices and perceptions of that practice. Methods Oral hygiene section of a larger survey study on prevention of ventilator-associated pneumonia. Critical care nurses at 8 hospitals in Northern California that had more than 1000 ventilator days in 2009 were recruited to participate in the survey. Twenty-one questions addressed oral hygiene practices and practice perceptions. Descriptive statistics, analysis of variance, and Spearman correlations were used for analyses. Results A total of 576 critical care nurses (45% response rate) responded to the survey. Three types of institutional oral hygiene guidelines existed: nursing policy, order set, and information bulletin. Nursing policy provided the most detail about the oral hygiene care; however, adherence, awareness, and priority level were higher with order sets (P < .05). The content and method of disseminating these guidelines varied, and nursing practices were affected by these differences. Nurses assessed the oral cavity and used oral swabs more often when those practices were included in institutional guidelines. Conclusions The content and dissemination method of institutional guidelines on oral hygiene do influence the oral hygiene practices of critical care nurses. Future studies examining how institutional guidelines could best be incorporated into routine workflow are needed. (American Journal of Critical Care. 2015;24:309-317) 2 VAP increases the duration of mechanical ventilation and hospital length of stay by a mean of 7 to 9 days, 2 costing $10 000 to $40 000 per case. 3-6Maintaining oral hygiene is one of the key components of VAP prevention. [7][8][9][10][11] For intubated patients, endotracheal tube placement provides a direct pathway for bacteria to enter the body, reduces the cough reflex, and decreases salivary flow, which inhibits mechanical removal of plaque by saliva.9 Ideally, oral hygiene care of patients receiving mechanical ventilation should consist of oral cavity assessment, swabbing the oral cavity using an oral swab or "toothette," toothbrushing, suctioning, oral rinse, and providing moisture.12 Professional organizations recommend that hospitals implement comprehensive oral hygiene programs to prevent VAP. 13,14 However, professional recommendations often lack the specifics needed to be practical in bedside practice. 7,15The American Association of Critical-Care Nurses (AACN) guideline 14 presents one of the most comprehensive lists of oral hygiene recommendations. Their recommendations are as follows: (1) brush teeth, gums, and tongue at least twice a day using a soft pediatric or adult toothbrush; (2) provide oral moisture to oral mucosa and lips every 2 to 4 hours; and (3) use an oral chlorhexidine gluconate (0.12%) rinse twice a day during the perioperative period for...

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Background: Older adults are often reluctant to engage in fall prevention activities. Objectives: To understand how older adults respond to fall prevention and identify attributes that affect their responses to fall prevention. Methods: Qualitative content analysis of Fall Prevention Motivational Interviewing conversations that were conducted as an intervention for a fall prevention study in the USA. We report the methods, results and discussions using the COnsolidated criteria for REporting Qualitative research checklist. Results: Conversations from 30 participants were analysed. Participants showed various responses to fall prevention from acceptance and engagement to ambivalence to denial or giving up. Three attributes affecting how they responded to fall prevention were as follows: (a) their perception of fall risks, (b) their perception about fall prevention strategies and (c) self-identity. If participants perceived that their fall risks were temporary or modifiable, they were more likely to engage in fall prevention. If participants perceived that their fall risks were permanent or unmodifiable, they seemed to have difficulty accepting fall risks or gave up engaging in fall prevention strategies. Participants were more willing to adopt fall prevention strategies that involved minor adjustments but expressed more resistance to adopting strategies that required major adjustments. Further, their response to accepting or not accepting fall prevention was influenced by their perception of whether the fall risks and fall prevention strategies aligned with their self-identity. Conclusion: Findings underscore the importance of understanding older adults' selfidentify and perceptions about fall prevention. Relevance to clinical practice: Exploring older adults' self-identity and perceptions about fall prevention can be useful to support their engagement in fall prevention.