A context analysis on how oral care is delivered in hospitalised patients: A mixed‐methods study

Abstract

Aims and Objectives:To analyse oral care delivery in one hospital through exploring experiences from both nurses' and patients' perspectives and examining patients' oral health.Background: Oral health problems are associated with undernutrition and other general health outcomes. Although oral care belongs to the essentials of nursing, it is often neglected. Improving oral health may require behaviour change of both nurses and patients. Defining tailored strategies need a clear view on the context. Design:A context analysis in one hospital using a convergent parallel mixed-methods design was reported following the EQUATOR guidelines using two checklists:COnsolidated criteria for REporting Qualitative research (qualitative research) and STROBE (observational research).Methods: Semi-structured interviews were conducted with 19 nurses and 11 patients. The topic list was based on the Integrated Change Model. Prospective oral examination was performed among 91 surgical patients using the Oral Health Assessment Tool (OHAT).Results: Nurses acknowledged that they did not prioritise oral care in daily practice. Furthermore, they lacked knowledge and skills to identify and provide care for oral problems. Nurses mentioned helpful resources to perform oral care, like standardised language and instruments. However, they had no access to or were unaware of them. Patients admitted that they did not prioritise oral care due to their sickness during hospitalisation, were unaware of the importance of oral care, but felt responsible for their oral care. The most prominent oral problems identified with the OHAT were unclean mouths (n = 75, 82%), unhealthy gum and tissues (n = 55, 60%) and dry mouth (n = 42, 46%). Conclusions:This context analysis identified inadequate oral care due to lack of positive attitude and knowledge in both nurses and patients, skills for nurses, and resources. S U PP O RTI N G I N FO R M ATI O NAdditional supporting information may be found online in the Supporting Information section. How to cite this article: van Noort HHJ, Witteman BJM, den Hertog-Voortman R, Everaars B, Vermeulen H, Huismande Waal G. A context analysis on how oral care is delivered in hospitalised patients: A mixed-methods study. J Clin Nurs.

Mouth care training and practice: a survey of nursing staff working in National Health Service hospitals in England

“…Of these admissions 42% of patients were aged over 65 years and 64% required an overnight stay (NHS Digital, 2019). A growing body of evidence has shown that following hospital admission oral health deteriorates, with an increase in dental plaque, gingival inflammation and subsequent deterioration in oral mucosal health (Needleman et al, 2012;Sachdev et al, 2013;Terezakis et al, 2011;Van Noort et al, 2020).…”

“…There is a wealth of studies on nurses' knowledge, attitudes to, and practice of oral care. Studies have found that nurses often recognise the importance of oral care but lack adequate knowledge about oral health and the practice of oral care (Adams, 1996;Daniel et al, 2004, Van Noort et al, 2020. Oral care is often considered as a low priority compared to other aspects of care and it has been found that there is a need for more training in the area (Bonetti et al, 2015;Costello and Coyne, 2008;Davis, 2019;Odgaard and Kothari, 2019;Southern, 2007).…”

Knowledge, Attitudes, and Practices of Nurses towards Oral Care of Hospitalized Patients in Zimbabwe

“…These findings are comparable to findings from other similar studies. In a context analysis of how oral and maxillofacial care was provided to hospitalized patients in a Dutch hospital, it was found that nurses did not prioritize oral care for patients; a lack of requisite skills for the provision of oral care and inability to identify oral health problems were also obtained (Noort et al, 2019). These findings are echoed by Al Rababah et al (2018), who found that oral care administered to patients by nurses across five hospitals in Saudi Arabia was suboptimal.…”

Differences in the oral health status in hospitalised stroke patients according to swallowing function: A cross‐sectional study

“…Second, oral care may be more difficult when swallowing safety was impaired, as the patients may fail to prevent any food debris, toothpaste or rinsing from entering the airway (Lyons et al, 2018). Third, oral care was an overlooked part and seldom regarded as a high priority in hospital (Chipps et al, 2014; Van Noort et al, 2020). Especially when patients developed swallowing disorders, their oral management was more likely to be neglected (Lyons et al, 2018).…”