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Oral care quality in intensive care units and short-term care units: Nursing staff and older people's perspectives
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).ORCID iD: 0000-0002-4381-4288
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to investigate oral care and its quality through the perspectives of nursing staff in intensive care units and short-term care units and from the perspectives of older people in short-term care units. Methods: The mix-method study (I) had a concurrent embedded design and was cross-sectional. Eighty-eight intensive care nurses (response rate (RR) 40%) responded to the Nursing Care related to Oral Health questionnaire, and the data were analysed with analytic statistics and qualitative content analysis. The quantitative studies (II-IV), which were also cross-sectional, included 432 nursing staff in intensive care and short-term care (RR 51–52%) and 391 older people (RR 77%) in short-term care units. Participants responded to the modified version of the Quality from Patients’ Perspective instrument and provided information about person-related conditions. Descriptive and analytical statistics were used. Main results: Intensive care nurses perceived having the antecedents, knowledge, and skills to provide optimal oral care quality, but the result indicated that they were having difficulties putting these into practice (I). Areas for improvement in oral care quality were identified in both care environments (II). Older people preferred personalised information about oral health and oral care (III). Nursing staff as well as older people’s perceptions of oral care quality and its humanity aspects, seemed to be related to person-related conditions and differed between the two care environments. In short-term care, nursing staff’s preferences for the humanity aspects of oral care quality were higher compared to older people’s preferences (IV). Conclusion: Oral care is complicated and proactive and requires registered nurses’ and other nursing staff’s attention as well as educational and organisational initiatives. Many older people were assessed to have oral health problems. With early identification and optimal oral care, unnecessary suffering might be prevented. The identified quality improvement areas might guide RNs, nurse managers, and other nursing staff to further oral care quality development.

Abstract [en]

Oral care is complex and multifaceted, and knowledge about nursing staff and older people’s perceptions of oral care quality are limited. The overall aim was to investigate oral care and its quality through the perspectives of nursing staff in intensive care units and short-term care units and from the perspectives of older people in short-term care units.

Intensive-care nurses perceived having the antecedents, knowledge, and skills needed to provide optimal oral care quality, but the result indicated that they were having difficulties putting these into practice. Areas for improvement in oral care quality were identified in both care environments. Older people preferred personalised information about oral health and oral care. Perceptions of oral care quality and its humanity aspects, seemed to be related to person-related conditions, and differed between nursing staff in different units and older people.

Oral care is complicated and proactive and requires registered nurses’ and other nursing staff’s attention as well as educational and organisational initiatives. Many older people were assessed to have oral health problems. With early identification and optimal oral care, unnecessary suffering might be prevented. The identified quality improvement areas might RNs, nurse managers, and other nursing staff to guide further oral care quality development.

Place, publisher, year, edition, pages
Karlstads universitet, 2019. , p. 114
Series
Karlstad University Studies, ISSN 1403-8099 ; 2019:14
Keywords [en]
Oral care, quality of care, intensive care, short-term care, older people’s perceptions, nursing staff’s perceptions, person-related conditions
National Category
Health Sciences
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:kau:diva-71820ISBN: 978-91-7867-020-8 (print)ISBN: 978-91-7867-025-3 (electronic)OAI: oai:DiVA.org:kau-71820DiVA, id: diva2:1304151
Public defence
2019-06-14, 1A305, Lagerlöfsalen, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2019-05-16 Created: 2019-04-11 Last updated: 2019-10-09Bibliographically approved
List of papers
1. Intensive care nurses fail to translate knowledge and skills into practice: A mixed-methods study on perceptions of oral care
Open this publication in new window or tab >>Intensive care nurses fail to translate knowledge and skills into practice: A mixed-methods study on perceptions of oral care
2019 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 52, p. 51-62Article in journal (Refereed) Published
Abstract [en]

Objectives: To identify intensive care nurses’ perceptions of oral care according to Coker et al.'s (2013) conceptual framework and to contribute to the knowledge base of oral care in intensive care. Design/methods: This was a concurrent embedded mixed-methods design, with more weight given to the quantitative part. Participants responded to the Nursing Care related to Oral Health questionnaire, including perceptions of oral care antecedents (18 items), defining attributes (17 items), and consequences (6 items) and two open-ended questions. The data were analysed with descriptive and correlation statistics and qualitative content analysis. Setting: Intensive care nurses (n = 88) in six general intensive care units. Results: Intensive care nurses perceived that an important part of nursing care was oral care, especially to intubated patients. They perceived that the nursing staff was competent in oral care skills and had access to different kinds of equipment and supplies to provide oral care. The oral cavity was inspected on a daily basis, mostly without the use of any assessment instruments. Oral care seemed to be task-oriented, and documentation of the patients’ experiences of the oral care process was rare. Conclusions: The antecedents, knowledge and skills are available to provide quality oral care, but intensive care nurses seem to have difficulties translating these components into practice. Thus they might have to shift their task-oriented approach towards oral care to a more person-centred approach in order to be able to meet patients’ needs. © 2018 Elsevier Ltd

Place, publisher, year, edition, pages
Churchill Livingstone, 2019
Keywords
Conceptual framework, Intensive care nurses, Mixed-method, Oral care, adult, article, content analysis, controlled study, documentation, female, human, intensive care unit, language, major clinical study, male, mouth cavity, mouth hygiene, nursing care, nursing staff, perception, quantitative analysis, questionnaire, skill, statistics
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-70243 (URN)10.1016/j.iccn.2018.09.006 (DOI)30297151 (PubMedID)2-s2.0-85054505634 (Scopus ID)
Note

Conflict of interest statement: https://doi.org/10.1016/j.iccn.2019.02.001

Available from: 2018-11-22 Created: 2018-11-22 Last updated: 2019-05-28Bibliographically approved
2. Oral care: identifying quality improvement areas
Open this publication in new window or tab >>Oral care: identifying quality improvement areas
2019 (English)In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 32, no 1, p. 45-58Article in journal (Refereed) Published
Abstract [en]

Purpose: To describe and compare nurses' and healthcare assistants' oral care qualityperceptions, including perceived reality and subjective importance, to identify improvementareas in intensive care and short-term care, and to explore potential nursing satisfactionpredictors regarding oral care.Design/methodology/approach: Swedish staff, 154 within intensive care and 278 withinshort-term care responded to a modified Quality of Care from a Patient Perspectivequestionnaire. Descriptive and analytical statistics were used.Findings: Staff scored oral care quality both high and low in relation to perceived reality andsubjective importance. Improvement areas were identified, despite high satisfaction valuesregarding oral care. Setting, subjective importance, and perceived reality explained 51.5% ofthe variance in staff satisfaction regarding oral care quality.Practical implications: Quality improvements could guide oral care development.Originality/value: This study describes oral care by comparing nurse perceptions of howimportant they perceive different oral care aspects and to what extent these oral care aspectsare performed.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2019
Keywords
Oral care; Quality improvement; Satisfaction; Oral health; Nurses.
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-70819 (URN)10.1108/IJHCQA-09-2017-0176 (DOI)000460932700005 ()
Available from: 2019-01-28 Created: 2019-01-28 Last updated: 2019-04-11Bibliographically approved
3. Older people's perceptions of the quality of oral care in short-term care units: A cross-sectional study
Open this publication in new window or tab >>Older people's perceptions of the quality of oral care in short-term care units: A cross-sectional study
2018 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 13, no 2, p. 1-14, article id e12185Article in journal (Refereed) Published
Abstract [en]

Background: There is a lack of knowledge about oral care among older people living in short-term care (STC) units and how the quality of oral care provided by nursing staff is perceived by the older people. Aim: To (i) describe person-related conditions among older people in STC, (ii) describe and compare perceptions of the quality of oral care (including perceptions of care received and the subjective importance of such care), within and between older people who have the ability to perform oral self-care and those who are dependent on help with oral care and (iii) examine the relationship between person-related conditions and the quality of oral care. Methods: A cross-sectional study was conducted with 391 older people in STC units in Sweden based on self-reported questionnaire and clinical assessments. Results: The older people were assessed as having normal oral health (2%), moderate oral health problems (78%) or severe oral health problems (20%). When comparing older people's perceptions of quality of oral care in terms of perceived reality and subjective importance, significant differences appeared within and between groups. Psychological well-being had a significant relationship with perception of the quality of oral care (both perceived reality and subjective importance), and gender and oral health status had a significant relationship with subjective importance. Conclusions: Older people's perceptions of areas for improvement regarding quality of oral care is a new and important knowledge for nursing staff in STC units. Older people want personalised information regarding oral health and oral care. Registered Nurses who take the responsibility in nursing care for older people's oral health may avoid unnecessary suffering by older people caused by oral health problems. Implications for practice: Older people's perspective is an important component for quality work and might lead to improvements in the quality of oral care in STC. © 2018 John Wiley & Sons Ltd.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
Nursing, Older people, Oral health, Person-centred care, Quality of care, adult, article, clinical assessment, controlled study, cross-sectional study, female, gender, human, human experiment, male, mouth hygiene, nursing care, nursing staff, perception, psychological well-being, questionnaire, registered nurse, responsibility, self care, Sweden
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-66214 (URN)10.1111/opn.12185 (DOI)000434118100008 ()2-s2.0-85040973929 (Scopus ID)
Available from: 2018-02-09 Created: 2018-02-09 Last updated: 2019-07-12Bibliographically approved
4. Oral care quality - do humanity aspects matter? Nursing staff and older people's perspectives
Open this publication in new window or tab >>Oral care quality - do humanity aspects matter? Nursing staff and older people's perspectives
(English)Manuscript (preprint) (Other academic)
National Category
Health Sciences
Research subject
Nursing Science; Nursing Science
Identifiers
urn:nbn:se:kau:diva-71819 (URN)
Available from: 2019-04-11 Created: 2019-04-11 Last updated: 2019-05-21Bibliographically approved

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