This is the first clinically focused nursing study published from the United Arab Emirates. It could be the first research presentation from the country at an international event. However, it is simple reflecting the beginning nature of the

author.

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byBelal M Hijji, Department of Nursing

Mafraq Hospital, Abu Dhabi, United Arab EmiratesPrepared for

The Centennial Nursing Conference, Beirut, June 30 – July 2, 2005

Published in the Online Journal of Brazilian Nursingwww.uff.br/nepae/objn203hijji.htm

Trained Nurses’ Knowledge and Reported Practice of Mouth Care on Three Wards in Acute Care Hospital in Abu Dhabi, UAE.

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DEFINITION OF RESEARCH

• “Research is a means of understanding, assessing and evaluating what we do as nurses” (1).

1. BURNARD, P. & MORRISON, P. Nursing research in action: developing basic skills. London, Macmillan, 1990.

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BACKGROUND

Mouth care, an essential nursing procedure, helps to maintaina comfortable, clean, moist and infection free mouth.

Poor knowledge has the potential to compromise the qualityof patient care and result in unsafe practice. Therefore, it is

crucial for nurses to have up-to date knowledge and skills oforal care. In the UAE, there is no evidence of nurses‘

knowledge and practice and,thus, no baseline data on whichimprovement efforts may proceed.

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AIMS OF THE STUDY

• Investigate nurses’ knowledge and reported practice of oral care.

• Identify nurses' perceived barriers to good practice.

• Establish an association, if any, between nurses’ knowledge and practice and their demographics.

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METHOD

Cross-sectional exploratory survey. All 58 nurses onthree wards in a general hospital represented the targetpopulation.The questionnaire generated informationabout personal data, education and level of knowledgeand practice of mouth care. Nurses were supervisedduring questionnaire completion.

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RESULTS

46 nurses (79%) participated in the study. Multiple factors interact culminating in poor oral care.

1. Knowledge deficits:• Importance of oral assessment (Graph 1)• Indicators of healthy mouth (Slide 13, Graph 2)

• Drug effects on mouth health (Table 1, Slide 22)

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RESULTS

• Frequency of mouth care (Table 2)

• Materials ideal for mouth care (Table 3)

2. Practice deficits:

• Deficient reported oral assessments (Graph 3)

• Limited categories of patients reported to be assessed (Table 4)

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RESULTS

• Limited use of brush and paste (Table 5A&5B)• Use of materials that are ineffective or could be

potentially harmful (Table 5A & 5B)• Lack of oral assessment guide

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NURSES’ PERCEIVED BARRIERS TO GOOD MOUTH CARE

• Lack of materials (n=19)• Lack of time (n=17)• staff shortages (n= 15)• Uncooperative patients (n= 16)• Lack of assignment system (n= 4)• 17 nurses identified one barrier• 19 nurses identified more than one barrier

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INFLUENCE OF DEMOGRAPHICS ON KNOWLEDGE AND PRACTICE

At 95% CI, no statistically significant differences were detected among groups due to small numbers of nurses having certain demographic characteristics

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CONCLUSION AND RECOMMENDATIONS

• Individual results of the study were communicated to participating wards

• Nurses urged not to use Hydrogen Peroxide 3%

• Regular supply of paste and brush provided

• Resource material on oral hygiene provided to nurses

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Graph (1)

1

6

11

16

21

26

31

36

41

46

Nurses responses

ImportantNot important

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Indicators of Healthy Mouth

• Clean teeth

• No infection

• Pink mucosa

• Pink tongue

• Moist tongue

• No dentures debris

• Normal swallow

Moist mucosa Smooth lips Pink lips Moist lips Watery saliva Voice

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Graph (2)

Number of indicators identified by nurses

0

4

8

12

16

20

24

28

32

36

40

44

Indicators

Nurses

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Table (1) 

Drug Nurses

N %Steroids 6 23%

Antibiotics 5 19%

Radiotherapy 4 15%

Chemotherapy 4 15%

Immunosuppressants 4 15%

Epaneutin 3 12%

Iron 3 12%

Other drugs 6 23%

.

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Table (2)

Patient condition Frequency of care/hr & number of nurses stating each frequency

  1-6 >6-12 >12-18 >18

Dehydrated 36 7 -- 2

Oxygenated 32 13 1 --

Has oral infection 39 5 -- --

Unconscious 32 13 -- 1

As a preventive measure

13 26 -- 3

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Table (3)Nurses response

of ideal equipment

N % Nurses response

of ideal solution

N %

Oral care set 19 41.3 Toothpaste 18 38.1

Toothbrush 18 38.1 Hydrogen per 3% 16 34.8

Tongue depressor & gauze

7 15.2 Normal saline 15 32.6

Other equipment 4 8.7 Antiseptic wash 7 15.2

Betadine 4 8.7

Other solutions 8 17

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Graph (3)

05

1015202530354045

ReportedAssessments

YESNO

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Table (4)

Nurses Responses

SN Patient condition N %

1 Bedridden 11 42

2 Unconscious 9 35

3 Stroke 9 35

4 Oral problems 3 35

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Table (5A)

Materials names  No. of nurses citing materials used

N %

Equipment

Oral care set 22 48.8

Tongue depressor & gauze 17 37.8

Toothbrush 17 37.8

Dressing set 4 9

Other equipment5 11

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Table (5B)Materials Used No. of nurses citing materials

use

N %

Solutions

Hydrogen Peroxide 28 62

Normal Saline 24 53

Toothpaste 17 38

Betadine 4 9

Water 4 9

Other solutions 6 13

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DRUGS AFFECTING MOUTH HEALTH• Antibiotics• Oxygen therapy• Cytotoxic drugs• Steroids• Antidepressants• Antihistamines• Antihypertensives

• Anticholinergics• Antipsychotic• Anorectics• Anticonvulsants• Duiretics• Sympathmimetics