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ORIGINAL ARTICLE
Year : 2017  |  Volume : 15  |  Issue : 3  |  Page : 244-246

Attitude and practices among nurses regarding oral health care of nonambulatory patients in hospitals of Warangal city - Telangana, India


Department of Public Health Dentistry, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India

Date of Web Publication18-Sep-2017

Correspondence Address:
Nitish Pagatur
Department of Public Health Dentistry, Sri Sai College of Dental Surgery, Kothrepally, Vikarabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_36_17

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  Abstract 

Introduction: Dental care for chronically ill and nonambulatory patients has an impact on the clinical outcomes and well-being. Poor oral care can result in nutritional deficiency, infections and can have an adverse effect on quality of life. Hence, oral hygiene of these patients is a basic responsibility of nurses. Aim: This study aims to assess the attitudes and practices among nurses regarding the oral health care of nonambulatory patients in hospitals of Warangal city, Telangana. Materials and Methods: A descriptive cross-sectional study was conducted at five private and one government hospitals of Warangal city, Telangana. Data were collected among 208 nurses using pretested self-administered questionnaire regarding attitude and practices of nurses toward oral health care of nonambulatory patients. Responses were coded and analyzed using Statistical Package for the Social Sciences version 20. Results: Majority of the nurses (45.2%) stated that trained nurses carry out the oral care in wards. About 53.8% nurses reported that uncooperative patients hinder them in performing oral care, 47% considered cleaning the oral cavity of the patients as an unpleasant task, and 70.2% nurses felt that checking the oral cavity and its status of the patient is their responsibility. Conclusion: Practices and attitudes of nurses on oral health care toward nonambulatory patients are found to be satisfactory.

Keywords: Dental care, oral health, oral hygiene, ventilator-associated pneumonia


How to cite this article:
Monica M, Koppula YR, Reddy P P, Anjum S, Sheetal A, Pagatur N. Attitude and practices among nurses regarding oral health care of nonambulatory patients in hospitals of Warangal city - Telangana, India. J Indian Assoc Public Health Dent 2017;15:244-6

How to cite this URL:
Monica M, Koppula YR, Reddy P P, Anjum S, Sheetal A, Pagatur N. Attitude and practices among nurses regarding oral health care of nonambulatory patients in hospitals of Warangal city - Telangana, India. J Indian Assoc Public Health Dent [serial online] 2017 [cited 2020 Dec 1];15:244-6. Available from: https://www.jiaphd.org/text.asp?2017/15/3/244/215059


  Introduction Top


The oral status of nonambulatory patients can be compromised by their medical conditions, their inability to attend their own oral care, or Intensive Care Unit equipment and treatments, including medications.[1] Oropharyngeal colonization is associated with several systemic diseases including cardiovascular disease, chronic obstructive pulmonary disease, endocarditis, and bacteremia.[2] Bacterial colonization of the oropharynx is an important risk factor for ventilator-associated pneumonia.[2] In the light of these conditions, it would, therefore, be expected that patients with the nonambulatory condition suffer many oral health problems, and care must be taken to improve their oral health.

Nursing is a profession within the health-care sector focused on the care of individuals, families, and communities; so, they may attain, maintain, or recover optimal health and quality of life. Nurses are the one who monitor the patients round the clock and are trained to provide basic needs to the patient and are trained to demonstrate skills in meeting basic care of patients. Therefore, the purpose of the present study is to assess the attitude and practices of nurses attending nonambulatory patients on oral care.


  Materials and Methods Top


A cross-sectional study was done in the year of 2016 during the period of 2 months (February and March) on 208 nurses attending nonambulatory patients in medical wards of Warangal city, Telangana. The study design was approved by the ethical committee, and permission to conduct the study was obtained from the superintendent and managing directors of the hospitals in Warangal. Informed consent (verbal) was obtained from the nurses and purpose of the study was explained. There are 14 hospitals in Warangal city with emergency departments, out of which six hospitals (five private and one government) granted permission for conducting the study. Nurses with experience of 6 months and above and present on the day of the study were included.

A self-administered questionnaire with 15 closed ended questions was prepared; of which 5 questions were practices based and 10 were attitude based. A pilot study was conducted on 30 nurses to check the validity and reliability (Cronbach's alpha coefficient = 0.81) of the questionnaire. Data were collected according to their day and night shifts schedule, and an attempt was done to include the participants who missed on the day of the study. Responses were coded, and descriptive analysis was done using SPSS version 20 (SPSS Version 20 IBM, United states 2011).


  Results Top


Mean age of the study participants was found to be 30.4 ± 8.2 years. Among them, 98.1% of the nurses were females and 67.3% were qualified in General Nursing and Midwifery. About 85.1% of nurses stated that teeth, gums, and tongue of the patients have to be checked which indicate the condition of the oral health and 45.2% of them perceived that it was the trained nurses who should carry out the oral examination for nonambulatory patients in the wards. About (79.8%) of nurses used gauze / soft cloth / cotton swab as aids for cleaning patient's mouth. About 54.8% of nurses answered that they preferred mouthrinses over plain water and toothpaste to clean patient's oral cavity, and more than half (53.8%) of the nurses felt that the major problem which hinders them from performing mouth care was cooperation of the patients [Table 1].
Table 1: Practice of nurses toward oral health care of nonambulatory patients

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About 66.8% agreed that oral care should be done as often as possible during the hospital stay and 47.1% of the nurses reported that cleaning oral cavity of the patients is an unpleasant task. Maximum number of nurses perceived that they have taken adequate training in providing oral care and about 88% of them agreed that proper oral care is needed for the general health [Table 2].
Table 2: Attitudes of nurses toward oral health care of nonambulatory patients

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  Discussion Top


In this study, the majority of the nurses stated that teeth, gums, and tongue are to be checked as they indicate the condition of the oral health and perceive as their responsibility to clean the nonambulatory patient's teeth and tongue to keep oral cavity healthy which is on par with the study done by DeKeyser Ganz et al.[3] About 45.2% of the nurses stated that only trained nurses will perform oral care procedures for patients admitted to the hospital which is in contrast with the study done by Adams[4] and Wårdh et al.[5] as they state that untrained nurses can substantially do oral health care of the patients.

Gauze (79.8%) and mouthwash (54.8%) were the aids used by nurses to clean patient's mouth when admitted in hospital which was homogeneous with the study done by DeKeyser Ganz et al. as the nurses are aware that mouthwash is easy to use and cleans more effectively because of its antimicrobial action which increases the oral health condition.[3] More than half (53.8%) of the nurses stated that uncooperative patients hinder them from performing oral care procedure as patients perceive that oral health is not that important compared to general health problems which are higher than the study done by Ranjbar H (40.4%).

Overall, 90.9% of the nurses agreed that patients should have an oral check up on admission. Among them, 66.8% of the nurses agreed that oral care should be done as often as possible during hospital stay and only 47.1% perceived that cleaning oral cavity of the patients is an unpleasant task; these results are found to be contrary with the study done by Ranjbar et al.,[6] which states that majority of the nurses (i.e., 77%) were not willing to clean oral cavity and they perceived that cleaning oral cavity is an unpleasant task. In this study, 92.8% of the nurses agreed that they have received adequate training in providing oral care. These results are in contrast with the study done by Ranjbar et al. where nurses agreed that they had not received adequate training.[6] Majority (88%) of nurses perceived that proper oral care is needed for good general health, they were aware that oral health can hinder the general health; these results were in disagreement with the study done by Ranjbar et al. where only 51.9% believed that oral cavity had no effect on improvement of the patient's condition.[6]

About 70.2% of the nurses agreed that it was their responsibility to check the oral cavity and provide oral care to patients, and more than half (63.9%) of the nurses disagreed that oral problems need not to be given more attention, but they felt that worsening of oral health can affect the quality of life of the patient.

About 62.5% of nurses perceived that oral problems and their treatments should not be delayed even though they are not life threatening, as they are aware that poor oral health has a profound effect on general health and quality of life.

Mechanically ventilated critically ill patients are usually more prone to hospital-acquired infections which usually depends on their duration of stay.[7] In these patients, as oral route becomes the only source of administration, they are frequently exposed to oral infections. These infections are known to cause many of the systemic diseases such as diabetes, cardiovascular diseases, and pneumonia by affecting the host's susceptibility in different ways. Periodontitis, one of the major oral infections in which subgingival biofilms act as reservoirs for Gram-negative bacteria, periodontium itself acting as reservoir of inflammatory mediators, is found to be commonly occurring factor for the cause of systemic diseases.[8] Therefore, maintenance of oral care is pivotal to patient's well-being and comfort.

This study provides a view on nurse's perceptions, their attitudes, and practices regarding the oral care of nonambulatory patients in medical wards. Despite the importance toward oral care in these patients, there is very less literature available. Practical skills of nurses toward oral care on nonambulatory patients were not assessed in this study.

Future researches could address the assessment of practical skills of the nurses toward the oral care of the nurses on nonambulatory patients. Apart from nurses, dental surgeons should be posted to attend bedridden patients to take care of their oral health.


  Conclusion Top


Overall attitudes and practices among nurses regarding oral health care for nonambulatory patients were satisfactory.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Yildiz M, Durna Z, Akin S. Assessment of oral care needs of patients treated at the Intensive Care Unit. J Clin Nurs 2013;22:2734-47.  Back to cited text no. 1
[PUBMED]    
2.
Munro CL, Grap MJ. Oral health and care in the Intensive Care Unit: State of the science. Am J Crit Care 2004;13:25-33.  Back to cited text no. 2
[PUBMED]    
3.
DeKeyser Ganz F, Fink NF, Raanan O, Asher M, Bruttin M, Nun MB, et al. ICU nurses' oral-care practices and the current best evidence. J Nurs Scholarsh 2009;41:132-8.  Back to cited text no. 3
[PUBMED]    
4.
Adams R. Qualified nurses lack adequate knowledge related to oral health, resulting in inadequate oral care of patients on medical wards. J Adv Nurs 1996;24:552-60.  Back to cited text no. 4
[PUBMED]    
5.
Wårdh I, Andersson L, Sörensen S. Staff attitudes to oral health care. A comparative study of registered nurses, nursing assistants and home care aides. Gerodontology 1997;14:28-32.  Back to cited text no. 5
    
6.
Rajbar H, Arab M, Abbasszadeh A, Ranjbar A. Affective factors on oral care and its documentation in icu of hospitals affiliated to Kerman University of M edical Sciences Iran J Crit Care Nurs 2011;4:45:28-32.  Back to cited text no. 6
    
7.
Jones DJ, Munro CL. Oral cancer and risk of bloodstream infections in mechanically ventilated adults: A review. Intensive Crit Care Nurs 2008;24:152-61.  Back to cited text no. 7
[PUBMED]    
8.
Li X, Kolltveit KM, Tronstad L, Olsen I. Systemic diseases caused by oral infection. Clin Microbiol Rev 2000;13:547-58.  Back to cited text no. 8
[PUBMED]    



 
 
    Tables

  [Table 1], [Table 2]


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