Nurses’ Oral Hygiene Care Practices With Hospitalized Older Adults In Post-Acute Settings

Abstract

Background and Purpose: Evidence now links poor oral hygiene to systemic and infectious diseases such as pneumonia. Hospitalized patients, who now retain their teeth into older adulthood, often rely on nurses to provide oral hygiene care. Nurses have the potential to impact oral health outcomes and quality of life by controlling plaque. However, oral hygiene care practices of nurses in post-acute hospital settings are relatively unknown. The purpose of this study was to explore how nurses provide bedtime oral hygiene care, how they decide on interventions provided, and how certain factors influence their ability to provide oral care.

Methods: A qualitative, exploratory multiple-case study was conducted with 25 nurses working on five inpatient units at different hospitals. Nurses were accompanied on their evening rounds to observe oral care practices, the physical environment, and workflow. Thematic analysis was used to analyse the case study data base including transcripts of guided conversations, field notes, and documents. Within-case analysis was followed by cross-case analysis.

Findings: Findings indicate that: (a) nurses often convey oral hygiene care to their patients as being optional; (b) nurses are inclined to preserve patient autonomy in oral hygiene care; (c) oral hygiene care is often spontaneous and variable, and may not be informed by evidence; and (d) oral hygiene care is not embedded into bedtime care routines.

Implications: Oral health history and assessment data are essential to the creation of individualized, feasible oral hygiene care plans that consider patient dignity. Knowledge of the health benefits of oral care, and skills related to assessment and approaches to oral care are required by nurses. Availability of effective products and supplies facilitates provision of oral care. The evidence for oral hygiene care practices, outcomes of nurse-administered oral care, and the role of nurses in influencing the oral health literacy of patients requires further study.