Oral care practices among critical care nurses in Singapore: a questionnaire survey

Oral hygiene has an important role in maintaining the health and well-being of critically ill patients. Although a number of studies have examined nurses' oral hygiene practices, few were conducted among nurses caring for critically ill patients or involved Asian nurses.

The study aims to assess local nurses' knowledge, attitudes, and practices regarding oral care for critically ill patients.

A descriptive cross-sectional design was used. We developed a 31-item questionnaire based on the literature, existing questionnaires, and focus group discussion. The tool covers three domains: beliefs and attitudes, prevailing practices, and knowledge. We sampled all nurses who worked in five intensive care units and high dependency during a 2-week period. We summarized data using descriptive statistics and explored the association between the nurses' knowledge of oral practices and ward specialty, job function, nurses' education level, and work shift. We used exploratory factor analysis to investigate factorial validity of the beliefs and attitudes domain.

A total of 244 nurses (97%) returned the surveys. More than 80% of the respondents believed that good oral care has a significant impact on the patients' clinical outcomes. However, practices varied with regard to the frequency, requisites, and methods used for oral care. Only 66.3% perceived that they have adequate oral care training. Nurses' oral health knowledge varied with education level (p = .019). Nurses' knowledge did not differ statistically across different specialities, job functions, and type of shift work. Factor analysis on the beliefs and attitudes domain revealed three factors, which we labeled as task efficacy, knowledge need, and task salience.

The survey provided useful insights on the oral hygiene knowledge and practices of nurses caring for critically ill patients. The findings indicated that local nurses lacked adequate knowledge related to oral health and generally were ill equipped to deliver proper oral hygiene for critically ill patients. The large majority of the nurses' oral care knowledge was learned during their basic nursing education. This knowledge is inadequate to prepare them for the challenge of caring for the oral hygiene needs of critically ill patients. The results emphasized the need for continuing training in this area.