Nurses' knowledge, attitudes, and practices in oral care for mechanically ventilated patients: A scoping review

The aim of this scoping review was to synthesise current evidence on nurses' knowledge, attitudes, and practices (KAP) regarding oral care for mechanical ventilated patients, and to identify factors and barriers influencing the implementation of evidence-based oral care in intensive care settings.

The review followed Joanna Briggs Institute (JBI) methodology and was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guideline. Cross-sectional studies published between 2015 and 2025 were identified through searches of PubMed, Scopus, ScienceDirect, ProQuest, and Google Scholar. Studies examining nurses' KAP related to oral care for mechanical ventilation patients were included. Data were extracted using a structured framework and synthesised descriptively, with methodological quality appraised using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies. The protocol was registered with the Open Science Framework (OSF.IO/6EWQD).

Twenty-seven cross-sectional studies were included from 1,882 screened records, conducted across Asia, the Middle East, Africa, Europe, South America, and the United States. Nurses demonstrated moderate knowledge and generally positive attitudes toward oral care, but practices were inconsistent. Key knowledge gaps involved oral biofilm management, ventilator-associated pneumonia prevention, and selection of oral care solutions. Despite favourable attitudes, practice was limited by workload, lack of standardised protocols, insufficient training, and limited resources, with education level and institutional support influencing practice.

While nurses possess reasonable knowledge of oral care for mechanical ventilation patients, substantial variability in attitudes and practices persists. The widespread use of non-standardised assessment tools limits comparability across studies, highlighting the need for validated and standardised KAP instruments.

Standardising oral care assessment tools and protocol may enhance nurses' competence, support consistent evidence-based oral care practices in intensive care units, and contribute to improved infection prevention, patient safety, and overall quality of critical care nursing.