Changing mouth care practice in intensive care: implications of the clinical setting context

The purpose of the study was to identify the prerequisites for achieving research-based mouth care practice in a district general hospital intensive care unit. An action research approach was adopted and a convenience sample of 10 qualified nurses was studied. Initial identification of current mouth care practice was achieved by observation and interview of these nurses. Following this an in-service teaching and support programme was introduced, after which the identification of any change in practice was made by re-interviewing the same nurses and observing for any change in the availability and use of suitable toothbrushes. Data analysis consisted of comparing information from the before teaching and after teaching observation schedules, and performing content analysis on the before and after teaching interview data. The results indicated that the use of toothbrushes had increased as had the knowledge of oral hygiene after the teaching programme. Factors which were identified as facilitating a change in practice included eliciting the perceptions of those experiencing change so that information and support could be tailored to meet the nurses' needs as they perceived them, the importance of context relevant information and practical instruction, the influence of role models and the availability of suitable brushes. Inhibiting factors included misconceptions about the risk to patient safety associated with toothbrushing.