Nurses’ practice and educational needs of oral care for postoperative patients with oral cancer in ICUs：a multicenter cross-sectional study
Authors: Wei XiaoJing , Jing MengJuan , Zhang XianXian , Li ChunPeng , Li LiMing 
Published: May 2022

Abstract
Background: Structural changes in oral cavity, surgical incision, endotracheal intubation and other factors lead to divergence in oral care between patients after oral surgery and ordinary inpatients. High-quality oral care can reduce the incidence of incision infection and ventilator associated pneumonia. However, there is a lack of guidelines or expert consensus on oral care after oral cancer surgery . The aim of this study was, therefore, to assess ICU nurses’ practicing situation of oral care for postoperative patients with oral cancer and their need for training.Methods: A multicenter cross-sectional study design was conducted in 19 intensive care units of 11 tertiary hospitals from Henan province in China. Data was collected from 173 nurses and 19 head nurses online using a structured questionnaire. Mann-Whitney U and Kruskal-Wallies H tests were performed to analyze the data using SPSS (Version 25.0). Results: There were 7 (36.8%) ICUs and 8 (42.1%) ICUs formulating standard regulations on evaluation and procedure of oral care for postoperative patients with oral cancer respectively. A total of 173 nurses completed the questionnaire, and the median number of score was 75 (68, 78). Almost all nurses (91.2%) assessed patients’ oral hygiene at fixed time, while 52.0% and 28.3% of nurses depended on patient’s situation to conduct the first oral care and decide the frequency of oral care after surgery. More than half of the nurses (55.5%) spent about 5~10 min to conduct oral care for patients. Physiological saline solution (82.7%), swabbing (91.9%) and oral care package with cotton ball (86.1%) were the most popular oral care mouthwash, method and tool respectively. Nurses sought help from senior nurses (87.3%) and doctors (83.8%) mostly to solve difficulties of oral care, and 76.9% of nurses believed that the lack of knowledge and skills of oral care was the main barrier for nurses to implement oral care. Majority of participants (69.4%) have never received continuing education or training in oral care for postoperative patients with oral cancer and almost all (98.8%) of the respondents wanted standardized oral care skills. They thought that indications and contraindications (84.4%), the needed tools (81.5%) and mouthwash (80.9%) of oral care were the most eager to learn for ICU nurses. Approximately three quarters of nurses preferred scenario simulation practice as the training method.Conclusion: The participants had high scores in the oral care for the postoperative patients with oral cancer, nevertheless, there were great diversities in the practice. Lack of oral care knowledge was considered to be the main barrier in delivering quality oral care, and educational need was stated by almost all participants. We suggested that standard protocol or clinical practice guidelines of oral care for postoperative patients with oral cancer should be developed, and nurses should be educated with professional knowledge and skills.