PMID- 27134232
OWN - NLM
STAT- MEDLINE
DCOM- 20180126
LR  - 20180629
IS  - 1937-710X (Electronic)
IS  - 1062-3264 (Linking)
VI  - 25
IP  - 3
DP  - 2016 May
TI  - Ethnographic Investigation of Oral Care in the Intensive Care Unit.
PG  - 249-56
LID - 10.4037/ajcc2016795 [doi]
AB  - BACKGROUND: Oral care plays a clear and important role in the prevention of
      ventilator-associated pneumonia. However, few studies have explored the actual
      work of oral care by nurses in the intensive care unit. OBJECTIVE: To explore
      intensive care nurses' knowledge of and experiences with the delivery of oral
      care to reveal less visible aspects of this work. METHODS: In an institutional
      ethnography, go-along and semistructured interview methods were used to explore
      the oral care practices and perspectives of 12 bedside nurses and 12
      interprofessional (intensivist, allied health, and management) participants in an
      intensive care unit at a large urban teaching hospital in Ontario, Canada.
      RESULTS: Nurses described how obstacles frequently inhibited the delivery of oral
      care. Technical barriers included oral crowding with tubes and aversive responses
      by patients, such as biting. Contextual impediments to oral care included time
      constraints, lack of training, and limited opportunities for interprofessional
      collaboration. A key discovery was the presence of an informal unit-based nursing
      curriculum, whereby nurses acquired strategies to overcome barriers to oral care.
      Although the nurses did extensive problem solving in providing oral care, the
      interprofessional participants had limited knowledge of how oral care was
      accomplished. CONCLUSION: These data suggest the complexity of performing oral
      care in intensive care is underestimated and perhaps undervalued. Future research
      is needed to address technical and contextual barriers to optimize current
      guideline expectations for the provision of regular and effective oral care.
CI  - (c)2016 American Association of Critical-Care Nurses.
FAU - Dale, Craig M
AU  - Dale CM
AD  - Craig M. Dale is an assistant professor and Jan E. Angus is an associate
      professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto,
      Toronto, Canada. Tasnim Sinuff is an assistant professor, Department of Critical 
      Care, Sunnybrook Health Sciences Centre, and Interdepartmental Division of
      Critical Care, University of Toronto. Louise Rose is the TD Nursing Professor of 
      Critical Care Research, Sunnybrook Health Sciences Centre, an associate
      professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto,
      research director, Provincial Centre of Weaning Excellence/Prolonged Ventilation 
      Weaning Centre, Toronto East General Hospital, and an adjunct scientist, Mt Sinai
      Hospital, Li Ka Shing Knowledge Institute, St Michael's Hospital, and West Park
      Healthcare Centre, Toronto, Canada. craig.dale@utoronto.ca.
FAU - Angus, Jan E
AU  - Angus JE
AD  - Craig M. Dale is an assistant professor and Jan E. Angus is an associate
      professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto,
      Toronto, Canada. Tasnim Sinuff is an assistant professor, Department of Critical 
      Care, Sunnybrook Health Sciences Centre, and Interdepartmental Division of
      Critical Care, University of Toronto. Louise Rose is the TD Nursing Professor of 
      Critical Care Research, Sunnybrook Health Sciences Centre, an associate
      professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto,
      research director, Provincial Centre of Weaning Excellence/Prolonged Ventilation 
      Weaning Centre, Toronto East General Hospital, and an adjunct scientist, Mt Sinai
      Hospital, Li Ka Shing Knowledge Institute, St Michael's Hospital, and West Park
      Healthcare Centre, Toronto, Canada.
FAU - Sinuff, Tasnim
AU  - Sinuff T
AD  - Craig M. Dale is an assistant professor and Jan E. Angus is an associate
      professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto,
      Toronto, Canada. Tasnim Sinuff is an assistant professor, Department of Critical 
      Care, Sunnybrook Health Sciences Centre, and Interdepartmental Division of
      Critical Care, University of Toronto. Louise Rose is the TD Nursing Professor of 
      Critical Care Research, Sunnybrook Health Sciences Centre, an associate
      professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto,
      research director, Provincial Centre of Weaning Excellence/Prolonged Ventilation 
      Weaning Centre, Toronto East General Hospital, and an adjunct scientist, Mt Sinai
      Hospital, Li Ka Shing Knowledge Institute, St Michael's Hospital, and West Park
      Healthcare Centre, Toronto, Canada.
FAU - Rose, Louise
AU  - Rose L
AD  - Craig M. Dale is an assistant professor and Jan E. Angus is an associate
      professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto,
      Toronto, Canada. Tasnim Sinuff is an assistant professor, Department of Critical 
      Care, Sunnybrook Health Sciences Centre, and Interdepartmental Division of
      Critical Care, University of Toronto. Louise Rose is the TD Nursing Professor of 
      Critical Care Research, Sunnybrook Health Sciences Centre, an associate
      professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto,
      research director, Provincial Centre of Weaning Excellence/Prolonged Ventilation 
      Weaning Centre, Toronto East General Hospital, and an adjunct scientist, Mt Sinai
      Hospital, Li Ka Shing Knowledge Institute, St Michael's Hospital, and West Park
      Healthcare Centre, Toronto, Canada.
LA  - eng
GR  - CIHR/Canada
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am J Crit Care
JT  - American journal of critical care : an official publication, American Association
      of Critical-Care Nurses
JID - 9211547
SB  - IM
SB  - N
MH  - Anthropology, Cultural
MH  - Canada
MH  - Critical Care Nursing/*methods
MH  - Female
MH  - Humans
MH  - *Intensive Care Units
MH  - Interviews as Topic
MH  - Male
MH  - *Nursing Staff, Hospital
MH  - Oral Hygiene/*methods
MH  - Pneumonia, Ventilator-Associated/*prevention & control
EDAT- 2016/05/03 06:00
MHDA- 2018/01/27 06:00
CRDT- 2016/05/03 06:00
PHST- 2016/05/03 06:00 [entrez]
PHST- 2016/05/03 06:00 [pubmed]
PHST- 2018/01/27 06:00 [medline]
AID - 25/3/249 [pii]
AID - 10.4037/ajcc2016795 [doi]
PST - ppublish
SO  - Am J Crit Care. 2016 May;25(3):249-56. doi: 10.4037/ajcc2016795.