Int. J. Int. J. Cur. Tr. Res (20) (2):104-10 ISSN:227-042 www.injctr.com Nurse s practice concerning mouth care for unconscious or debilitated patient Abdulkareem Salman Khudhair* Nuraing College Basrah University, Basrah- Iraq Received: August 10, 20 Accepted: 24 August 20/ Published online 2 August 20. INJCTR 20 Abstract The study aims to assess nurses' practice concerning oral care at the ICU, and to identify the relationship between nurses practice and their demographic characteristic data. A descriptive study uses the assessment approach and uses non-probability sampling. A purposive sample of (2) nurses was selected from ICU at Al- Sader Teaching Hospital. The data were collected through the use of constructed questionnaire, which comprised of (1) items as an observation technique as mean of data collection. The data were analyzed through the application of descriptive statistical analysis that include frequency, percentage and the application of inferential statistics that including the mean of score, and Chi- square test. The results of the study show that the nurses have inadequacy skills towards oral care for unconscious or debilitated patient. Based on the results of research, he study recommended that training sessions programs can be designed and presented to the ICU nurses. Keywords: Nurse practices, unconscious patients and intensive care unit. Introduction Unconsciousness is a state of total absence of awareness and ability to respond even when stimulated, or it is the abnormal stat of complete or partial unawareness of self or environment (Patricia et al., 2007). Coma is deep sleeplike state from which the patient cannot be aroused. Oral hygiene maintenance of an adequate level of daily oral hygiene, including brushing, flossing, and rising, is essential for the prevention and control plaque-associated diseases ( Endacott et al., 200). In addition to preventing inflammation and infection, oral hygiene promotes comfort, nutrition, and verbal communication (Anne Griffin et al., 200). Brushing cleanses the teeth of food particles, plaque (the cause of dental caries), and bacteria; massages the gums; and relieves discomfort from unpleasant odors and tastes Patricia and potter, 2002). Some clients require mouth care as often as every 1to 2 hours until the mucosa returns to normal (Saladin Kenneth, 2004). Many unconscious clients have no gag reflex as a result of neurological injury ( Daniels Rick, 2004). The accumulation of salivary secretions in the mouth can easily lead to aspiration Perry et al., 200). Proper oral hygiene requires keeping the oral mucous moist and removing secretions that can lead to infection (Bentz et al, 2007). Preventing deterioration of oral health is an important part of nursing care of the unconscious or debilitated (Berman et al., 200). Depressed state of consciousness is the most common neurologic problem in intensive care units ranging from lethargy to coma (Perry and potter, 200). Caring for unconscious patient is critical care nursing ( Badra, 1). The nurse plays an important role in prevention and early detection of complication by checking, reporting his/her observation, notifying the doctor, rehabilitation of patient and preventing disabilities ( Irwin and Rippe, 200). The study aims to assess nurses' practice concerning oral care at the ICU, and to identify the relationship between nurses practice and their demographic characteristic data. Corresponding author* E.mail: abdulkareem.salman@yahoo.com
10 Methodology Abdulkareem Int. J. Cur. Tr. Res (20) 2 (1):104-10 half of study sample was nursing institute graduate (Table 1). A purposive "non-probability" sample of 2 nurses who work in ICU in Alsader teaching hospital in Basra city. Data were collected through the use of the constructed questionnaire for demographical characteristics and observational checklist use for assessment of nurses practices. The questionnaire and observational checklist was constructed by the investigator to achieve the objectives of the study, which consisted of two parts; the first part is concerned with the socio-demographic characteristics of the nurses which included; age, gender, level of education; the second part is consists of 1 items about nurses practices of unconscious patient. These items were measured, scored and rated of -level Likert rating scale; always (), sometimes (2), never (1). or each level respectively so cut of point was (2) and the lowest value for acceptance (adequate) was (.7) as and all value below (.7) are inadequate. The validity and reliability for the constructed questionnaire were determined by using pilot study and the experts panel, and the application of alpha correlation coefficient (r= 0.0) which was statistically acceptable. Data were analyzed through the application of descriptive statistical analysis (requency, Percentage, Mean of score) and inferential statistic the Chi- square test (Polit and Hungler, 1; Mcnemar, 1). Results and Discussion Throughout the course of the preset study, it has noticed that the majority (0) of the study sample was female. The highest proportion (40) of them was (2-2) years old. Concerning level of education, approximately Table 1 Distribution of nurses by their demographic data 1. Gender Male 10 40 emale 1 0 2 100 2. Age 20-24 2 2-2 10 40 0-4 20 & over 2 2 100. Level of Education Intermediate nursing school 24 Secondary nursing school 7 2 Nursing institute graduate 12 4 2 100 Throughout the use of observational checklist the highly percentage of nurse's have inadequate practices in all items concerning mouth care(table 2). These findings are indicate that the unconscious patient may susceptible to many problem like pneumonia, bed sores, risk of infections, other problems that may lead death. This finding agrees with study conducted by Batool and Ali (20) that find poor nursing care and increase complications. There were no significant relationships between nurses practice and gender, age and level of education in ICU (Tables,4,), this results are due to lack of training courses in the field of ICU about the job description and responsibility between nurses. Table Association between nurse's practice and their gender Gender Always Sometime Never Male 44 4.07 2.1 1.7 100 emale 7 7 221.2 2.4.7 100 17 100 1 72.2 2..2 100 X 2 calculated =.10 df= 2 X 2 tabulated=.1 P 0.0 =requency; df= degree of freedom ; p= probability value; = percent The finding of this table presented that there were no significant associations between the nurse's gender and their practice.
Int. J. Cur. Tr. Res (20) 2 (1): 104-10 Abdulkareem 10 Table 2 Statistics of the nurse's practice for the studied items concerning oral care Items Always Some times Never MS RS Assessment 1. Wash hand 2.24 74.7 adequate 2. Raise bed to it is highest horizontal level lower side rail.. Position client close to side of bed. Turn client is head toward mattress. 4. Remove dentures or partial plates if present.. Place towel under client's head and emesis basin under chin.. If client is uncooperative or having difficulty keeping mouth open, insert an oral air way. Insert up side down, then turn the air way side ways and then over tongue to keep teeth apart. Insert when client is relaxed, if possible.do not use force. 7. Clean month using brush or sponge toothettes moistened with peroxide and water.clean chewing and inner tooth surfaces first. Clean outer tooth surface. Swab roof of mouth,gums and inside cheeks. Genly swab or brush tongue but avoid stimulating gag reflex. Moisten clean swab or toothetterter with water to rinse. Repeat rinse several times.. or clients without teeth, use a toothette moistened in water or normal saline to clean oral cavity.. Suction secretions as they accumulate.if necessary. 10. Apply thin layer of watersoluble gelly to lips.. Inform client that procedure is completed. 12. Raise side rails as appropriate. Remove gloves and dispose in proper receptacle. 1. Reposition client comfortably and return bed to original position.. Clean equipment and return to it is proper place. Place soiled linen in proper receptacle. 1. Wash hands. 2 2 7 7 4 1 4 1 1 1 1 1 1 1 1 1.0 1.2 1. 1.2 1. 1. 1.40 1.2 1.40 1, 1.7 1. 0 1. 1. 0 4 4. 0. 2 4. 4. 4 4. 2... MS= Mean of score; RS= Relative sufficiency The findings of the table indicate that the nurses have inadequate practices in all items concerning mouth care accept hand wash.
107 Abdulkareem Int. J. Cur. Tr. Res (20) 2 (1):104-10 Table 4 Association between nurse's practice and their age Level of education Always Sometime Never Primary 1 2 47 school 21.4 2. 2.1 100 Secondary 1 7 101 school 2.7 0..4 100 Institute 2 47 graduate 2.27 2.4 4.1 100 104 101 1 74 27.2 27 4.1 100 X 2 calculated =. df= 4 X 2 tabulated=.4 P 0.0 =requency; df= degree of freedom ; p= probability value; = percent The finding of this table presented that there were no significant associations between the nurse's age and their practice. Table Association between nurse's practice and their level of education Age Always Sometime Never 20-24 4 27 4. 22.. 100 2-2 7 4 4.1 1.0 0.41 100 0 4 27 1 2 7. 24.. 100 & more 1 2 17.2 27..17 100 1 1. 2.. 100 X 2 calculated =.72 df= X 2 tabulated= 12. P 0.0 =requency; df= degree of freedom ; p= probability value; = percent The finding of this table presented that there were significant associations between the nurse's education and their practice. Recommendations The study recommends increasing trainingsession program for nurses for care of unconscious patient in ICU, developed assessment sheet for skills and daily nursing note for unconscious patient depends upon hospital policy and strategy, nurses should be provided with in-service education regarding nursing for unconscious patient in intensive care unit. References Patricia, A. Potter and Anne Griffin Perry: undamentals of Nursing (1 th ed.) Upper Saddle River co.2007 ;P.0. Endacott Ruth; Phil Jevon, and Simon Cooper: Clinical Nursing Skill and Advanced, th ed. Mosby co. 200 ; P.7. Anne Griffin Perry and Patricia A. Potter (200). Clinical Nursing Skill and Techniques, 7 th ed. Elsevier Mosby co. p.401. Patricia A. potter :Clinical Nursing Skill and Techniques, th ed. Mosby co. 2002; P.17. Saladin S. Kenneth : Anatomy and Physiology. New York, McGraw Hill co. 2004; P. 4 Daniels Rick: Nursing undamental Caring and Clinical decision making, 2 nd ed. Upper Saddle River co. 2004,PP. 1-20. Perry G. Ann and Patter A. Patricia :Clinical Nursing Skill and Techniques. 7 th ed. Mosby co. 200, PP.401 4 Bentz p, et al,: Modules for Basic Nursing Skills 7 th ed. Philadelphia: Lippincott. Williams 2007..pp. 2-4. Berman,A.; Snyder, S. ;and Kozier,B: undamentals of Nursing. Upper Saddle River 200.PP.772-77.
10 Abdulkareem Int. J. Cur. Tr. Res (20) 2 (1):104-10 Perry, A. G and P.A. Potter (200). Clinical nursing Skills and Techniques th ed. Mosby co. PP. 401. Badra, I (1). K nowdege and practice the three pillars of excel lace and wisdom. East. Mediterr. Health J. 1(1): Copy right 1, P.. Irwin S and J. Rippe (200). Intensive care medicine, TH ED Philadelphia: USA 200: P. 2. Polit D. and B. Hungler (1). Nursing Research: Principle ad Methods, th ed. Philadelphia: Lippincott company, 1; p. 2. Mcnemar Q (1). Psychological statistics, 4 th ed., John Wiley and sons, Inc, New York, 1; pp.2-24. Batool, A., and A. Ali (20). Assessment of Nurses Practice for Neurological Unconscious patients In intensive care unit. Iraqi national j, for nursing Specialties, vol 24(1); 20.