Background
Oral care is one of the fundamental nursing procedures that have adverse effect on patient well-being and general health. Patients’ oral hygiene is defined as the practice of keeping the oral cavity healthy through cleaning of gums, teeth, tongue, lips and dentures [1]. Effective and routine oral care is necessary for maintaining the health of oral cavity and overall health of hospitalized patients [2]. On the other hand, poor oral hygiene causes oral discomfort, pain, and effect on chewing and swallowing that affect nutritional intake. It affects the quality of life and has a negative effect on nutritional status, increased vulnerability to gum and respiratory infections [3].
In most healthy adults’ oral cavity consist about 350 harmless aerobic microorganisms [4]. However, in hospitalized patients, these nonpathogenic microbes are potential risk to ship to pathogenic if oral care is not given within 48 h of admission. These virulent organisms form dental plaque in the oral cavity which becomes a source of bacteria and toxins [4-7]. If the plaque content is dislodged and get an access to enter the blood stream or the lungs it may cause cardiac or lung infections. Moreover, lately, poor oral hygiene has been shown to be a possible independent risk factor for hypertension [5].
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In hospitalized patients’ Hospital Associated Pneumonia (HAP) is the first leading cause of death and the third most common cause of infection [4]. In industrialized countries, hospital-acquired infections like HAP and Ventilator Associated Pneumonia (VAP) are the main causes of morbidity and mortality with a death rate of around 21.8, 62 and 62.07% in USA, Canada and India, respectively [8-10]. In a condition where a patient is under endotracheal tube (ETT)/ventilator, the ETT acts as a direct conduit for the dental plaque to enter into the lungs, which might cause VAP [4, 5, 11]. Ventilated patients have higher risk (9 to 27%) to develop pneumonia with a mortality rate of 36 to 60% of all hospital related deaths [4]. A study done in Florida revealed that oral hygiene was significantly associated with prevention of HAP in patients without endotracheal tube [5]. Therefore meticulous oral care is recommended for hospitalized patients to enhance comfort and reduce the incidence of nosocomial pneumonia [12].
In critical care units or in medically compromised patients, the mouth needs special attention [2, 13, 14]. In these patients oral cavity should be assessed, cleansed with a soft bristled tooth brush and documented properly at least in every shift [4]. However, oral care is often overlooked and not prioritized in daily activity plan of nurses even when oral problems are apparent [12, 15]. Even if oral care is performed it’s done in a substandard way just by swabbing the mouth with gauze and normal saline solely for comfort measure [13, 14, 16, 17]. Moreover, many studies showed that oral care is often seen as a difficult and unpleasant task by nurses which compromises its practice [14, 16, 18].
The role of nurses in maintaining the oral health and wellbeing of hospitalized patients is undeniable [16]. Having this in mind it is essential that nurses should be aware of evidence-based information and use of standard protocols to deliver appropriate oral care in their setting. The first step is to change the attitude of the nurses from viewing oral care solely as a comfort measure; to oral care as an obligation to help to improve nursing practice, create positive social change by improving the quality of care provided to patients, and improve patient outcomes by providing comfort and decreasing the risk of aspiration [19]. This could be achieved by enhancing their practice via improving the nursing curricula, providing on the job training and workshops, and equipping the health care setup.
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Nurses, as well-established, are the principal health-care providers for patients admitted to hospitals and provision of oral care is one of their duties [20]. In African studies, existing data shows that majority of nurses had favorable attitude towards prioritizing oral care in their nursing care plan. Hospital-based data are available for specific sites in Sudan (97.4%), Nigeria (94.3%), Egypt (81%) and South Africa (97.9%) [3, 16, 17, 21]. In contrast, unfavorable attitude towards oral care has been reported in some studies – 84% in Menoufia University study [22]. On the other hand, in studies done in Egypt (78%) and South Africa (57.6%) majority of the nurses used gauze swabs with mouth wash to clean the mouth [16, 17]. Moreover, in the study done in Menoufia University, 100% of the nurses had poor practice of oral care [22].
In Eritrea, oral care is not considered as an essential care for patients in the hospital. Subsequently, it was not done routinely. Even if it was performed, the practice was unsatisfactory (it was given once a day using gauze and normal saline or clean water). And generally, to date, there is no documented evidence that shows the attitude and practice of nurses or related studies towards patient oral care and its associated factors in Eritrea. This is therefore the first study to investigate the attitude and practice regarding oral care delivery for hospitalized patients among nurses working in Orotta hospital.
Therefore, the aim of this study was to assess the nurses’ attitude towards oral care and their practicing level for hospitalized patients in adult medical-surgical department of Orotta hospital and identify any associated factors. The finding of the study might help in improving quality of nursing care, particularly oral care and practice, among nurses. This may enhance oral health in Eritrea where there are few dentists. In addition, the findings may provide essential data for subsequent studies.
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