Improvement of the oral health of patients in the ICU

Improvement of the oral health of patients in the ICU

Midterm Project

Student Name

Institution Affiliation

Effective Oral Healthcare

Project Description and Objective Rationale

This given project’s primary grail is to use evidence-based research to establish and provide a useful oral healthcare educational package in improving oral health care practice by nurses with the support of relevant literature.

Among hospitalized patients, those in intensive care units often require more specialized care than other individuals. Additionally, these individuals need specialized care because they often have critical health conditions that render them dependent on multidisciplinary teams. Haresaku et al. (2018) assert that these multidisciplinary teams can always provide ethical, human, and clinical help. Odgaard and Kothari (2019) further add that these given individuals will always find it challenging to undertake the simplest activities in which oral hygiene is inclusive. Therefore, as health practitioners, providing oral care to these given individuals is often essential. Why is oral hygiene a fundamental aspect for patients in the intensive care unit? Moore and Cunningham (2016) assert that oral hygiene is fundamental for intensive care unit patients. It is vital in helping them uphold the health of their stomatognathic systems.

According to a study conducted by El Aziz (2014) on patients’ oral health in the intensive care unit, there is an alarming percentage of about 93% of the population who experience low and poor oral health hygiene. Consequently, to the given literature review carried out in the mentioned study, Miranda et al. (2016) also add that 87 percent of nurses working in the intensive care unit have many issues and drawbacks when maintaining the patients’ oral health care. Nonetheless, these given drawbacks and issues often surface even though these nurses have the required knowledge and expertise to do so. Therefore, this is an aspect that raises many questions when it comes to routine practices put in place to care for the patients in the intensive care unit.  Akin et al. (2014) further adds that it is the nurse’s role and duty to make sure that oral hygiene and oral health care is upheld in intubated patients in the intensive care unit in ensuring oral hygiene was essentially crucial in the case of intubated patients as the practice is entirely dependent on the nursing staff for the maintenance or oral care.

Consequently, the authors also argued that oral hygiene is given a low priority to the mentioned aspects since it is the most challenging and complicated procedure to perform given that some patient tends to bite their nurses due to confusion. The given challenges often stir complications and difficulties in upholding and establishing good oral hygiene of patients in the intensive care unit. The literature review present on the nurse’s attitude also reveals that many of the nurses working in the intensive care unit often have a positive attitude and perception towards oral hygiene. None the less, according to Moore and Cunningham (2016), many of the nurses working in the intensive v=care unit to provide oral healthcare to the patients often have a positive attitude when it comes to the service they offer on oral hygiene but fail to put into place the best practices that are needed to take care of the delicate patients. Thus, according to El Aziz (2014), this implies that nurses dealing with oral healthcare and hygiene in the intensive care unit need to be provided with relevant and effective education on the most recent skills and techniques required in taking care of the given patients.

Conducted investigations reveal that there is no standardized oral hygiene protocol in many of the hospitals. Moreover, a health professional in these given hospitals often gives very little or no attention at all when it comes to activities that are directed towards oral hygiene, such as dental activities. According to Haresaku et al. (2018), many of the health professionals will most likely fail to recognize or acknowledge the difference between the aspect of oral hygiene and the treatment of systemic diseases or infections. Additionally, oral assessments conducted in the given hospital in conjunction with the charts and the ICU’s equipment had not been updated from a prolonged period since the year 2010 (Haresaku et al., 2018). Moreover, Haresaku et al. also assert that many dentist sections in hospitals always focus more on curative and rehabilitative practices than offering education and prevention. Therefore, the project’s primary aims towards promoting oral healthcare in the intensive care unit are to.

1. Assess and analyze the nurses in the intensive care unit’s level of knowledge and skills in providing oral healthcare and hygiene to the patients.
2. Assess the challenges and difficulties related to hospitalized patients in the intensive care unit regarding receiving oral health care and hygiene services.
3. Assess the oral preventive measures’ effectiveness in place by the oral healthcare nurses in the intensive care unit to promote patients’ overall health.
4. Determine the effectiveness of the oral healthcare and hygiene guidelines implementation in the care of critically affected patients in the intensive care unit

Implementation to date

The project’s implementation is to undergo eight stages or steps of the research process at the given hospital’s training department in providing relevant teachings and pieces of training regarding oral healthcare of patients in the intensive care unit as required by the health guidelines of oral healthcare in the intensive care unit. Consequently, each given session is delivered to the staff in two sessions by the researcher to the given steps. With the current situation of Covid-19, having a higher group of individuals will be essentially unsafe. The number of staff is about 12, and each attended to two at a time. Additionally, the sessions’ coordination is to be done by the researcher involving both the day duty nurses and night duty nurses towards diversifying the given population. The conduction of the education sessions will include putting in place a 20 minutes PowerPoint presentation. A five-minute video demonstration will be done on the preventive aspect of oral care and hygiene utilizing of representative models of patients in conjunction with a five-minute discussion session. Ultimately, with the guidelines presented by the healthcare body, both the pre-tests and post-tests questionnaires will be carried out towards assessing the effect of the oral healthcare education sessions towards improving the patients’ welfare.

The oral healthcare project was to follow given planned actions and deadlines that had to be met in eight weeks as guided by Lockhart (2006). Nonetheless, several parts of the project have been completed so far, while the others are still in progress, as illustrated by the dates indicated. The overall plans for the project include:

• Hold meetings with key stakeholders, have conferences directed to the projects’ details, and attain ethical clearance and appropriate administrative approval.
• Conducting an extensive literature review on oral healthcare in the ICU.
• Completing the project plan
• Gathering of effective and essential equipment for the development of the educative video.
• Bookings of education rooms and setting of proper appointments
• Preparing pre-test and post-test questionnaires
• Consultation with key stakeholders
• Completion of the mid-project report
• Conduction of education sessions
• Data analysis, evaluation, and storage
• Completing the final report
• Challenges faced
• Reflection on the project design

Out of the plans, as mentioned above to date, the following has been completed as per the project plan:

• Hold meetings with key stakeholders, have conferences directed to the projects’ details, and attain ethical clearance and appropriate administrative approval.
• Conducting an extensive literature review on oral healthcare in the ICU.
• Completing the project plan

The given project was commenced on the 25^th of May 2020, by conducting an extensive literature review on oral healthcare in the intensive care unit, including an intense search of E.H.’s databases for protocols and analysis currently used R.H. by extensively analyzing and studying the project title. During the study of NSG5IPC. The analysis of the E.H.’s database for the most current policies and protocols for oral healthcare in the ICU was conducted on the 27^th of July 2020. Consequently, on the extensive review, the researchers did ethical clearance and appropriate administrative approval on the 1st of August 2020, holding meetings with the key stakeholders and having conferences directed towards the projects. Consequently, to the plan, discussions were also done with key stakeholders using emails and given video conferences while, in turn, garnering support towards obtaining approval and clearance before starting the project.

Additionally, submission of the necessary administrative forms of information, including details such as the ethical clearance checklist and audit registrations, was also made. Discussions were also conducted with the nursing educators on making bookings for educational venues within the specific set dates concerning completing the projects utilizing the nurses and staff on day duty or night duty. Approval was also sought to use the stock and mannequin from the education sessions’ equipment room. Ultimately, on completion of the project plan, the assessment was conducted for Latrobe universities NSM5NPI subject on the 24^th of August 2020.

The next remaining steps for the project completion of the project include gathering relevant equipment and materials for developing educative film demonstrations with PowerPoint slides. Additionally, other aspects include early choosing and asking for education venues with suitable appointments. Other steps entail developing test questionnaires and discussions with the involved parties to evaluate the project. Completing the mid-project report, conducting education sessions, data analysis, evaluation, and completion of the final project are other vital remaining steps. The completion of the project is still set to be on the 19^th of October 2020. A point also notes that the final report format will include data collection methods, data analysis, and relevant evaluation feedback, among other vital aspects such as future recommendations in a two-page written report submitted for Latrobe University NSM5NPI subject.

An important point to note is that before the project commenced, strict ethical considerations were made. According to the hospital’s parent organization, the project was set to adhere to the relevant ethical requirements in carrying out a project, eastern heath. Ultimately, the eastern heaths code of conduct and the ethical guidelines stipulated under nursing care set rules (2018). Additionally, even before the beginning of the project, the signing of the quality assurance and audit registration forms was done and, in turn, submitted to the eastern health ethics committee as part of the guidelines and steps needed for researching eastern heath. However, since it has a low negligible risk when matched with the checklist, ethical approval was unnecessary. None the less, for the remaining uncompleted steps of the project, informed verbal consent to ensure the participants’ privacy would be obtained before starting the education sessions. Random picking and selecting participants will be made, allowing them to participate in the project at their own will and have the freedom and right to withdraw from the project. Conduction of both the pre-test and post-test post-test will be done with the researcher’s absence in the education room when submitting the questionnaires in the ballot boxes. This probe will be necessary for making sure that the researcher does not recognize the participant with the answer they have given during the questionnaires’ submission and hence fosters the participants’ anonymity and confidentiality. Consequently, the obtained data will eventually be destroyed to the mentioned aspect as required by the data management body provided by the NHMRC (2018).

Key challenges

From the onset of the project, there has not been any severe challenge incurred. However, since some minor challenges were not an exception, several challenges were faced when beginning the project. There are few challenges too that are expected to might arise when carrying on with the project. Ultimately, before the project’s onset, fear acted as a barrier to executing the project. It looked enormous and required many details and steps, not forgetting the many activities that were to be carried out. However, with support from other members, that became an issue long forgotten.

Additionally, the Covid-19 pandemic’s onset also dealt a significant blow to the project’s progress and activities in many ways. For instance, with the lockdown situation, a free movement was restricted to given times, making it challenging to carry out some of its activities. Additionally, the pandemic was not only a challenge at the beginning of the project but is also expected to be a challenge in the future as the project progresses in significant ways. Moreover, the current global pandemic situation will limit the number of staff attended to adhere to the curbing guidelines.

Another relevant challenge that arose while progress wan the aspect of time. None the less, even though the time set for the project to be carried out seemed enough, some few difficulties arose between the steps to the extent that one of the steps had to be reshuffled to a new date, as shown per the project plan. These difficulties were attributed to the fact that some of the staff work in more than one hospital area in different shifts. Therefore, accessing all of them at a reasonable time became somehow a challenge to the researcher. Additionally, time was also a challenge since there was also at hand to attend to, shifting form school work to housework and attending to the project. Financially, everything is going on well as the stakeholders’ cooperation in carrying out the project through each step is unquestionable.

Reflections on the Project Design

Reflective practice is often described as the ability to reflect on an individual’s action to engage in continuous learning. According to Fook, (2015), a reflective practice also involves the essence of paying attention in a critical way towards ethe both practical values and theories. These given aspects often inform daily actions through the examination of practice both reflectively and reflexively. None the less, reflective practice is also often a vital means of both growing and professionally developing skills. Consequently, to the meditative aspect, to develop skills as a professional, there are many reflective models presented within the available literature such as the Kolb reflective cycle, Schon model, Driscoll model, and the gibs reflective cycle. However, despite the given diversity of reflective models, his assessment will utilize the Gibbs reflective cycle in conducting an effective and up to point reflection.

Description of what happened

ultimately, looking back at the project to this far, the most challenging aspect is coming up with the right steps in the most appropriate time. Moreover, this given aspect is contributed to the fact that one has to shift from school work to work and other family commitments. Additionally, coordinating with the stakeholders concerning deadlines is also one of the most challenging aspects since one is given minimal time to complete the project. Therefore, to succeed in the given area, one has to significantly put in more effort and sacrifice towards achieving the bigger goal. None the less, so far, the experience has been very educational, and I look forward to even working harder to complete the project in time.

Feelings-what were you thinking and feeling?

When given the project, I thought to myself that this was the best opportunity for me to express my level of expertise and grow my skills further in the given area. Additionally, I thought that I had been allowed to do something good both for society and the nursing fraternity at large, significantly contributing to the patients’ welfare. Therefore, when beginning the project, I thought to myself how I could make the project more effective and educative while meeting the set deadlines. Additionally, the steps that were carried out the best interest were to the patients and the staff involved in the project. Ultimately, I felt happy that I had begun a journey of making a significant impact on other people’s lives. None the less, I also feel that the project will be completed in time as all the steps are being attended to most suitably and effectively.

Evaluation- what was good and bad about the experience

There seemed to be so much to be done with the project’s onset in a brief period, making everything looking so overwhelming and tiresome. Additionally, there was a time that I even almost gave up. None the less, when I look back and think about giving up, I find it to be the worst experience I have ever had with the project. The Covid-19 pandemic has also been a bad experience when it comes to handling the project as it slowed down many of the activities. However, up to this far, I would say it is the best experience I have had since the project has been running even more smoothly, with each step being completed in the set deadline. Another good feeling that I have while working on the project is that I can develop a realistic program that will help too many by positively impacting their profession and others’ lives.

Analysis-what sense can you make of the situation?

From the situation at the begging in of the project to where it has reached now, I can agree with the fact that failing to try is planning to fail. None the less, I was only paranoid of the whole plan even without critically looking at the steps and activities needed to complete the project, making it seem like a hard nut to crack. Additionally, the fear of public speaking will only make me let myself and the group down because I can try and fix the given problem. Ultimately, no one should have to bet themselves over failing to achieve a particular goal but rather work hard and put in more effort to achieve the set goals. Therefore, I believe that I can effectively meet the set deadline and achieve the expected goals.

Conclusion- what else would you have done?

Reflecting on the mentioned aspect above, I feel that working as tam and making consultation is the essential aspect that is needed towards completing this given project. Additionally, I think that all that it takes to effectively meet the given project is to believe in oneself and have the seal to try harder.  For instance, before the project commenced, I felt that I did not have what it takes but later realized is that all that matters is that one step towards success that counts. None the less, even with the remaining part of the project, I believe that I will make as al that it takes to complete it is within me even though it runs on a tough time with the world battling Covid-19.

Action plan- if it arose again, what would you do?

I plan to discuss different aspects of the project with my colleagues and friends and effectively meet the set deadlines professionally. Additionally, I plan to do early research and ensure that every resource is implemented to complete the project on the stipulated deadline.

Reference

Akın Korhan, E., Hakverdioğlu Yönt, G., Parlar Kılıç, S., & Uzelli, D. (2014). Knowledge

Chidambaram, A.G., & Josephson, M. (2019) Clinical research study designs: The essentials.

Conduct of Research. Retrieved from

Fook, J. (2015). Reflective practice and critical reflection. Handbook for practice learning in social work and social care: Knowledge and theory, 3.

Haresaku, S., Monji, M., Miyoshi, M., Kubota, K., Kuroki, M., Aoki, H., … & Naito, T. (2018). Factors associated with a positive willingness to practice oral health care in the future amongst oral healthcare and nursing students. European journal of dental education, 22(3), e634-e643.

Jannetti, A. (2012). A representation: Incorporating a needs assessment and gap analysis into the educational design. NJ: Pitman

levels of intensive care nurses on the prevention of ventilator‐associated pneumonia.

Lockhart, J. (2006). Creating an Educational Plan That Meets the Learning Needs of Nursing

Miranda, A. F., de Paula, R. M., de Castro Piau, C. G. B., Costa, P. P., & Bezerra, A. C. B. (2016). Oral care practices for patients in Intensive Care Units: A pilot survey. Indian journal of critical care medicine: peer-reviewed, the official publication of Indian Society of Critical Care Medicine, 20(5), 267.

Moore, T., & Cunningham, S. (Eds.). (2016). Clinical Skills for Nursing Practice. Taylor & Francis.

National Health and Medical Research Council (2018). Australian Code for Responsible

Nursing in Critical Care, 19(1), 26-33.

Odgaard, L., & Kothari, M. (2019). Survey of oral nursing care attitudes, knowledge, and practices in a neurorehabilitation setting. Journal of oral rehabilitation, 46(8), 730-737.

Research Process (2012). 8 Essential Steps in the Research Process. Retrieved on the 22nd of August, 2020 from https://www.researchomatic.com/Research-Process-60167.html

Staff. Clinical Journal of Oncology Nursing, 10(2), P.P. 257-266.

`Pre-test questionnaire (underline on the appropriate answer)

What is your level of education?

1. University
2. College

What level of education certificates do you have?

1. PhD certificate
2. Doctorate certificate
3. Degree certificate
4. Diploma

What is your experience period in this field?

1. Less than five years
2. Five years
3. less than ten years
4. above ten years

how well are you conversant with the current best practices on oral healthcare?

1. Not conversant
2. Averagely conversant
3. Well conversant
4. Excellently conversant

How often do you apply or use the current best practices in oral healthcare?

1. Never
2. Once
3. Every time

Do you think the current best practices on oral healthcare should be taught and used more often?

1. Yes
2. No

How effective are the best practices in oral healthcare?

1. Less effective
2. Averagely effective
3. Very effective

Posttest questionnaire

(Please tick on the appropriate answer)

How effective were the education sessions on oral healthcare practices?

• Poor
• Slightly effective
• Very effective

How satisfied were you with the education sessions?

• Not satisfied
• Satisfied
• Very satisfied

How frustrated were you with the education sessions?

• Not at all
• Very frustrated

Ho effective were the topics covered in the education sessions?

• Not effective
• Less effective
• Averagely effective
• Very effective

How pleasing were the education sessions on oral healthcare?

• Not pleasing
• Slightly pleasing
• Very pleasing

Evaluation questions

1. Were the staffs satisfied with regards to convenience and the quality of the presentation?
2. Did the staff feel that the given education package had the maximum amount of information that met their needs?
3. Did the staff demonstrate increased knowledge related to the education program on the best practices of oral healthcare in ICU?
4. Will the staff report the understanding of the impact of the skills obtained on the patient’s outcomes?
5. Wil, the patients in the ICU report satisfaction on the nurses’ acquired skills in oral healthcare?
6. Did the staff show increased involvement in the given education process?
7. Will the staff apply the skills obtained in the education sessions in real clinical encounters?