Nurses' Views on Barriers to Oral Care in Non-Mechanically Ventilated Patients in the Intensive Care Unit: A Qualitative Study.

Background: Optimal oral care is essential in preventing non-ventilator hospital-associated pneumonia and enhancing patient comfort. However, nurses' clinical oral care practices for patients not on mechanical ventilation in the intensive care unit are both underreported and understudied.

Aim: To explore intensive care nurses' clinical oral care practices for patients not on mechanical ventilation in intensive care units.

Study design: A qualitative descriptive study using semi-structured in-depth individual interviews. Intensive care nurses with more than 6 months experience were recruited via the professional association, the Australian College of Critical Care Nurses and snowballing. Purposive sampling was used, and information power was used to indicate when to stop data collection. Interviews were undertaken with ten intensive care nurses working with adult patients between May and September 2023. The interviews were audio-recorded, transcribed and analysed using Framework Analysis.

Results: Most of the participants had a postgraduate qualification in intensive care nursing. Four main themes were derived from the data: (i) challenging patient needs and prioritisation of care, (ii) inadequate knowledge and education, (iii) perception of inadequate use of evidence-based practice and equipment and (iv) structured support needed for evidence-based practice.

Conclusions: These themes highlight ongoing issues with nurses' knowledge and education and implementation of available evidence-based practice. Findings suggest the need for a well-established policy to underpin practice. The barriers faced by intensive care nurses need to be addressed to enhance the quality of patient care.

Relevance to clinical practice: Improving oral care in non-mechanically ventilated patients would decrease the rates of hospital-associated pneumonia, systemic diseases such as respiratory and cardiovascular diseases, and promote patient comfort. A comprehensive strategy using an implementation framework is required to address nurses' knowledge gaps and techniques that enhance evidence-based practices.