Development of a competency for professional oral hygiene care of endotracheally-intubated patients in the intensive care unit: development and validity evidence

Eunsil Choi1, HieJin Noh2, Won‐Gyun Chung2, So‐Jung Mun2
1Department of Dental Hygiene, The Graduate School, Yonsei University, Wonju, South Korea
2Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, 1 Yonseidae-gil, Wonju, Gangwondo, 26493, Republic of Korea

Tóm tắt

Abstract Background Professional oral care in the intensive care unit may reduce the incidence of Ventilator Associated Pneumonia, which increases the patient’s mortality rate. This study aimed to develop a competency for professional oral hygiene care of endotracheally-intubated intensive-care patients. Methods First, we developed a competency draft by reviewing the literature on oral hygiene care of patients in the intensive care unit. Next, we developed expert validity test questionnaires using this draft and conducted expert validity tests twice on 18 experts. We determined competency as a content validity index of 0.8 or more and received expert additive opinions about competency through an open-questionnaire expert validity test paper in this methodology study. Results The content validity index ranged from 0.8 ~ 1.0 for all items. The competency of ‘professionalism’ comprised 2 sub-competencies with 7 behavioral indicators. ‘POHC preparation’ comprised 3 sub-competencies with 10 behavioral indicators. ‘POHC implementation’ comprised 3 sub-competencies with 6 behavioral indicators. ‘POHC evaluation’ comprised 2 sub-competencies with 8 behavioral indicators. Lastly ‘Cooperation among experts’ comprised 3 sub-competencies with 7 behavioral indicatiors. Conclusions To provide patients with high quality oral hygiene care, these competencies should be implemented, and oral hygiene care professionals and related medical personnel should form a cooperative system.

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Tài liệu tham khảo

Korean Society of Critical Care Medicine. Critical care medicine, vol. 38. Seoul: Koonja Publishing; 2016. p. 35.

An JH. A study on the awareness of ICU nurses about mouth care and the state of their mouth care [unpublished master’s thesis]. Busan: Dong-A University; 2006.

Abidia RF. Oral care in the intensive care unit: a review. J Contemp Dent Pract. 2007;8(1):76–82. https://doi.org/10.5005/jcdp-8-1-76.

Munro CL, Grap MJ. Oral health and care in the intensive care unit: state of the science. Am J Crit Care. 2004;13(1):25–33. https://doi.org/10.4037/ajcc2004.13.1.25.

Khatib M, Jamaleddine G, Abdallah A, Ibrahim Y. Hand washing and use of gloves while managing patients receiving mechanical ventilation in the ICU. Chest. 1999;116(1):172–5. https://doi.org/10.1378/chest.116.1.172.

Mori H, Hirasawa H, Oda S, Shiga H, Matsuda K, Nakamura M. Oral care reduces incidence of ventilator-associated pneumonia in ICU populations. Intensive Care Med. 2006;32(2):230–6. https://doi.org/10.1007/s00134-005-0014-4.

Cho WH. Comparison of water jet irrigation and gauze cleansing method on oral hygiene for patients in the intensive care unit [unpublished master’s thesis]. Seoul: Seoul National University; 2004.

McNeill HE. Biting back at poor oral hygiene. Intensive Crit Care Nurs. 2000;16(6):367–72. https://doi.org/10.1054/iccn.2000.1531.

Kwak YG, Choi JY, Yoo H, Lee SO, Kim HB, Han HS. Korean National Healthcare-associated Infections Surveillance System, Intensive Care Unit Module Report: Summary of data from July 2014 through June 2015. Korean J Healthc Assoc Infect Control Prev. 2016;21(2):37–49. https://doi.org/10.14192/kjhaicp.2016.21.2.37.

Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med. 2005;33(10):2184–93. https://doi.org/10.1097/01.CCM.0000181731.53912.D9.

Scannapieco FA, Papandonatos GD, Dunford RG. Associations between oral conditions and respiratory disease in a national sample survey population. Ann Periodontol. 1998;3(1):251–6. https://doi.org/10.1902/annals.1998.3.1.251.

Munro CL, Grap MJ, Elswick RK Jr, Mckinney J, Sessler CN, Hummel ШRS, et al. Oral health status and development of ventilator-associated pneumonia: a descriptive study. Am J Crit Care. 2006;15(5):453–60. https://doi.org/10.4037/ajcc2006.15.5.453.

Institute for Healthcare Improvement. How-to guide: Prevent ventilator-associated pneumonia. 2012. www.ihi.org. Assessed 2 June 2020.

Institute for Healthcare Improvement. What is a bundle?. 2012. http://www.ihi.org/resources/Pages/ImprovementStories/WhatIsaBundle.aspx. Assessed 2 June 2020.

Kim JH. Development of oral assessment tool for critically ill patients [unpublished doctoral dissertation]. Seoul: Chung-Ang University; 2011.

Kim EK, Lee HK. Oral health and hygiene in the neurosurgical patients in intensive care unit. J Korean Soc Dent Hyg. 2015;15(1):147–52. https://doi.org/10.13065/jksdh.2015.15.01.147.

Choi KB, Mo HS, Kim JS. Survey of oral health care practices for intubaed patients by intensive care unit nurse. Health Nursing. 2009;21(1):1–12.

Cho SH, Hwang JH, Kim YM, Kim JS. Variations in nurse staffing in adult and neonatal intensive care units. J Korean Acad Nurs. 2006;36(5):691–700. https://doi.org/10.4040/jkan.2006.36.5.691.

Lee YJ, Noh HJ, Han SY, Jeon HS, Chung WG, Mun SJ. Oral health care provided by nurses for hospitalized patients in Korea. Int J Dent Hygiene. 2019;17(4):336-42. https://doi.org/10.1111/idh.12417.

Prendergast V, Kleiman C. Interprofessional practice: translating evidence-based oral care to hospital care. J Dent Hyg. 2015;89(Suppl 1):33–5.

Rello J, Koulenti D, Blot S, Sierra R, Diaz E, De Waele JJ, et al. Oral care practices in intensive care units: a survey of 59 European ICUs. Intensive Care Med. 2007;33(6):1066–70. https://doi.org/10.1007/s00134-007-0605-3.

Abed-Eddin L. 6. Oral care competency and practices among critical care nurses for mechanically ventilated patients. J Saudi Heart Assoc. 2016;28(3):188. https://doi.org/10.1016/j.jsha.2016.04.007.

Chung JS, Chang JH. A three-round delphi study on developing a competency model of performance consultants in changing corproate culture. Korean Soc Educ Technol. 1999;15(3):99–124. https://doi.org/10.17232/KSET.15.3.99.

Lynn MR. Determination and quantification of content validity. Nurs Res. 1986;35(6):382–5.

Batiha AM, Bashaireh I, Albashtawy M, Shennaq S. Exploring the competency of the Jordanian intensive care nurses towards endotracheal tube and oral care practices for mechanically ventilated patients: An observational study. Glob J Health Sci. 2012;5(1):203–13. https://doi.org/10.5539/gjhs.v5n1p203.

Bae SM, Shin SJ, Jang JH, Chung WG, Shin BM. Analysis of current status of a dental hygiene science curriculum according to the dental hygienist competency. J Korean Soc Dental Hygiene. 2016;16(2):173–83. https://doi.org/10.13065/jksdh.2016.16.02.173.

Lee SH. Analysis of the factors, the differential of performance and the awareness of significance in the competency cluster of the middle manager accounting department in general hospital [unpublished master’s thesis]. Seoul: Yonsei University; 2015.

Chung MJ. A study on the effects of emotional ability on teamwork capability and business creation intention : centering in airline flight attendants [unpublished doctoral dissertation]. Suwon: Kyonggi University; 2012.

Byeon HS. A study on the nursing managerial competency of head nurses in the general hospitals [unpublished master’s thesis]. Gwangju: Chonnam National University; 2000.

Lee JK. Reflection on a methodoloy of developing competency-based curriculum: Based on a case of curriculum development for improving marketing competency. J Educ Technol. 2002;18(4):25–56. https://doi.org/10.17232/KSET.18.4.25.

DeVellis RF. Scale development: Theory and application. 4th ed. Los Angeles: SAGE publications; 2016. p. 84.

Young PJ, Ridley SA. Ventilator-associated pneumonia. Diagnosis, pathogenesis and prevention. Anaesthesia. 1999;54(12):1183–97. https://doi.org/10.1046/j.1365-2044.1999.01035.x.

Tablan OC, Anderson LJ, Arden NH, Breiman RF, Butler JC, McNeil MM. Guideline for prevention of nosocomial pneumonia. Infect Control Hosp Epidemiol. 1994;15(9):588–627. https://doi.org/10.2307/30147436.

Grap MJ, Munro CL, Ashtiani B, Bryant S. Oral care interventions in critical care: frequency and documentation. Am J Crit Care. 2003;12(2):113–8. https://doi.org/10.4037/ajcc2003.12.2.113.

Park MJ. An easy way to understand mechanical ventilation. Seoul: Korean Medical Books; 2016. p. 114,136–7.

Celik GG, Eser I. Examination of intensive care unit patients’ oral health. Int J Nurs Pract. 2017;23:e12592. https://doi.org/10.1111/ijn.12592.

Malkin B. The importance of patients’ oral health and nurses’role in assessing and maintaining it. Nurs Times. 2009;105(17):19–23.

White R. Nurse assessment of oral health: A review of practice and education. Br J Nurs. 2000;9(5):260–6. https://doi.org/10.12968/bjon.2000.9.5.6359.

Choi DS, Kim SH, Kim JS. A comparative analysis of competencies in American dental education association and American dental hygiene schools. J Korean Soc Dent Hyg. 2015;15(3):547–53. https://doi.org/10.13065/jksdh.2015.15.03.547.

Cho YA. Effect on oxygen saturation, heart rate, mean arterial pressure as type of endotracheal suctioning system to patients are ventilated in intensive care unit [unpublished dotoral dissertation]. Seoul: Yonsei University; 2004.

Park SY, Lee HB. Prevention and management of ventilator-associated pneumonia. Korean J Med. 2014;86(5):537–45. https://doi.org/10.3904/kjm.2014.86.5.537.

Korea legislation Research Institute. Enforcement of decree of the medical service technologists, etc. ACT, Article 2, paragraph 1. http://www.law.go.kr/lsInfoP.do?lsiSeq=209737&efYd=20190702#0000. Accessed 2 June 2020.

ShirobonNet. Japanese dental health insurance claim. 2020. Online information available at http://shirobon.net/. Assssed 2 June 2020.