Oral care knowledge, attitude and practice of inpatients among nursing staff in acute hospital settings in Hong Kong

Abstract

Oral care is a fundamental component of nursing care. Poor oral care can lead to poor oral health, physical health, quality of life and overall well-being. Despite its importance, oral care has always been neglected in the hospital setting and placed at low priority compared with other essential nursing routines that involve life-threatening cases. Oral care knowledge, attitude and practice of nursing staff have been investigated. However, no validated instrument has been developed to measure oral care knowledge, attitude and practice of nursing staff. Few studies have focused on acute hospital settings. Therefore, it is necessary to explore the knowledge, attitude and practice of oral care for inpatients among nursing staff in acute hospital settings by using a validated instrument. This thesis aims to do the following: (1) assess the current level of knowledge, attitude and practice of oral care for inpatients among nursing staff in Hong Kong; (2) identify possible barriers to the provision of oral care in acute hospital settings; and (3) identify training preference to improve the oral care of inpatients in acute hospital settings. A mixed method approach was adopted to explore and investigate the current level of oral care knowledge, attitude and practice for inpatients among nursing staff in hospital settings in Hong Kong. In phase one, a qualitative study with three focus group interviews was conducted. Ten nursing staff with different ranks from different departments and hospitals were invited for interview. Thematic analysis was adopted for identifying and organising themes. In phase two, a self-administered structured questionnaire was designed, and a cross-sectional study was implemented from July 2018 to April 2019. A total of 404 nursing staff were recruited for the survey via convenience sampling. Analysis of covariance was used to compare the mean scores of knowledge, attitude and practice among different independent variables and identify the factors affecting good knowledge, attitude and practice. Findings from the focus group study indicated that neglect of oral care was evident in acute hospital settings, except for the intensive care unit. The nursing staff, especially the group of health care assistants, showed knowledge deficits on oral care. The survey findings showed that approximately 29.5% (95% CI: 25.1% to 33.9%), 33.7% (95% CI: 29.1% to 38.3%) and 14.9% (95% CI: 11.4% to 18.4%) of the respondents had good oral care knowledge, attitude and practice, respectively. Good oral care practice was associated with high levels of oral care knowledge (β=0.1, 95% CI: 0.1 to 0.1, p<0.001) and oral care attitude (β=0.3, 95% CI: 0.2 to 0.4, p<0.001). This study was the first to explore the oral care knowledge, attitude and practice of nursing staff in acute hospital settings in Hong Kong. The designed questionnaire could identify the gap between oral care policy, protocol, oral care assessment, actual oral care knowledge, attitude and practice. The results may encourage future studies on oral care education, oral care training reinforcement, oral care assessment tools and guideline development for oral care standardisation.