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CE Article

Frequency of Oral Care and Positioning of Patients in Critical Care: A Replication Study

• Background Oral care and head-of-bed elevation are interventions to decrease risk of aspiration pneumonia in hospitalized patients. In a previous study, nurses’ self-reports of how often they performed oral care did not match documented provision of such care.

• Objectives To replicate the original study and estimate instrument reliability.

• Methods A cross-sectional design was used, and survey data from nursing personnel and bedside observational data from 9 intensive care units were collected.

• Results A total of 181 surveys (47%) were returned, and data were collected from 436 bedsides. Reported frequencies of oral care and use of oral care products differed between nonintubated and intubated patients (P<.001). The mean documented frequency of oral care for nonintubated patients was 1.8 (SD 1.5); self-reported frequency was 3 (SD 2.4). The mean documented frequency of oral care for intubated patients was 3.3 (SD 1.8); self-reported frequency was 4.2 (SD 2.1). Documented oral care frequency differed by unit (P = .006) and intubation status (P < .001). Mean observed head-of-bed position was 38° (SD 24°) for nonintubated patients and 23° (SD 12°) for intubated patients (P < .001). Intubation status, but not unit, affected observed head-of-bed position (P < .001). Three survey items had adequate reliability evidence (r=0.70). Interrater reliability for bedside data collection was 96% or greater.

• Conclusions Despite inadequate estimates of survey reliability, findings generally were comparable to results of the original study; nurses report more frequent oral care than is documented. Intensive care nurses elevate the head of patients’ beds in accordance with self-reports.

Notice to CE enrollees: A closed-book, multiple-choice examination following this article tests your understanding of the following objectives: Discuss the process for conducting a replication research study State how instrument reliability was determined for the Oral Care and Positioning survey State 2 additional findings reported in the replication study that were not reported in the original study

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