KNOWLEDGE ATTITUDE AND PRACTICE AMONG NURSES TOWARDS ORAL CARE OF INTUBATED PATIENTS IN SHEIKH ZAYED HOSPITAL, RAHIM YAR KHAN

Abstract

BACKGROUND
Oral care is a critical component of nursing management in intensive care units, particularly for intubated patients who are at increased risk of compromised oral hygiene due to mechanical ventilation, reduced salivary flow, and limited self-care ability. The accumulation of dental plaque, colonization by pathogenic microorganisms, and the use of medications causing xerostomia contribute to deterioration of oral health in critically ill patients. These changes significantly increase the risk of ventilator-associated pneumonia (VAP) and other nosocomial infections. Despite its clinical importance, oral care is often perceived as a low-priority task in critical care settings, leading to inconsistencies in practice. Nurses’ knowledge, attitudes, and adherence to evidence-based protocols play a vital role in ensuring effective oral care and improving patient outcomes.

OBJECTIVES
The study aimed to assess the level of knowledge, attitude, and practices among nurses regarding oral care of intubated patients in the intensive care units. Additionally, the study sought to identify gaps in knowledge, evaluate attitudes toward oral care provision, and examine routine practices followed by nurses in a tertiary care hospital setting.

METHODOLOGY
A descriptive cross-sectional study design was conducted over a period of three months in the intensive care units of Sheikh Zayed Hospital, Rahim Yar Khan. The study included 180 registered nurses (RNs) and licensed practical nurses (LPNs), selected through purposive sampling. Data were collected using a structured and validated questionnaire developed through expert review, including an infection control nurse, a periodontist, and a critical care physician. A pilot test was conducted to assess clarity and feasibility. The questionnaire consisted of sections assessing knowledge, attitude, and practice related to oral care. Participation was voluntary and anonymous, with implied consent through questionnaire completion. Data were analyzed using SPSS version 23, applying descriptive statistics and Likert scale analysis at a 95% confidence interval.

RESULTS
The findings indicated that the majority of nurses (78%) strongly recognized the importance of oral care in critically ill patients. However, gaps were identified in specific areas of knowledge, particularly regarding the appropriate use, concentration, and frequency of antiseptic agents. Attitudinal assessment revealed generally positive perceptions toward oral care, although a notable proportion of nurses considered it an unpleasant task and demonstrated variability in prioritizing oral care in clinical practice. In terms of practice, most nurses reported providing routine oral care and acknowledged its role in reducing infection rates. Chlorhexidine use was commonly reported; however, adherence to standardized evidence-based practices, such as the use of powered toothbrushes, was limited. A discrepancy between knowledge and actual clinical practice was observed, indicating barriers such as lack of training, absence of standardized protocols, and fear of dislodging endotracheal tubes.

CONCLUSION
The study concludes that although nurses possess adequate knowledge and generally positive attitudes toward oral care of intubated patients, their clinical practices are not consistently aligned with evidence-based guidelines. Significant gaps exist between knowledge and implementation, influenced by institutional and individual barriers. Strengthening continuous education programs, establishing standardized oral care protocols, and enhancing clinical training are essential to improve nursing practices, reduce the incidence of nosocomial infections, and ensure better patient outcomes in critical care settings