After Institutional Review Board approvals a letter will be sent to the

After Institutional Review Board approvals, a letter will be sent to the Vice-President of Nursing requesting a meeting. The meeting will discuss the outline and purpose of the study, inclusion and exclusion criteria, and request for RN and Respiratory Therapist participation in the study. Subsequent meetings will be held with the Unit Managers and staff to discuss the study criteria.The ICU staff members will not be informed as to when the observers would be present in the unit or why. Specially trained researchers will observe any oral care interventions at random blocks of 4 hours that will include morning and evening shifts. Evidence of interrater reliability will be tested with 20 patients randomly selected from the study units. The evaluations of interrater reliability will consist of the percentage agreement from cross-tabulations of rater by variable. Interrater reliability will then be retested before collection of bedside data and intermittently thereafter. Data collectors will become certified.All mechanically ventilated patients will be used during the time frames of this study. Exclusion criteria include any patient less than 18 years of age. Design 16This study will utilize a Pre-test Post-test design to determine oral care practices delivered to mechanically intubated patients in an ICU at baseline and after an education intervention. This study will examine the differences as occurs naturally in the setting. The study will consist of three phases: baseline, educational, and intervention. The baseline phase will last 4 months. Baseline data collection will include observation of current practice of oral care in patients receiving mechanical ventilation. Data will be collected on the types of oral care produces used, methods used to provide care, and frequency of oral care provided.An educational intervention will be offered to the personnel and will include all needed information necessary for oral cleansing protocol. The education intervention period will last 1 week. There are approximately 25 health care providers. A mandatory 1 hour in-service will be provided for all health care providers within the unit. InstrumentationThe Oral Care Data Collection Tool was specially designed by Cutlet et al. (2005) on the basis of the standardized comprehensive oral-cleansing protocol. This tool allows the trained observers to document frequency, tasks, and tools used for oral care during the randomized 4-hour time blocks by walking around the unit and watching nurses and respiratory care personnel performed the tasks. Types of oral care cleaning products located at the bedside will be documented as well as tasks performed when sounds of suctioning come from the room (Cutler & Davis, 2005).All staff members will be monitored including; nurses and respiratory therapists. 17Data that will be documented includes: oral cavity assessment; teeth brushing; lips and mouth moisturized; suction swab of teeth and mouth; suctioning of mouth and pharynx; suctioning of oropharynx; suction tubing changed; other care; and types of oral care products used at the bedside.Data AnalysisDescriptive statistics will be used for continuous data and numbers and percentages for categorical data will be used to calculate all variables recorded. Variables that will be recorded include; types of tools utilized for oral care, defined tasks and methods, and frequency of oral care. This method is often used to record physiological dimensions of patient status. Direct measurement is more valid compared with indirect (Burns & Grove, 2005).

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