經品氣管內管留置病人口腔護理方法與步驟之觀察研究

Oral Care Practice and Procedures in Intubated Patients: An Observational Study

背景：有效的口腔護理可增進病人舒適與預防口腔感染，雖然口腔護理是基礎的護理實務，但護理人員提供氣管內管留置病人口腔護理卻是一大挑戰。目的：本研究旨在探討加護病房護理人員執行經口氣管內管留置病人口腔護理的方式與步驟。方法：採橫斷式觀察法，以立意取樣，利用結構性觀察表於2008年1月到4月於北部某醫學中心進行資料收集，共觀察六個成人加護病房，31位護理人員執行經口氣管內管留置病人口腔護理的方式與步驟。結果：腔棉棒與海綿潔牙棒是氣管內管留置病人口腔護理主要的清潔工具，清潔溶液主要選擇以自來水或開水稀釋的漱口水；口腔護理步驟平均得分百分比為74.2%；護理人員所屬加護病房性質不同，護理人員選擇口腔護理之清潔工具、清潔溶液、清潔溶液使用方式及氣管內管固定方式有所不同；護理人員年齡越年長，其執行口腔護理步驟完整率越高；內科系加護病房護理人員執行口腔護理步驟的完整性顯著高於外科系加護病房護理人員。結論／實務運用：本研究發現護理人員提供氣管內管留置病人口腔護理的方式與步驟未完全符合目前實證研究的建議方式，如使用軟毛牙刷清潔病人口腔、執行口腔護理過程協助病人採半坐臥姿勢等；加護病房需依據單位病人性質建立氣管內管留置病人口腔護理規範、政策與流程，並進行相關在職教育訓練，期望提昇重症病人口腔護理的品質。

Background: Effective oral care improves patient comfort and prevents oral infection. While common in general nursing practice, administering oral care to intubated patients is particularly challenging.Purpose: This study investigated practices and factors associated with oral care of intubated patients in intensive care units (ICUs).Methods: This study used a cross-sectional design and recruited nurses using purposive sampling. Data were collected with a structured observational checklist between January and April 2008 at a medical center in northern Taiwan. Observational data reflected oral care procedures performed by thirty-one ICU nurses on intubated patients in six ICUs.Results: Cotton and foam swabs were found to be the main oral care cleaning instruments used with intubated patients, with dilute mouthwash the primary cleaning solution. Nearly three-quarters (72.4%) of participants were found to employ proper oral care procedures. Participants selected different cleaning equipment, cleaning solutions, cleaning solution usage methods and oral endotracheal tube securement methods based on differing conditions. ICU nurse age was positively associated oral care completeness. The level of oral care completeness achieved by participants in medical ICUs was significantly higher those assigned to surgical ICUs.Conclusions/Implications for Practice: Study findings showed that ICU nurses did not follow procedures and steps recommended by current evidence-based practice (e.g., brushing the teeth and gums; positioning patients in a side or semi-/high-fowlers position when providing oral care to intubated patients). ICUs must establish policies and procedures for oral care of intubated patients that reflect patient characteristics. Furthermore, ICUs should provide oral care related on-the-job training and education in order to improve the quality of oral care administeredto critical care patients.