title: Frequency of oral care and positioning of patients in critical care: a replication study.
abstract: 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.
  
  
  OBJECTIVE
  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 degrees (SD 24 degrees ) for nonintubated patients and 23 degrees (SD 12 degrees ) 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.
authors.affiliation: Center for Nursing Research, University of Texas School of Nursing at Houston, TX, USA.
authors.forename: Sandra K
authors.initials: SK
authors.lastname: Hanneman
authors.forename: Gary Michael
authors.initials: GM
authors.lastname: Gusick
mesh_terms: D001513:Beds; D015400:Clinical Nursing Research; D003422:Critical Care / Q000379:methods*; D003430:Cross-Sectional Studies; D004750:Enteral Nutrition; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units; D007440:Intubation; D009910:Oral Hygiene / Q000379:methods / Q000451:nursing*; D011015:Pneumonia, Aspiration / Q000517:prevention & control; D011187:Posture; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires