title: Mouth care for orally intubated patients: a critical ethnographic review of the nursing literature.
abstract: OBJECTIVE
  The aim of this critical ethnographic literature review was to explore the evolution of nursing discourse in oral hygiene for intubated and mechanically ventilated patients.
  
  
  METHODS
  The online databases CINAHL and MEDLINE were searched for nurse-authored English language articles published between 1960 and 2011 in peer-reviewed journals. Articles that did not discuss oral problems or related care for intubated adult patients were excluded. Articles that met the inclusion criteria were chronologically reviewed to trace changes in language and focus over time.
  
  
  RESULTS
  A total of 469 articles were identified, and 84 papers met all of the inclusion criteria. These articles presented an increasingly scientific and evaluative nursing discourse. Oral care originally focused on patient comfort within the literature; now it is emphasized as an infection control practice for the prevention of ventilator-associated pneumonia (VAP). Despite concern for its neglected application, the literature does not sufficiently address mouth care's practical accomplishment.
  
  
  CONCLUSIONS
  Mouth care for orally intubated patients is both a science and practice. However, the nursing literature now emphasises a scientific discourse of infection prevention. Inattention to the social and technical complexities of practice may inhibit how nurses learn, discuss and effectively perform this critical aspect of patient care.
authors.affiliation: Trauma, Emergency and Critical Care Program, Sunnybrook Health Sciences Centre, B508 - 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5. craig.dale@mail.utoronto.ca
authors.forename: Craig
authors.initials: C
authors.lastname: Dale
authors.forename: Jan E
authors.initials: JE
authors.lastname: Angus
authors.forename: Tasnim
authors.initials: T
authors.lastname: Sinuff
authors.forename: Eric
authors.initials: E
authors.lastname: Mykhalovskiy
mesh_terms: D000884:Anthropology, Cultural; D015400:Clinical Nursing Research; D006801:Humans; D007442:Intubation, Intratracheal; D024802:Nurse's Role; D009910:Oral Hygiene; D053717:Pneumonia, Ventilator-Associated / Q000451:nursing* / Q000517:prevention & control*
keywords: Institutional ethnography; Intensive care; Mouth care; Oral hygiene; Ventilator-associated pneumonia