title: Effects of simulation education on oral care practices - a randomized controlled trial.
abstract: BACKGROUND
  Implementation of evidence-based oral care protocols, nurse education programmes and assessment tools may reduce the risk of developing ventilator-associated pneumonia by increasing critical care nurses' knowledge and skills in adhering to current oral care recommendations.
  
  
  OBJECTIVE
  To evaluate the longitudinal effects of single-dose simulation education with structured debriefing and verbal feedback on critical care nurses' knowledge and skills in adhering to current oral care recommendations.
  
  
  METHODS
  A randomized controlled trial with repeated measurements.
  
  
  METHODS
  The data for the study were collected in a single academic centre in a 22-bed adult, mixed, medical-surgical intensive care unit in Finland from February 2012 to March 2014. The effectiveness of simulation education was evaluated through the validated Ventilator Bundle Questionnaire and Observation Schedule at baseline (n = 30) and 24 months (n = 17) after simulation education. Data were analysed using a linear mixed model and intention-to-treat analyses.
  
  
  RESULTS
  During the study period, the average knowledge score in the intervention group increased significantly (44·0% to 56·0% of the total score) in the final post-intervention measurement (pt= 0·51, pg= 0·002, pt*g= 0·023). However, single-dose simulation education with structured debriefing and verbal feedback had no impact on critical care nurses' skill scores.
  
  
  CONCLUSIONS
  Single-dose simulation education had only a minimal effect on critical care nurses' knowledge and skills in adhering to current oral care recommendations. Despite increased awareness, there was no significant difference in oral care practices between the study groups after simulation education.
  
  
  CONCLUSIONS
  The need for regularly repeated educational sessions with theoretical training and practical exercises and direct feedback is evident. Certain aspects of oral care, such as prevention of microaspiration of oropharyngeal secretions and moistening of oral mucosa and lips, require more reinforcement than others.
authors.affiliation: Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland.|Unit of Nursing Science and Health Management, University, Oulu, Finland.|Medical Research Center, Oulu, Finland.
authors.forename: Miia M
authors.initials: MM
authors.lastname: Jansson
authors.affiliation: Chief of Department of Infection Control, Medical Research Center, Oulu University Hospital, Oulu, Finland.
authors.forename: Hannu P
authors.initials: HP
authors.lastname: Syrjälä
authors.affiliation: Department of Anesthesiology, Oulu University Hospital, Oulu, Finland.
authors.forename: Pasi P
authors.initials: PP
authors.lastname: Ohtonen
authors.affiliation: Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Medical Research Center, Oulu, Finland.
authors.forename: Merja H
authors.initials: MH
authors.lastname: Meriläinen
authors.affiliation: Unit of Nursing Science and Health Management, Medical Research Center Northern Ostrobothnia Hospital, Oulu, Finland.
authors.forename: Helvi A
authors.initials: HA
authors.lastname: Kyngäs
authors.affiliation: Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland; Medical Research Center, Oulu, Finland.
authors.forename: Tero I
authors.initials: TI
authors.lastname: Ala-Kokko
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D002983:Clinical Competence; D003422:Critical Care / Q000379:methods; D064648:Critical Care Nursing / Q000193:education*; D004521:Educational Measurement; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D008875:Middle Aged; D009910:Oral Hygiene / Q000193:education*; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D000066908:Simulation Training / Q000379:methods*
keywords: Critical care; Nursing education; Oral care; Simulation; Ventilator-associated pneumonia