Three 2

The PICO(T) question I chose to search for was “In acute stroke patients with dysphagia, how does an oral care regimen help reduce aspiration pneumonia rather than no oral care regimen?” The PICOT questions are: (P) Stroke patients with dysphagia (I) Frequent oral care regimen (C) No oral care regimen (O) Reduce aspiration pneumonia (T) Three weeks post-implementation I chose this question because I have worked in a Stroke unit. The hospital that I work for has a very strict protocol regarding stroke care. One of the guidelines for stroke patients is to complete a bedside dysphagia screen by nursing staff. If the screen is failed, then the patient is to be kept NPO until Speech-Language Pathologist (SLP) can assess the patient. During this in-between time bedside staff is supposed to do oral care every two hours. However, I never see the staff be diligent in this manner. This makes me question the long-term outcomes related to good oral care versus little to none.

To start my search, I used the Walden University Library (n.d.) to search for the term “oral care.” This search went across a myriad of databases that have been acknowledged by the University’s Library. The term “oral care” was far too broad and listed over 53,000 results.

At this point, I knew it was time to use Boolean operators as explained by the Library of Congress (n.d.) to help narrow my search. I also chose to use one specific database: Cochrane Database of Systematic Reviews. I found this database by using the dropdown box in the list of databases to narrow my topic to “Nursing” (Walden University Library, n.d.). Melnyk and Fineout-Overholt (2018) praise this specific database for its rigorous study designs which lead to strong levels of evidence. I then searched using the Boolean operator of “stroke AND oral care.” This lessens to only one article which was published in 2006.

I figured just one outdated article was not enough, so I decided to do a new search using MEDLINE with Full Text. This time I used a “nesting” term “oral care (stroke OR dysphagia).” This led to 46 results ranging from 2002-2020. From this point I updated the publication date ranges from 2015-2020, which then decreased the results to 25 articles. Of these 25 articles, I found an article titled “Implementing oral care to reduce aspiration pneumonia amongst patients with dysphagia in a South African setting” (Seedat & Penn, 2016). The study compared two groups, both of which had oropharyngeal dysphagia: one with consistent oral care and one without routine oral care (Seedat & Penn, 2016). This study concluded that “a regimen of regular oral care and free water provision when combined with dysphagia intervention did prevent aspiration pneumonia in patients with oropharyngeal dysphagia” (Seedat & Penn, 2016).

 

References

Library of Congress. (n.d.) Search/browse help-Boolean operators and nesting.

https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.

Seedat, J., & Penn, C. (2016). Implementing oral care to reduce aspiration pneumonia amongst patients with dysphagia in a South African setting. The South African Journal of Communication Disorders, 63(1). https://doiorg.ezp.waldenulibrary.org/10.4102/sajcd.v63i1.102

Walden University Library. (n.d.). Databases A-Z: Nursing. https://academicguides.waldenu.edu/az.php?s=19981