The Barriers and Facilitators to Deliver Oral Care for Older Adults in Hospital Settings
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Hospitalised older adults often experience deconditioning and frequently develop aspiration pneumonia. These form a potential vicious cycle that is connected by swallowing dysfunction (dysphagia) and sarcopenia during hospitalisation. Many studies indicate that oral hygiene care can prevent aspiration pneumonia and improve hospitalised older adult health outcomes. However, despite being an essential nursing care that restores oral function and promotes patient wellness, it is one of the most neglected nursing interventions. This study aimed to identify the factors that impede nursing delivery of oral health care and determine what is required to overcome these barriers. Mixed methods is employed for the study, and the data from 176 questionnaires and 13 interviews were collected from nurses and HCAs in medical and surgical wards in North Shore and Waitakere hospitals. The results of quantitative data analysis and qualitative data analysis indicated three main barriers to oral care delivery: 1. oral care practice gaps and barriers; 2. insufficient oral care delivery training; and 3. lack of oral care protocols and policies. The most prominent barriers identified by nursing staff from the questionnaires were patients’ challenging behaviours, and a lack of time, priority, and tools. The results also indicated that current oral health education and training were not effective to support delivery of oral care, and that these problems are resulted from a lack of oral care protocols. Therefore, there is an urgent organisational level of support to establish oral care protocols in hospitals. These improvements on organisational level of support, education, and establishment of protocols in oral health care will, in turn, benefit hospitalised older adults by preventing aspiration pneumonia and deconditioning. In the long term, the positive health outcomes in patients will empower nurses and HCAs to deliver consistent oral care through evidence-based practice and protocols.