Description of the study
The study seeks to review and summarize available evidence that show the significance of tooth brushing among critically-ill patients undergoing mechanical ventilation. Tooth brushing being a standard intervention strategy in health promotion and disease prevention, there is the need for nurses to help critically-ill patients in performing this task. Despite that recent studies have failed to link tooth brushing to the occurrence of other bloodstream infections, researchers claim that additional studies may show this link (Ames, 2011, p. 242).
Meanwhile, this study highlights evidence showing the outcome of tooth brushing in samples of critically-ill patients. Additionally, the study provides reasons as to why tooth brushing was not beneficial for patients in the trials reviewed. Further, the researcher provides recommendations that will inform future studies on the same group of critically-ill patients. Conversely, it is hypothesized that there may be a link between tooth brushing in patients with delicate dental vigor and the entry of oral bacteria into the bloodstream. Therefore, there may be a positive link between tooth brushing and the prevention of ventilator-associated pneumonia (VAP) (Ames, 2011, pp. 242-243).
Literature Evaluation
This quantitative research study (meta-analysis) thoroughly reviews the most recent research studies (2000-2006) documenting the types and rate of tooth brushing recommended for the effective removal of plaques in healthy individuals. Furthermore, other studies utilized in the literature review document the effect of the lack of tooth brushing on the health of the oral cavity. Therefore, the studies reviewed relate directly to the problem addressed in the current study. Moreover, most of the studies reviewed document evidence of the benefit of tooth brushing in healthy subjects, and thus, the current study seeks to show the same results in critically-ill subjects and find out whether there is a link between tooth brushing and other health problems such as ventilator-associated pneumonia (VAP). Overall, the quantitative approach utilized in the current study is appropriate for the research problem addressed (Ames, 2011; LoBiondo-Wood & Haber, 2010).
Conceptual Framework
The study lacks a clear conceptual or theoretical framework to guide the research. Therefore, the study fails to define the key concepts, which would have guided the design and implementation of the study. However, since the current study entails a review and summary of published research studies, the information provided is appropriate in guiding the readers through what is happening in the study. Here, the researcher documents that the study will utilize various databases to inform the research findings and conclusions. Furthermore, the approach used by the researcher in presenting the research problem is enough to justify the significance of the current study (Ames, 2011; LoBiondo-Wood & Haber, 2010).
Sample
As noted earlier, the current study reviews and summarizes published studies from PubMed, CINAHL Plus, and Scopus databases. The participants in the selected studies are mainly children and adults receiving mechanical ventilation in different critical care units. Therefore, the researcher does not indicate whether procedures were put in place to safeguard the rights of the clinical subjects. Conversely, the inclusion criteria for the studies reviewed is based on selecting studies documenting the inclusion of participants receiving mechanical ventilation. However, it is not possible to tell how the participants were recruited into individual studies (Ames, 2011, pp. 244-246). On the other hand, the summaries of clinical trials included in the current study provide brief descriptions of the sizes and key attributes of the samples. Again, it is important to note that one cannot tell whether the samples for individual studies are appropriate or representative of the total populations.
Method and Design
The study methodology utilizes different databases to select published studies on the basis of language (English) and the research problems addressed (mainly tooth brushing and critical care). Here, the current study does not limit the studies selected on the basis of their publication dates. Further, the researcher formulated the search question using different search strategies coupled with Boolean terms (OR & AND) and Medical Subject Headings (MeSH). In the long run, studies documenting the inclusion of critically-ill patients under mechanical ventilation as primary participants were included in the current review (Ames, 2011, p. 244).
Furthermore, the review included observational studies because there were no randomized control trials dealing with the same research problem. On the other hand, the review excluded randomized studies because their participants were not admitted into the critical care units. Other surveys and observational studies failed to satisfy the inclusion criteria because they were based on nurses’ opinions relative to oral care, and thus, they did not show the expected link between tooth brushing and VAP (Ames, 2011, p. 244). Overall, the instruments used for data collection (PubMed, CINAHL Plus, and Scopus) are appropriate and reliable sources of information for the current study.
Analysis
Analysis of the data collected in the individual research studies under review in the current study was undertaken in line with the acceptable standards of research judging from the discussions provided by the author. However, the details concerning the statistical methods, instruments, and measurement of variables are not provided in the current study, and therefore, one cannot tell whether they were appropriate for the individual studies under review. Furthermore, there is no rationale provided to support the selection of different statistical tests for the individual studies reviewed in the current study. Conversely, the results obtained are significant to the current research problem because the researcher managed to limit the findings to studies, which provided evidence regarding the effect of tooth brushing on the prevalence of other health problems (Ames, 2011).
Results
The researcher located eight studies, which were then used to inform the discussions of the current study. Out of the eight selected studies, the analytical results of five studies documented a positive link between tooth brushing and the prevention of VAP. Four out of the eight selected studies were designed to measure different parameters including bacteria profiles, ICU mortality rates, and the outcomes of VAP among others. Furthermore, three other studies were designed to observe the infection rates prior to and after the introduction of an intervention (tooth brushing) in a specific critical care unit. Another observational study was designed as a quality improvement task. Overall, the latter four observational studies were designed to measure VAP outcomes as the only parameter. All the eight selected studies represented participants drawn from the pediatric, neuroscience, medical, trauma, and surgical units of critical care (Ames, 2011, p. 244).
The results are presented in a clear, coherent, and understandable manner. From the discussions, the author notes that in studies that were well controlled, there was evidence to show that tooth brushing does not produce any significant changes in pneumonia outcomes. Therefore, despite that tooth brushing may be important in the prevention of VAP; there is no evidence from the studies reviewed to this effect. However, it is important for nurses to have prior information regarding the link between tooth brushing and bacteremias in their patients. Moreover, nurses should know the significance of plaque removal instruments considering that the studies reviewed have demonstrated that plaque removal and decontamination of the oral cavity limits the occurrence of VAP (Ames, 2011, p. 249). Overall, the interpretations given by the author are consistent with the results obtained in the studies reviewed.
In conclusion, the author notes that future studies should pay more attention to protocol compliance and controlling for confounding in order to show the clear link between tooth brushing and VAP incidence rates in critically-ill patients. This will also guide the determination of the risk-benefit ratio in initiating tooth brushing among critically-ill patients (Ames, 2011, p. 249). These conclusions are relevant and appropriate to the research problems identified in the discussions. Conversely, the current study is limited by the fact that it is a review of primary studies, and thus, the lack of primary data will prevent other researchers from replicating the same study in future.
Clinical Significance
Considering that there is limited evidence to support the benefit of tooth brushing in the control and prevention of various health complications especially VAP, the current study can be used to inform the development of an oral assessment tool relative to the recommendations of the American Association of Critical Care Nurses. Here, the association recommends that the critical care units should develop and implement oral care protocols relative to oral assessment and moistening of the patient’s lips and oral mucosa as primary care strategies. This exercise should also include documenting the patient’s oral history to ensure that the risk of bacteremias is not aggravated by other conditions such as poor dental hygiene, gingivitis, caries, and periodontitis. Moreover, the current study emphasizes the significance of tooth brushing as a standard intervention strategy that should be embraced by the nurses in their day-to-day operations (Ames, 2011, p. 249).
References
Ames, N.J. (2011). Evidence to support tooth brushing in critically ill patients. Journal of Critical Care, 20(3), 242-250.
LoBiondo-Wood, G., & Haber, J. (2010). Nursing research: Methods and critical appraisal for evidence-based practice (7th ed.). St. Louis, MA: Mosby.