All ETDs from UAB

Advisory Committee Chair

Nataliya V Ivankova

Advisory Committee Members

Gwendolyn D Childs

Karen L Heaton

Loretta T Lee

Victor W Mark

Document Type

Dissertation

Date of Award

2019

Degree Name by School

Doctor of Philosophy (PhD) School of Nursing

Abstract

The purpose of this qualitative grounded theory study was to explore how the nursing staff approaches oral hygiene in stroke survivors with dysphagia during the rehabilitation phase of recovery and what guides their decisions. Oral hygiene is a proven effective task known to prevent systemic health disparities (i.e. aspiration pneumonia, diabetes, gastrointestinal disparities, and even stroke). However, there are no current evidenced-based guidelines that provide instruction on how to execute oral hygiene to stroke survivors with dysphagia. Little is known about how nurses make decisions to implement oral hygiene in stroke survivors with dysphagia. Using a theoretical sampling strategy, data were collected through individual semi-structured interviews with 21 rehabilitation nurses that care for stroke survivors with dysphagia employed at various facilities across the eastern sector of the United States (n=6 states). The researcher also used video elicitation to gain viewpoints on oral hygiene execution from the participants. The data were analyzed using Strauss and Corbin’s grounded theory systematic approach, which included three levels of coding—open, axial, and selective, creation of a conceptual model, and development of propositions. The study revealed that adaptable influences, unadaptable influences, and modalities play a major role for the oral hygiene task to be completed or neglected. Nurses’ approaches to care delivery and commitment of oral hygiene implementation are at the core of the decision-making process. Nurses relied on previous experiences, vicarious experiences, and trial/error methods to execute oral hygiene to stroke survivors with dysphagia. When oral hygiene was executed, nurses felt that stroke survivors had a decreased chance of developing a healthcare associated infection such as pneumonia. However, when oral hygiene was neglected, the patient was at increased risk for rehospitalization. Implications for practice include training nurses in oral hygiene delivery and involving them in oral hygiene processes. Future research needs to focus on the development of an evidenced-based protocol for oral hygiene, as nurses have limited and inconsistent guidance to base their care.

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Nursing Commons

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