Pilot study interview findings

When asked about the scenario, nine of the eleven participants described reflecting upon patients that they had seen. The remaining two described general dependency needs of patients who had had a stroke. Participants’

descriptions indicated a common and shared understanding of oral care needs, disability and dependency for the stroke patient.

One student nurse commented on the choice of scenario during the interview:

Student nurse participant 116: “it's probably the best category of patient to

pick coz they’re the most helpless not being able to do much for themselves.”

Specific cues in the scenario were meaningful. For example, a number of participants felt that the patient in the scenario would find it difficult to self- care because of the loss of function in the arm. Participants also commented that when unable to communicate with nursing staff, patients could have difficulty in saying what they needed, or if care provided was causing pain as illustrated below. The implications for care were that greater communication skills needed to be employed.

Interviewer (prompt): and speech difficult to understand…

Student nurse participant 118: yeah they might not be able to tell me if I’m

hurting them or where it hurt or what they felt.

Participants described a greater sense of responsibility and emotion towards providing care when the patient was allocated to them for care. These feelings were further reinforced when their patients asked student nurses for help. They also indicated that the care provided may change in a different scenario. Responsibility towards a patient who was not theirs is illustrated below:

Interviewer (prompt): On the wards you have certain patients who are yours?

Student nurse participant 101: Oh yeah, well I believe it would be their

responsibility then. But if a patient asked me to help them then I would, that’s how it works.

Terminology used was similar for all participants. Participants described “Brushing” as toothbrushing inside the mouth. Participants interpreted the term “using a swab” as using a pink swab on a stick.

Participants interpreted the terms “occasionally” and “frequently” differently. For some, frequently meant two or three times a week while for others it meant daily.

Images were reported to represent a range of patient oral care conditions that could be seen on the ward. When asked about seeing the patient in the pictures, participants described how they felt seeing the picture or the content of the picture.

Interview responses using the questionnaire as a guide

Participants reported that tissue damage looked uncomfortable or painful for the patient. In these situations, they described needing to provide care and being anxious and disgusted as a patient. Participants expressed very little anxiety or disgust towards scenarios with clean images with most indicating that they were less concerned about normal and clean appearances and this could change their behaviour as illustrated below.

Student nurse 110: No I wouldn’t be so worried about number fourteen. I

don’t know, I wouldn’t be desperate to go and clean their teeth. I wouldn’t think it was the end of the world if I didn’t brush them, if I didn’t have time.

Some participants described being unsure when they saw fillings and crowns as shown below. Participants reported that these uncertainties changed their approach to care and their feelings.

Interviewer: Is there anything with that picture that made you feel uncomfortable?

Student nurse 317: I think it was this bit here.

Interviewer: Ok just around here [pointing to the fillings and the crown]?

Student nurse 317: Yeah, It looks sort of decayed there.

Not providing care made participants feel uncomfortable. A small number of participants reported that dissatisfaction should be used for questions about not providing care as that better represented their feelings. Many described emotions of disgust and anxiety, guilt and dissatisfaction towards not providing care as shown below.

Interviewer: And if you didn’t brush the teeth how would you feel?

Student nurse 116: I’d be very disgusted at myself not anyone else. Erm, I’d be anxious the longer they were left unattended the more the anxiety. I’d be scared what’s lurking in there for when I did brush them. I’d be afraid of causing more damage. But the longer they’d remained dirty the greater my satisfaction when I did clean them.

Participants felt most comfortable providing care for the scenarios with clean images and were most uncomfortable providing care for scenarios with tissue damage. In situations where there was evidence of tissue damage, participants described changing the way they delivered care. Some of the participants described how they take extra care or be extremely gentle around areas that looked sore. Most described tooth brushing as the best way to clean teeth. But some of the participants described pink swabs or mouth rinses as being gentler for sore areas. Discomfort providing care is illustrated below:

Interviewer: How would you feel while brushing these [dirty image]? Student nurse 118: Dunno, like made my stomach churn a little bit.

Student nurses who were currently caring for fully independent patients indicated that they used other placements where they had been caring for stroke patients or were able to carry out oral care as a basis for their responses. Care frequencies, which specified times per day, were clearly interpreted. The terms occasional and infrequent described as sporadic care.

When describing oral care, participants spoke of needing to ask for help when they did not know what to do. They stated that they would ask for help from their peers, their mentors or dentists. Participants were comfortable to carry out care without any assistance in scenarios with no tissue damage, and most needed help where they were anxious about not knowing what to do, feeling unable to help or causing damage to the patient.

Interviewer: And asking for help?

Student nurse 116: Erm, if it were just normal teeth like that then no, but if

there’s blood, pus something like that then I’d always refer, especially coz I don’t know what it is.

Participants did not report the need for any further scenarios in the questionnaire. They however reported that at times it felt long and repetitive.