Learning Objective #1: Compare and contrast survey and observational findings from two studies conducted in distinct geographic areas of the United States

Learning Objective #2: Appreciate the value of replication to extend generalizability of study findings

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Background: Oral care and head of bed (HOB) elevation are interventions to decrease risk of aspiration pneumonia in hospitalized patients. In a previous study (Grap et al., 2003), nurses reported performing oral care more frequently than documented; the present study was done to extend generalizability of original study findings. Objectives: To replicate the original study and estimate instrument reliability. Methods: Using a cross-sectional design, survey data from nursing personnel and bedside observational data from nine intensive care units were collected. Results: 181 (47%) surveys were returned and data were collected from 436 patient bedsides. Reported oral care frequency and use of oral care products were different for intubated and nonintubated patients (p < .001). The mean (± S.D.) documented frequency of oral care for intubated patients was 3.3 ± 1.8, compared with self-reported frequency of 4.2 ± 2.1. The mean documented frequency of oral care for nonintubated patients was 1.8 ± 1.5, compared with a self-reported frequency of 3 ± 2.4. Documented oral care frequency was different by unit (p = .006) and intubation status (p < .001). Mean observed HOB position was 23 ± 12° for intubated patients and 38 ± 24° for nonintubated patients (p < .001). Intubation status, but not unit, affected observed HOB position (p < .001). Three survey items had adequate reliability evidence (r > .70). Inter-rater reliability for bedside data collection was > 96%. Conclusions: In general, findings were comparable to those of the original study; nurses report more frequent oral care than documented. No evidence exists for reliability of the survey.