Intensive care nurses' barriers and facilitators to oral care practices for ventilator-associated pneumonia prevention: A scoping review

Abstract

This scoping review systematically maps the barriers and facilitators encountered by intensive care unit (ICU) nurses regarding oral care practices for adult mechanically ventilated patients to prevent ventilator-associated pneumonia (VAP), while identifying existing research gaps in the literature. Structured around the Joanna Briggs Institute (JBI) framework for evidence synthesis and the PCC (Population, Concept, Context) guidelines, the review analyzed studies published in English or Turkish between 2016 and 2026. Literature searches were conducted across PubMed, Scopus, and Web of Science. Seventeen studies meeting the eligibility criteria were selected according to the PRISMA-ScR guidelines and synthesized using the COM-B behavioral framework. Identified barriers were categorized into four domains: system-related barriers, including understaffing, time constraints, and supply shortages; nurse-related barriers, including knowledge gaps, skill deficits, and low prioritization; patient-related barriers, including physical resistance and altered consciousness; and technical/procedural constraints, including mechanical obstruction from endotracheal tubes and the absence of localized protocols. Conversely, organizational and educational facilitators included the integration of oral care into daily clinical routines, peer-to-peer knowledge transfer from experienced staff, and the availability of specialized single-use oral care kits. This review demonstrates that suboptimal oral care processes point to macro-level institutional policies, material supply chains, and administrative priorities rather than a purely individual nursing care deficit. The findings indicate that future research should evaluate the clinical effectiveness of patient-specific, flexible oral care algorithms adaptable to variable clinical dynamics and innovative, ergonomic equipment designs.