{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T21:38:59Z","timestamp":1772487539548,"version":"3.50.1"},"reference-count":34,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,1,31]],"date-time":"2023-01-31T00:00:00Z","timestamp":1675123200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nursing Reports"],"abstract":"<jats:p>Oral hygiene has been shown to reduce adverse events and promote the quality of life of patients with stroke. However, a stroke can result in the impairment of physical, sensory, and cognitive abilities, and comprise self-care. Although nurses recognize its benefits, there are areas for improvement in the implementation of the best evidence-based recommendations. The aim is to promote compliance with the best evidence-based recommendations on oral hygiene in patients with stroke. This project will follow the JBI Evidence Implementation approach. The JBI Practical Application of Clinical Evidence System (JBI PACES) and the Getting Research into Practice (GRiP) audit and feedback tool will be used. The implementation process will be divided into three phases: (i) establishing a project team and undertaking the baseline audit; (ii) providing feedback to the healthcare team, identifying barriers to the implementation of best practices, and co-designing and implementing strategies using GRIP, and (iii) undertaking a follow-up audit to assess the outcomes and plan for sustainability. So, the successful adoption of the best evidence-based recommendations on oral hygiene in patients with stroke will reduce the adverse events related to poor oral care and may improve patients\u2019 quality of care. This implementation project has great transferability potential to other contexts.<\/jats:p>","DOI":"10.3390\/nursrep13010016","type":"journal-article","created":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T05:57:56Z","timestamp":1675231076000},"page":"148-156","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Oral Hygiene in Patients with Stroke: A Best Practice Implementation Project Protocol"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1573-7657","authenticated-orcid":false,"given":"Ana Filipa","family":"Cardoso","sequence":"first","affiliation":[{"name":"Nursing School of Coimbra, 3004-011 Coimbra, Portugal"},{"name":"The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal"},{"name":"Health Sciences Research Unit: Nursing, Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, 3004-011 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3798-347X","authenticated-orcid":false,"given":"Liliana Escada","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal"},{"name":"Centro Hospitalar e Universit\u00e1rio de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal"}]},{"given":"Teresa","family":"Santos","sequence":"additional","affiliation":[{"name":"Centro Hospitalar e Universit\u00e1rio de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal"}]},{"given":"Maribel","family":"Pinto","sequence":"additional","affiliation":[{"name":"Centro Hospitalar e Universit\u00e1rio de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal"}]},{"given":"Cl\u00e1udia","family":"Rocha","sequence":"additional","affiliation":[{"name":"Centro Hospitalar e Universit\u00e1rio de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal"}]},{"given":"Joana","family":"Magalh\u00e3es","sequence":"additional","affiliation":[{"name":"Centro Hospitalar e Universit\u00e1rio de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal"}]},{"given":"Berta","family":"Augusto","sequence":"additional","affiliation":[{"name":"Centro Hospitalar e Universit\u00e1rio de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8412-6556","authenticated-orcid":false,"given":"Diana","family":"Santos","sequence":"additional","affiliation":[{"name":"The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal"},{"name":"Centro Hospitalar e Universit\u00e1rio de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0534-5812","authenticated-orcid":false,"given":"Filipa Margarida","family":"Duque","sequence":"additional","affiliation":[{"name":"The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal"}]},{"given":"Beatriz Lavos","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Nursing School of Coimbra, 3004-011 Coimbra, Portugal"},{"name":"Hospital de Cascais Dr. Jos\u00e9 de Almeida, Av. Brigadeiro Victor Novais Gon\u00e7alves, 2755-009 Alcabideche, Portugal"}]},{"given":"Ros\u00e1rio Caixeiro","family":"Sousa","sequence":"additional","affiliation":[{"name":"Nursing School of Coimbra, 3004-011 Coimbra, Portugal"},{"name":"Hospital da Luz, Praceta Robalo Cordeiro, 1, 3020-479 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3947-7098","authenticated-orcid":false,"given":"Rosa","family":"Silva","sequence":"additional","affiliation":[{"name":"Nursing School of Coimbra, 3004-011 Coimbra, Portugal"},{"name":"The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal"},{"name":"Health Sciences Research Unit: Nursing, Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, 3004-011 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5722-5612","authenticated-orcid":false,"given":"Filipa","family":"Ventura","sequence":"additional","affiliation":[{"name":"Nursing School of Coimbra, 3004-011 Coimbra, Portugal"},{"name":"The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0712-5968","authenticated-orcid":false,"given":"Ant\u00f3nio Manuel","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Nursing School of Coimbra, 3004-011 Coimbra, Portugal"},{"name":"The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal"},{"name":"Health Sciences Research Unit: Nursing, Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, 3004-011 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1425-885X","authenticated-orcid":false,"given":"Daniela","family":"Cardoso","sequence":"additional","affiliation":[{"name":"Nursing School of Coimbra, 3004-011 Coimbra, Portugal"},{"name":"The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal"},{"name":"Health Sciences Research Unit: Nursing, Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, 3004-011 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4261-1147","authenticated-orcid":false,"given":"Rog\u00e9rio","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Nursing School of Coimbra, 3004-011 Coimbra, Portugal"},{"name":"The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal"},{"name":"Health Sciences Research Unit: Nursing, Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, 3004-011 Coimbra, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1111\/j.1744-1609.2011.00214.x","article-title":"Translating evidence into nursing practice: Oral hygiene for care dependent adults","volume":"9","author":"Chan","year":"2011","journal-title":"Int. J. Evid. Based Healthc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2324","DOI":"10.1080\/09638288.2016.1226970","article-title":"Lasting effect of an oral hygiene care program for patients with stroke during in-hospital rehabilitation: A randomized single-center clinical trial","volume":"39","author":"Kim","year":"2017","journal-title":"Disabil. Rehabil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.jdent.2017.04.001","article-title":"A randomized clinical trial of oral hygiene care programmes during stroke rehabilitation","volume":"61","author":"Dai","year":"2017","journal-title":"J. Dent."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1111\/hex.13074","article-title":"A qualitative exploration of oral health care among stroke survivors living in the community","volume":"23","author":"Powell","year":"2020","journal-title":"Health Expect."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Chen, H.J., Chen, J.L., Chen, C.Y., Lee, M., Chang, W.H., and Huang, T.T. (2019). Effect of an oral health programme on oral health, oral intake, and nutrition in patients with stroke and dysphagia in taiwan: A randomised controlled trial. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16122228"},{"key":"ref_6","unstructured":"Rudd, T. (2016). National Clinical Guideline for Stroke, Royal College of Physicians."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.jdent.2014.06.005","article-title":"A systematic review and meta-analysis of clinical, microbiological, and behavioural aspects of oral health among patients with stroke","volume":"43","author":"Dai","year":"2015","journal-title":"J. Dent."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.oooo.2016.10.024","article-title":"Oral health status in patients with acquired brain injury: A systematic review","volume":"123","author":"Kothari","year":"2017","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"520","DOI":"10.2340\/16501977-1806","article-title":"Predictors of oral health-related quality of life in patients following stroke","volume":"46","author":"Lam","year":"2014","journal-title":"J. Rehabil. Med."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Bangee, M., Martinez-Garduno, C.M., Brady, M.C., Cadilhac, D.A., Dale, S., Hurley, M.A., McInnes, E., Middleton, S., Patel, T., and Watkins, C.L. (2021). Oral care practices in stroke: Findings from the UK and Australia. BMC Nurs., 20.","DOI":"10.1186\/s12912-021-00642-y"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1111\/joor.12229","article-title":"Oral care post stroke: A scoping review","volume":"42","author":"Kwok","year":"2015","journal-title":"J. Oral Rehabil."},{"key":"ref_12","first-page":"1465","article-title":"Interventions for improving oral health in people after stroke","volume":"12","author":"Campbell","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1111\/ger.12309","article-title":"An oral hygiene protocol improves oral health for patients in inpatient stroke rehabilitation","volume":"35","author":"Murray","year":"2018","journal-title":"Gerodontology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1913","DOI":"10.1111\/jocn.14241","article-title":"Oral hygiene practices and knowledge among stroke-care nurses: A multicentre cross-sectional study","volume":"27","author":"Malik","year":"2018","journal-title":"J. Clin. Nurs."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.jebdp.2017.08.002","article-title":"Oral Health Interventions Using Chlorhexidine\u2014Effects on the Prevalence of Oral Opportunistic Pathogens in Stroke Survivors: A Randomized Clinical Trial","volume":"18","author":"Malik","year":"2017","journal-title":"J. Evid. Based Dent. Pract."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1111\/joor.12582","article-title":"A multi-centre randomised clinical trial of oral hygiene interventions following stroke-A 6-month trial","volume":"45","author":"Malik","year":"2018","journal-title":"J. Oral Rehabil."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.apmr.2012.10.024","article-title":"Randomized Clinical Trial of Oral Health Promotion Interventions Among Patients Following Stroke","volume":"94","author":"Lam","year":"2013","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1159\/000520505","article-title":"Best Practice Recommendations for Dysphagia Management in Stroke Patients: A Consensus from a Portuguese Expert Panel","volume":"39","author":"Oliveira","year":"2021","journal-title":"Port. J. Public Health"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Tian, F., Li, J., Wu, B., Xiao, R., Liu, J., Yu, J., Li, N., and Zhu, R. (2022). Differences in the oral health status in hospitalised stroke patients according to swallowing function: A cross-sectional study. J. Clin. Nurs., 1\u20138.","DOI":"10.1111\/jocn.16254"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1097\/JNN.0b013e31828a412c","article-title":"Dysphagia screening and intensified oral hygiene reduce pneumonia after stroke","volume":"45","author":"Rasmussen","year":"2013","journal-title":"J. Neurosci. Nurs."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1161\/STR.0000000000000158","article-title":"2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association\/American Stroke Association","volume":"49","author":"Powers","year":"2018","journal-title":"Stroke"},{"key":"ref_22","unstructured":"Australian and New Zealand Living Clinical Guideline (2022, September 10). Clinical Guidelines for Stroke Management. Available online: https:\/\/informme.org.au\/en\/Guidelines\/Clinical-Guidelines-for-Stroke-Management-2017."},{"key":"ref_23","unstructured":"Scottish Intercollegiate Guidelines Network (2022, September 20). Management of Patients with Stroke: Identification and Management of Dysphagia a National Clinical Guideline. (SIGN Guideline no119). Available online: http:\/\/www.sign.ac.uk\/guidelines\/fulltext\/50\/index.html."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1177\/1747493018786616","article-title":"Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018","volume":"13","author":"Boulanger","year":"2018","journal-title":"Int. J. Stroke"},{"key":"ref_25","unstructured":"Registered Nurses\u2019 Association of Ontoria (2022, July 12). Oral Health: Supporting Adults Who Require Assistance. 2020. pp. 10\u2013138. Available online: https:\/\/rnao.ca\/bpg\/guidelines\/oral-health-supporting-adults-who-require-assistance-second-edition."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Remijn, L., Sanchez, F., Heijnen, B.J., Windsor, C., and Speyer, R. (2022). Effects of Oral Health Interventions in People with Oropharyngeal Dysphagia: A Systematic Review. J. Clin. Med., 11.","DOI":"10.3390\/jcm11123521"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1007\/s00455-020-10218-8","article-title":"Best Practice Recommendations for Stroke Patients with Dysphagia: A Delphi-Based Consensus Study of Experts in Turkey-Part II: Rehabilitation","volume":"36","author":"Umay","year":"2021","journal-title":"Dysphagia"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1111\/ger.12404","article-title":"Family and friends: Supporting oral care in care homes","volume":"36","author":"Jones","year":"2019","journal-title":"Gerodontology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2013\/827670","article-title":"Oral Care of Hospitalised Older Patients in the Acute Medical Setting","volume":"2013","author":"Salamone","year":"2013","journal-title":"Nurs. Res. Pract."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12903-021-01501-7","article-title":"Patient perceptions of oral health care following stroke: A qualitative study","volume":"21","author":"Ajwani","year":"2021","journal-title":"BMC Oral Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"133","DOI":"10.12707\/RIV19057","article-title":"Terap\u00eauticas de enfermagem na pessoa com degluti\u00e7\u00e3o comprometida ap\u00f3s acidente vascular cerebral","volume":"23","author":"Oliveira","year":"2019","journal-title":"Rev. Enferm. Ref."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e19099","DOI":"10.12707\/RIV19099","article-title":"Higiene oral: Atua\u00e7\u00e3o da equipa de enfermagem em ambiente hospitalar","volume":"1","author":"Junior","year":"2020","journal-title":"Rev. Enferm. Ref."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Porritt, K., McArthur, A., and Lockwood, C.M.Z. (2022, July 13). JBI Manual for Evidence Implementation. JBI; 2020. Available online: https:\/\/implementationmanual.jbi.global.","DOI":"10.46658\/JBIMEI-20-01"},{"key":"ref_34","unstructured":"Pamaiahgari, P. (2020). Evidence Summary. Stroke: Oral Hygiene. JBI-ES-155-1. JBI EBP Database. JBI-ES-155."}],"container-title":["Nursing Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-4403\/13\/1\/16\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:19:49Z","timestamp":1760120389000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-4403\/13\/1\/16"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,31]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["nursrep13010016"],"URL":"https:\/\/doi.org\/10.3390\/nursrep13010016","relation":{},"ISSN":["2039-4403"],"issn-type":[{"value":"2039-4403","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,31]]}}}