Effect of Telenursing on Oral Health

Studies evaluating the effectiveness of oral health interventions in individuals with COPD are limited in the literature. Maintaining oral health is a crucial part of patient care. Sustainable nursing interventions are necessary from the onset of the disease to the end of life. Patient education conducted by nurses is important in improving medication adherence and preventing comorbidities. Furthermore, it is known that practices involving a multidisciplinary team approach with nurse participation reduce readmissions and hospital stays for COPD patients. Therefore, this study aims to evaluate the effect of telenursing intervention on oral health in individuals with COPD. The experimental group will receive oral health education via telenursing intervention (via video call) and daily oral health reminders. The control group will not receive education. Oral health education for the experimental group is planned to be given within 24 hours after the pre-test. The experimental group will be invited to the hospital one month after the oral health education for evaluation of oral health and quality of life related to oral health, and the control group will be invited one month after the pre-test.

• telenursing (Behavioral): The responsible researcher will provide oral health education to the experimental group via video call during the telenursing intervention. The content of the education will include oral health in adults; the consequences of poor oral hygiene; things to pay attention to in oral health; demonstration of toothbrushing technique; and coping with care-resistant behaviors. Participants' questions regarding oral health will be answered during the call. The oral health education session is planned to last approximately 20 minutes.
• reminders (Behavioral): Participants in the experimental group will be reminded to perform oral care at least twice a day, every day, and to rinse their mouths with water after using an inhaler. They will also be reminded to schedule a face-to-face meeting one month after the education.

Primary outcomes

• oral healt [pre-test and post-test (1 month)]: The Oral Assessment Guide (ADR) will be used to evaluate oral health. The guide supports the creation of an oral care protocol for patients with impaired oral mucosal membranes. Scores on the guide range from 8 to 24. According to the ADR, a low score indicates good oral health, while a high score indicates negative changes in oral health. The oral mucosal membrane score will be evaluated in both pre-test and post-test. A light source and a tongue depressor (one for each participant) are planned to be used during the oral health assessment.
• Quality of Life Related to Oral Health [pre-test and post-test (1 month)]: The scale has seven sub-dimensions: 'Functional Limitation', 'Physical Pain', 'Psychological Distress', 'Physical Disability', 'Psychological Disability', 'Social Disability', and 'Handicap'. Scores obtainable from the Oral Health Impact Scale range from 0 to 56. Since all questions are in a negative form, a score close to 0 indicates good quality of life related to oral and dental health, while a score close to 56 indicates poor quality of life related to oral and dental health. A high score on the scale indicates low quality of life related to oral health.

Sex: All, ages: 40 Years to any

Inclusion Criteria:

* Participants must have been diagnosed with COPD for at least 6 months,
* receive inpatient treatment in internal medicine and surgical clinics,
* signed the informed consent form to participate in the study,
* have internet access and a mobile device with Android/iOS operating system,
* be able to use a phone,
* ≥ 40 years old,
* have no communication barriers,
* mild (Stage 1), moderate (Stage 2), severe (Stage 3), or very severe (Stage 4) stages according to the GOLD (2023) report.

Exclusion Criteria:

* Those diagnosed with COPD less than 6 months ago,
* Those receiving outpatient treatment,
* Those hospitalized in the intensive care unit,
* Those without internet access and a mobile device with Android/iOS operating system,
* Those who do not have the ability to use a phone,
* Those under 40 years of age,
* Those with communication barriers,
* Those who wish to withdraw from the research/withdraw from participation during the research process,

• SEVDA ATEŞ, Associate Professor, Principal investigator, Çanakkale Onsekiz Mart University