Abstract
INTRODUCTION: Oral care is a critical yet often neglected aspect of nursing, essential for preventing complications like ventilator-associated pneumonia and systemic inflammation. Despite its importance, nurses face challenges due to limited training, time constraints, and inconsistent protocols. The evolving role of nurses in oral care reflects broader healthcare shifts toward interprofessional and patient-centered models. This systematic review examines these dynamics to inform evidence-based improvements. METHODS: Following PRISMA guidelines, this systematic review synthesized qualitative, quantitative, and mixed-methods studies from 2015 to 2025, sourced from PubMed, CINAHL, Scopus, Web of Science, Embase, and grey literature. Search terms targeted nurses' roles, perceptions, barriers, and interventions in oral care. Eligible studies involved registered nurses or students in healthcare settings, with data extracted on study characteristics, outcomes, and interventions. Quality was assessed using JBI and MMAT tools, and a narrative synthesis integrated findings via thematic analysis using NVivo. RESULTS: From 2,347 records, 32 studies across 12 countries were included, covering ICUs (n = 12), general wards (n = 8), and nursing homes (n = 5), with sample sizes ranging from 7 to 1,576 participants. Key themes emerged: inadequate knowledge due to limited education, variable attitudes influenced by setting, inconsistent practices lacking standardized tools, and barriers like workload and resource shortages. Enablers included enhanced training, with over 80% of nurses in multiple studies seeking further education, patient empowerment, interdisciplinary collaboration, and policy support. Training programs, such as virtual reality simulations, improved knowledge and confidence, while resource availability enhanced practice quality. CONCLUSION: Nurses' effectiveness in oral care is hindered by educational gaps, systemic barriers, and inconsistent prioritization, but bolstered by targeted training and resources. These findings can guide nursing curricula and hospital policy reforms to prioritize oral care globally. Comprehensive nursing curricula, evidence-based protocols, and interdisciplinary collaboration are essential to elevate oral care as a core responsibility. Future research should focus on scalable interventions in diverse settings to enhance patient outcomes.