By 24 item structured observational schedule, data were collected which was adapted from (Scott & Vollman,
2011) and CDC guidelines (CDC, 2004) (Appendix). Pilot study was done to identify any problems that might
possibly affect the research process and practically of the observational schedule. No modifications were made
to the instrument based on the pilot study. The research assistants (observers) are registered nurses who received
systematic training and education prior to data collection to follow the ETT and oral care according to Scott &
Vollman (2011) and CDC recommendations (CDC, 2004).
To prevent Hawthorne effect, the research assistants deliberately planned the observations throughout eight
months of the observational study. Observations were done during A shift (7am-3pm), B shift (3pm-11pm) and
C shift (11pm-7am).