Date of Award


Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Thomas J. Blodgett


Oral mucositis [OM] is one of the most severe non-hematological problems related to cancer treatments and can impact quality of life. It is linked to poorer outcomes due to the associated weight loss, pain, dehydration, and risk of developing life-threatening infections. The purpose of this evidence-based practice project was to determine if OM is preventable with the use of an oral care protocol and zinc supplementation when compared to use of oral care protocols alone. The Johns Hopkins Nursing Evidence-Based Practice Model was used to guide project implementation in an outpatient oncology office. Recommendations were developed from an exhaustive review of literature. Implementation of the project occurred in two phases. Phase one was establishment and implementation of an oral care protocol as the standard of care. Phase two included the standard of care and incorporated use of zinc supplements to select participants. Groups were selected by convenience sampling. A two group pretest-posttest quasi-experimental design was applied. OM Symptoms were tracked using the Patient Reported Oral Mucositis Symptom (PROMS) survey, a visual analog scale consisting of ten questions. Participants (N=23) filled out baseline surveys and were followed over a six-week period. Independent t-test were used to analyze the data. Statistically significant results were noted in 8 out of 10 variables assessed using PROMS: Mouth pain, weeks 5 (2.91 vs. 8.75, p = .046) and 6 (2 vs. 8.91, p = .004), difficulty speaking, weeks 4 (2.7 vs. 7.33, p = .008) and 6 (1.18 vs. 3.36, p = .036), eating soft foods, weeks 3 (2 vs. 4.2, p = .024) and 5 (1.82 vs. 7.25, p = .008), restriction of eating week 6 (3.45 vs. 11.82, p = .017), difficulty drinking weeks 5 (2 vs. 5, p = .024) and 6 (1.36 vs. 3.73, p = .023, restriction of drinking week 3 (1.2 vs. 2.7, p = .033), difficulty swallowing weeks 4 (2 vs. 6.89, p = .048) and 5 (1.91 vs. 8.25, p = .027), and change in weeks 4 (6.3 vs. 14.33, p = .045) and 5 (4.55 vs. 16.88, p = .04)(Figure 4.8). There were no statistically significant differences in the groups with regards to restriction of speech or difficulty eating hard foods.