# Nurses’ Perspectives on the Non-Pharmacological Management of Oral Mucositis in Onco-Hematological Care: A Qualitative Content Analysis

## TL;DR

This study explores how nurses in Italy manage oral mucositis in cancer patients without using drugs, highlighting their experiences and the need for better training and protocols.

## Contribution

The study provides new insights into nurses' non-pharmacological OM management practices and identifies gaps in formal education and standardized protocols.

## Key findings

- Nurses rely heavily on experiential competence and interprofessional collaboration for OM care.
- Training pathways for OM management are mostly informal and inconsistent across clinical settings.
- Standardized protocols and governance structures are lacking, affecting care consistency.

## Abstract

Background/Objectives: Oral mucositis (OM) is a common complication in onco-hematological patients undergoing chemotherapy and hematopoietic stem cell transplantation, negatively affecting comfort, nutrition, and quality of life. Despite existing assessment tools and recommendations, OM management—particularly non-pharmacological approaches—remains inconsistent, and evidence on nurses’ perspectives and contextual factors is limited. This study explored nurses’ perceptions and experiences regarding non-pharmacological treatments for OM, including educational needs and barriers and facilitators to implementation in clinical practice. Methods: A qualitative descriptive study using inductive content analysis was conducted. Semi-structured interviews were carried out with nurses working in onco-hematological settings in Italy. Data were analysed according to the Elo and Kyngäs framework. Results: Twelve nurses with extensive experience in onco-hematology and transplant care participated in the study. Five main themes emerged: (1) education and training pathways; (2) approaches to mucositis management; (3) nursing competence in OM care; (4) interprofessional collaboration; and (5) governance of practice, including protocols and guidelines. Findings highlighted strong experiential competence, high levels of nursing autonomy in assessment and patient education, and effective interprofessional collaboration, particularly in specialised settings. However, training pathways were predominantly informal, and the availability and use of protocols varied widely across clinical contexts. Conclusions: Non-pharmacological management of OM appears to be sustained primarily by advanced nursing competence and a specialised clinical culture rather than by structured education and standardised governance. Addressing educational gaps and promoting shared protocols may enhance the consistency, quality, and equity of supportive care while ensuring that the findings are clearly reflective of nurses’ experiences.