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Oda K, Bakri NN, Majeed S, Bartlett S, Thomson MW, Parsons J, Boyd M, Ferguson AC, Smith M. Improving Nursing Oral Care Practice for Community-Dwelling Care-Dependent Older People. Int J Older People Nurs 2024; 19:e12656. [PMID: 39344447 DOI: 10.1111/opn.12656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 08/26/2024] [Accepted: 09/16/2024] [Indexed: 10/01/2024]
Abstract
AIM Oral care is one of the most neglected nursing practices owing to a lack of training, standard nursing oral care guidelines and low confidence and skills. There is little evidence to inform the development of oral care training and guidelines, which ideally should be done in collaboration with oral health professionals. Further, there is a lack of research, particularly in New Zealand, with nursing staff caring for care-dependent older people, including those ageing in their own homes. This pilot study aimed to determine the impact of oral care training on nursing staff knowledge, attitudes and confidence in supporting community-dwelling older peoples' oral care. METHOD Mixed methods design comprising delivery of an oral healthcare and assessment training intervention by a team comprising nursing and oral health professionals, pre- and post-intervention questionnaires (N = 14) and a post-intervention focus group with community-based nursing staff (N = 5). RESULTS Staff knowledge significantly improved (p = 0.046) following interprofessional collaborative training, but attitude and confidence scores did not (p = 0.127), although focus group responses suggested that participants' confidence was heightened. Participants expressed the need to implement oral care practices to benefit clients' health, clarify roles and identify oral care as a core competency. They sought to make individual- and organisational-level practice changes accordingly. CONCLUSION Oral care training based on interprofessional collaboration and education enhances nursing staff knowledge but not their confidence in oral care provision. Ongoing, hands-on practical training for nursing staff in collaboration with oral health professionals has the potential to advance nursing oral-care practice and improve care-dependent older peoples' oral care. IMPLICATION FOR PRACTICE Oral care training and education with oral health professionals is effective to enhance nursing staff knowledge and awareness in oral health care. However, transforming knowledge into nursing oral care practice requires hands on practical training and ongoing collaboration with oral health professionals to improve care-dependent older people's oral health care.
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Affiliation(s)
- Keiko Oda
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Nazahiah N Bakri
- Centre of Population Oral Health and Clinical Prevention Studies, Universiti Teknologi MARA, Selangor, Malaysia
- Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
| | - Sarah Majeed
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Shennae Bartlett
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Murray W Thomson
- Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
| | - John Parsons
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Anna C Ferguson
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Moira Smith
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
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Zhu Z, Yang Z, Qi X, Mao W, Pei Y, Wu B. Association Between Oral Hygiene Behaviours and Cognitive Decline in Adults: A Systematic Review and Meta-Analysis. J Adv Nurs 2024. [PMID: 39373499 DOI: 10.1111/jan.16525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 09/11/2024] [Accepted: 09/23/2024] [Indexed: 10/08/2024]
Abstract
AIM To evaluate the association between oral hygiene behaviour and cognitive decline in adults. The outcomes include changes in global cognitive function, visual attention, task switching and the risk of dementia. DESIGN We conducted a systematic review following the preferred reporting items for systematic reviews and meta-analyses guidelines. DATA SOURCES A systematic search of 11 databases and grey literature sources was conducted from inception to January 2024. We included interventional trials or cohort studies that investigated the effect of oral hygiene behaviours (e.g., toothbrushing, mouth washing, flossing, using toothpicks and cleaning dentures) on cognitive decline in adults. METHODS Data extraction and risk of bias assessment were performed by two independent reviewers with expertise in conducting systematic reviews. Meta-analyses were conducted using random-effects models, and heterogeneity was assessed with the I2 statistic and χ2 test. RESULTS A total of eight studies (six intervention studies and two cohort studies) met inclusion criteria, including 261,772 participants. Follow-up periods ranged from 30 days to 48 months for interventions and 9 to 18 years for cohorts. Toothbrushing was associated with a significantly slower decline in global cognitive overtime. Toothbrushing in older adults with moderate/severe dementia could achieve significant changes in cognitive decline. There was no significant difference between the effectiveness of toothbrushing performed by professionals and caregivers. Other oral hygiene behaviours, including dental flossing, using mouthwash, using toothpicks and cleaning dentures, were not associated with the risk of dementia. CONCLUSIONS Toothbrushing is linked to a decreased risk of dementia and improved global cognitive function. Promoting toothbrushing at least twice daily may significantly reduce the risk of cognitive decline and dementia. IMPACT These findings highlight the urgent need for programmes that encourage daily toothbrushing, particularly in nursing home settings and among older adults with moderate-to-severe dementia.
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Affiliation(s)
- Zheng Zhu
- School of Nursing, Fudan University, Shanghai, China
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Zhongfang Yang
- School of Nursing, Fudan University, Shanghai, China
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Xiang Qi
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Weiyu Mao
- School of Social Work, University of Nevada, Reno, Nevada, USA
| | - Yaolin Pei
- School of Nursing, The University of Texas at Austin, Austin, Texas, USA
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, New York, USA
- NYU Aging Incubator, New York University, New York, New York, USA
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Gu L, Zhang J, Chen W, Weng Y, Chen L, Zhang L. Feasibility of an oral health promotion program among older people in geriatric care facilities, Shanghai, China: a pre/post-implementation study. BMC Geriatr 2024; 24:272. [PMID: 38504192 PMCID: PMC10953076 DOI: 10.1186/s12877-024-04870-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 03/04/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The oral health of older people is closely related to their overall health. Timely and effective intervention in oral issues is necessary to maintain their overall health. This study aimed to evaluate the feasibility and effectiveness of an Oral Health Promotion Program (OHPP) in Geriatric Care Facilities (GCFs). METHODS The OHPP was implemented in two GCFs and evaluated using a pre/post-design. Questionnaires on self-efficacy and attitude for providing oral care were sent to 42 nurse participants before and three months after the implementation of the OHPP. Outcomes of 295 patient participants were assessed at four time points (T1-baseline, T2-one month, T3-two months, and T4-three months post-implementation) including Activities of Daily Living (ADL), Mini-Mental State Examination (MMSE), and Oral Health Assessment Tool (OHAT). RESULTS The oral health and daily activity ability of patient participants showed an improving trend at four time points pre/post-implementation of the OHPP. The proportion of patients with healthy mouths (OHAT: 0-3 points) increased from 29.8 to 67.8% and their scores of OHAT and ADL were significantly better at T4 compared to T1, T2, and T3 (p < 0.001). Self-efficacy (SE-PMC: T1 = 18.93 ± 3.18, T4 = 28.83 ± 6.56, p < 0.001) and attitude (A-PMC: T1 = 18.78 ± 3.09, T4 = 28.20 ± 6.03, p < 0.001) for oral care among nurse participants improved after the implementation of the OHPP. CONCLUSIONS This study highlights the feasibility of implementing OHPP within GCFs, potentially enhancing the oral health and daily living activities of older individuals. Integrating the OHPP into routine care in geriatric settings is not only practical but also widely acceptable, offering a proactive approach to address oral health disparities among older residents. Stakeholders can maximize the impact of the OHPP by fostering collaboration among healthcare professionals, administrators, and residents, ultimately improving oral health outcomes and overall quality of life of older residents. TRIAL REGISTRATION ChiCTR2000035236 (registration date: 04/08/2020).
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Affiliation(s)
- Liyan Gu
- Department of Neurology, NO. 905 Hospital of PLA Navy, Naval Medical University, 1328 Huashan Road, 200052, Shanghai, China
- Key Laboratory of Ministry of Education for Geriatric Long-term Care, Shanghai, China
| | - Jingwen Zhang
- Education and Scientific Research Department of Clinical Nursing, Changhai Hospital affiliated to Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Wenyao Chen
- Education and Scientific Research Department of Clinical Nursing, Changhai Hospital affiliated to Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Yanqiu Weng
- Education and Scientific Research Department of Clinical Nursing, Changhai Hospital affiliated to Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Lan Chen
- Nursing Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.
| | - Lingjuan Zhang
- Key Laboratory of Ministry of Education for Geriatric Long-term Care, Shanghai, China.
- Education and Scientific Research Department of Clinical Nursing, Changhai Hospital affiliated to Naval Medical University, 168 Changhai Road, Shanghai, 200433, China.
- Shanghai Quality Control Center of Geriatric Care, 168 Changhai Road, Shanghai, 200043, China.
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Chen M, Weng Y, Zhang J, Gu L, Chen W, Qiao M, Wang M, Huang X, Chen L, Zhang L. Factors associated with nurses' attitudes for providing oral care in geriatric care facilities: a cross-sectional study. BMC Oral Health 2023; 23:801. [PMID: 37884891 PMCID: PMC10605944 DOI: 10.1186/s12903-023-03517-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The world's population is getting older. This issue is accompanied by a rise in the number of older people suffering from dementia and disability, for whom oral hygiene care is challenging. Nurses' attitudes toward providing oral care (POC) are critical for the elderly, while few studies have investigated the determinant factors of nurses' attitudes by identifying the current work pressure, resilience and self-efficacy in geriatric care facilities (GCFs). It is of great significance to explore the nurses' attitudes toward POC and associated influencing factors related to psychological aspects including resilience, self-efficacy, and stress from the workplace. METHODS Attitudes for Providing Mouth Care (A-PMC) in Chinese version were used in this cross-sectional study with 160 nurses in 2 GCFs. Data were collected using online questionnaires and analyzed by multiple linear regression analysis. Statistically significant values were considered at p < 0.05. RESULTS A total of 160 nurses participated in this study, with an average age of 32.86 ± 7.43. The mean score for the A-PMC was 2.81 ± 0.47. The score of A-PMC was negatively correlated with work pressure (r=-0.332, p < 0.01), and positively correlated with resilience (r = 0.735, p < 0.01) and self-efficacy (r = 0.425, p < 0.01) respectively. Multiple linear regression analyses identified that the potential influencing factors of A-PMC were education background, work hours every shift, self-efficacy, work pressure and resilience. CONCLUSIONS The study results indicate nurses' attitudes regarding PMC were at a low level, which is influenced by many factors. To improve nurses' attitudes toward PMC and the oral hygiene (OH) of the elderly in GCFs, it is necessary to increase nurses' education and training, establish a reasonable and effective incentive mechanism to improve nurses' work motivation and other intervention measures to reduce work pressure.
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Affiliation(s)
- Mengxia Chen
- Education and Scientific Research Department of Clinical Nursing, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yanqiu Weng
- Education and Scientific Research Department of Clinical Nursing, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Shanghai Quality Control Center of Geriatric Care, Shanghai, China
| | - Jingwen Zhang
- Education and Scientific Research Department of Clinical Nursing, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Liyan Gu
- Department of Neurology, No. 905 Hospital of PLA Navy, Shanghai, China
| | - Wenyao Chen
- Education and Scientific Research Department of Clinical Nursing, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Shanghai Quality Control Center of Geriatric Care, Shanghai, China
| | - Mengting Qiao
- Education and Scientific Research Department of Clinical Nursing, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Mengdi Wang
- Education and Scientific Research Department of Clinical Nursing, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xiaorong Huang
- Department of Nursing, Huzhou University, Huzhou, Zhejiang, China
| | - Lan Chen
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Lingjuan Zhang
- Education and Scientific Research Department of Clinical Nursing, The First Affiliated Hospital of Naval Medical University, Shanghai, China.
- Shanghai Quality Control Center of Geriatric Care, Shanghai, China.
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Franco-Rodríguez A, Domínguez-Martís EM, Mosteiro-Miguéns DG, López-Ares D, Cotón-Sánchez B, Domínguez-Varela M, Novío S. Translation, Cross-Cultural Adaptation, and Validation of the Galician Version of the Nurse Prescribing Self-Efficacy Scale. Healthcare (Basel) 2022; 10:healthcare10122563. [PMID: 36554086 PMCID: PMC9778594 DOI: 10.3390/healthcare10122563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Low self-efficacy has been identified as one of the factors that could hinder the prescribing competence of nurses. No valid and reliable existing instruments assess Galician nurses' confidence to prescribe. The aim of this study was to determine the reliability and validity of the Galician version of the Nurse Prescribing Self-Efficacy Scale (G-NP-SES, 19 items). The study was conducted in two phases: the translation and adaptation to the Galician version of the NP-SES, and the assessment of its psychometric properties. G-NP-SES was sent to nurses working in primary healthcare centers in Galicia (Spain) between March and June of 2022. Its content, construct and discriminant validity, and internal consistency reliability were examined. A total of 193 people participated in the study. As the original scale, G-NP-SES also had three dimensions (% of cumulative variance = 80.82%). It showed good internal consistency (Cronbach's alpha coefficient (α) = 0.90, with each factor ranging from 0.86 to 0.89), high content validity (scale's content validity index = 0.92, with item-content validity index ranged from 0.87 to 1), and good discriminant validity. G-NP-SES is an instrument with good psychometric properties which could be used to accurately assess Galician nurses' self-efficacy to prescribe and consequently to improve their job performance.
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Affiliation(s)
| | - Eva María Domínguez-Martís
- Galician Public Healthcare Service, Healthcare Centre of Concepción Arenal, C/Santiago León de Caracas 12, 15701 A Coruña, Spain
| | - Diego Gabriel Mosteiro-Miguéns
- Galician Public Healthcare Service, Healthcare Centre of Concepción Arenal, C/Santiago León de Caracas 12, 15701 A Coruña, Spain
| | - David López-Ares
- Galician Public Healthcare Service, University Hospital Complex of A Coruña (CHUAC), 15006 A Coruña, Spain
| | | | | | - Silvia Novío
- Department of Psiquiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, C/ San Francisco s/n, 15782 A Coruña, Spain
- Correspondence:
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Oda K, Boyd M, Parsons J, Smith M. Integrating oral care into nursing practice in care homes. Nurs Older People 2022; 34:27-34. [PMID: 35730481 DOI: 10.7748/nop.2022.e1406] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2022] [Indexed: 01/31/2023]
Abstract
This article details a narrative review that explored the barriers to and facilitators of integration of oral care into nursing practice in care homes to enhance nurses' delivery of oral care. Three themes were identified: gaps in oral care protocols and the complexity of nursing oral care; how interprofessional collaboration and education can improve oral care; and limitations and unresolved issues in nurses' oral care training. The review found that interprofessional collaboration and education were important in normalising oral care practice and nurse leadership in care homes. Nurse-led interprofessional oral care could enhance the quality of care in care homes by advancing interprofessional collaboration and education, coordinating care and improving organisational support.
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Affiliation(s)
- Keiko Oda
- Department of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- Department of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - John Parsons
- Department of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Moira Smith
- Department of Public Health, University of Otago, Wellington, New Zealand
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Chen L, Gu L, Li X, Chen W, Zhang L. Translation, cross-cultural adaptation, and validation of the Chinese version of self-efficacy and attitudes for providing Mouth Care scale. PLoS One 2022; 17:e0271800. [PMID: 35867694 PMCID: PMC9307152 DOI: 10.1371/journal.pone.0271800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background
In recent years, oral care for older people has received extensive attention in long-term care facilities. The Self-Efficacy for Providing Mouth Care (SE-PMC) and Attitudes for Providing Mouth Care (A-PMC) scale evaluated the self-efficacy and attitude of nursing staff while providing oral care. However, whether this scale is valid and reliable for Chinese nursing staff in China remains unverified. This study aims to translate the English version of SE-PMC and A-PMC into Chinese and determine their reliability and validity.
Methods
After obtaining the author’s consent, the procedure for a double-back translation and cross-cultural adaptation was conducted to develop the Chinese version of SE-PMC and A-PMC. The validity and reliability of the Chinese version of SE-PMC and A-PMC were evaluated in a cross-sectional observational study with 852 nurses from 42 Geriatric Care Facilities (GCFs). Exploratory factor analysis (EFA) (n = 427) and confirmatory factor analysis (CFA) (n = 425) were conducted to test the construct validity and quality of the factor structures. We applied the item discrimination test and homogeneity test for item analysis. Cronbach’s alpha coefficient and split-half coefficient were adopted to evaluate internal consistency.
Results
The Chinese version of SE-PMC (11 items, 3 factors) and A-PMC (11 items, 2 factors) included 22 items, reflecting adequate construct validity and reliability. In addition, test-retest reliability was 0.809 for SE-PMC and 0.811 for A-PMC, evincing good stability. The Cronbach’s α coefficient of SE-PMC was 0.831, with each factor ranging from 0.793~0.906. The Cronbach’s α coefficient of the A-PMC was 0.768, with each factor ranging from 0.814~0.824. Item-Content Validity Index (I-CVI) of SE-PMC and A-PMC ranged from 0.84 ~1.00 and 0.82~1.00, respectively.
Conclusion
The Chinese version of SE-PMC and A-PMC was validated as a reliable assessment tool to evaluate the self-efficacy and attitude of nursing staff in GCFs for providing oral care in China.
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Affiliation(s)
- Lan Chen
- Nursing Department, Shanghai General Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Education and Scientific Research Department of Clinical Nursing, Changhai Hospital Affiliated to Naval Medical University, Shanghai, China
| | - Liyan Gu
- Department of Neurology, NO. 905 Hospital of PLA Navy, Shanghai, China
| | - Xianchen Li
- Clinical Research Center, Shanghai General Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenyao Chen
- Education and Scientific Research Department of Clinical Nursing, Changhai Hospital Affiliated to Naval Medical University, Shanghai, China
| | - Lingjuan Zhang
- Education and Scientific Research Department of Clinical Nursing, Changhai Hospital Affiliated to Naval Medical University, Shanghai, China
- Shanghai Quality Control Center of Geriatric Care, Shanghai, China
- * E-mail:
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Gu L, Chen L, Li X, Chen W, Zhang L. Self-efficacy and attitudes of nurses providing oral care in geriatric care facilities: A cross-sectional study in Shanghai. Nurs Open 2022; 10:202-207. [PMID: 35856707 PMCID: PMC9748059 DOI: 10.1002/nop2.1295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/06/2022] [Accepted: 06/27/2022] [Indexed: 01/04/2023] Open
Abstract
AIMS To investigate nurses' self-efficacy and attitudes of providing oral care in geriatric care facilities (GCFs) and compare differences between individuals, facilities and countries. DESIGN A cross-sectional and multicentre study. METHODS Data were collected from 852 nurses in 42 GCFs using two scales, "Self-Efficacy for Providing Mouth Care" (SE-PMC) and "Attitudes for Providing Mouth Care" (A-PMC), and analysed using t-test and ANOVA. RESULTS Totally 852 nurses (844 females, 99%) participated in this study with an effective response rate of 85.2%. Scores of SE-PMC and A-PMC of nurses varied significantly among GCFs with different sizes, types and years of establishment and differentiated among staff about the length of employment (p < .05). Nurses (N = 434) in North Carolina scored higher than nurses in Shanghai both in SE-PMC and A-PMC (p < .05). Establishment and implementation of Oral health promotion programmes were desired based on characteristics of different institutions and nurses' clinical ladder.
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Affiliation(s)
- Liyan Gu
- Department of NeurologyNo. 905 Hospital of PLA NavyShanghaiChina
| | - Lan Chen
- Nursing DepartmentShanghai General Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina,Education and Scientific Research Department of Clinical NursingChanghai Hospital Affiliated to Naval Medical UniversityShanghaiChina
| | - Xianchen Li
- Clinical Research CenterShanghai General Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Wenyao Chen
- Education and Scientific Research Department of Clinical NursingChanghai Hospital Affiliated to Naval Medical UniversityShanghaiChina
| | - Lingjuan Zhang
- Education and Scientific Research Department of Clinical NursingChanghai Hospital Affiliated to Naval Medical UniversityShanghaiChina,Shanghai Quality Control Center of Geriatric CareShanghaiChina
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Aro T, Laitala ML, Vähänikkilä H, Kyngäs H, Tiisanoja A, Syrjälä AM. Developing an Instrument to Measure Self-Efficacy, Challenges and Knowledge in Oral Care among Geriatric Home Care Nurses-A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910019. [PMID: 34639321 PMCID: PMC8508242 DOI: 10.3390/ijerph181910019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022]
Abstract
The role of geriatric nurses is essential in preventing oral health problems of older people with impaired daily functioning. Nurses have reported low self-efficacy with regard to oral health care practices and wish to receive more information on the topic. The main aim of this pilot study was to develop an instrument to measure the self-efficacy beliefs, challenges and knowledge of geriatric home care nurses with regard to the oral health care of older. A questionnaire was developed to evaluate geriatric home care nurses' self-efficacy beliefs, challenges and knowledge regarding the oral health care of the older people. In this case, 18 nurses participated in a one-day intervention and filled in the questionnaire before and after the intervention. The comments and questions of the nurses were analysed utilising the principles of inductive content analysis. Cronbach's alpha for the scales varied between 0.69-0.79. The interactive intervention improved both nurses' self-efficacy beliefs and oral health-related knowledge, and most of the challenges faced by nurses in older people's oral health care were diminished. Financial resources and older people's self-determination were the most common limitations to oral care. In this pilot study, we developed an instrument to measure geriatric home care nurses' self-efficacy beliefs, challenges and knowledge regarding older people's oral health care. In the future, this instrument can be validated with a larger study population.
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Affiliation(s)
- Taru Aro
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, 90014 Oulu, Finland; (M.-L.L.); (A.T.); (A.-M.S.)
- Correspondence: ; Tel.: +358-504103281
| | - Marja-Liisa Laitala
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, 90014 Oulu, Finland; (M.-L.L.); (A.T.); (A.-M.S.)
- Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, 90014 Oulu, Finland
| | - Hannu Vähänikkilä
- Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, 90014 Oulu, Finland;
| | - Helvi Kyngäs
- Research Unit of Nursing Science and Health Management, Oulu University Hospital, 90014 Oulu, Finland;
| | - Antti Tiisanoja
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, 90014 Oulu, Finland; (M.-L.L.); (A.T.); (A.-M.S.)
- Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, 90014 Oulu, Finland
- Periodontology and Geriatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, 90014 Oulu, Finland
| | - Anna-Maija Syrjälä
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, 90014 Oulu, Finland; (M.-L.L.); (A.T.); (A.-M.S.)
- Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, 90014 Oulu, Finland
- Periodontology and Geriatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, 90014 Oulu, Finland
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Lowman SG, Zimmerman S, Ward K, Weintraub JA. Family perceptions of mouth care for assisted living residents with dementia: Implications for care. Geriatr Nurs 2021; 42:926-934. [PMID: 34098447 DOI: 10.1016/j.gerinurse.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
Mouth care is an important component of care for persons with dementia in assisted living (AL). However, there is little information about family member knowledge, beliefs, and experiences with resident oral health. Family perceptions and involvement in care may impact oral and systemic health for AL residents. Therefore, semi-structured interviews to assess these domains were conducted with 23 adult family members of AL residents with dementia, from 9 AL communities. Thematic analysis found that families identified (1) the centrality of oral health to well-being; (2) organizational influences on mouth care; (3) mouth care in the context of dementia; and (4) collaboration to facilitate mouth care. Family perspectives can provide useful guidance for collaborative interventions that support oral health and mouth care in AL.
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Affiliation(s)
- Sarah G Lowman
- North Carolina Department of Health and Human Services, Division of Public Health, Oral Health Section, Raleigh, NC, United States; School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, NC, United States; School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kimberly Ward
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, NC, United States
| | - Jane A Weintraub
- School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Kistler CE, Scott J, Ward K, Zeigler R, Sullivan L, Tomlinson SE, Wretman CJ, Zimmerman S. Mouth Care in Assisted Living: Potential Areas for Improvement. J Am Med Dir Assoc 2020; 22:1190-1193.e2. [PMID: 33385333 DOI: 10.1016/j.jamda.2020.11.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Poor oral care may lead to systemic disease, and there is evidence that assisted living (AL) residents lack quality oral care; in AL, poor care may be due to staff knowledge and attitudes, as well as organizational barriers to providing care. OBJECTIVES Determine AL staff knowledge and attitudes regarding mouth care and barriers to changing care. DESIGN Self-administered repeated-measures questionnaires completed before and after oral care training. SETTING AND PARTICIPANTS A total of 2012 direct care staff and administrators from 180 AL communities. METHODS Nine knowledge questions and 8 attitude and practice intention questions, and open-ended questions regarding training and obstacles to providing oral care. RESULTS Overall, 2012 participants completed pretraining questionnaires, and 1977 completed posttraining questionnaires. Baseline knowledge was high, but staff were not uniformly aware of the systemic-oral link whereby mouth care affects pneumonia and diabetes. Almost all staff reported learning a new technique (96%), including for residents who resist care (95%). Suggested areas to improve mouth care included having more hands-on experience. The primary perceived obstacles to care centered around residents who resist care and a lack of time. CONCLUSIONS AND IMPLICATIONS Based on reports of having benefitted from training, AL staff overwhelmingly noted that new knowledge was helpful, suggesting the benefit of skills-based training, especially in dementia care. Mouth care in AL has been sorely understudied, and merits additional attention.
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Affiliation(s)
- Christine E Kistler
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Jessica Scott
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Kimberly Ward
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Robin Zeigler
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Louise Sullivan
- College of Nursing, Salve Regina University, Newport, RI, USA
| | - Sarah E Tomlinson
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Christopher J Wretman
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sheryl Zimmerman
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Fidelity and sustainability of Mouth Care Without a Battle and lessons for other innovations in care. Geriatr Nurs 2020; 41:878-884. [PMID: 32593489 DOI: 10.1016/j.gerinurse.2020.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/17/2020] [Accepted: 06/08/2020] [Indexed: 01/25/2023]
Abstract
There are countless efficacious interventions that improve outcomes when conducted in controlled situations. Many fewer are effective when implemented in real-world situations, largely because they are not implemented with fidelity. Still fewer are sustained over time, for reasons including lack of institutional support and fit with existing values, among others. It is especially important to examine fidelity and sustainability when efficacious interventions are being implemented, because these interventions are the ones that hold the most promise. This project examined the fidelity and sustainability of Mouth Care Without a Battle (MCWB), an evidence-based program conducted in a two-year cluster randomized trial in 14 nursing homes. Results that triangulated two sources of data indicated that fidelity decreased after the first year; they provide guidance to promote fidelity and sustainability of this and other new care practices in nursing homes, including ongoing education, coaching, evaluation, feedback, and sufficient resources.
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Zimmerman S, Sloane PD, Ward K, Wretman CJ, Stearns SC, Poole P, Preisser JS. Effectiveness of a Mouth Care Program Provided by Nursing Home Staff vs Standard Care on Reducing Pneumonia Incidence: A Cluster Randomized Trial. JAMA Netw Open 2020; 3:e204321. [PMID: 32558913 PMCID: PMC7305523 DOI: 10.1001/jamanetworkopen.2020.4321] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/01/2020] [Indexed: 12/30/2022] Open
Abstract
Importance Pneumonia affects more than 250 000 nursing home (NH) residents annually. A strategy to reduce pneumonia is to provide daily mouth care, especially to residents with dementia. Objective To evaluate the effectiveness of Mouth Care Without a Battle, a program that increases staff knowledge and attitudes regarding oral hygiene, changes mouth care, and improves oral hygiene, in reducing the incidence of pneumonia among NH residents. Design, Setting, and Participants This pragmatic cluster randomized trial observing 2152 NH residents for up to 2 years was conducted from September 2014 to May 2017. Data collectors were masked to study group. The study included 14 NHs from regions of North Carolina that evidenced proportionately high rehospitalization rates for pneumonia and long-term care residents. Nursing homes were pair matched and randomly assigned to intervention or control groups. Intervention Mouth Care Without a Battle is a standardized program that teaches that mouth care is health care, provides instruction on individualized techniques and products for mouth care, and trains caregivers to provide care to residents who are resistant and in special situations. The control condition was standard mouth care. Main Outcomes and Measures Pneumonia incidence (primary) and hospitalization and mortality (secondary), obtained from medical records. Results Overall, the study enrolled 2152 residents (mean [SD] age, 79.4 [12.4] years; 1281 [66.2%] women; 1180 [62.2%] white residents). Participants included 1219 residents (56.6%) in 7 intervention NHs and 933 residents (43.4%) in 7 control NHs. During the 2-year study period, the incidence rate of pneumonia per 1000 resident-days was 0.67 and 0.72 in the intervention and control NHs, respectively. Neither the primary (unadjusted) nor secondary (covariate-adjusted) analyses found a significant reduction in pneumonia due to Mouth Care Without a Battle during 2 years (unadjusted incidence rate ratio, 0.90; upper bound of 1-sided 95% CI, 1.24; P = .27; adjusted incidence rate ratio, 0.92; upper bound of 1-sided 95% CI, 1.27; P = .30). In the second year, the rate of pneumonia was nonsignificantly higher in intervention NHs. Adjusted post hoc analyses limited to the first year found a significant reduction in pneumonia incidence in intervention NHs (IRR, 0.69; upper bound of 1-sided 95% CI, 0.94; P = .03). Conclusions and Relevance This matched-pairs cluster randomized trial of a mouth care program compared with standard care was not effective in reducing pneumonia incidence at 2 years, although reduction was found during the first year. The lack of significant results in the second year may be associated with sustainability. Improving mouth care in US NHs may require the presence and support of dedicated oral care aides. Trial Registration ClinicalTrials.gov Identifier: NCT03817450.
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Affiliation(s)
- Sheryl Zimmerman
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
- School of Social Work, University of North Carolina at Chapel Hill
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Philip D. Sloane
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill
| | - Kimberly Ward
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Christopher J. Wretman
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
- School of Social Work, University of North Carolina at Chapel Hill
| | - Sally C. Stearns
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Patricia Poole
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - John S. Preisser
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill
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