Conceptions of oral health among nurse managers. A qualitative analysis

Periodontal status of students living with disability in Amhara region, Ethiopia: a cross-sectional study

Background

Periodontal disease is the most common oral health problem among individuals living with disabilities. Any physical impairment and/or mental handicap can compromise the capability to perform oral health care. Individuals with poor oral hygiene practice were prone to dental caries, periodontal disease, and upper respiratory tract infections. Despite the high prevalence of disabled people in Ethiopia, data are scarce about their periodontal status. The aim of this study was to determine the prevalence and determinant factors of periodontal disease among students living with disability in the Amhara region.

Methods

A school-based cross-sectional study was done on eight special needs schools in Amhara regional state from November 30, 2020, to April 10, 2021. A simple random sampling technique using a computer random generator was employed to recruit the study participants. The participants were interviewed for sociodemographic characteristics, oral hygiene practice, type of disability, and medical condition through a pre-tested semi-structured questionnaire. The periodontal status of the participants was evaluated using the community periodontal index (CPI). Data entry was done using the Epi-data and analyzed using SPSS 26. Binary logistic regression analysis was used to identify the predictors of periodontal disease at a 5% level of significance.

Results

A total of 443 study participants were involved with a mean age of 15.84 ± 3.882. Among these, 27.5% (95%CI 23.4–32.0) had a periodontal pocket depth of ≥ 4 mm, and 56.7% had bleeding on probing. The prevalence of periodontal disease was higher in participants with poor oral health status (52.2%), dental caries (34.8%), class-2 malocclusion (46.1%), and low monthly income (30.4%), visually impaired (30%), and mentally disorder (29.9%). Age of above 18 years (AOR = 3.41, 95%CI 1.40, 8.28), low family monthly income (AOR = 2.21; 95%CI 1.22, 4.03), malocclusion (AOR = 1.59, 95%CI 1.01, 2.54), poor oral health status (AOR = 9.41; 95%CI 4.92, 17.98), and dental caries (AOR = 1.85, 95%CI 1.21, 2.82) were independent predictors of periodontal disease.

Conclusions

A substantial amount of disabled school students in the study area had periodontal disease. The study found that there was a statistically significant association between age, family monthly income, malocclusion, oral health status, and dental caries with periodontal disease. The implementation of school oral health programs has a great benefit for the oral health status of disabled school students.

Oral health care beliefs among care personnel working with older people - follow up of oral care education provided by dental hygienists

Objectives

The proportion of older people in the population is increasing rapidly. Along with this comes an increase in the number of people requiring assistance in daily living, including oral care. Swedish law stipulates that care personnel who work with older people should be offered oral health education every year. The aim of this study was to investigate oral health care beliefs among such personnel.

Methods

A questionnaire study was conducted among 2167 personnel providing care to older people at special accommodation sites and in home care. Data were collected using the Nursing Dental Coping Beliefs Scale. Descriptive statistics were calculated and logistic regression analysis was performed.

Results

Personnel working in home care had lower odds of having an internal locus of control than those working in special accommodation, and personnel with less than 10 years of working experience had lower odds than their more experienced counterparts. Men had higher odds of having an external locus of control than women.

Conclusions

It seems important to ensure that home care personnel and less experienced personnel attend oral care educational sessions, and to encourage male staff to focus on oral care work.

Why oral palliative care takes a backseat? A national focus group study on experiences of palliative doctors, nurses and dentists

Aim

Poor oral care among frail older people at the end of life endangers quality of life. However, only few dying people have access to oral palliative care services. Therefore, this study aimed to investigate oral palliative care practices and referral patterns for palliative patients in the Brunei healthcare settings.

Design

An exploratory qualitative study.

Methods

Five focus groups were conducted among palliative care nurses (N = 7), palliative medicine doctors (N = 4), dentists (N = 6), oncologists (N = 4) and oncology nurses (N = 4). Verbatim was analysed using qualitative thematic analysis.

Results

Analyses revealed four distinct themes emerging as current oral palliative care assessment and referral practice in the Brunei healthcare settings: "taking a back seat," "opportunistic oral care," "they refused and refused" and "challenging healthcare resources and oral palliative care."

Long-term effect of an oral healthcare programme on oral hygiene in a nursing home

This article reports on the long-term effect of an oral healthcare programme aimed at improving and maintaining the oral hygiene of elderly residents in a nursing home. The method was based on (i) motivation and oral-care training of the nursing staff, (ii) production of picture-based oral-care procedure cards, (iii) distribution of adequate oral-care equipment, (iv) practical implementation of new routines, and (v) assessment of results attained. The level of oral hygiene in the nursing home was assessed using the mucosal-plaque score (MPS) index. Overall evaluation was made before the start of the study, after 3 months, and eventually after 6 yr. Before implementation of the oral healthcare programme, 36% of the residents had an acceptable score. Six years later, the proportion was 70%. The evaluation showed that the introduction of such an oral healthcare programme significantly improved the oral hygiene of the residents on a long-term basis. However, 30% of the residents did not achieve an acceptable score because they were very ill or dying, aggressive or wanted to brush their teeth themselves.

Recognition and behaviour of caregiver managers related to oral care in the community

OBJECTIVES

The purposes of this study were to investigate the knowledge, practice and educational background of caregiver managers regarding oral health, how they cope with visiting activities, and to explore related factors to develop an appropriate working strategy for them in the community.

METHODS

The subjects were 102 caregiver managers, who voluntarily participated in a seminar organised by the M city government. The collected data were analysed to assess the relationship between the related factors of oral health, career and age, and the correlation amongst items of action process concerning oral health using Spearman's correlation coefficient and Fisher' s exact test with spss 14.0 for Windows.

RESULTS

The results were as follows; (i) the mean length of careers of home-care staff and caregiver managers was 3.6 +/- 3.2 and 1.6 +/- 1.6 years respectively, (ii) 90.2% recognised the importance of oral care and 92.2% were interested in oral care, although 32.4% hesitated to provide oral care, (iii) the career of caregiver managers was not significantly related to recognition of concrete objectives of oral care, soft debris and symptoms of periodontal disease, but they recognised the effectiveness of oral care in prevention of aspiration pneumonia, (iv) there was a total of 11 significantly correlated items of knowledge, recognition and practice of oral care and (v) there was a total of 10 significantly correlated items amongst factors of action process.

CONCLUSION

Results suggested that knowledge of oral care was related not only to the career but also to age and revealed a basic gap in the range of abilities between the respondent caregiver managers. Some did perform appropriate oral care and carried out the necessary processes.

Improving the oral health of older people in long-term residential care: a review of the literature

Background.  Unrefutable evidence now links poor oral health with the development of preventable systemic illnesses and debilitating conditions that threaten quality of life and life itself. This is especially significant for an increasing older population who are dependent on others for care. Aims and objectives.  The majority of studies analysing the oral health of older dependent people in long-term residential care have been undertaken by dental professionals. This critical literature review examines the issue from a nursing perspective because nursing care providers have a fundamental role in daily oral health provision for dependent residents. Conclusions.  Multiple barriers were found to negatively impact on daily oral healthcare provision, including lack of care provider education, oral health values, availability of resources, implementation of supportive policies, documentation and oral health assessment tools. Relevance to clinical practice.  The nursing profession, at all levels, must become pro-active in removing financial, political and workforce barriers that impact negatively on oral health outcomes. A multi-faceted approach is required to address these barriers, including development and implementation of oral health education programmes, assessment screening tools, care plans, documentation, supply of oral hygiene aids and the appointment of oral care 'champions'.

Care home staff knowledge of oral care compared to best practice: a West of Scotland pilot study

AIM

To evaluate care home (N) staff knowledge of oral care provision for dependent older people in comparison to guidelines from NHS Quality Improvement Scotland (NHSQIS). This pilot study also aimed to identify barriers to delivering oral care and determine if oral health educator (OHE) training had an effect upon staff knowledge of oral care delivery.

SETTING

This cross-sectional analytic investigation was undertaken within the Greater Glasgow & Clyde area between 2005 and 2007.

METHODS

From 33 care homes (N), 28 participated in data gathering through an interview schedule involving 109 staff. A 'knowledge check-list' founded upon daily oral care guidelines from the NHSQIS best practice statement (BPS) served as a template for knowledge assessment. An OHE undertook small group discussions related to the BPS in a sub-group of original participants and a second round of data was collected.

RESULTS

The majority of surveyed staff (n = 86, 79%) agreed that residents required assistance with oral care and placed oral care (n = 85, 78%) in a moderate to high priority. However, only 57% of managers and 49% of nurses had received training in oral care provision. Most staff (79% of managers, 85% of nurses) were unaware of the NHSQIS BPS. Deficiencies in knowledge were identified in several areas of the BPS. In particular, knowledge in the care of the natural dentition was inadequate. Between pre- and post-OHE training, the research suggests the following areas are liable to change: prioritisation given to oral care (p = 0.01), perceived competence (p <0.0001) and confidence in providing oral care advice (p <0.0001). Following OHE intervention, staff knowledge in oral care procedures compliant with best practice guidelines increased by 45%.

CONCLUSIONS

Knowledge of oral health provision by those responsible for the care of home residents was deficient. An OHE training programme structured around the NHSQIS BPS demonstrated a measurable increase in levels of staff knowledge of oral care procedures.

Comparison of oral health assessments between nursing staff and patients on medical wards

The maintenance of good oral health is essential for nutrition, recovery and well-being. This requires the involvement of the nursing staff, especially in cases where oral care and any necessary dental treatment are vital to ensure medical treatment. The aim of this study was to evaluate the validity of oral assessments performed by nursing staff using the revised oral assessment guide (ROAG), using comparisons with patients' self-assessment of oral problems. When a comparison was made of how the staff and patients assessed their oral status, a high level of agreement was found. In these assessments, with the exception of oral mucosa and teeth, the percentage agreement was >80. The kappa coefficient revealed slight to moderate agreement. When there was a disagreement, the staff assessed the oral health as being significantly poorer than the patients did. In the present study, it was shown that few oral assessments performed by the nursing staff and patient disagreed. The ROAG may therefore be useful for the nursing staff to make the patients' oral health problems visible.

Nursing staff's understanding of oral health care for patients with cancer diagnoses: an intervention study

AIMS AND OBJECTIVES

The aim of this study was to evaluate long-lasting changes in the nursing staff's understanding of oral health care for cancer patients after an oral health care intervention. The study also assessed whether there were changes between registered nurses and auxiliary nurses.

BACKGROUND

The maintenance of good oral health care in cancer patients is essential for nutrition, recovery and wellbeing and requires the involvement of nursing staff. However, several studies reveal that the need to prioritize oral health care has not been made sufficiently clear.

METHODS

The nursing staff (registered nurses, n = 133 and auxiliary nurses, n = 109) on five wards at different hospitals providing cancer care took part in a four-hour oral healthcare training session, including the use of an oral assessment guide and answered a questionnaire initially and after this intervention. The data were statistically analyzed.

RESULTS

Several aspects of implementation opportunities improved, but they did not include attitudes to oral health care. Knowledge of oral diseases decreased, more for auxiliary nurses than for registered nurses.

CONCLUSIONS

A four-hour oral health training session and subsequent activities improve the nursing staff's understanding of oral health care for patients with cancer diagnoses in some respects but not in terms of attitudes to oral health care or specific oral knowledge.

RELEVANCE TO CLINICAL PRACTICE

Oral healthcare education and training activities for nursing staff can produce some improvements in the understanding of oral health care for cancer patients but not in attitudes and specific oral knowledge. These areas must be covered during the basic education period or/and by a routine oral healthcare programme for nursing staff, probably including an oral healthcare standard.

Oral care in cancer nursing: nurses' knowledge and education

AIM

This paper reports a study of nurses' knowledge and education in relation to oral care and oral health assessment for patients undergoing cancer treatment.

BACKGROUND

Studies suggest that ritualistic practice of oral care occurs and that nurses dislike providing this type of care. Inadequate knowledge and education of oral care among nurses have also been revealed, as well as a lack of involvement of dentists in this aspect of nurse education.

METHOD

In 2003, an oral care questionnaire was administered to a non-random sample of 100 general and cancer nurses employed in an oncology centre, with a response rate of 72%. Information was collected on knowledge and education in relation to oral care, management of oral care, and influences on nurses' knowledge of oral care and performance of oral care. The questionnaire was tested for content validity by a panel of experts and modified accordingly. Reliability of the questionnaire subscales varied from a Cronbach's alpha of 0.56-0.82. Internal consistency for the total knowledge of oral care scale obtained an alpha of 0.93.

FINDINGS

Data indicated that respondents had not had substantial oral care education during preregistration education, and their knowledge of oral health status, signs and symptoms of abnormalities was inadequate. Nurses placed a high degree of priority on oral care for patients with cancer. Respondents had also received insufficient support from hospital dentists for patients undergoing cancer treatment.

CONCLUSION

Nurses require more education if they are to manage the oral care of patients with cancer effectively, and further research is needed into the actual practice of oral care for patients with cancer.

Factors affecting quality of oral care in intensive care units

AIMS

This paper presents a study to assess to nurses' attitudes and practices concerning oral care and to determine predictors of the quality of oral care in intensive care units.

BACKGROUND

The oropharynx of critically ill patients becomes colonized with potential respiratory pathogens; oral care has been shown to reduce oropharyngeal bacteria and ventilator-associated pneumonia.

METHODS

In April 2002, a random and national sample of 420 intensive care unit directors was asked to participate in the survey. Of invited directors, 126 (30%) agreed to participate and were sent questionnaires to be completed anonymously by their staff, and 102 institutions returned 556 surveys. This gave a response rate of 83% of those who consented to participate.

RESULTS

The path model shows that nurses' oral care education, having sufficient time to provide care, prioritizing oral care, and not viewing oral care as unpleasant had direct effects on the quality of provided care. Intensive care unit experience, oral care education, and having sufficient time had indirect effects.

CONCLUSION

Improving the quality of oral care in intensive care units is a multi-layered task. Reinforcing proper oral care in education programmes, de-sensitizing nurses to the often-perceived unpleasantness of cleaning oral cavities, and working with hospital managers to allow sufficient time to attend to oral care are recommended.

Oral hygiene care for adults with dementia in residential aged care facilities

OBJECTIVE

The objective of this systematic review was to report on the best available evidence relating to oral hygiene for adults with dementia in residential aged care facilities, including: INCLUSION CRITERIA: This review considered any randomised or non-randomised controlled studies, cohort studies, case-control studies, multiple time series studies, uncontrolled studies, descriptive studies and opinions of respected authorities (including theses and other publications) related to residents with dementia living in residential aged care facilities in Australia and overseas; community-dwelling adults with dementia; and special needs adult populations (for preventive oral hygiene care strategies and interventions).The review considered studies and publications designed to:1 quantify the oral health status of older adults living in residential aged care facilities;2 quantify the oral health status of adults with dementia living in the community and in residential aged care facilities;3 evaluate tools used to assess the oral health of residents by staff and carers working in residential aged care facilities;4 evaluate preventive oral hygiene care strategies and interventions used in special needs adult populations (including adults with dementia); and5 evaluate oral health care training and oral hygiene care provision, staff and carers working in residential aged care facilities.Dental outcome measures of interest were those relating to the prevalence, incidence, experiences and increments of oral diseases and conditions including: denture problems, coronal and root caries, periodontal diseases (plaque accumulation, gingivitis, loss-of-attachment), oral mucosal conditions, xerostomia and salivary gland hypofunction, tooth loss, difficulty chewing, behavioural problems and pain/discomfort. Related characteristics and outcomes of interest included: medical conditions, medications, cognitive status, functional status, nutritional status and sociodemographics.

SEARCH STRATEGY

The aim of the search was to locate relevant English-language studies and publications appearing between 1980 and 2002. The search utilised a two-step approach, involving an initial search of electronic databases using combinations of key words followed by a second extensive search carried out using the identified key words. This was supplemented with a secondary search of the references cited in the identified studies. Electronic database searched were: Cinahl, Embase, Psycinfo, Medline and Current Contents.

METHODOLOGICAL QUALITY

All selected studies were critically appraised by two reviewers prior to inclusion in the review.

RESULTS

In regards to relevance, incidence, experiences, and increments of oral diseases and conditions, possible risk factors identified included: saliva dysfunction, polypharmacy, comorbid medical conditions, swallowing and dietary problems, increased functional dependence, need for assistance with oral hygiene care, and poor access and utilisation of dental care.Evidence on the use of assessment tools by carers to evaluate residents' oral health showed that successful assessment of residents with and without dementia by nursing staff requires appropriate staff training by a dental professional. Coupled with appropriate training, an oral assessment screening tool designed for residents with dementia has been successfully used by nursing and care staff to identify residents requiring further review by dental professionals. Expert opinion in the field indicates that oral assessment screenings by a staff member and then by a dentist would ideally be undertaken upon admission to a facility, and regularly thereafter by staff and/or dentists as required.Clinicians and researchers suggested that oral hygiene care strategies to prevent oral diseases and conditions were found to be effective in preventing oral diseases, and thus are relevant for use in the resident with dementia.In regards to the provision of dental treatment and ongoing management of oral diseases and conditions, the use of adjunctive and preventive aids were found to be effective when introduced in conjunction with a staff training program:Expert opinion suggests that behaviour management techniques will increase the potential of performing oral hygiene care interventions.

CONCLUSIONS

This review suggests that the training of staff in the form of a comprehensive practically oriented program addressing areas such as oral diseases, oral screening assessment, and hands-on demonstration of oral hygiene techniques and products is likely to have a positive impact on the management of oral hygiene care within residential aged care facilities. The review also identified that regular brushing with fluoride toothpaste, use of therapeutic fluoride products and application of therapeutic chlorhexidine gluconate products are validated by research as effective for the general population and some populations with special needs.

Inter-rater reliability of an oral assessment guide for elderly patients residing in a rehabilitation ward

The aim of this study was to test the inter-rater reliability of a revised oral assessment guide (ROAG) for patients residing in a geriatric rehabilitation ward. A consecutive sample of 140 patients was recruited for the study. Oral assessments were performed for 133 newly admitted patients by one registered nurse (RN) during a period of six months. A dental hygienist (DH) carried out 103 oral assessments during the same half-year. For 66 patients, the RN and the DH performed independent assessments. There was an agreement between the RN and the DH in the majority of the independent assessments, except for tongue and teeth/dentures. The percentage agreement exceeded 80 percent. Inter-rater agreement measured by Cohen's Kappa coefficient ranged from moderate to very good and percentage agreement had a range of 58 to 91 percent. The agreement was highest in assessment of voice and swallowing (91%). Assessments of teeth and dentures seemed to be most difficult for the RN to evaluate. ROAG was found to be a clinically useful assessment tool. Additional education and training is needed to improve the reliability of the oral assessments and should include continuous support from a dental hygienist as well as a pictorial manual on how to use the ROAG.

Malnutrition in patients suffering from chronic heart failure; the nurse's care

Chronic heart failure is associated with a bad prognosis with considerably shortened survival and repeated hospitalisations. Patients suffering from heart failure also have symptoms that can affect their food intake, for example, tiredness when strained, breathing difficulties and gastrointestinal symptoms like nausea, loss of appetite and ascites. Pharmacological therapy can lead to a loss of appetite, which will make the intake of food inadequate to fill the required energy and nutritional needs. The nurse's interest in and knowledge of diet issues can improve these patients' nutritional status. The aim of this literature review was to describe the nurse's interventions regarding malnutrition in patients suffering from chronic heart failure. The literature search gave 13 articles, which were analysed, and sentences whose content was related to the aim were identified. Three areas of content appeared; drug treatment and consequences, gastrointestinal effects, and information and education. The results show that the nutritional status of these patients can be significantly improved by means of simple nursing interventions. Future research should focus on controlled experimental studies to evaluate differences in body weight, body mass index and quality of life between patients suffering from chronic heart failure, who are taking part in a fully enriched nutrition intervention, and patients suffering from chronic heart failure, who are eating their normal diet.

Oral health care needs of dependent older people: responsibilities of nurses and care staff

The population of older people as well as the number of dependent older people is steadily increasing. Those unable to live independently at home are being cared for in a range of settings and varying degrees of dependency means that many are unable to attend fully to their needs, one aspect of which is oral care. The fact that the oral and dental health of the UK population is generally improving, makes more emphatic the responsibilities of nurses and care staff in this area. This review of the literature reveals that oral health of older people in continuing care settings is generally inadequate and that nurses' and care staff's knowledge and practice of oral care for older people is variable. Inadequate oral care is identified as multifactorial, with implications for educators, policy makers, practitioners and researchers. The need to address oral care for nurses pre- and post-registration as well as adequate preparation for support workers is highlighted. Development of a robust oral assessment tool, as well as empirical investigation of the effectiveness of oral cleaning agents, equipment and techniques to inform standard setting is indicated, with monitoring of standards being imperative.