Dental hygiene registration: development, and reliability and validity testing of an assessment scale designed for nurses in institutions

[Integrating risks for oral diseases into Structured Information Collection: A practice development project]

Integrating risks for oral diseases into Structured Information Collection: A practice development project Abstract: Background: Deficient oral hygiene and oral diseases are highly prevalent among nursing staff. Up to now, there is no assessment for nursing professionals integrated in the daily nursing routine, which depicts the complex risks for oral diseases. The Structured Information Collection (SIS) is a concept to guide the nursing process and enables individual action planning. Aim: The aim was to integrate oral diseases as a nursing-relevant risk into the SIS and to develop an assessment instrument for oral hygiene deficits/diseases integrated into the SIS topic areas. Methods: Based on a literature search, 21 systematic reviews describing SIS topic areas and oral health risks were analysed by a panel of experts. The caregiver-relevant oral health risks identified in this way were compared with existing oral health assessment instruments and with screening criteria recommended in the German national expert standard for the promotion of oral health in care. Since none of the oral health assessments covers all nursing-relevant oral health risks and the recommended screening criteria of the expert standard, the area of "oral diseases" was integrated into the SIS as an additional category, and an oral health assessment adapted to the SIS was developed. Results: This article presents the SIS expanded to include nursing-relevant oral disease risk and the newly developed Oral Risk Assessment Prevention (Mu-RAP) for use by nurses. Conclusions: The SIS expanded to include oral disease and the Mu-RAP for identifying oral hygiene deficits/diseases cover all nursing-relevant oral health risks. Further studies on the applicability, reliability, and validity of the instrument, as well as on care-effective and patient-relevant effects of its use are needed.

Aspiration pneumonia in nursing literature-a mapping review

Introduction

Aspiration pneumonia (AP) is an infection of the lungs caused by inhalation of material. The reported incidences vary across literature and clinical populations and is associated with high morbidity and mortality. Management of AP is best carried out by a multidisciplinary team.

Methods

This aim of this review was to collate and describe the available evidence on AP to develop a greater understanding of the concept of AP as it is represented in the nursing literature. As a collaborative team, we undertook the six stages of a systematic mapping review. We searched for the term aspiration pneumonia in 200 peer reviewed nursing journals across 10 databases, over a ten-year period (2013-2023).

Results

In this review, 293 papers were coded. Dysphagia, oral health and tube feeding emerged as the most frequent risk factors for AP, and the most reported factors for preventing this condition. Mortality was the most commonly described consequence of AP, followed by hospitalisations and morbidity. Multiple management approaches were reported including dysphagia assessment, risk evaluation, oral care and texture modification of food and fluids. The role of nurses and interprofessional collaborations were described.

Discussion

Despite limited evidence related to the topic of AP in the nursing literature, the complexity of the causes, prevention, management and consequences of AP emerged. Certain factors, such as dysphagia, oral health, and tube feeding, were described under prevention, cause and management of AP. The importance of multidisciplinary approach in the management and prevention of AP was presented.

The association between oral health status and physical function in elderly patients with acute heart failure

OBJECTIVES

Oral health problems are common and are associated with various geriatric conditions in older adults. The importance of oral health has not been fully highlighted in the assessment and management of patients with heart failure. Here, we investigated the association between oral health status and the decline in physical function during hospitalization in elderly patients with acute heart failure.

MATERIALS AND METHODS

We evaluated oral health using the revised oral assessment guide in 77 patients aged 65 years or older who were admitted to hospital for acute heart failure. Oral health problems were defined as a revised oral assessment guide score ≥9.

RESULTS

Oral health problems were identified in 66.2% of the patients. Patients with oral health problems had high prevalence of decreased physical function, undernutrition, and cognitive impairment. A reduction in the Barthel Index, as an indicator of activities of daily living during hospitalization, was significant in the enrolled patients. The Barthel Index decreased more in patients with oral health problems than those with normal oral health. Furthermore, the revised oral assessment guide score on admission was found to be the only independent predictor of changes in the Barthel Index during hospitalization in the multivariate analyses.

CONCLUSIONS

Oral assessment using the revised oral assessment guide during hospitalization could provide useful information for the management of elderly heart failure patients.

Oral Health Assessment Tools for Elderly Adults: A Scoping Review

Purpose

The aim of this study was to synthesize the Oral Health Assessment Tool for elderly adults and determine its psychosocial properties.

Methods

We conducted a scoping review. The Arkey and O'Malley methodology was employed to conduct scoping reviews involving the exploration of both national and international databases, as well as a manual search of the reference lists of the selected studies. We focused on oral health assessment tools for elderly adults (>60 years). The review report adhered to the standards outlined in the PRISMA-ScR guidelines. The study protocol was officially filed with the Open Science Framework.

Results

A total of 19 documents were included. The literature search included a time frame ranging from 1995 to 2023 and covered a diverse range of 13 countries. Of the 19 assessment tools examined, it was found that only the Oral Assessment Sheet had multidimensional characteristics, while the remaining tools were unidimensional in nature. The evaluation of oral health assessment tools was conducted across several contexts, including nursing homes, geriatric facilities, communities, and hospitals. A total of eleven studies underwent reliability testing, whereas two studies were alone validated for validity and did not undergo reliability testing. Additionally, seven studies were exclusively validated for reliability and did not undergo validity testing.

Conclusion

Multidimensional oral health assessment tools for elderly adults that integrate social and psychological aspects need to be developed and validated. It is necessary to develop oral health assessment tools based on hospitalized elderly patients to meet the oral and dental health needs of elderly patients.

A systematic review of measurement instruments for oral health assessment of older adults in long-term care facilities by nondental professionals

BACKGROUND

Regular oral health assessment of older adults living in Long-term Care Facilities (LTCF) can improve their oral health.

AIMS

This study aimed to systematically review studies describing the development of instruments employed by nondental professionals to assess the oral health of older adults in LTCF and to evaluate their measurement properties.

MATERIAL & METHODS

Electronic searches were conducted in the MEDLINE (PubMed), Embase, Web of Science, Scopus, and LILACS databases. Measurement properties of the identified instruments were evaluated using the Consensus-based Standards to select health Measurement Instruments (COSMIN) checklist. Studies assessing at least one measurement property (validity, reliability, or responsiveness) of instruments used to assess oral health of older adults living in LTCF by nondental professionals were considered. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) checklist was used to evaluate the quality of evidence.

RESULTS

Fifteen studies reporting measurement properties of seven instruments were selected. The ohr-interRAI and the OHAT were considered to have sufficient content validity, with high and moderate evidence quality, respectively. OHAT, BOHSE, and DHI showed acceptable results on reliability but with very low quality of evidence. DHI and OHSTNP also showed acceptable results for criterion validity, but, with low quality of evidence, insufficient or unclear results were observed for the remaining measurement properties. Studies evaluating the validity criteria of BOHSE and hypotheses testing of ohr-MDS were considered to have high evidence quality.

DISCUSSION AND CONCLUSION

The ohr-interRAI can be provisionally recommended for use until further evidence is provided. Further methodologically rigorous studies are needed to assess the measurement properties of the existing instruments.

[Promotion of oral health in nursing-An interprofessional expert standard]

BACKGROUND

People in need of care or with severe disability have a worse oral health status compared to people without these needs. The increasing number of older people who are able to keep their own teeth requires specific steps to support oral health. Whereas in 1997 1 in 4 people between 65 and 74 years of age was toothless, in 2016 this figure had risen to 1 in 8. Special challenges in oral care arise for older people and people with dementia. The management requires an interprofessional approach.

OBJECTIVE

Interprofessional development of an expert standard for the promotion of oral health by nurses and a focus on older people.

METHODS

The expert standard is based on a systematic literature analysis. Based on this, members of an interprofessional expert working group consisting of nurses, dentists and a representative of those affected formulated recommendations to promote oral health of people in need of care.

RESULTS

The interprofessional approach defines the selection of the guiding questions for the literature search, the evaluation of the literature and the formulation of the recommendations. Interventions to maintain and promote oral health were identified for the guiding questions of the expert standard, for example, in cases of oral fungal diseases, mucositis, gingivitis or accompanying symptoms, such as dry mouth and pain.

DISCUSSION

Interventions to promote oral health of people in need of care or with severe disability could be focused more deeply within the nursing profession and formulated by an interprofessional group to guide their actions.

Oral health assessment of older adults living in long-term care facilities by non-dental professionals: a systematic review protocol of instruments

INTRODUCTION

Regular oral health assessment among older adults living in long-term care facilities (LTCF) can improve their oral health. Different instruments have been developed and used to evaluate the oral health of institutionalised older people by non-dental professionals. These instruments must demonstrate adequate measurement properties. This systematic review aims to examine the studies describing the instruments employed to assess the oral health of older adults living in LTCF by non-dental professionals. The study will also evaluate the measurement properties of such instruments using the checklist proposed by the Consensus-based Standards to select health Measurement Instruments (COSMIN).

METHODS AND ANALYSIS

Studies describing the development of instruments for assessing oral health of institutionalised older adults by non-dental professionals will be included. Studies assessing at least one measurement property (validity, reliability or responsiveness) will be also considered. Electronic searches will be conducted on MEDLINE (PubMed, Ovid), Embase, Web of Science, Scopus and LILACS databases. Two independent reviewers will select the studies and will extract data concerning the characteristics of the research and the instrument. The measurement properties will be evaluated using the COSMIN checklist. The Grading of Recommendations, Assessment, Development and Evaluation approach will be used to grade the quality (or certainty) of evidence and strength of recommendations.

ETHICS AND DISSEMINATION

No ethical approval is required. The results will be submitted for publication to a peer-review journal and presented at relevant conferences.

PROSPERO REGISTRATION NUMBER

CRD42020191479.

The development and psychometric properties of oral health assessment instruments used by non-dental professionals for nursing home residents: a systematic review

BACKGROUND

Globally, oral health status of the geriatric population residing in nursing homes is poor. The integration of non-dental professionals is vital to monitor oral health, early identification and triaging of oral health problems, and timely referral to dental professionals. The aims of this systematic review were to provide a summary on the development and characteristics of oral health assessment instruments currently used by non-dental professionals for nursing home residents, and to perform a critical appraisal of their psychometric properties.

METHODS

This review was conducted as per the PRISMA guidelines. CINHAL (EBSCO), Medline (Ovid), and EMBASE (Ovid) were searched systematically. Two reviewers independently screened the title, abstract, and full text of the studies as per the eligibility criteria. Studies describing oral health assessment instruments used to assess oral health of nursing home residents by non-dental professionals were included. Using a methodological framework, each instrument was evaluated for purpose, content, and psychometric properties related to validity, reliability, feasibility, generalisability, and responsiveness. Additionally, the reporting quality assessment of each included study was performed according to the SURGE guidelines.

RESULTS

Out of the 819 screened articles, 10 studies were included in this review. The 10 identified instruments integrated 2 to 12 categories to assess oral health, which was scored on a 2 to 5-point scale. However, the measurement content varied widely, and none were able to comprehensively measure all aspects of oral health. Three measurement approaches were identified: performance- based assessment, direct inspection of the oral health status, and interview measures. Only eight instruments provided quality assessment on the basis of validity, reliability, feasibility and generalisability, whereas three instruments- Brief Oral Health Status Examination, Dental Hygiene Registration, and Oral Health Assessment Tool reported good methodological quality on at least one assessment criteria.

CONCLUSIONS

None of the instruments identified in this review provided a comprehensive assessment of oral health, while three instruments appeared to be valid and reliable. Nonetheless, continuous development of instruments is essential to embrace the complete spectrum of oral health and address the psychometric gaps.

Measurement properties of oral health assessments for non-dental healthcare professionals in older people: a systematic review

Background

Regular inspection of the oral cavity is required for prevention, early diagnosis and risk reduction of oral- and general health-related problems. Assessments to inspect the oral cavity have been designed for non-dental healthcare professionals, like nurses. The purpose of this systematic review was to evaluate the content and the measurement properties of oral health assessments for use by non-dental healthcare professionals in assessing older peoples’ oral health, in order to provide recommendations for practice, policy, and research.

Methods

A systematic search in PubMed, EMBASE.com, and Cinahl (via Ebsco) has been performed. Search terms referring to ‘oral health assessments^’, ‘non-dental healthcare professionals’ and ‘older people (60+)’ were used. Two reviewers individually performed title/abstract, and full-text screening for eligibility. The included studies have investigated at least one measurement property (validity/reliability) and were evaluated on their methodological quality using “The Consensus-based Standards for the selection of health Measurement Instruments” (COSMIN) checklist. The measurement properties were then scored using quality criteria (positive/negative/indeterminate).

Results

Out of 879 hits, 18 studies were included in this review. Five studies showed good methodological quality on at least one measurement property and 14 studies showed poor methodological quality on some of their measurement properties. None of the studies assessed all measurement properties of the COSMIN. In total eight oral health assessments were found: the Revised Oral Assessment Guide (ROAG); the Minimum Data Set (MDS), with oral health component; the Oral Health Assessment Tool (OHAT); The Holistic Reliable Oral Assessment Tool (THROAT); Dental Hygiene Registration (DHR); Mucosal Plaque Score (MPS); The Brief Oral Health Screening Examination (BOHSE) and the Oral Assessment Sheet (OAS). Most frequently assessed items were: lips, mucosa membrane, tongue, gums, teeth, denture, saliva, and oral hygiene.

Conclusion

Taken into account the scarce evidence of the proposed assessments, the OHAT and ROAG are most complete in their included oral health items and are of best methodological quality in combination with positive quality criteria on their measurement properties. Non-dental healthcare professionals, policymakers and researchers should be aware of the methodological limitations of the available oral health assessments and realize that the quality of the measurement properties remains uncertain.

Development of an instrument to assess oral hygiene ability in older adults: The oral hygiene ability instrument

OBJECTIVES

To describe the development process of an instrument to assess the ability to manage daily oral hygiene and the cause of impaired oral hygiene. The instrument is initially aimed for use by the dental team in the ageing population.

BACKGROUND

Oral hygiene is an important component of oral health. Inability to manage oral hygiene combined with other risk factors often results in poor oral health and impaired quality of life.

METHODS

A guideline for instrument development was used during the construction of the instrument. The method included three phases: I. planning: the purpose and target group of the instrument were determined, and a literature review and qualitative focus-group study were conducted; II. construction: objectives were formulated, and a pool of items was built; and III. evaluation and validation, which included two pilot studies, interviews, item analyses and revision of the instrument.

RESULTS

The planning and construction phases resulted in an instrument with 47 items comprising three parts: (a) interview, (b) clinical examination and (c) observation of activities of daily living (oral hygiene). After two pilot studies, the instrument was found to have good content validity. Analyses of qualitative and quantitative data resulted in a reduction in the number of items to 33.

CONCLUSION

OHAI can be a valuable tool as a preventive method to identify older adults at risk of impaired oral health. However, the instrument needs further evaluation before wider use.

Oral hygiene practices and knowledge among stroke-care nurses: A multicentre cross-sectional study

AIMS AND OBJECTIVES

To investigate oral health knowledge for stroke care and the clinical practices performed for oral hygiene care in Malaysia.

BACKGROUND

Oral hygiene care following stroke is important as the mouth can act as a reservoir for opportunistic infections that can lead to aspirational pneumonia.

DESIGN

A national cross-sectional survey was conducted in Malaysia among public hospitals where specialist stroke rehabilitation care is provided.

METHODS

All (16) hospitals were invited to participate, and site visits were conducted. A standardised questionnaire was employed to determine nurses' oral health knowledge for stroke care and existing clinical practices for oral hygiene care. Variations in oral health knowledge and clinical practices for oral hygiene care were examined.

RESULTS

Questionnaires were completed by 806 nurses across 13 hospitals. Oral health knowledge scores varied among the nurses; their mean score was 3.7 (SD 1.1) out of a possible 5.0. Approximately two-thirds (63.6%, n = 513) reported that some form of "mouth cleaning" was performed for stroke patients routinely. However, only a third (38.3%, n = 309) reported to perform or assist with the clinical practice of oral hygiene care daily. Their oral health knowledge of stroke care was associated with clinical practices for oral hygiene care (p < .001).

CONCLUSIONS

The clinical practice of providing oral hygiene care is less than ideal, and there are deficiencies in oral health knowledge for stroke care. Oral health knowledge was associated with clinical practice of providing oral hygiene care. This has implications for training and integrating oral hygiene care within stroke rehabilitation.