Success factors and barriers in interprofessional collaboration between dental hygienists and dietitians in community-dwelling older people: Focus group interviews.

INTRODUCTION: Poor nutritional status can impair oral health while poor oral health can influence the individual's dietary intake, which may result in malnutrition. This interaction between nutritional status and oral health in older age requires attention, coordination and collaboration between healthcare professionals. This qualitative study explores dental hygienists' and dietitians' opinions about current collaboration with the aim of identifying success factors and barriers to this interprofessional collaboration. METHODS: Three focus group interviews were held with Dutch dental hygienists and dietitians about nutritional and oral healthcare in community-dwelling older people. RESULTS: In total, 9 dietitians and 11 dental hygienists participated in three online focus group interviews. Dental hygienists and dietitians seldom collaborated or consulted with each other. They struggled with the professional boundaries of their field of expertise and experienced limited knowledge about the scope of practice of the other profession, resulting in conflicting information to patients about nutrition and oral health. Interprofessional education was scarce during their professional training. Organizational and network obstacles to collaborate were recognized, such as limitations in time, reimbursement and their professional network that often does not include a dietitian or dental hygienist. CONCLUSION: Dental hygienists and dietitians do not collaborate or consult each other about (mal)nutrition or oral health in community-dwelling older people. To establish interprofessional collaboration, they need to gain knowledge and skills about nutrition and oral health to effectively recognize problems in nutritional status and oral health. Interprofessional education for healthcare professionals is needed to stimulate interprofessional collaboration to improve care for older people.

Care-resistant behaviour during oral examination in Dutch nursing home residents with dementia.

OBJECTIVE: To assess the occurrence and associations of verbal and non-verbal care-resistant behaviour (CRB) during oral examination by a dental hygienist in nursing home residents with dementia. BACKGROUND: CRB is a barrier to providing professional oral care and daily oral hygiene care. Understanding the predictors of CRB might help care professionals in learning to anticipate this behaviour. METHODS: In this multicentre cross-sectional study signs of verbal and non-verbal CRB were reported during the oral examination. Data collection occurred in the psychogeriatrics wards of 14 different nursing homes in the Netherlands (N = 367). RESULTS: A total of 367 residents were included. CRB was evident in 82 residents (22.3%), of whom 45 (55%) showed verbal and 37 (45%) non-verbal CRB. Associated with CRB were age >85 years, duration of residential stay longer than 2 years, and having Korsakov dementia. Other factors associated with CRB were duration of residential stay (categories ">2 and ≤4 years" or ">4 years") and having a natural dentition (P = .043-.005, OR = 1.20-1.33, 95% CI = 1.00-8.48). Significant associations for verbal and non-verbal CRB were age between 76 and 85 years, vascular dementia and Korsakov dementia (P = .031-.006, OR = .020-1.49, 95% CI = 0.43-2.15). CONCLUSION: The occurrence of CRB was 22.3% and was associated with older age and longer duration of residential stay, Vascular and Korsakov dementia and natural dentition.

Is there burnout related to work among Dutch dental hygienists?: Combining studies by using the UBOS and the UWES.

OBJECTIVES: To investigate the prevalence of burnout among Dutch young and more experienced dental hygienists and the work experience of young professional dental hygienists. MATERIAL AND METHODS: Two studies were carried out using the Dutch version of the Maslach Burnout Inventory; the Utrecht Burnout Scale (UBOS) and the Utrecht Work Engagement Scale (UWES). In Study I, 400 participants completed an online questionnaire, including the UBOS-general version. In Study II, a questionnaire was distributed via social media to young professionals, including the UBOS-health care version and the UWES-9. RESULTS: 2.5% of 157 dental hygienists (Study I) satisfied the norm of burnout. Dental hygienists' average work experience was 16.6 years, and one-thirds worked 25-32 hours per week. In Study II, 73 young professionals (M = 26.5 years) reported 32.9 weekly working hours. Three-quarters were employed and worked in a dental clinical team practice. UWES-mean scores indicated a moderate to high level of work engagement. Mostly, all aspects of burnout were low compared with the test Manual norms. CONCLUSIONS: Exploratory findings show that generally burnout appears no threat for Dutch dental hygienists, and moderate to high level of work engagement coincides with a low level of burnout-related symptoms.

Perceptions of interprofessional collaboration in education of dentists and dental hygienists and the impact on dental practice in the Netherlands: A qualitative study.

INTRODUCTION: The purpose of this study was to evaluate the perceptions of dentists and dental hygienists regarding their own and each other's roles in interprofessional collaboration following a clinical interprofessional educational programme (CIEP) as part of their graduate programme at Radboud university medical center (Radboudumc) and HAN University of Applied Sciences (HAN UAS), Nijmegen, the Netherlands, respectively. Perceptions were obtained at the end of their study (2014) and two years after their graduation (2016). METHODS: A qualitative study was conducted using a questionnaire with open-ended questions. Sixty-two dentists and thirty-eight dental hygienists were invited. Theory-based analyses were applied in combination with principles of Grounded Theory to analyse and synthesise the collected data from the open-ended questions. RESULTS: At baseline, 100% responded. At follow-up, thirty-two dentists (51.6%) and twenty-six dental hygienists (68.4%) responded; twenty-seven dentists (43.5%) and eighteen dental hygienists (47.4%) were included. Many similarities were found between baseline and follow-up regarding perceptions of each other's expertise and responsibility, learning from and with each other, and the behaviour of students and the "novice" professionals in interprofessional collaboration. Both dentists and dental hygienists experienced the CIEP as useful for interprofessional collaboration. The "novice" dentists and dental hygienists indicated that in dental practices interprofessional collaboration was less common. CONCLUSION: The CIEP resulted in more understanding amongst dentists and dental hygienists with regard to interprofessional roles, but in practice the "novice" dentists and dental hygienists face difficulties in applying the interprofessional roles.

The effect of a daily application of a 0.05% chlorhexidine oral rinse solution on the incidence of aspiration pneumonia in nursing home residents: a multicenter study.

BACKGROUND: Dysphagia and potential respiratory pathogens in the oral biofilm are risk factors for aspiration pneumonia in nursing home residents. The aim of the study was to examine if the daily application of 0.05% chlorhexidine oral rinse solution is effective in reducing the incidence of aspiration pneumonia in nursing home residents with dysphagia. Associations between background variables (age, gender, dysphagia severity, care dependency, medication use, number of medical diagnoses, teeth and dental implants, and wearing removable dentures) and the incidence of aspiration pneumonia were also examined. METHODS: This study is a multicenter study in which for 1 year participants with dysphagia in the intervention group received the usual oral hygiene care with the addition of a 0.05% chlorhexidine oral rinse solution, whereas participants in the control group received only oral hygiene care. RESULTS: Data of 103 participants in 17 nursing homes were analyzed. Survival analysis showed no significant difference in the incidence of pneumonia between both groups (Cox regression, HR = 0.800; 95% CI [0.368-1.737], p = 0.572). Cox regression analysis for Functional Oral Intake Scale (FOIS)-level showed a significant risk of the incidence of pneumonia (HR = 0.804; 95% CI [0.656-0.986], p = 0.036). After adjustment for Group and FOIS-level, Cox multivariate proportional hazard regression analysis showed that the variables age, gender, Care-dependency Scale-score (CDS) number of diseases, medication use, number of teeth, and the presence of dental implants or removable dentures were not significantly associated with the incidence of pneumonia. CONCLUSIONS: Chlorhexidine oral rinse solution 0.05% as an adjunctive intervention in daily oral hygiene care was not found to reduce incidence of aspiration pneumonia. The requested number of participants to achieve sufficient power was not established and high drop-out rate and non-structural compliance was present. The power was considered to be sufficient to analyze the associations between the background variables and the incidence of pneumonia in the included nursing home residents with dysphagia. Dysphagia was found to be a risk factor for aspiration pneumonia. TRIAL REGISTRATION: Registration in The Netherlands National Trial Register: TC = 3515. Approval for the study was obtained from the Medical Ethical Committee of the Radboud University Medical Center (NL. nr:41,990.091.12).

Nursing home-acquired pneumonia, dysphagia and associated diseases in nursing home residents: A retrospective, cross-sectional study.

BACKGROUND: Nursing home-acquired pneumonia (NHAP) is a common infection among nursing home residents. There is also a high prevalence of dysphagia in nursing home residents and they suffer more often from comorbidity and multimorbidity. This puts nursing home residents at higher risk of (mortality from) NHAP. Therefore it is important to gain more insight into the incidence of NHAP and the associated medical conditions in nursing home residents with dysphagia. OBJECTIVE: To investigate possible associations between NHAP and dysphagia in nursing home residents and to search for a medical risk profile for NHAP. DESIGN: A retrospective cross-sectional study. SETTING: Three nursing homes in The Netherlands. PARTICIPANTS: 416 electronic medical files of nursing home residents aged 65 or older living in 3 nursing homes. METHODS: Data about age, gender, diagnosis of dysphagia and/or pneumonia, medical diagnosis and possible cause of death of the nursing home residents were extracted from electronic medical files. RESULTS: The data of 373 electronic medical files were analyzed. A significant difference in the prevalence of dysphagia was found between the nursing homes (p < 0.001). The incidence of NHAP was 5-12% in the participating nursing homes. Statistically significant higher incidence of NHAP was found in residents with dysphagia (p = 0.046). Residents with dysphagia had statistically significantly more diseases compared to residents without dysphagia (p = 0.001). Logistic regression analyses revealed no statistically significant associations between NHAP and the number of diseases and the ICD-10 diseases. CONCLUSIONS: Dysphagia was found to be a risk factor for NHAP. Awareness of the signs of dysphagia by nurses and other care providers is important for early recognition and management of dysphagia and prevention of NHAP.

Work engagement among Dutch dental hygienists.

OBJECTIVES: The aim of this study was to investigate the level of work engagement among Dutch dental hygienists. METHODS: A total of 1,520 questionnaires were randomly distributed to the members of the Dutch Dental Hygienists' Association (Nederlandse Vereniging van Mondhygiënisten). The questionnaire consisted of the short form Utrecht Work Engagement Scale, a hypothesized three-factor structure of work engagement (Vigor, Dedication, and Absorption). Participants ranked statements about how they felt at work on 7-point rating scales (0 = never to 6 = always). RESULTS: From a sample of 490 dental hygienists (32 percent) with a mean age of 38.2 years [standard deviation (SD) = 10.1], the mean level of work engagement was 4.77 (SD = 0.90). The mean score on the dimension of Vigor was 4.74 (SD = 0.74), Dedication was 5.08 (SD = 0.89), and Absorption was 4.48 (SD = 1.12). A significant correlation was found between the dimension Absorption and age (r = -0.11, P < 0.05). CONCLUSIONS: Dutch dental hygienists reported a very high level of work engagement. Many dental hygienists experienced high levels of well-being at work at least once a week, with some reporting high levels of well-being on a daily basis. Only a small percentage of dental hygienists reported experiencing very low levels of well-being at work. Dental hygienists also reported significantly higher scores for work engagement and the three dimensions as compared with the manual norms based on a variety of professions. Finally, dental hygienists had higher scores on these questionnaires compared with Dutch dentists.