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.

Views of xerostomia among health care professionals: a qualitative study.

AIM: To explore and describe views of xerostomia among health care professionals. BACKGROUND: Xerostomia (dry mouth) is caused by changes in quality and quantity of saliva due to poor health, certain drugs and radiation therapy. It is a common symptom, particularly among older people and has devastating consequences with regard to oral health and general well-being. METHODS: Data were obtained and categorised by interviewing 16 health care professionals. Qualitative content analysis was chosen as the method of analysis. DESIGN: Qualitative. RESULTS: The latent content was formulated into a theme: xerostomia is a well-known problem, yet there is inadequate management of patients with xerostomia. The findings identified three categories expressing the manifest content: awareness of xerostomia, indifferent attitude and insufficient support. CONCLUSIONS: Although xerostomia was recognised as commonly occurring, it was considered to be an underestimated and an ignored problem. Proper attention to conditions of xerostomia and subsequent patient management were viewed as fragmentary and inadequate. Additional qualitative studies among patients with xerostomia would be desirable to gain further understanding of the problems with xerostomia, its professional recognition and management. RELEVANCE TO CLINICAL PRACTICE: A holistic view, positive professional attitudes and enhanced knowledge of xerostomia seem essential to augment collaboration among health care professionals and to improve compassion for and support of patients with xerostomia.

Mental health professional support in families with a member suffering from severe mental illness: a grounded theory model.

The aim of this study was to develop a model of mental health professional (MHP) support based on the needs of families with a member suffering from severe mental illness (SMI). Twelve family members were interviewed with the focus on their needs of support by MHP, then the interviews were analyzed according to the grounded theory method. The generated model of MHP support had two core categories: the family members' process from crisis to recovery and their interaction with the MHP about mental health/illness and daily living of the person with SMI. Interaction based on ongoing contact between MHP and family members influenced the family members' process from crisis towards recovery. Four MHP strategies--being present, listening, sharing and empowering--met the family members' needs of support in the different stages of the crisis. Being present includes early contact, early information and protection by MHP at onset of illness or relapse. Listening includes assessing burden, maintaining contact and confirmation in daily living for the person with SMI. Sharing between MHP and family members includes co-ordination, open communication and security in daily living for the person with SMI. Finally, the MHP strategy empowering includes creating a context, counselling and encouraging development for the family members. The present model has a holistic approach and can be used as an overall guide for MHP support in clinical care of families of persons with SMI. For future studies, it is important to study the interaction of the family with SMI and the connection between hope, coping and empowerment.

The effect of an oral health education program after three years.

Three years after providing an oral health education program (OHEP) to nursing personnel, the authors analyzed the effect of the program on knowledge of the importance of oral health and on perception among the nurses of the possibility to implement oral care in patient care. The study was based on a cross-sectional survey of all nursing personnel (N = 2,901) in five municipalities in the Southwestern Sweden, of whom 950 had attended four one-hour lessons during an OHEP in 1996. The response rate to the survey questionnaire was 67% (1,930 subjects). Statistical analysis was performed by means of descriptive and analytical statistics. The program was shown to have an independent effect on the dependent variables "knowledge of oral health" and "assessment of implementation possibilities," This study has given further evidence of the feasibility of an educational program to improve both knowledge and implementation of oral health care.

The relation between xerostomia and hyposalivation in subjects with rheumatoid arthritis or fibromyalgia.

Aim of this study was to evaluate the relation between xerostomia and hyposalivation in 100 subjects with either rheumatoid arthritis or fibromyalgia, and further, to evaluate the predictive value of xerostomia on hyposalivation. Unstimulated and chewing stimulated whole saliva was collected in the morning with the subjects in a strict fasting condition and then about 2 hours later, after intake of a standardised breakfast. All participants filled in a questionnaire, mainly dealing with xerostomia. Forty subjects demonstrated a pathological fasting unstimulated whole saliva secretion rate, the corresponding number for fasting stimulated secretion being 39. For unstimulated, but not for stimulated saliva, the fasting secretion rate was significantly lower than the non-fasting. Xerostomia was reported by 74 subjects, this group having significantly lower both unstimulated and stimulated secretion rates than the non-xerostomic group. On the individual level, the predictive value of xerostomia on hyposalivation showed high sensitivity but unsatisfactory specificity. In conclusion, this study underlines the importance of applying strictly standardised procedures when collecting saliva, and that fasting unstimulated whole saliva is the diagnostic salivary secretion of choice. Finally, xerostomia was found to predict hyposalivation on a group, but not on an individual level.

Nursing personnel's views on oral health from a health promotion perspective: a grounded theory analysis.

The aim of this study was to develop a model for how nursing personnel view oral health in general and the oral health of the care receivers in particular, applying a health promotion perspective and using grounded theory analysis. Data were collected through interviews with 17 nursing personnel, selected by strategic sampling. Analysis of the transcribed interviews showed that there were four strategies, related to staff education, hospital resources, and leadership motivation. The strategies were grounded in data and emerged from the interaction between the two main categories: 'the valuation of the importance of oral health' and 'the behavior towards oral health maintenance'. They were characterized as the routine, theoretical, practical, and flexible strategies, with the latter considered ideal. As increased knowledge is one important part in enhancing the nursing personnel's ability to perform oral hygiene procedures, there is a need for education among nursing personnel, primarily among those using a routine strategy.