Oral care and ventilator-associated pneumonia: an integrated review of the literature.

The purpose of this study was to review evidence-based research studies specific to oral care in critical care and its relationship to ventilator-associated pneumonia. Twenty articles were analyzed. Results showed a pattern of 4 themes: (1) oral care practices, (2) deviation from practices, (3) interventions, and (4) documentation. Results are varied across the articles reviewed, although some pattern of essential oral care was revealed as crucial to the prevention of ventilator-associated pneumonia.

Dimensions of oral care management in Texas hospitals.

PURPOSE: There is a growing body of evidence that suggests improved oral health can help patient outcomes in hospitals. Yet there are indicators that oral care in hospitals is less than ideal. This study was conducted to quantify and qualify the dimensions of oral care in Texas hospitals with a focus on the dental knowledge, attitudes and practices of nurses and barriers to providing such care. METHODS: A random sample of 582 registered nurses, licensed and employed in Texas, was surveyed about oral care attitudes, practices and knowledge. Frequencies and Spearman correlations were used to describe and analyze the data with SPSS. RESULTS: Ninety-eight respondents returned surveys for a 16.8% response rate. Of these, 52% reported their nursing education did not ("minimally/not at all") prepare them for oral care management. However, they felt oral health was important (95%), felt responsible for oral care (79%) and assessed the oral cavity of their patients (78.6%). Although they reported being "knowledgeable" or "very knowledgeable" about oral health management (67%), their score on the knowledge questions was low (mean=51%, sd=0.132). There was not a significant correlation between the knowledge scores and education levels (ρ=0.136, p>0.05) or knowledge scores and work areas (ρ=-0.080, p>0.05). They also reported such barriers as low priority for oral care, lack of time, no mandate and the need for more resources. CONCLUSION: This study revealed that nurses experienced a disconnect between feeling responsible yet somewhat incapable and/or ill-prepared to provide adequate oral care for their patients. This suggests a possible need for revising nurse education, hospital requirements and protocols for performing oral care and employing dental professionals in hospitals.

[Improvement of oral health care in geriatric care by training of nurses and nursing assistants for the elderly]. / Verbesserung der zahnmedizinischen Betreuung in der Altenpflege durch Schulungen von Pflegekräften.

Because oral health among residents of German nursing homes is inadequate, this intervention study evaluated the effects of dental training for nurses and nursing assistants (RN and RA) in homes for the elderly on their assessment of oral health in residents and, as a consequence, on the status of residents' oral health. 53 residents and the RNs and RAs from three homes for the elderly participated in this study. The nursing staff received training in dental health care. As primary outcome, the competence in performing the Brief Oral Health Examination (BOHSE) was measured at baseline date and four months after training. Additional outcome measures were dental and denture hygiene in residents, functional status of dentures, and treatment needs. Dental training was shown to improve the nursing staff's competences in oral health assessment in tendency. Residents' oral hygiene improved significantly, whereas no relevant effects on hygiene and functional status of dentures were registered. The need for dental treatment turned out to be considerable at both measurements. Modifications in test tools with identification of dental treatment needs seem to be indicated in order to improve cooperation between nursing staff and dentists in homes for the elderly.

Effect evaluation of a supervised versus non-supervised implementation of an oral health care guideline in nursing homes: a cluster randomised controlled clinical trial.

OBJECTIVE: To compare a supervised versus a non-supervised implementation of an oral health care guideline in Flanders (Belgium). BACKGROUND: The key factor in realising good oral health is daily oral hygiene care. In 2007, the Dutch guideline 'Oral health care in care homes for elderly people' was developed to improve oral health of institutionalised elderly. MATERIALS AND METHODS: A random sample of 12 nursing homes was randomly allocated to the intervention or the control group. Representative samples of 30 residents in each home were monitored during a 6-month study period. The intervention included a supervised implementation of the guideline. RESULTS: At the 6-month follow-up, only a small but statistically significant (p = 0.002) beneficial effect (0.32) of the intervention was observed for denture plaque after adjustment for baseline value and the random effect of the institution. In the linear mixed regression models, including a random institution effect, difference in denture plaque level was no longer statistically significant at the 5% level. CONCLUSION: Only denture hygiene has been improved by the supervised implementation, although with lower benefits than presumed. Factors on institutional level, difficult to assess quantitatively, may play an important role in the final result.

The invisible work with tobacco cessation - strategies among dental hygienists.

OBJECTIVE: This study elucidates dental hygienists' experiences of work with tobacco cessation among patients who smoke or use snuff. METHODS: Data were obtained and categorized by interviewing 12 dental hygienists, who worked actively with tobacco cessation interventions. Qualitative content analysis was used for analysis. RESULTS: The latent content was formulated into the core category 'the invisible oral health promotion work'. The informants thought that they had a responsibility to work with tobacco cessation. They perceived the financial system in which they perform the activity as frustrating, because tobacco cessation has no treatment code in the dental care insurance. This was one of several reasons why they had to integrate it in other treatment procedures. The results identified three categories: 'balance in the meeting', 'possibilities and hindrance' and 'procedures'. In the narratives, both positive and negative aspects were displayed. CONCLUSIONS: The financial conditions for tobacco cessation interventions need to be reformed and the activity has to be given a higher priority in the organization of dental care. Practical training in performing tobacco cessation interventions is important during the dental hygiene education; otherwise, tobacco cessation interventions will remain invisible in oral health promotion in the future.

Effects of systematic oral care in critically ill patients: a multicenter study.

BACKGROUND: No standard oral assessment tools are available for determining frequency of oral care in critical care patients, and the method of providing oral care is controversial. OBJECTIVES: To examine the effects of a systematic program of oral care on oral assessment scores in critically ill intubated and nonintubated, patients. METHODS: Clinical data were collected 3 times during critical care admissions before and after institution of a systematic program of oral care in 3 different medical centers. The oral care education program consisted of instruction from a dentist or dental hygienist and a clear procedure outlining systematic oral care. The Beck Oral Assessment Scale and the mucosal-plaque score were used to assess the oral cavity. Data were analyzed by using linear mixed modeling with controls for severity of illness. RESULTS: Scores on the Beck Scale differed significantly (F = 4.79, P = .01) in the pattern of scores across the 3 days and between the control group (before oral education) and the systematic oral care group. Unlike the control group, the treatment group had decreasing scores on the Beck Scale from day 1 to day 5. The mucosal-plaque score and the Beck Scale scores had strong correlations throughout the study; the highest correlation was on day 5 (r = 0.798, P < .001, n = 43). CONCLUSIONS: Oral assessment scores improved after nurses implemented a protocol for systematic oral care. Use of the Beck Scale and the mucosal-plaque score could standardize oral assessment and guide nurses in providing oral interventions.

Dental insurance and dental service use by U.S. women of childbearing age.

OBJECTIVES: Oral health has a significant effect on health, and for women, poor oral health can lead to poor birth outcomes and can affect their child's health. Nursing interventions to improve the oral health of at-risk women have the potential to increase maternal and child systemic and oral health. The identification of women at a high risk for poor oral health is a necessary to develop and evaluate these interventions. DESIGN AND SAMPLE: This study examined the factors related to dental insurance and dental service use for women of childbearing age in the United States. A secondary analysis of the 2003-2004 National Health and Nutrition Examination Survey was completed to examine the predisposing, enabling, and need variables associated with dental insurance status and dental service use in a representative random sample of 1,071 women. RESULTS: The results showed that over 40% of women had no dental insurance. Women with less education, lower income, and dental need were significantly less likely to have dental insurance. Dental utilization by the uninsured was low and a racial/ethnic disparity was noted. CONCLUSION: A lack of dental insurance and dental service utilization is a significant concern. Nurses working with low-income women should educate the population about oral health and advocate for policies to increase dental insurance coverage.

Dental care of frail older people and those caring for them.

AIMS AND OBJECTIVES: To describe oral health utilisation patterns of frail older people and contrast these with attitudes and utilisation patterns of nursing staff who are caring for them. BACKGROUND: In view of widespread poor oral health of frail older people in long-term care, staff attitudes have been identified as an area of interest. In addition to data on attitudes, the current study contributes a description of aspects of oral health related behaviour of staff and clients. DESIGN: Cross-sectional study. METHODS: Structured interviews of a random selection of long-term care staff (n=320) and frail older people (n=172), within the two groups of home-care services (HCS) and long-term care facilities (LTCF). RESULTS: Of staff members, 55·3% attach the same importance to their own oral health compared to that of clients and 35·7% regard their own oral health as more important; 98·4% of staff attended two or more dental examinations per year; 3·4% of HCS and 37·1% of LTCF routinely arranged oral examinations. In 81·4% HCS and in 34·4% of LTCF, there was no routine dental service available. Patterns of oral health service attendance greatly differ between staff and clients. CONCLUSION: The oral health awareness of the majority of long-term care staff did not translate into adequate oral health care for clients. A gap exists between attitudes supportive of oral health, adequate and prevention driven own oral health related behaviour of staff and actual oral health care delivered to clients. RELEVANCE TO CLINICAL PRACTICE: To bridge the gap identified, a concept is suggested for nursing educators and managers of LTCF targeting educational measures while taking into account individual attitudes.

Pregnancy and oral health: a review and recommendations to reduce gaps in practice and research.

This article presents a review of the research relevant to oral health during pregnancy and includes nursing practice recommendations for referral of women to a dentist for safe and effective dental care during pregnancy. In recent years, research linking periodontitis to the risk for adverse birth outcomes has resulted in increased interest in the topic of oral health during pregnancy. The achievement of optimal oral health in pregnant women as its own benefit, however, has in the past been hampered by myths surrounding the safety of dental care during pregnancy. Many women also lack access to dental care and dental insurance, which interferes with their ability to receive adequate oral care during pregnancy. Intraoral changes that occur with pregnancy because of hormonal changes, combined with lack of routine exams and delays in treatment for oral disease, place pregnant women at higher risk for dental infections.

Dental auscultation for nursing personnel as a model of oral health care education: development, baseline, and 6-month follow-up assessments.

Oral health care has been shown to have low priority in nursing and has been only partly successful. To create more positive effects than those achieved through traditional oral health care education, this project tested an educational model for nursing staff personnel. In addition to traditional oral health care education, some of the nursing staff members passed an additional dental auscultation period and served as oral care aides. The aides were responsible for the oral health care of the residents at their nursing facilities (intervention group). The intervention nursing facilities were compared with facilities where nursing personnel only received a traditional oral health care education program. Assessments were made at baseline and at a 6-month follow-up. At follow-up it was shown that the nursing staff in the intervention group gave higher priority to the oral health care work than the nursing staff in the control group.

The Oral Care Link Nurse: a facilitator and educator for maintaining oral health for patients at the Royal Hospital for neuro-disability.

This paper describes an ongoing oral health education project developed and implemented at the Royal Hospital for Neuro-disability (RHN) by the Dental Team. The Oral Care Link Nurse (OCLN) project was developed to assist the dental team in the promotion of oral care within the hospital. The Dental Team identified that, in addition to providing knowledge and skills to perform effective oral care, it is important that nursing staff retain positive attitudes and behavior toward providing that care. In conjunction with the Quality Assurance department, oral care guidelines were introduced throughout the hospital, with further input being focused on the training of at least one unqualified nursing auxiliary from each ward. These became the OCLN who were trained by the Dental Team to assist with the promotion of good oral care practices on the wards and to aid communication regarding patient oral health within the multidisciplinary team. Formal evaluation, by clinical audit, indicated that the project continued to improve the overall standard of oral care throughout the hospital. To ensure that this high standard continues, it is essential that continued support, commitment, and enthusiasm be given from the dental team and that support is constant.

Implementation of an oral care standard for leukemia and transplantation patients.

The purpose of this project was to develop an oral care standard on two nursing units in a university hospital where care was given to patients undergoing bone marrow or stem cell transplantation (BMSCT) and other treatments for leukemia. Strategies used in this interdisciplinary effort included collaboration, consultation, education, and evaluation. In the collaboration phase, a core group of nurses talked with staff about current practices, reviewed literature and published standards, examined protocols from other institutions, decided on goals, and developed the standard. Consultation with a dentist, pharmacist, and physician occurred before completion of the standard. The education phase included in-service sessions for nurses and technicians. The evaluation phase, which occurred in two phases, focused on checking to see if the goals had been met, including tolerability and adherence. The first phase allowed identification of problem areas and subsequent revisions, whereas the second phase evaluated adherence at a later time point. Overall, most of the patients adhered to the standard. Future implications include specific recommendations such as an emphasis on oral care, documentation, and patient and staff education. This project is an example of how nurses addressed the challenge of implementing an acceptable oral care standard to decrease patients' oral complications and distress.

An evaluation of the oral care given to patients when staying in hospital.

The aim of this preliminary clinical audit was to use the resource of patients attending medical or dental practices to conduct a survey into the experiences of those who had been hospital in-patients as to their opinion of the oral care provided. A self-completing questionnaire was used. All 33 respondents were unable to carry out their own oral hygiene for 21 different reasons. The period of this disability was at least one week for 51% and over three weeks for 12%. A total of 40% were full-denture wearers, 30% had their own teeth and partial dentures and 30% had natural teeth only. Fifty-two per cent were not asked if they required any assistance with oral care. None of the patients with full or partial dentures had them cleaned after meals. Of those with full dentures 80% did not have their dentures cleaned at night; the corresponding figures for those with partial dentures (60%) and those with their own teeth and no dentures (69%) showed a similar lack of care. Over 72% rated the oral care given in hospital worse than that which they were able to provide for themselves at home. As a result of this preliminary audit, an interface audit across all the hospitals and residential nursing homes of north and east Devon has been set up to investigate the provision of oral care and to set up procedures to address any deficiencies found. The conclusions from this preliminary audit reinforce recent research into the training of nurses in oral care which found that this was inadequate and that awareness of oral need was minimal.

Oral health services in primary care nursing centers: opportunities for dental hygiene and nursing collaboration.

PURPOSE: The basic oral health needs of more than 100 million Americans are not being met, which places them at an increased risk for serious oral and systemic health consequences. Primary care nursing centers, a comparatively new method of health care delivery, provide health care screening, education, and referral services to person typically underserved in the traditional health care delivery system. Primary care nursing centers were surveyed to determine to what extent they provide oral health screening, education, and referral services for clients, and to identify factors that discourage and encourage the integration of these services. METHODS: Nurses from 158 primary care nursing centers in the United States made up the study population. Data were collected using a self-administered questionnaire. Data from 59 primary care nursing centers were analyzed using frequency distributions and measures of central tendency. RESULTS: Almost half of the responding nurses at primary care nursing centers "almost always" screen their clients for gum infections (49%) and oral lesions (48%). Fewer teach their clients how to perform oral cancer self-examinations (20%); or educate them regarding use of athletic mouth protectors (15%), the effects of xerostomia (19%), and the benefits of fluoride (38%). The majority do not always refer clients needing treatment for dental decay (55%), gum infections (61%), missing teeth (80%), oral lesions (67%), oral pain (64%), or oral trauma (65%). Lack of referral sources (64%) and unavailability of oral health professionals to provide on site basic oral health services (63%) were the leading factors that discourage the integration of oral health services in the centers. An appreciation for the benefits of oral health (73%) and a knowledgeable clinician to perform oral health services (68%) were the leading factors that encourage the integration of oral health services into primary care nursing centers. CONCLUSION: These data could be useful in planning, implementing, and evaluating more effective and efficient methods for channeling basic oral health services to the public. The data provide support for the collaborative efforts by dental hygienists and nurses to expand oral health services beyond the confines of the current dental care delivery system.

A cross-sectional study of the oral healthcare instruction given to nurses during their basic training.

OBJECTIVE: To ascertain the current nurse training establishments' (NTEs') commitment to the teaching of oral care, and its coverage in nursing literature. DESIGN: Cross-sectional. SETTING: All NTEs in the UK for 1996/97 SUBJECTS AND METHODS: Self-completion questionnaire sent to all 162 Directors of Education of NTEs in the UK. MAIN OUTCOME MEASURES: A subjective assessment of the adequacy of the coverage of oral care in syllabi offered as part of nursing training; a subjective assessment of the relevance of literature recommended for student reading. RESULTS: 72% (117) responded. 27% (32) were post-registration NTEs not teaching oral care. The remaining 85 completed questionnaires were analysed. 79% (67) of these had no dental input; 75% (64) would welcome some. 28% (24) taught the use of an oral care assessment form; 38% (32) discussed dental plaque. 38% (32) had no exclusive lectures on oral care. Of 31 textbooks, only 1 had comprehensive coverage of the subject. The majority scored less than 25% on the assessment system. CONCLUSIONS: Many NTEs have oral care syllabus deficiencies. Students are recommended books which have insufficient information to provide an insight into oral care or dental disease. There would appear to be an urgent requirement for the nursing and dental professions to liaise in order to remedy this situation.

[Importance of oral and dental care in home medical care].

Recently, the importance of home medical care has been stressed. But patients, those assisting them and home care nurses do not attach much importance to oral and dental care in home medical care. When we visit patients who have asked for dental treatment through home care nurses, they appeared to have very poor oral hygiene; cavities were uncared for, dental plaque and dental calculus built up, and they used ill-fitting dentures. Through home dental care visits, it was not just the dental treatment but advice on dental hygiene management and diet that helped patients regain their appetite and bring back a smile to their face, while giving a rhythm to their life. This created a certain human feeling and brought about better patient quality of life (QOL), while at the same time helping to improve the QOL of the family as well.