Oral health care in nursing. Attitudes, priorities and education

Abstract

The number of functionally dependent elderly with natural teeth is increasing. Daily oral health care for those living at nursing facilities is expected to be performed by the nursing staff but has been reported as unsatisfactory. This thesis focuses on the nursing staff's views on oral health care. Further, the effects of an education model, which aims to create more positive, longstanding oral health care effects compared with traditional oral health care education, were studied. The applied research methods were mainly qualitative, where assessments were performed among staff and residents at intervention and control nursing facilities. The general findings revealed that oral health care was seen as a part of daily nursing duties, but was regarded as a troublesome activity by most staff personnel. The nursing staff with the shorter education mostly performed oral health care and it was this group that held more negative oral health care attitudes as compared with nurses with a longer education. All staff personnel expressed a desire to obtain more oral health care education, but they also wanted more practical help from the dental team. Oral health care was described as having a low practical priority in nursing. Other daily routines were often considered more urgent because of experiences of negative circumstances associated with oral health care work. Most staff personnel expressed a need for better support in oral health care. A new education model in oral health care was developed and tested. Oral care aides were appointed among the nursing staff at the intervention facilities and supplemented a traditional lecture, which was given to all personnel at both the intervention and control nursing facilities. The oral care aides passed a special training curriculum, including an auscultation period at a dental clinic. Baseline and follow-up assessments were made among both nursing staff and residents in an intervention and a control group. It was shown that the oral health care needs of nursing staff could be met in either passive or active ways, but the intervention group expressed a higher commitment to oral health care than the control group, where only traditional oral health care education had been given. The oral care aides reported that they went from oral health care novices to competent nursing oral health care providers. They took responsibility for the oral health care work at their wards, and more dental contacts for the residents were created in the intervention group compared with the control group. Other oral health care effects for the residents were not noticeable during an 18-month follow-up period. Semi-structured interviews with the residents supported the nursing staff's experiences of residents' low oral health care values. Oral health care in nursing remains a duty for the nursing staff; however, to attain and keep up with a high level of performance in this work well functioning co-operation between the nursing and dental professions is required.