O-HEALTH-EDU: A viewpoint into the current state of Oral Health Professional education in Europe: Part 1: Programme-level data.

INTRODUCTION: Current legislation leaves Oral Health Professional (OHP) education open to wide interpretation and may result in significant variation in educational practice and resultant professional attributes across Europe. Data regarding the current state of OHP education across Europe is limited. The aim of Part 1 of this series is to provide programme-level data for Primary Dental Degree Programmes, Dental Hygiene and Postgraduate Education. METHODS: A 91-item questionnaire was developed following the Delphi method. The questionnaire and the Articulate glossary of OHP education terms were developed concurrently to facilitate a common understanding of language. Piloting was performed in multiple stages and included institutions internal and external to the research group. The questionnaire was uploaded online and converted to a data hub, allowing dental schools to control their own data and update the data provided whenever they wish. All ADEE member schools (n = 144) were invited to provide data. Forty questions relating to school details, Primary Dental Degree Programmes, Dental Hygiene and Postgraduate Education were included in this part of the series. RESULTS: Seventy-one institutions from 25 European countries provided data between June 2021 and April 2023, which represents a response rate of 49.3% of ADEE members. Programme-level data for Primary Dental Degree Programmes, Dental Hygiene and Postgraduate Education is presented including programme length, funding, languages and fees, student numbers and demographics, student admission and selection processes and permission to practice after graduation. CONCLUSION: This series of papers, as far as the authors are aware, are the first attempts to build a comprehensive picture of the current state of OHP education in Europe. A comprehensive view of the state of OHP education in Europe is not yet available but the O-Health-Edu data hub provides a means for all education providers in Europe to contribute data to reach this goal. It is anticipated that the data hub will be updated and built upon over time to continually establish a clearer picture of the state of OHP education in Europe.

O-Health-Edu: A viewpoint into the current state of oral health professional education in Europe: Part 2: Curriculum structure, facilities, staffing and quality assurance.

INTRODUCTION: Oral health professional (OHP) education is likely to vary across Europe in accordance with an EU directive that is open to broad interpretation. It is not clear how OHP curricula are structured or delivered across Europe. The objectives of Part 2 of this paper series are: (i) to provide an overview of common practices in curriculum structure, the availability of facilities, staffing (faculty) and quality assurance processes and (ii) to consider how the existing programme structures align to stakeholder guidance documents. METHODS: A total of 27 questions from a 91-item questionnaire were used for this manuscript. The questionnaire was developed following the Delphi method to establish consensus from a group of experts. Members of the research team and colleagues from other countries in Europe completed a multi-step piloting process. An online data hub was created to allow the respondents to be data controllers and respond to the questionnaire. ADEE member schools (n = 144) were invited to provide data. RESULTS: Totally, 71 institutions from 25 European countries provided data between June 2021 and April 2023, which represents a response rate of 49.3% of ADEE members. Data on curriculum approaches, teaching methods, integration of topics of interest, clinical education, staff-student ratios, access to facilities and new technologies, teaching staff (faculty) and quality assurance processes are presented for Primary Dental Degree Programmes. CONCLUSION: To the best of our knowledge, this series of papers are the first attempts to provide a comprehensive overview of OHP education in Europe. Results showed that the majority of European dental programmes are engaged in providing innovative and scientifically grounded education in order to develop quality future OHPs. Nevertheless, significant variability in the delivery of clinical education across the European OHP schools was notable in this dataset. A comprehensive view of the state of OHP education in Europe is not yet available but the O-Health-Edu data hub provides a means for all education providers in Europe to contribute data to reach this goal. It is anticipated that the data hub will be updated and built upon over time to continually establish a clearer picture of the state of OHP education in Europe.

Spirituality in palliative care.

Although being recognized by the World Health Organization as an essential domain of palliative care, spiritual care is still one of the most neglected component of the healthcare system. In this editorial, we set the context and invite contributions for a BMC Palliative Care Collection of articles titled 'Spirituality in Palliative Care'.

'Whose role is it anyway?' Experiences of community nurses in the delivery and support of oral health care for older people living at home: a grounded theory study.

BACKGROUND: Older people who receive care at home are likely to require support with oral health care. Community nurses, who are also referred to as district or home care nurses, have an important role with this population. This is because they are the healthcare professionals who are most likely to encounter this population, who may also not be receiving regular dental care or oral health promotion. However, few studies have explored community nursing experiences in the delivery and support of oral healthcare for older people living at home. METHODS: A grounded theory approach was used to explore experiences of community nurses in the delivery and support of oral health care for older people living at home. Fifteen practising community nurses from the United Kingdom participated in one-to-one semi-structed interviews from May 2021 to December 2021. These interviews were audio-recorded, transcribed verbatim and analysed using constant comparative analysis. Ethical approval was obtained for this study prior to data collection. RESULTS: Four categories emerged from the data to support development of the core phenomena. These four categories were: (1) Education, in relation to what community nurses knew about oral health, (2) Practice, with regards to how community nurses delivered oral health care to older people in their own home, (3) Confidence, with consideration to the extent to which this supported or impeded community nurses in providing oral healthcare to older people and (4) Motivation, in terms of the extent to which community nurses thought they could or should influence future practice improvement in the area. The core category was (C) Uncertainty as it was both present and central across all four categories and related to community nursing understanding about their specific role, and the role of other professionals, with reference to oral health of their patients. CONCLUSIONS: This study reveals community nurses' uncertainty in providing oral healthcare to older adults at home. Emphasising comprehensive and continuous oral health education can boost nurses' confidence in patient support. Interprofessional collaboration and clear role definitions with oral health professionals are crucial for improving oral health outcomes in this vulnerable population.

Evaluation of a co-designed educational e-resource about oral health for community nurses: study protocol.

BACKGROUND: Oral health is a crucial aspect of health and wellbeing for older people. Poor oral health has been found to significantly increase the risk of chronic health conditions and poor quality of life for older people. Nurses practicing in the community are well-placed to provide oral health care to older people in their own homes, yet there has been little research in this field to develop accessible support for them to do so. Previous literature, reviewed in an earlier phase of this work, revealed that there has, historically, been a paucity of oral health care education for nurses and very few educational resources have been developed in this field. METHODS: This study will evaluate an educational e-resource which has been co-designed by service users, carers and clinicians. In the first phase of research, evidence of promise will be evaluated by analysing quantitative data on community nurses' oral health attitudes and self-efficacy for oral health assessments of older people. In the second phase of research, facilitators and barriers to community nurses' provision of oral health care to older people and the acceptability of the educational e-resource will be evaluated. DISCUSSION: This research will investigate the potential of an educational e-resource to improve community nurses' capabilities to deliver oral health care to older people in their own homes. This research will inform both future intervention design and understanding of community nurses' knowledge and attitudes about oral health care. Facilitators and barriers to provision of this care for older people will also be explored.

ARTICULATE: A European glossary of terms used in oral health professional education.

INTRODUCTION: The Erasmus+O-Health-EDU project aims to gain a comprehensive view of oral health professional (OHP) education in Europe, through the development of web-based surveys and online toolkits. A glossary to facilitate a common language through which academic teams could cooperate and communicate more accurately was identified as a key need within the project. The aim of ARTICULATE was thus to create a shared language, with a European focus, for terms and concepts used in the field of OHP education. METHODS: The methodology was developed from those published for construction of other glossaries with a circular and iterative process: the creation of content and definitions by a group of experts in OHP education, the testing of "fitness for purpose" of the content, and stakeholder consultation. All creation steps were followed by refinements based on testing results and stakeholder comments. The final glossary was then launched as an online resource including a built-in mechanism for user feedback. RESULTS: The scope and structure of the glossary were mapped out at a workshop with 12 dental education experts from 7 European countries. A total of 328 terms were identified, of which 171 were finally included in ARTICULATE. After piloting with a close group of other colleagues, the glossary was opened for external input. Thirty European Deans or Heads of Education assessed the definition of each term as "clear" or "not clear." A total of 86 definitions were described as "clear" by all individuals. Terms deemed unclear by at least one individual were revisited and changes made to 37 of the definitions. In conjunction with the launch of the glossary, a range of stakeholder organisations were informed and asked to participate in an open global consultation by providing feedback online. Since its launch in June 2021, the ARTICULATE website (https://o-health-edu.org/articulate) has had an average of 500 visits/month. To promote community ownership, forms embedded on the ARTICULATE webpage allow users to give feedback and suggest new terms. A standing taskforce will meet regularly to consider amendments and make changes to ensure that the glossary remains a relevant and up-to-date resource over time. CONCLUSION: ARTICULATE is a unique, evolving, online glossary of terms relating to OHP education, created as a resource for all interested OHP educators. The glossary is a key output of the O-Health-Edu project, which relies on a comprehensive vision of OHP education to address the future oral health needs of the European population.

O-Health-Edu: A vision for oral health professional education in Europe.

This consensus paper reports on the process of developing a renewed vision for Oral Health Professional (OHP) education across Europe, and forms part of a larger EU-funded collaborative Erasmus+ project, "O-Health-Edu." The vision aligns with the World Health Organisation milestones (2016) and resolutions (2021), and EU4Health programme (2020) objectives - and projects 20 years into the future, to 2040. This longitudinal vision takes a multi-stakeholder perspective to deliver OHP education that acts in the best interests of both students and patients, and sits within the context of a wider strategy for general health. Included, it is an infographic to help communicate the vision to various stakeholders of OHP education.

Interventions supporting community nurses in the provision of Oral healthcare to people living at home: a scoping review.

BACKGROUND: Oral health is a critical issue for public health and poor oral health is associated with significant chronic health conditions and lower quality of life. There has been little focus on providing oral health care to people who receive care in their own homes, despite the high risk of poor oral health in older people. Nurses practicing in the community are well placed to deliver this care, but little is known about how to build this capability through education or training interventions. METHODS: A scoping review methodology was employed to find and review studies of oral health interventions involving populations of people receiving care in their own home or those nurses who deliver this care. The research question asked what previous research tells us about oral health interventions delivered by nurses in the community. Data was extracted for four areas: setting and type of intervention, patient outcomes, changes to nursing practice and implementation and process evaluations of interventions. RESULTS: Two thousand eighty papers were found from the searches, and only nine were ultimately deemed eligible for inclusion in the review. Included studies spanned community nursing for older people (n = 3) and health visiting or community nursing for children and infants (n = 6). Patient outcomes were generally positive, but this is based on a low level of evidence. Changes to practice including increased oral health care administered by nurses were found, but this required professional support to be sustainable. CONCLUSIONS: This review has found that there is a clear gap in the research around interventions designed to be used by community nurses to improve oral health care for people receiving care in their own homes. The results also suggest that any future intervention must make use of a participatory, co-design approach and consider the complex setting of nursing practice in the community and the barriers to delivering this care, such as time pressure and lack of prior experience.

O-HEALTH-EDU: A scoping review on the reporting of oral health professional education in Europe.

INTRODUCTION: The variability in oral health professional education is likely to impact on the management of oral health needs across Europe. This scoping review forms the initial part of a larger EU-funded collaborative Erasmus + project, 'O-Health-Edu'. The aim of this scoping review is to investigate how oral health professional education in Europe is reported. METHODS: The PRISMA and Arksey & O'Malley methodological frameworks for scoping reviews were used to guide reviewers in answering the research question "How is oral health professional education reported in Europe?". The search strategy encompassed published literature searches, internet searches and further searching of relevant documents from educational organisations, regulators and professional bodies. Once the search strategy was developed, it was sent to key stakeholders for consultation. Sources were reviewed by two authors (JD, JF) and included in the review if they reported on oral health professional education in Europe. RESULTS: A total of 508 sources were retrieved from all of the searches. A total of 405 sources were excluded as they did not report on the topic of interest, leaving 103 sources that reported on oral health professional education in Europe. Handsearching the references of published sources lead to a further 41 sources being screened, of which, 15 were included. In total, 33 duplications were removed and the final number of included sources was 85. The average year of publication for the included sources was 2007, with sources most commonly published in journals dedicated to dental education. Surveys represented the most common form of reporting. From the data obtained, four broad themes of reporting were evident: dental education at a programme level, dental education at a discipline level, other oral health professional education, and postgraduate education and continuous professional development. CONCLUSION: The reporting of dental and oral health professional education in Europe is limited. Whilst there are many useful documents that provide guidelines on dental education, there is limited knowledge on how education is implemented and delivered. There is a greater need for comprehensive educationally driven programme-level data on oral health professional education across Europe.

Tackling the challenge of the impact of continuing education: An evidence synthesis charting a global, cross-professional shift away from counting hours.

INTRODUCTION: Health professionals worldwide are required to maintain their knowledge and skills through continuing education. However, there is limited evidence that the accumulation of hours of educational activity enhances practice. The aim of this study was to review evidence of the impact of continuing professional development (CPD), best educational practice and new models of CPD requirements. METHODS: We conducted a rapid evidence synthesis, reviewing literature and websites on continuing education for healthcare and non-healthcare professionals. RESULTS: We extracted data from 184 publications. Evidence of changed practice and improved patient care is uncommon in studies of CPD. What evidence there is suggests that activities are more likely to have impact if a combination of methods is used and if they are aligned with learning needs. Impact is also affected by the learner and their work environment. In terms of CPD requirements, we identified three models: input-based; outcomes-based and mixed models. We found a clear shift from quantitative, time-serving, input-models to outcomes-focused models which emphasise the identification of learning needs, selection of educational activity relevant to practice and reflection on practice improvement. Across a range of professions, recently updated CPD regulations no longer require registrants to accumulate CPD hours/points/credits. CONCLUSION: Outcomes-based models support registrants' engagement in relevant, meaningful CPD which holds greater potential to positively impact on practice and strengthen patient safety. In funding this study, the UK General Dental Council exemplifies its commitment to reviewing its CPD requirments.

COVID-19: The immediate response of european academic dental institutions and future implications for dental education.

The COVID-19 pandemic has had an immediate and dramatic impact on dental education. The Association of Dental Education in Europe decided to carry out an investigation to assess the immediate response of European Academic Dental Institutions. An online survey was sent to both member and non-member dental schools to investigate the impact on non-clinical and clinical education, assessment and the well-being/pastoral care measures implemented. The preliminary findings and discussion are presented in this paper, for the responses collected between the 25 March and 5 April 2020. The survey at this time of publication is ongoing, and detailed results can be accessed https://adee.org/covid-19-european-dental-education%E2%80%99s-immediate-response.

Are we doing enough to support new recruits?

It is often said the skills and expertise of our staff are among our greatest resources. So, reading this issue's article by Susan Wilkinson and Richard Hayward ( page 30 ) on band 5 nurses' insights into professional development has prompted me to ask: 'Are we doing enough to support new recruits to our profession?'

Using the Gold Standards Framework to deliver good end of life care.

The aims of excellent end of life care (EOLC) and nursing are at the heart of healthcare. Chelsea and Westminster Hospital NHS Foundation Trust, a multi-site London teaching care provider, recognises and values the importance of good EOLC, and the quality of EOLC is used as one of the key metrics in assessing the quality of patient and family care across the trust. The principles of EOLC, including those enshrined in the Gold Standards Framework (GSF), are closely aligned with the trust's core values. Each member of staff is encouraged and supported, through the GSF process, to recognise and respond as befits their role in implementing the principles of EOLC, agreed by staff, and by patients and their relatives. This article describes the experience of, and collaboration between, trust staff and members of the GSF team, who have worked together for the past 18 months, and how this work has placed EOLC at the heart of patient care and staff recruitment. This collaboration has helped to enrich the culture of compassion and care that the trust aims to deliver, and to focus on providing person-centred care.

Developing, implementing and evaluating an end of life care intervention.

Aim To develop, implement and evaluate a collaborative intervention in care homes seeking to increase the confidence and competence of staff in end of life care and enable more people to receive end of life care in their usual place of residence. Method A two-phase exploratory mixed methods design was used, evaluating the effect of an end of life care toolkit and associated training in care homes, facilitated by a specialist palliative care team. Six care homes in England were recruited to the intervention; 24 staff participated in discussion groups; 54 staff attended at least one training session; and pre- and post-intervention questionnaires were completed by 78 and 103 staff respectively. Results Staff confidence in receiving emotional and clinical support and managing end of life care symptoms increased post-intervention, but confidence in discussing death and dying with residents and relatives decreased. Audit data indicate greater reduction in the number of residents from participating care homes dying in hospital than those from comparison homes. Conclusion Collaborative end of life care interventions support care home staff to manage end of life and may enable residents to have choice about their place of death.

The role of biodegradable stents in the management of benign and malignant oesophageal strictures: A cohort study.

BACKGROUND: Oesophageal strictures can be caused by benign or malignant processes. Up to 10% of patients with a benign stricture are refractory to pneumatic dilatation and may benefit from biodegradable stent (BD) insertion. Biodegradable stents also have a role in malignant oesophageal strictures to facilitate enteral nutrition while staging or neo-adjuvant treatment is completed. The aim of this study was to review the safety and efficacy of BD stents in the management of benign or malignant oesophageal strictures. METHODS: A single centre retrospective cohort study was performed. Dysphagia was graded before and after stenting using a validated score. All patients were followed up for at least 30 days and all adverse events were recorded. RESULTS: Twenty eight stents were inserted in 20 patients; 11 for malignant and 17 for benign disease. One further attempted stenting was impossible due to a high benign stricture. There were no perforations and the 30-day mortality rate was zero. Mean dysphagia scores improved from 2.65 to 1.00 (p value <0.001) in benign disease and from 3.27 to 1.36 (p value <0.001) in patients with malignant disease. Surgical resection was not compromised following stent insertion in the malignant group. CONCLUSIONS: Biodegradable stent insertion is a safe and efficacious adjunct in the treatment of benign and malignant oesophageal strictures. In malignant disease, BD stent insertion can maintain enteral nutrition while staging or neo-adjuvant therapy is completed without adversely impacting on surgical resection.

We need compassion through listening.

'To find grace, watch a 16-year-old carer feed an 85-year-old woman with severe dementia, but pass by those in the office writing care plans' ( Barritt 2005 ).

Basic oral care for hematology-oncology patients and hematopoietic stem cell transplantation recipients: a position paper from the joint task force of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT).

PURPOSE: Hematology-oncology patients undergoing chemotherapy and hematopoietic stem cell transplantation (HSCT) recipients are at risk for oral complications which may cause significant morbidity and a potential risk of mortality. This emphasizes the importance of basic oral care prior to, during and following chemotherapy/HSCT. While scientific evidence is available to support some of the clinical practices used to manage the oral complications, expert opinion is needed to shape the current optimal protocols. METHODS: This position paper was developed by members of the Oral Care Study Group, Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT) in attempt to provide guidance to the health care providers managing these patient populations. RESULTS: The protocol on basic oral care outlined in this position paper is presented based on the following principles: prevention of infections, pain control, maintaining oral function, the interplay with managing oral complications of cancer treatment and improving quality of life. CONCLUSION: Using these fundamental elements, we developed a protocol to assist the health care provider and present a practical approach for basic oral care. Research is warranted to provide robust scientific evidence and to enhance this clinical protocol.

How to manage being bullied as a nurse leader.

RATIONALE AND KEY POINTS: Bullying has existed in health and social care organisations for many years. Although researchers have examined the effects of bullying on nurses and nursing students, there has been too little focus on bullying behaviours inflicted directly or indirectly on nurse leaders and managers. This article provides concise and practical guidance for nurses in leadership or management roles on how to identify and manage bullying behaviours directed at themselves. • Overt or covert bullying in nursing can happen at every level of the organisation. • Bullying negatively affects practice, teamwork, staff morale and patient care. • Identifying bullying is the first step in addressing unacceptable behaviours. • Admitting that you may be being bullied and seeking support to manage bullying is a hallmark of an effective nurse leader. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when managing being bullied as a nurse leader. • How you could use this information to educate your peers about managing being bullied as a nurse leader.

End of life care: how nurses can use a compassionate approach.

The reality of death and dying is a central facet of life, often surrounded by feelings of sadness, fear and uncertainty. Nurses have an essential role in caring for people who are approaching the end of life and their families, while being mindful of the current demands and challenges in health and social care services. In this article, the author suggests that being more open to the reality of death as part of life may assist nurses in being more attuned to the personal needs of those who are dying. The article emphasises the importance of considering each person's symptoms and concerns through the lens of compassion to address pain, fear and distress. While the focus is on caring for people who are approaching the end of life, the author asserts that there is much that nurses can learn from those they care for about the beauty of life and the naturalness of death.