Nurse-Led Physical Health Interventions for People with Mental Illness: A Scoping Review of International Literature.

People with mental illness have a higher prevalence of co-occurring physical health conditions and poor health behaviors, leading a mortality gap of up to 16 years, compared with the general population. Nurses working in mental health settings play an important role in addressing factors influencing sub-optimal physical health. Therefore, this scoping review aimed to identify nurse-led physical health interventions and align interventions to eight recognized physical healthcare priority areas (i.e. Equally Well in Victoria Framework). A systematic search strategy was used to identify relevant literature. Data extraction included alignment to the Equally Well priority areas, research design, and indication of co-design (meaningful and collaborative involvement of consumers and significant others) and recovery-oriented practice (focusing on needs and goals of a consumer's recovery journey). All included papers (n = 74) were aligned to at least one of eight Equally Well priority areas. Papers were predominately quantitative (n = 64, 86%), with the remainder mixed methods (n = 9, 9%) or qualitative (n = 4, 5%). Most papers were aligned to improving metabolic health and support to quit smoking. One study focused on nurse-led intervention designed to reduce falls. Recovery-oriented practice was evident in six papers. No paper described evidence of co-design. A research gap was identified for nurse-led intervention to reduce falls and improve dental/oral care. Relative to mental healthcare policy, there is a need for future nurse-led physical health research to be co-designed and include recovery-oriented practice. Evaluation and description of future nurse-led physical interventions should seek to report perspectives of key stakeholders as these remain relatively unknown.

[Nursing role in oral health care]. / Rôle infirmier dans les soins bucco-dentaires.

Dental care, which has long been neglected by health policies, is now an integral part of a multi-professional health system. The nurse, an essential sentinel in hospital structures, plays a key role in the patient's dental care. At the dawn of an increasingly personalized medicine, initiatives are being implemented to decompartmentalize the skills of each specialty.

Nursing strategies for COVID-19 prevention and control in a selected dental clinic.

AIM: To comprehensively introduce the prevention and control measures that we can take in dental clinics during the pandemic period of coronavirus disease 2019 (COVID-19) and provide some practical experience for the development of nursing and health policies applicable to COVID-19. BACKGROUND: The outbreak of COVID-19 has placed the global health system under threat, which seriously influences the normal operations of human society. Safe and effective nursing measures should be taken to ensure the normal operation of dental clinics. SOURCES OF EVIDENCE: We searched and referenced many references on the PubMed database. Through the combination of related literatures and our experience, we describe various strategies, including personnel management, personal protection, disinfection and isolation, adopted in the dental clinic of our Chinese hospital during the pandemic of COVID-19. DISCUSSION/CONCLUSIONS: We introduced strategies for the nursing staff in dental clinics to assist them with the prevention and control of COVID-19. The successful implementation of the protective measures could ensure the safety of medical staff and patients, and contributed to the normal operation of dental clinics during the pandemic period. CONCLUSIONS FOR NURSING AND HEALTH POLICY: During the pandemic, frontline nurses are under physical and mental pressure facing the threat of infection while at work. In addition to pandemic prevention, we should also pay attention to the needs of nursing staff. More reasonable and effective nursing and health policies should be formulated to ensure their safety and protect their rights and interests. This is the only way that the prevention and control of COVID-19 can be achieved, and we can prepare for future public health events.

Leadership in healthcare education.

Effective leadership is a complex and highly valued component of healthcare education, increasingly recognised as essential to the delivery of high standards of education, research and clinical practice. To meet the needs of healthcare in the twenty-first century, competent leaders will be increasingly important across all health professions, including allied health, nursing, pharmacy, dentistry, and medicine. Consequently, incorporation of leadership training and development should be part of all health professional curricula. A new type of leader is emerging: one who role models the balance between autonomy and accountability, emphasises teamwork, and focuses on improving patient outcomes. Healthcare education leaders are required to work effectively and collaboratively across discipline and organisational boundaries, where titles are not always linked to leadership roles. This paper briefly considers the current theories of leadership, and explores leadership skills and roles within the context of healthcare education.

[Cost-Effective, Easy-to-Implement, but Still-Neglected Oral Hygiene].

In rapidly aging societies, it is commonly found that the limited number of remaining teeth in elders results in chewing difficulties that cause health problems and malnutrition. Surprisingly, even the latest high-tech oral medical care achieves health maintenance results that are inferior to those regularly achieved by healthy natural teeth. Oral health issues are particularly serious in rural areas. The literature supports a close association between oral hygiene and general health. Because oral microorganisms are known to cause infections and inflammation reactions, people with poor oral hygiene often have high incidences of periodontal disease and tooth loss and an even higher prevalence of cardiometabolic-related chronic diseases, poorer life quality, and higher mortality than their peers with better oral hygiene (Ma et al., 2017; Tsai et al., 2015; World Health Organization, 2018). Although promoting oral hygiene may be done on a minimal budget and with high efficacy, many people retain improper oral-hygiene concepts and behaviors. For instance, many do not recognize the relationship between real teeth and general health, brush their teeth for inadequate durations, and/or apply improper methods. Furthermore, many do not make use of the regular dental cleaning resources available through the National Health Insurance program, leading to poor oral hygiene care outcomes such as tooth decay in school-age children, periodontal disease and tooth loss in adulthood, and the current average of fewer than 20 real teeth in adults 65~80 years of age. All of these poor oral-hygiene realities lead to Taiwan falling far short of WHO oral-health-related goals. Based on the perspective of prevention and health promotion, this column presents the important role of the nursing profession in improving the quality of oral hygiene care through the three critical phases of life: school age, active adulthood, and elderly adulthood. We look to advance national oral hygiene in Taiwan to a standard exceeding that of the World Health Organization in order to demonstrate the practical benefit of Taiwan's two-decade-long National Health Insurance system.

Perceptions of older people's oral health care among nurses working in geriatric home care.

OBJECTIVES: This study investigates nurses' self-reported experiences and perceptions of older people's oral health care using a qualitative method. METHODS: We interviewed 10 nurses working in geriatric home care who regularly visit and take care of older people in their homes. The interviews consisted of semi-structured questions. The interviews were then transcribed and analysed. RESULTS: All nurses were aware of the connection between oral health and general health, but more detailed knowledge about oral health was lacking and confidence in oral health care practices was limited. Many of the interviewees noted the cleaning of removable dentures and problems related to them, but did not mention anything about periodontal diseases. Oral health education among the nurses was rare. The nurses reported lack of time to take care of their clients' oral health. As possible development steps, the interviewees suggested that including oral health care in the daily treatment plan would improve oral health care practices. CONCLUSIONS: The nurses' lack of knowledge about oral health care and uncertainty in oral health practices among older people are major problems in daily geriatric home care. Oral health education and confidence in oral health practices should be improved in both basic and on-the-job education.

Nursing Case Management Strategies for Adults with Serious Mental Illness Seeking Dental Services.

A university-community partnership initiated a dental screening and nursing case management program for Medicaid-insured adults with serious mental illness (SMI). Forty-three adults with SMI participated in dental screening; 72% participated in case management. Per client, an average of six case management contacts was made. After 6 months, 87% (27/31) had attended at least one dental appointment, with a 13% no-show rate; 8 completed treatment, 4 had ongoing treatment, 12 had interrupted care, and 3 were lost to follow-up. Adults with SMI experienced high unmet dental needs; nursing case management strategies aided clients to initiate and complete dental care.

Scars: impact and management, with a focus on topical silicone-based treatments.

Many people are living with scars caused by surgery or traumatic injury. Scar prevention in the early stages of wound healing is an essential aspect of care. Ongoing scar management is generally by self-care, using non-invasive methods such as silicone sheeting and/or massage. Silicone is considered to be the first-line non-invasive, prophylactic and therapeutic measure for scar management. Nurses have a role in supporting patients with self-care of their scars as well as providing psychological support, as the impact of a scar and effect of quality of life can be significant.

Oral Healthcare and Cardiovascular Disease: A Scoping Review of Current Strategies and Implications for Nurses.

BACKGROUND: There is epidemiological evidence showing an association between periodontal disease and cardiovascular disease (CVD). Despite this evidence* no comprehensive review has been undertaken to identify strategies to improve the oral health of people with CVD. OBJECTIVES: The aim of this review is to identify current evidence relating to the oral healthcare and management of patients with CVD. METHODS: A scoping review was undertaken focusing on 4 key areas, namely, the impact of periodontal treatment on CVD, current recommendations regarding oral health and CVD, the role of nurses in promoting oral health, and available resources to support them. Databases were searched using a combination of keywords and search terms and 34 articles were selected. RESULTS: Systematic reviews suggest that periodontal treatment may improve CVD outcomes by reducing systemic inflammation and improving endothelial function. However, there is insufficient evidence to confirm or refute these findings. International guidelines recognize the link between periodontal disease and CVD and recommend preventative strategies in this area. Non-oral health professionals, including nurses, can promote oral health and have been undertaking this role in areas like aged care and pregnancy. However, this aspect of nursing care has not been explored in the cardiac setting and no relevant training and assessment tools are available. CONCLUSIONS: Maintaining oral health among cardiovascular patients is important, yet it appears to be neglected during cardiac care. Cardiac nurses are in an excellent position to promote oral health but further research is required to define their role and develop supporting resources.

Integrated oral health care for stroke patients - a scoping review.

AIMS AND OBJECTIVES: To identify current evidence on the role of nurses and allied health professionals in the oral health management of stroke patients, detailing their current knowledge, attitudes and practices and the potential benefits of an integrated oral care programme. BACKGROUND: Stroke has disabling oral health effects, such as dysphagia and hindered brushing due to upper limb hemiparesis. Together, these can increase bacterial load, increasing risk of pneumonia. In general management of stroke, nurses play a key role in early identification, assessment and referral, while occupational therapists, dieticians and speech pathologists are important in rehabilitation. While this should logically apply to the oral care of stroke patients, there is currently limited information, especially in Australia. DESIGN: Scoping review. METHOD: A literature search was conducted using multiple databases regarding the oral health management of stroke patients by nondental professionals, and 26 articles were reviewed. RESULTS: The Australian National Clinical Guidelines for Stroke accentuate the need for oral care following stroke and suggest how hospital staff need to be involved. Currently, there are no Australian studies. However, international literature suggests that lack of oral health knowledge by nurses and poor patient attitude are reflected in infrequent assistance with stroke patient oral hygiene. There is limited information regarding the benefits of nursing-driven oral hygiene programme in reducing pneumonia incidence, and only few studies show that involving nurses in assisted oral care reduces plaque. There are some suggestions that involving nurses and speech pathologists in oral rehabilitation can improve dysphagia outcomes. CONCLUSION: Managing oral health poststroke is vital, and there is a need for an appropriate integrated oral care service in Australia. RELEVANCE TO CLINICAL PRACTICE: Nondental professionals, especially nurses, can play a key role in the poststroke oral health management of stroke patients to reduce complications, especially pneumonia.

Determination of nurses' mental workloads using subjective methods.

AIMS AND OBJECTIVES: To adapt the National Aeronautics and Space Administration Task Load Index scale into Turkish, to determine the nurses' mental workload using subjective methods and to identify the factors affecting the mental workloads of nurses. BACKGROUND: As the concept of safety gains prominence in healthcare services, the determination of employees' mental workloads using subjective methods is considered important in preventing errors caused by employees. DESIGN: Methodological and descriptive design. METHODS: The population of the study consisted of a total of 1900 nurses working at three hospitals and a dentistry faculty hospital affiliated with a public university in Istanbul. The sample of the study consisted of 1266 nurses who agreed to participate in the study (the rate of return was 66·6%). Language and content validity and reliability measurements were performed to adapt the National Aeronautics and Space Administration Task Load Index into Turkish, which was used as the data collection tool. RESULTS: It was found that the mean total mental workload score of the nurses was 80·48 (SD 11·76), and the weighted score of mental workload was 83·7. While the highest mean score was obtained on the subscale of mental demand (88·08, SD 16·12), the lowest mean score was obtained on the subscale of frustration (54·52, SD 29·96). The mean total mental workload score of the nurses showed a significant difference according to the units in which the nurses worked. CONCLUSION: The mean mental workload scores of nurses working at hospitals within the scope of the study were higher than the results of other studies. RELEVANCE TO CLINICAL PRACTICE: It is recommended that nurse managers perform mental workload measurements of nurses and compare the results with the quality indicators observed in units to determine and employ a labour force that is qualified for the profession and that may benefit more effectively from human resources.

Oral care for intubated patients: a survey of intensive care unit nurses.

AIMS: This study aimed to determine attitudes and practices of intensive care unit (ICU) nurses towards provision of oral care for intubated patients. BACKGROUND: Oral care is as an essential nursing intervention for intubated patients to maintain patient comfort and prevent colonization of dental plaque by respiratory pathogens. DESIGN: This was a cross-sectional study. METHODS: Data were collected from 93 ICU nurses of a teaching hospital in the East Coast of Peninsular Malaysia using a self-administered questionnaire. RESULTS: Some nurses agreed that oral cavity of intubated patients was difficult (40·8%) and unpleasant (16·2%) to clean, but all of them realized the importance of oral care and the majority (97·9%) would like to learn more about it. Most nurses reported providing oral care at least two times daily using various methods and products such as suction toothbrush (90·4%), manual toothbrush (49·5%), cotton swab (91·5%) and foam swab (65·7%). Chlorhexidine gluconate oral rinse was the preferred mouthwash (97·8%) and swabs (93·5%) solution although few used non-optimal products such as sodium bicarbonate (14·0%), tap water (4·3%) and hydrogen peroxide (3·2%) to wash their patients' mouths. While the majority of nurses agreed that oral care supplies and equipments were available (93·6%) and suitable (88·2%), most of them also thought they need better hospital support (88·2%). CONCLUSIONS: The nurses' attitudes towards oral care were generally positive and most oral care methods were appropriate. However, some methods and products used were inconsistent with the current recommendations and they have mixed views about the suitability of oral care supplies and equipment provided by the hospital. RELEVANCE TO CLINICAL PRACTICE: Recommendations were made for providing standard oral care protocols for intubated patients and oral care training programs for ICU nurses to support delivery of quality patient care.

Oral Health Status of Older Adults in Sweden Receiving Elder Care: Findings From Nursing Assessments.

BACKGROUND: Frail elderly people often have poor oral hygiene, contributing to oral health problems that can detract significantly from quality of life. OBJECTIVE: The aim of this study was to describe oral health status of frail elderly individuals using the Revised Oral Assessment Guide-Jönköping (ROAG-J), a mouth assessment instrument that can be used in daily nursing care. METHODS: Data were obtained from the Swedish Senior Alert quality registry in one Swedish municipality. ROAG-J assessments on admission to elder care and one subsequent occasion were used. ROAG-J measurements documented oral health in nine areas: voice, lips, oral mucosa, tongue, gums, teeth, saliva, swallowing, and presence of any prostheses or implants. Assessments were made by nursing staff during the course of daily nursing care. RESULTS: Individuals 65 years of age or older and receiving elder care services (N = 667) were involved; 1,904 assessments made between November 2011 and March 2014 were used for the analysis. On the basis of both assessments, less than one third of participants had oral health problems. No significant difference in any of the oral health variables was found between first and subsequent assessments. At first assessment, men and women differed in tongue health (p < .01); at the subsequent assessment, gender differences in voice (p < .05), mucous membranes (p < .003), tongue (p < .01), and saliva (p < .006) were observed. DISCUSSION: Most participants had good oral health. Assessments made by nursing staff using the ROAG-J demonstrate that this tool can be used in daily nursing care, where different, important oral conditions may be encountered. However, knowledge about oral health conditions and the ROAG-J instrument is important to ensure high validity. The ROAG-J enables nursing staff to detect problems in the mouth and to guide decisions related to oral health interventions.

Finding Common Ground: Interprofessional Collaborative Practice Competencies in Patient-Centered Medical Homes.

The patient-centered medical home model is predicated on interprofessional collaborative practice and team-based care. While information on the roles of various providers is increasingly woven into the literature, the competencies of those providers have been generally profession-specific. In 2011, the Interprofessional Education Collaborative comprising the American Association of Colleges of Nursing, the American Association of Colleges of Osteopathic Medicine, the American Association of Colleges of Pharmacy, the American Dental Education Association, the Association of American Medical Colleges, and the Association of Schools of Public Health sponsored an expert panel of their members to identify and develop 4 domains of core competencies needed for a successful interprofessional collaborative practice: (1) Values/Ethics for Interprofessional Practice; (2) Roles/Responsibilities; (3) Interprofessional Communication; and (4) Teams and Teamwork. Their findings and recommendations were recorded in their Core Competencies for Interprofessional Collaborative Practice: Report of an Expert Panel. This article explores these 4 domains and how they provide common ground for team-based care within the context of the medical home model approach to patient-centered primary care.

Childhood constipation: recognition, management and the role of the nurse.

Constipation is a common childhood condition that health professionals will encounter in many different settings. The majority of these cases of childhood constipation are idiopathic in nature. It is considered to exhibit the 'tip of the iceberg' phenomenon as a large number of cases remain undetected due to under-recognition by families, embarrassment regarding the condition, fear of receiving a negative response from health professionals, or parental belief there is actually something more seriously wrong and failure to accept the diagnosis. Prompt evaluation and management is likely to be associated with better outcomes. To ensure this, fast recognition of symptoms, with care taken to exclude any 'red flag' symptoms that could indicate an organic cause and subsequently a different treatment pathway, is essential. Nurses, given their regular contact with families in different settings, are suitably placed to detect these symptoms early and can play a vital role in successful management of the condition. Laxatives are the first line in management of constipation. Polyethylene glycol 3350 is the laxative that evidence-based guidelines from the National Institute for Health and Care Excellence (2010) recommend as the initial pharmacological management. Advice should also be given about supportive measures, including diet and lifestyle changes.

The role of nurses and dietitians in managing paediatric coeliac disease.

Coeliac disease (CD) is an immune-mediated genetic condition elicited by the ingestion of gluten, leading to proximal small bowel enteropathy. It affects around 1% of the population, although only a small proportion of cases are actually diagnosed. It is a multisystem disorder presenting with both gastrointestinal and extra-intestinal manifestations such as diarrhoea, abdominal pain, constipation, vomiting, iron deficiency anaemia, faltering growth, dental enamel defects, short stature, liver disease, arthropathy and recurrent aphthous ulcers. Nurses, working in different clinical settings, are best placed for early recognition and diagnosis of CD in children. Suspicion of CD should lead to immunoglobulin A (IgA)-based anti-tissue transglutaminase antibody screening tests and a diagnosis confirmed by an intestinal biopsy. Modification of European (ESPGHAN) guidelines now enables CD to be diagnosed without a small-bowel biopsy in a select group of symptomatic children. A gluten-free diet should preferably be started by paediatric dietitians. Strict adherence to a gluten-free diet is essential to maintain good health and to prevent long-term complications. A case study demonstrating some of the challenges that may be faced in children with CD in clinical practice is described. Specialist nurse-led CD clinics are gaining popularity and have been found to be equally effective in providing continuity of quality care.

Oral Health and the Nurse's Role in Québec / La santé buccodentaire : quel rôle pour l'infirmière au Québec ?

Various international health care organizations strongly recommend the implication of non-dental health care professionals in oral health. Consequently, nurses are currently often required to question their ability to manage patients' oral health-related problems, as well as the very meaning of their management of patients in such situations. The purpose of this paper is to draw attention to the role of the nurse in the management of oral health. Professional associations and academic institutions involved in the development of nursing professional skills, and health policymakers involved in decisions concerning the geographical distribution of nursing personnel and adoption of laws in Quebec, act in a disconnected manner, independently from dental professionals and without taking into account the actual oral health care needs of the various categories of beneficiaries.The ever-growing elderly population, in a context of limited financial resources and other austerity measures, have contributed over time to diminishing access to oral health services, especially for vulnerable populations. Care orientation is fundamental to the nurse-patient relationship and nurses encounter many difficulties in addressing patients' oral health-related needs, leading to various ethical and deontological implications. In the multidisciplinary environment of the health care system, it is therefore necessary to support nurses in their clarification of their contemporary role in the oral health of their patients.

[Nursing Management of the Patient Suffering from Xerostomia]. / Manejo enfermero del paciente con xerostomía.

The oral health is a fundamental component of the health of the people, being its care a vital aspect of nursing. A frequent and unknown oral health problem is xerostomia, a condition that affects between 10% and 38% of the population and which is defined as the subjective experience of dry mouth. With this article we are looking forward to learn the difference based on evidence-interventions that as nurses we can perform in the care of the patient suffering from xersotomia. The management of xerostomia is based in the diagnosis, monitoring and treatment of the disease, using diverse farmalogical and no farmalogical measures, like salivary stimulants and substitutes and cholinergic drugs. The xerostomia has a big impact in the patient, being necessary a bigger research of the subject, in which the nursing has to play a lead role.

Promoting good dental health in older people: role of the community nurse.

Good dental health enables a person to eat, speak, and socialise. It contributes to nutrition, general health, and quality of life. The dental health of people living in the UK has improved in the last 40 years, and older people are retaining their natural teeth throughout their life; nontheless, a significant proportion of people over 75 years still rely on partial and full dentures. Dental disease in all age groups is readily prevented by daily oral hygiene and adherence to a healthy diet, avoidance of smoking, and sensible alcohol intake. Some older people may simply need reminding and encouragement to carry out oral hygiene, while more dependent adults may need support and active help to do so. Nursing teams and health professionals play a key role in promoting oral health by supporting oral hygiene and adequate nutrition, preventing discomfort, and detecting dental diseases early. This article gives a brief overview of how nursing teams and health professionals can promote oral health and provides details of resources from which further detailed information may be obtained.

Methods for managing residents with dysphagia.

Nurses working in nursing homes will care for residents who have dysphagia, or difficulty swallowing, on a regular basis. Clear, evidence-based guidelines are necessary for all staff to be able to meet the needs of these residents safely and efficiently. A multidisciplinary approach is important to ensure accurate assessment, devise appropriate care and achieve specific goals. Equipment such as valved beakers, rimmed plates and non-slip mats will help maintain safety during mealtimes. Prescription items, such as fluid thickeners and anticholinergic medication, help to manage the condition and provide comfort during mealtimes and in between. Robust education and training should be in place for all nursing and care staff who care for residents with the condition.