Oral Health: supporting adults who require assistance second edition

BPGs promote consistency and excellence in clinical care, administrative policies, procedures and education, with the aim of achieving optimal health outcomes for people, communities and the health system as a whole. This BPG replaces the RNAO BPG Oral Health: Nursing Assessment and Intervention, which was released in 2008. The purpose of this BPG is to provide nurses, the interprofessional team and caregivers with evidence-based recommendations for the provision of oral care for adults (18 years of age and older) that will: promote an interprofessional approach to providing oral care, enhance the delivery of oral care interventions, and ultimately lead to positive oral healthG outcomes for persons. This BPG recognizes that a person- and familycentredG approach to care is essential for providing oral care (or providing assistance with oral care) to adults across the continuum of care. This BPG also recognizes that when providing any form of oral care, infection control practices should be followed.

Oral health knowledge, attitude and practices among nurses in a tertiary care hospital in Bangalore, India: a cross-sectional survey.

Background: Maintaining good oral health among hospitalized individuals is essential for health outcomes and quality of life. Nurses, being the primary oral care givers require adequate knowledge, attitude and practice in this area to provide effective oral health care. However, limited studies have been undertaken to evaluate this aspect of nursing care in India. Aim: To determine the knowledge, attitude and practices of nurses regarding oral care for hospitalized patients. Design: Cross-sectional survey. Methods: A total of 244 nurses working in a tertiary care hospital in Bangalore, South India were purposively recruited for this study. Data was collected using a structured questionnaire with both closed and open-ended questions about knowledge, attitude and practice regarding oral care. Results: The mean oral health knowledge score was 6.74 out of maximum score of 22. Most nurses were aware of the importance of oral care among inpatients and the effect poor oral hygiene and systemic diseases have on oral health. Deficiencies in knowledge were prevalent in areas including common medications that affect oral health and regarding care of dentures. Nurses, with higher nursing qualifications and working in departments with longer length of stay had higher attitude scores. Most nurses assessed oral health needs within 24hrs of admission. However, there were inconsistencies in the oral health assessment and care protocols followed and documentation. Conclusion: Nurses' attitude towards oral health was positive yet their knowledge in specific aspects of care was inadequate. Their oral health practices needs improvement.

Dental Pain Relief in the Age of ALTO.

The opioid public health crisis necessitates that health care providers seek alternatives to opioid pain control. For patients presenting with dental pain, a dental nerve block provides effective, long-lasting pain relief without the use of opioid pain medications. This article presents the techniques required to safely and effectively administer 3 types of dental nerve blocks, allowing the emergency nurse practitioner to provide effective pain control to patients with dental pain.

Early experience of a nurse-led clinic in a tertiary centre.

A busy head and neck or oral and maxillofacial (OMFS) National Health Service (NHS) clinic treats patients with many different conditions. A large proportion will have cancer of the head and neck, and they will be at different stages of their treatment. Their clinical needs may be different from a larger group of patients who have been referred through the "two-week wait" referral pathway, and who are present in the same clinic for their biopsy results. We present our early experience of "fast-track" referrals and their potential effect on the overall volume of work. They are only a small number of the patients who are typically seen in a nurse-led clinic.

Oral Care: Exploring Education, Attitudes, and Behaviors Among Nurses Caring for Patients With Breast Cancer
.

BACKGROUND: Patients treated for breast cancer often experience severe oral complications, such as mucositis, xerostomia, and infections, which can result in dose reductions and treatment delays, affecting treatment outcomes.
. OBJECTIVES: The purpose of this article is to explore oncology nurses' perceptions of their educational experiences, professional attitudes, and behavior related to providing oral healthcare education to patients with breast cancer.
. METHODS: The Oncology Nursing Society sent an email to 5,000 nursing team members who cared for patients with breast cancer, requesting participation in a web-based survey; 194 responses were received, with 164 meeting study eligibility.
. FINDINGS: More oral health-related education was received during clinical experiences than during formal or continuing education. Although patient-driven oral care and diagnostic efforts were frequent, actual behavior was less frequent. No major barriers to providing oral care were indicated. Increased oral health-related education and behavior correlated with the reported importance of increased oral health education for nurses.

Part 3: Impact of systemic conditions and medications on oral health.

The people who are treated in the community setting will often have multiple comorbidities. Systemic medical conditions can have a negative impact on oral health. In addition, the medications used to treat systemic conditions may also themselves cause oral symptoms. As a large proportion of patients treated by the community nursing team will be elderly, this paper will focus on common geriatric conditions that can display oral or dental symptoms. The effects of medications will be discussed and linked to oral complaints patients may express. The primary aims are to give a broad overview of the oral effects of ageing, of illness and of polypharmacy and advise on how these can be best managed by the nursing team.

Manejo enfermero del paciente con xerostomía / Nursing management of the patient from xerostomia

La salud oral es un componente fundamental de la salud de las personas, siendo el cuidado de la boca un aspecto vital de la enfermería. Un problema de salud oral frecuente y desconocido es la xerostomía, una condición que afecta a entre el 10 % y el 38 % de la población y se define como la sensación subjetiva de boca seca. Con este artículo se busca conocer las distintas intervenciones basadas en la evidencia que como profesionales de enfermería podemos efectuar en el cuidado del paciente que sufre xerostomía. El manejo de la misma se basa en el diagnóstico, seguimiento y tratamiento de la enfermedad, mediante el empleo de diversas medidas farmacológicas y no farmacológicas, como son los estimulantes y sustitutos de la saliva y los fármacos con efecto colinérgicos. La xerostomía tiene un gran impacto en la persona que la sufre, siendo aún necesario mayor investigación, en la que la enfermería ha de jugar un papel protagonista (AU)

The oral healh 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 subjetive experience of dry mouth. With this article we are looking forward to learn the different 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 colinergic drugs. The xerostomia has a big impact in the pacient, being necessary a bigger research of the subject, in which the nursing has to play a lead role (AU)

Dental Procedures.

Dental problems are a common complaint in emergency departments in the United States. There are a wide variety of dental issues addressed in emergency department visits such as dental caries, loose teeth, dental trauma, gingival infections, and dry socket syndrome. Review of the most common dental blocks and dental procedures will allow the practitioner the opportunity to make the patient more comfortable and reduce the amount of analgesia the patient will need upon discharge. Familiarity with the dental equipment, tooth, and mouth anatomy will help prepare the practitioner for to perform these dental procedures.

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.

Review of therapies for the treatment of oral chronic graft-versus-host disease.

Oral chronic graft-versus-host disease is a frequent complication of allogeneic hematopoietic stem cell transplantation, contributing to patient morbidity and mortality. Although an optimal treatment is not available, several systemic and topical or local therapies have shown efficacy in treating the disease. New therapies are being tested through clinical trials. This article examines the efficacy and safety of reported treatment modalities studied from 2006-2012. Nurses will encounter patients with oral chronic graft-versus-host disease suffering from pain, discomfort, and a decreased quality of life. Knowledge of new therapies found to be effective in managing these symptoms is imperative. Nurses play a key role in the assessment and management of this complex oral disease.

Oral health assessment and mouth care for children and young people receiving palliative care. Part two.

This is the second part of a two-part article on oral health assessment and mouth care for children and young people receiving palliative care. This article covers basic oral hygiene and management of oral health problems: oral candidiasis, coated tongue/dirty mouth, dry mouth, hypersalivation, ulceration, painful mouth, stomatitis and mucositis. The article also covers treating patients who are immunocompromised and the need to educate families and carers in the basic principles of oral care, including the importance of preventing cross-infection. Part one outlined oral assessment and discussed the adaptation of the Nottingham Oral Health Assessment Tool (Freer 2000).

A concept analysis of oral hygiene care in dependent older adults.

AIM: To report a concept analysis of oral hygiene care. BACKGROUND: Oral hygiene care, as it is provided to older patients in hospital and long-term care settings by nurses and their delegates, has the potential to contribute to the oral health of patients while preventing aspiration pneumonia as well as periodontitis, which itself has been associated with several systemic diseases. However, the state of oral cleanliness in such patients tends to be poor and despite the existence of guidelines, nursing care practices may be inadequate and not reflective of recent advances in knowledge. DESIGN: Concept analysis. DATA SOURCES: A search of electronic databases (2002-2012), use of internet search engines, and hand searching yielded an international data set of 66 research studies, reviews, and practice guidelines. REVIEW METHODS: The concept analysis method of Walker and Avant was used to explore the concept of oral hygiene care in the context of frail older patients. RESULTS: Oral hygiene care involves approaches informed by knowing the patient, inspecting the oral cavity, removing plaque, cleansing the oral tissues, decontaminating the oral cavity, using fluoride products and maintaining oral tissue moisture. Those attributes, along with their antecedents and consequences, form a conceptual framework from which a middle-range theory of nurse-administered oral hygiene care is derived that could be tested, evaluated, modified, and translated into practice. CONCLUSIONS: Clarity around the concept of oral hygiene care as a nursing intervention could enable nurses to impact oral health outcomes and possibly prevent systemic diseases in older patients.

Oral health perceptions of paediatric palliative care nursing staff.

Systematic oral care reduces oral complications among children in paediatric palliative care (PPC), yet little is known about the oral health perceptions of PPC nursing staff. This qualitative cross-sectional study used semi-structured interviews based on phenomenography to explore PPC nursing staff's perceptions of oral health and the relationship of oral care to comfort and quality of life. A purposive sample of nine nursing staff employed at a California PPC facility participated. Five themes emerged from the analysis of the interviews: signs of oral health, reasons for oral care, adaptation of oral care on a case-by-case basis, barriers to providing oral care, and facilitators of improving oral care. The perceived importance of oral health was the underlining similarity between the themes. A need for further research in the area of oral PPC is indicated. Collaboration with dental professionals may be needed to create oral PPC guidelines that fit the complex needs of children with life-limiting illnesses.

Effects of a standard versus comprehensive oral care protocol among intubated neuroscience ICU patients: results of a randomized controlled trial.

The purpose of the study was to compare changes in oral health during intubation until 48 hours after extubation in neuroscience intensive care unit (ICU) patients enrolled in a standard or a comprehensive oral care protocol. The effects of manual toothbrushing (standard group, n = 31) were compared with those of tongue scraping, electric toothbrushing, and moisturizing (comprehensive group, n = 25) in intubated patients in a neuroscience ICU in a 2-year randomized clinical trial. Oral health was evaluated based on the Oral Assessment Guide (OAG) on enrollment, the day of extubation, and 48 hours after extubation. There were no significant differences in the frequency of the oral care protocol. Protocol compliance exceeded 91% in both groups. The total OAG score and all eight categories significantly deteriorated (Friedman test, p < .001, Bonferroni corrected) in the standard oral care group and did not return to baseline after extubation. Large effect sizes were present at all three points in this group. The total OAG score deteriorated during intubation within the comprehensive protocol group (Friedman test, p < .004) but returned to baseline status after extubation. In four categories, the ratings on tongue, mucous membranes, gingiva, and teeth did not deteriorate significantly over time. Published oral care protocols are substandard in promoting and maintaining oral health in intubated patients. A comprehensive oral care protocol, using a tongue scraper, an electrical toothbrush, and pharmacological moisturizers, was more effective for oral hygiene throughout intubation and after extubation than manual toothbrushing alone.

Oral health of psychiatric patients: the nurse's perspective.

OBJECTIVE: To assess nurses' perspectives on character, prevalence and cause of oral diseases among psychiatric patients and also their approach and suggestions in relation to the care of oral problems. MATERIALS AND METHODS: A questionnaire-based cross-sectional survey of all cadres of nurses (n = 136) at the Federal Psychiatric Hospital, Benin City, Nigeria, was conducted between December 2010 and January 2011. RESULTS: Two-thirds (67.6%) of the respondents reported that psychiatric in-patients in comparison with the general population have a higher occurrence of oral and dental problems. Commonly cited reasons for the poor oral health of patients included as follows: sedation for long periods, lack of care by family, psychopathological symptoms, poor access to dentists and lack of oral hygiene advice. The common oral health complaints received by the respondents included toothache, pain from the gums and inability to open the mouth. Majority (91.4%) of respondents claimed to be presently involved with oral care of psychiatric in-patients but oral care delivery is however bedevilled with lot of barriers like uncooperativeness of patients and lack of oral care materials. CONCLUSION: Oral complaints received are frequent and numerate with limited palliative action rendered. Attaching dentists to psychiatric hospitals and regular training of psychiatric nurses on oral care delivery are recommended to comprehensively cater for the oral health problems of psychiatric in-patients.

Oral care practices among critical care nurses in Singapore: a questionnaire survey.

BACKGROUND: Oral hygiene has an important role in maintaining the health and well-being of critically ill patients. Although a number of studies have examined nurses' oral hygiene practices, few were conducted among nurses caring for critically ill patients or involved Asian nurses. OBJECTIVES: The study aims to assess local nurses' knowledge, attitudes, and practices regarding oral care for critically ill patients. METHODS: A descriptive cross-sectional design was used. We developed a 31-item questionnaire based on the literature, existing questionnaires, and focus group discussion. The tool covers three domains: beliefs and attitudes, prevailing practices, and knowledge. We sampled all nurses who worked in five intensive care units and high dependency during a 2-week period. We summarized data using descriptive statistics and explored the association between the nurses' knowledge of oral practices and ward specialty, job function, nurses' education level, and work shift. We used exploratory factor analysis to investigate factorial validity of the beliefs and attitudes domain. RESULTS: A total of 244 nurses (97%) returned the surveys. More than 80% of the respondents believed that good oral care has a significant impact on the patients' clinical outcomes. However, practices varied with regard to the frequency, requisites, and methods used for oral care. Only 66.3% perceived that they have adequate oral care training. Nurses' oral health knowledge varied with education level (p = .019). Nurses' knowledge did not differ statistically across different specialities, job functions, and type of shift work. Factor analysis on the beliefs and attitudes domain revealed three factors, which we labeled as task efficacy, knowledge need, and task salience. CONCLUSIONS: The survey provided useful insights on the oral hygiene knowledge and practices of nurses caring for critically ill patients. The findings indicated that local nurses lacked adequate knowledge related to oral health and generally were ill equipped to deliver proper oral hygiene for critically ill patients. The large majority of the nurses' oral care knowledge was learned during their basic nursing education. This knowledge is inadequate to prepare them for the challenge of caring for the oral hygiene needs of critically ill patients. The results emphasized the need for continuing training in this area.

Raising oral health awareness among nephrology nurses.

PURPOSE: The complexity of care for patients with chronic kidney disease (CKD) reinforces the need for collaboration between health care providers. The purpose of this study was to raise oral health awareness by providing educational seminars to health care providers, specifically nephrology nurses. METHODS: Educational seminars entitled "Oral Health and Chronic Kidney Disease" were delivered by calibrated dental hygiene educators to nurses in 3 different regions in the United States. The nurse participants (n=106) were given randomly assigned pre- and post-tests, assessing their knowledge of oral health and its relation to CKD. RESULTS: Pre-tests revealed that nurses had little knowledge of oral health and its relation to CKD. Regardless of questionnaire order, a significant increase of knowledge was observed for both groups (p-value ≤ 0.015), increasing from 61 to 76% on average. CONCLUSION: Incorporating interdisciplinary education increases nurses' knowledge and may lead to greater quality of life outcomes and improved overall health in patients with CKD.