Are the barriers to good oral hygiene in nursing homes within the nurses or the patients?

OBJECTIVE To explore nursing home patients' oral hygiene and their nurses' assessments of barriers to improvement. BACKGROUND In nursing homes, nurses are responsible for patients' oral hygiene. MATERIALS AND METHODS This study assessed the oral hygiene of 358 patients in 11 Norwegian nursing homes. 494 nurses in the same nursing homes participated in a questionnaire study. RESULTS More than 40% of patients had unacceptable oral hygiene. 'More than 10 teeth' gave OR = 2, 1 (p = 0.013) and 'resist being helped' OR = 2.5 (p = 0.018) for unacceptable oral hygiene. Eighty percent of the nurses believed knowledge of oral health was important, and 9.1% often considered taking care of patients' teeth unpleasant. Half of the nurses reported lack of time to give regular oral care, and 97% experienced resistant behaviour in patients. Resistant behaviour often left oral care undone. Twenty-one percent of the nurses had considered making legal decisions about use of force or restraints to overcome resistance to teeth cleaning. CONCLUSION Oral hygiene in the nursing homes needed to be improved. Resistant behaviour is a major barrier. To overcome this barrier nurses' education, organisational strategies to provide more time for oral care, and coping with resistant behaviour in patients are important factors.

[1]  T. Willumsen,et al.  Oral health in institutionalised elderly people in Oslo, Norway and its relationship with dependence and cognitive impairment. , 2012, Gerodontology.

[2]  J. Hoogstraate,et al.  An evidence-based oral hygiene education program for nursing staff. , 2011, Nurse education in practice.

[3]  M. Iversen,et al.  Oral care training in the basic education of care professionals. , 2009, Gerodontology.

[4]  B. Fridlund,et al.  Nursing staff's understanding of oral health care for patients with cancer diagnoses: an intervention study. , 2008, Journal of clinical nursing.

[5]  K. Engedal,et al.  Quality of care in Norwegian nursing homes--deficiencies and their correlates. , 2008, Scandinavian journal of caring sciences.

[6]  Marianne Forsell,et al.  A Systematic Review of the Preventive Effect of Oral Hygiene on Pneumonia and Respiratory Tract Infection in Elderly People in Hospitals and Nursing Homes: Effect Estimates and Methodological Quality of Randomized Controlled Trials , 2008, Journal of the American Geriatrics Society.

[7]  P. Petersen,et al.  Oral health, general health, and quality of life in older people. , 2008, Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry.

[8]  J. Drummond.  Summary of: Care home staff knowledge of oral care compared to best practice: a West of Scotland pilot study , 2008, BDJ.

[9]  J. A. Thomson,et al.  Care home staff knowledge of oral care compared to best practice: a West of Scotland pilot study , 2008, BDJ.

[10]  E. Stoopler,et al.  Reducing the risk of aspiration pneumonia among elderly patients in long-term care facilities through oral health interventions. , 2008, Journal of the American Medical Directors Association.

[11]  I. Wårdh,et al.  'Oral health is not my department'. Perceptions of elderly patients' oral health by general medical practitioners in primary health care centres: a qualitative interview study. , 2007, Scandinavian journal of caring sciences.

[12]  K. Okuda,et al.  Oral hygiene evaluation for effective oral care in preventing pneumonia in dentate elderly. , 2006, Archives of gerontology and geriatrics.

[13]  K. Engedal,et al.  The quality of care in Norwegian nursing homes. , 2006, Scandinavian journal of caring sciences.

[14]  J. Meurman,et al.  Oral health and morbidity--implications of oral infections on the elderly. , 2006, Gerodontology.

[15]  N. Watson,et al.  Oral Care Provided by Certified Nursing Assistants in Nursing Homes , 2006, Journal of the American Geriatrics Society.

[16]  A. Pearson,et al.  Oral hygiene care for residents with dementia: a literature review. , 2005, Journal of advanced nursing.

[17]  J. Meurman,et al.  Oral infections as predictors of mortality. , 2005, Gerodontology.

[18]  M. J. Grap,et al.  The Role of Biobehavioral, Environmental, and Social Forces on Oral Health Disparities in Frail and Functionally Dependent Nursing Home Elders , 2005, Biological research for nursing.

[19]  P. Petersen,et al.  Improving the oral health of older people: the approach of the WHO Global Oral Health Programme. , 2005, Community dentistry and oral epidemiology.

[20]  G. Ljunggren,et al.  Oral status, cognitive and functional capacity versus oral treatment need in nursing home residents: a comparison between assessments by dental and ward staff. , 2002, Oral diseases.

[21]  J. Cohen-Mansfield,et al.  The underdetection of pain of dental etiology in persons with dementia , 2002, American journal of Alzheimer's disease and other dementias.

[22]  R. Newcombe,et al.  Improving oral health in institutionalised elderly people by educating caregivers: a randomised controlled trial. , 2001, Community dentistry and oral epidemiology.

[23]  T. Axéll,et al.  Evaluation of a mucosal-plaque index (MPS) designed to assess oral care in groups of elderly. , 1999, Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry.

[24]  B. Fridlund,et al.  Evaluation of an oral health education program for nursing personnel in special housing facilities for the elderly. , 1998, Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry.

[25]  R. Longhurst.  A cross-sectional study of the oral healthcare instruction given to nurses during their basic training , 1998, British Dental Journal.

[26]  L. Andersson,et al.  Staff attitudes to oral health care. A comparative study of registered nurses, nursing assistants and home care aides. , 1997, Gerodontology.

[27]  H. Howarth.  Mouth care procedures for the very ill. , 1977, Nursing times.