Health Care Assistants’ Experiences of Oral Hygiene Care in Elderly Residents.

Bríd McCarthy RGN, BNS, MSc.

What the literature says…

• Three main themes emerged…….

Theme 1

• Prevalence of poor oral hygiene in elderly residents.– More visible care needs are often given priority over

oral hygiene care (Leg 2012).– Of personal hygiene needs in elderly residents oral care

is the most neglected (Sloane et al 2013, Braun-Wimmer & Ruiz-Skol 2012).

– Age is not a risk factor for tooth loss (Griffin et al 2012).– Edentulousness (toothlessness) is diminishing in the

elderly population (Sonde et al 2011).

Theme 2

• Interventions to improve oral hygiene care.– Educational approaches may impact positively on

improving oral health in elderly – unclear which approach most effective (Coker et al 2014).

– Non pharmacological interventions should be considered to reduce responsive behaviours (Konno et al 2014).

– Lack of equipment is a barrier to carrying out oral hygiene care (Sonde et al 2011).

Theme 3

• Experiences of H.C.A.s carrying out oral hygiene care.– The main providers of oral hygiene care are Health Care

Assistants (Pyle 1999).– A relationship exists between the personal appearance of

carers and the oral hygiene habits of patients (Limeres et al 2014).

– Carers’ attitudes toward oral hygiene are influenced by their own experiences (Frenkel 1999).

– Ethical dilemmas persist on how to overcome responsive behaviours without violation or abuse (Wardh et al 2000).

Methodology

• Qualitative approach taken in order to explore understandings and motivations that prompts behaviour (Procter, 1999).

• Purposive sampling allowing researcher observe and interview people with experience of the topic.

• 12 semi structured interviews with HCAs in two different elderly care facilities (pilot interview also undertaken).

• Ethical considerations.• Data analysed using Thomas’s (2006) general inductive

approach.

Findings – Theme 1

• H.C.A.s’ experiences of oral health care.– Motivation of Staff

• “.. therefore they rely on the staff to help them”.

– Personal Value of Oral Hygiene• “I feel like I need to brush my teeth so I’d have the same feelins as who

I’m carin for”.

– Who is responsible for care• ”We work as a team over there like”.• “As far as I know it’s the Care Assistant’s role as such”.

– Benefit of good oral hygiene care / Risks of poor oral hygiene care.• “If you’re not lookin into the mouth you don’t know what’s in it!”.• “.. that they’re in pain and they can’t tell us”.

Findings – Theme 2• Prevalence of oral hygiene care..

– Frequency of Care Provided• “It’s part of the daily routine”• “.. But not night time, no it wouldn’t be done as much”.

– Barriers to providing care• “Well I mean challengin behaviour would be one of them”.• “Now sometimes you don’t get enough time to be honest. You don’t”.• “Not everyone can stand mouths”.• “Anything else I can handle.. It’s just the whole false teeth thing”.

– Equipment and technique used.• “once they have the tools, toothbrush, the beaker..”• “.. get the lollipop and just try and rub it along the lips”.

– Personal dental care.• “like we’ve more people going out to the dentist now”.

Findings – Theme 3

• Interventions to improve oral hygiene care..– Strategies used to reduce responsive behaviour

• “Approach it quietly or leave it and come back to them”.• “Just work with them”.• “The nurse was in the bad books for some reason. I don’t know

..it wasn’t her fault, so I was even the only one that could shave him, you know so play it by ear”.

– Autonomy of Resident• “you have to respect their wishes as well..”

– Education of Staff.• “We always have ongoing education. If you’re not sure of

anything you’d only have to ask”.

Limitations

• Sample was not randomly selected – findings less generalizable (Haber 2010).

• Participants self selected into the study – thus findings may be distorted ie. participants may have been enthusiastic about the topic.

• The topic chosen is one of interest to the researcher – this may have influenced interpretation of data during analysis resulting in researcher bias.

Recommendations• Continuing research and education in use of dementia focused

behaviour management.• Effective hands on training and education from dental hygienists for all

staff.• Acknowledment that oral hygiene care can be an unpleasant task for

some.• Clarification of responsibility and direction from clinical nurse managers.• Ongoing education and awareness of ethical rights of residents with

cognitive impairments. • Provision of adequate professional dental care and equipment in

residential facilities.• Further research using larger sample sizes to explore the experiences of

H.C.A.s of oral hygiene care in elderly residents.

References• Braun-Wimmer J.A. & Ruiz-Skol P. (2012) Impact of an oral hygiene education initiative on the

practice of oral care by unregulated care providers guided by registered nurses. Canadian Journal of Dental Hygiene 46 (4) 223-230

• Coker E., Ploeg J. & Kaasalainen S. (2014) The Effect of Programs to Improve Oral Hygiene Outcomes for Older Residents in Long-Term Care. Research in Gerontological Nursing 7 (2) 87-100

• Frenkel H.F. (1999) Behind the screens: Care staff observations on delivery of oral health care in nursing homes. Gerontology 16 (2) 75-80

• Griffin S.O., Jones J.A., Brunson D., Griffin P.M. & Bailey W.D. (2012) Burden of Oral Disease Among Older Adults and Implications for Public Health Priorities. American Journal of Public Health 102(3) 411-418

• Haber J. (2010) Sampling. In Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice. 7th edn. (LoBiondo-Wood G. & Haber J., eds), Mosby Elsevier, Missouri, pp 220-245

• Konno R., Sun Kang, H. Makimoto K. (2014) A best evidence review of intervention studies for mininizing resistance-to-care behaviours for older adults with dementia in nursing homes. Journal of Advanced Nursing. 70 (10) 2167-2179

References• Leg T.L. (2012) Oral Care in Older Adults with Dementia. Journal of Gerontological Nursing 38 (8) 10-13• Limeres J., Martinez F. Jeijoo J.F., Ramos I., Linares A. & Diz P. (2014) A new indicator of the oral hygiene

habits of disabled persons: relevance of the carer’s personal appearance and interest in oral health. International Journal of Dental Hygiene. 12 (2) 121-126

• Procter S. (1999) Qualitative Research. In Nursing Research Design and Practice. (Treacy M.P. & Hyde A., eds). University College Dublin Pres, Dublin. pp27-41

• Pyle , M., Nelson, S. & Sawyer D.R. (1999) Nursing assistants’ opinions of oral health care provision. Special Care in Dentistry 19 (3) 112-117

• Sloane P.D., Zimmerman S., Chen X., Barrick A.K., Poole P., Reed D., Mitchell M. & Cohen L.W. (2013) Effect of a Person-Centred Mouth Care Intervention on Care Processes and Outcomes in Three Nursing Homes. Dental and Oral Care 61 (7) 1158-1163

• Sonde L., Emami A. Kilunen H. & Nordenram G. (2011) Care providers’ perceptions of the importance of oral care and its performance within everyday caregiving for nursing home residents with dementia. Scandinavian Journal of Caring Sciences. 25 (1) 92-99

• Thomas D.R. (2006) A General Inductive Approach for Analyzing Qualitative Evaluation Data. American Journal of Evaluation Data 27 (2) 2237-2246

• Wardh I., Hallberg L.R-M., Berggren U., Andersson L. & Sorensen S. (2000) Oral Health Care – A Low Priority in Nursing. In-depth Interviews with Nursing Staff. Scandinavian Journal of Caring Sciences 14 (2) 137-142

Thank You!