Outcomes of training personal service providers in individualized oral care plans on a neuromuscular disorders unit.
C.M. Steele, J. Wimmer, Z. Fancy, G. Lee, M. Yoon
Funder: Collaborative Research Program in Rehabilitation and Long-Term Care. Funds also requested from the Canadian Foundation for Dental Hygeine Research and Education

Poor oral hygiene amongst institutionalized seniors has been implicated as a prequel to various morbidities including pneumonia secondary to aspiration. Aggressive dental interventions have recently been shown to reduce the occurrence of morbidities in nursing care facilities. However, the literature also shows that the oral care provided by nursing staff is often suboptimal, and points to the need for face-to-face training of nursing aides in specific oral care strategies for individual patients on their caseload. This study proposes to evaluate the impact of an individualized education program for personal service providers, both on their oral care knowledge and on the oral hygiene outcomes of their patients on a neuromuscular diseases unit.

At Bridgepoint Hospital, an audit by the oral care task force and Public Health dental team in 2000 showed that a substantial number of residents fail to maintain good oral health status between dental hygiene appointments. Residents on the neuromuscular disease unit (henceforth, NMURs) are among the most seriously affected, and therefore constitute a high priority group in which to pursue initiatives to improve oral hygiene services and outcomes. This study will explore the benefits of providing patient-specific education in oral care to the personal service providers (PSPs) of NMURs. It is anticipated that the results of this project will have broad applicability to other patient groups, and will ultimately inform methods of oral care training for long-term care institutions.

Oral care in long term care settings is often neglected. However, recent literature suggests that oral care can be an effective weapon for reducing the occurrence of pneumonia secondary to inoculation of the lungs by bacteria from the teeth, gums, oral mucosa and pharynx. In addition, researchers have demonstrated a link between good oral hygiene and quality of life amongst institutionalized patients. Oral care is one of the most basic nursing skills that student nurses learn in school.

However, many studies have demonstrated that oral care is frequently poorly provided. The literature shows that untrained nursing auxiliaries deliver most of the daily oral care in long-term care facilities. These staff typically receive little formal training in dental care. It has been suggested that training selected nursing aides to be specialists in oral care, with specific attention to the individual requirements of challenging patients on their caseload, may be an effective means of promoting improved oral care in long-term care facilities. The current project proposes to promote enhanced oral care and improved oral health outcomes in a group of NMURs through a program of resident-specific education to those PSPs involved in assisting with their oral care.

This study will specifically investigate the impact of patient-specific oral care training for PSPs on four dependent variables: a) the PSP’s knowledge of oral hygiene; b) the PSP's compliance with the oral care plan; c) uptake of understanding regarding and compliance with the oral care plan by PSPs on the subsequent nursing rotation; and d) the oral hygiene status of the NMUR at 16- and 32-week intervals following the baseline dental hygiene appointment.