Oral healthcare education of future nursing personnel and auxiliary nurses Astrid E. Mehl, Øivind G. Ellingsen, Joakim Kjeksrud and Tiril Willumsen Dental Faculty, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
doi:10.1111/ger.12147 Oral healthcare education of future nursing personnel and auxiliary nurses Objective: To investigate the oral healthcare training in the education of auxiliary nurses in Norway. Background: Many elderly residents need assistance in every aspect of daily living, including help with oral care. Auxiliary nurses are the professional group who most often provide this help. Materials and methods: An e-mail administered questionnaire was sent to all 164 high schools in Norway offering basic education for auxiliary nurse. Results: Of the 114 high schools responding to the survey (69.5% response rate), 83.3% reported mandatory courses, 49.1% offered three or more hours of teaching in oral health care. 89.5% offered both lectures and practical training, 93.9% had training in tooth cleaning, 37.7% lectured about different dental restorations, 50% lectured on ergonomic working positions, 12.3% on the working lights, 16.7% on inspection techniques, 25.4% on interdental brushes and 6.1% on electrical powered toothbrushes. Additionally, 45.6% assessed that their students are prepared for later work with oral health care. More lessons led to better quality of education. Conclusion: Almost all of the high schools had mandatory education in oral care in the auxiliary nurse programme. Increasing the number of lessons may improve the quality of knowledge, but the teaching programmes for a number of topics seem insufficient. There is a need to strengthen the position of oral health in the education of auxiliary nurses. To meet the future challenges in oral health, international or national expert-developed guidelines for oral care training programmes would be useful for the education of auxiliary nurses. Keywords: dental hygiene, educational system, auxiliary nurse, gerodontology. Accepted 1 August 2014
Introduction The proportion of elderly people in the population is presently increasing, and projections indicate that this trend will continue in the coming decades1. As the number of elderly people grows, the number of care-dependent elderly patients also increases. The international goal is to maintain natural teeth throughout life in more people2. Norwegian elderly people have many natural teeth. In clinical settings, patients with 28 natural teeth are common. Studies from Norwegian nursing homes show that the majority of residents have many natural teeth and few have full dentures3,4. From this point of view, research addressing oral health care in Norwegian long-term care (LTC) systems should be of international interest.
Generally, elderly residents in LTC systems need assistance in every aspect of daily living, including help with oral care. Auxiliary nurses are the professional group who most often provide this help. Assisting people with many natural teeth3,5 with oral care routines is a challenge. Thus, the need for adequate oral care skills in auxiliary nurses is clear. This applies to other care-dependent groups in our society, including people who have suffered a stroke6, those who suffer from dysphagia7, longterm care (LTC) patients8 and children9. Brady et al.10 concluded in a Cochrane review in 2006 that there is a lack of studies on improving oral hygiene in patients in the LTC systems. Further, they emphasised the necessity of oral health education among nurses. Oral health is correlated with a patient’s general health11; thus, adequate oral care is even more
© 2014 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd, Gerodontology 2016; 33: 233–239
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important. Historically, oral health care has not been emphasised in the medical community. A Norwegian study on nurses in home-nursing services revealed that oral care had a low priority12. A recent study in Sweden shows that attitudes towards oral health care among nursing personnel is good, but the knowledge about and the execution of oral health care need to be improved13. This study showed that 60% of the nursing staff found oral care to be a difficult activity, and more than 50% of the participants believed that teeth in elderly patients will fall out, regardless of normal daily dental care. Nurses working in the LTC settings have several barriers when assisting patients with oral care. Patients are often reluctant when nurses offer help with teeth cleaning4, and nurses reported that performing oral health care on patients who still had intact teeth was the most difficult task, while performing oral care on patients with partial or full dentures was the least difficult14. Several studies have reported that training nursing staff in oral health care has a positive effect15–17. Specially trained oral health coordinators are useful in the improvement of oral hygiene routines in the LTC settings18. Training nursing staff is important and appears effective, but to ensure quality in oral health care, providing adequate education for nurse professionals is more important. Generally, all essential topics should be properly addressed in the professional education systems. In this context, we should explore whether oral health training or education, including how to clean teeth, is adequate in the educational programmes of auxiliary nurses. In 2009, almost all high schools with auxiliary nursing programmes provided oral health education, and 40% had three or more theoretical lessons19. However, knowledge about the quality of oral healthcare education is still sparse. This study’s primary objective was to explore both the quantity and quality of oral healthcare training in educational programmes for auxiliary nurses. Additionally, we explored whether more lessons on oral care ensure greater competency in auxiliary nursing students to meet the challenging task of providing oral care to care-dependent elderly patients.
relevant issues based on our clinical observations and experiences. A pilot study with six respondents (one journalist, two teachers, one pharmacist, one engineer and a nurse) was created to test the new questions and to avoid linguistic misunderstandings. After a few linguistic adjustments from this pilot study, the questionnaire was revised into its current form. An e-mail-administered questionnaire was used to conduct this cross-sectional study. All 164 high schools in Norway, which offered basic education for auxiliary nurses in the 2011/2012 academic year, were invited to participate in the study. Email addresses were collected using a web page that contained an overview of all the high schools in Norway, as published by the Norwegian Directorate for Education and Training in Norway20. Participants were informed about the purpose of the study and that participation was voluntary. The electronic questionnaire was attached. One reminder was sent after 7 days. One employee in the auxiliary education programme from each high school was included. Six high schools answered the questionnaire two or more times. In these cases, the first response was included. Measures The questionnaire consisted of 14 questions, as shown in Table 1. The amount of teaching in the programme was explored, similar to Samson et al.19 with four alternatives (Fig. 1). For analytical purposes, to explore differences between the amount of education, this variable was dichotomised by a median split into ‘