Feature ArticleMouth Care in Nursing Homes: Knowledge, Beliefs, and Practices of Nursing Assistants
Section snippets
Background
Ninety-one percent of NH residents are aged 65 years or older; 46% are aged 85 years or older. Seventy-five percent require assistance with 3 or more activities of daily living (ADLs)1, 2 showering/bathing (including oral care), dressing, and eating are the most common ADLs with which residents require assistance.1, 2 Self-care is further compromised by cognitive impairment; 70% of NH residents exhibit some form of cognitive impairment regardless of diagnoses.
Older adults, especially the frail,
Setting and Sample
After approval from the institutional review board, NAs were recruited from 2 NHs. NH1 was a 200-bed urban for-profit facility that received the majority of its reimbursement from Medicaid. NH2 was a 250-bed suburban not-for-profit facility that received the majority of its reimbursement from private-paying residents. NAs were approached during existing in-services during all shifts and weekends during a 30-day period. They were asked to complete the survey. Of a total combined population of
Measurement and Methods
The Oral Care Survey measured the knowledge, beliefs, and self-reported practices of NAs who provided mouth care to frail and functionally dependent NH elders. The survey was a modification of one used by Grap et al.31 in their study of the oral care practices by nurses in intensive care units. Additional questions were added on the basis of findings in the literature. The final version of the survey contained 2 questions about oral care knowledge, 5 questions about oral care practices, 4
Results
The questions on the Oral Care Survey for NAs comprised 3 areas: knowledge, beliefs, and self-reported practices. Knowledge was measured using 2 questions, 1 about the routine for oral care and 1 about the presence or absence of a written mouth care policy. When asked to describe the routine for oral care in their facility, 79 provided responses that fell predominantly into 1 of 2 categories: timing (e.g., “upon awakening,” “before bedtime”) and task (e.g., “use a toothbrush”). Only one
Discussion
The purpose of this study was to examine the knowledge, beliefs, and practices of NAs providing oral hygiene to frail elders to design an educational intervention on the basis of their responses. According to their responses, the NAs possessed adequate knowledge regarding the minimum amount of oral hygiene necessary for frail and functionally dependent elders. They knew that mouth care should be provided, at a minimum, twice daily.
The NAs believed that brushing and flossing prevented gum
Conclusion
Mouth care is an important part of the self-care needs of institutionalized older adults. Nurses are in a powerful position to guide NAs and help them by modeling behavior—that is, by demonstrating techniques that minimize both care-resistive behaviors and functional dependency. For example, implicit memory is the ability to automatically complete a task learned in childhood if appropriately cued, and it remains intact even in very late stages of dementia.42 An NA who tries to brush an elder's
Acknowledgements
Funding for this study was provided by a grant from the National Institute of Dental and Craniofacial Research, National Institutes of Health, grant no. R21DE16464-02 (principal investigator: Jablonski). The authors wish to thank Ann Kolanowski and the anonymous reviewers for their thoughtful feedback.
RITA A. JABLONSKI, PhD, RN, ANP, School of Nursing, College of Health and Human Development, The Pennsylvania State University, University Park, PA.
References (42)
- et al.
Oral condition and its relationship to nutritional status in the institutionalized elderly population
J Am Dietetic Assoc
(2006) - et al.
Effect of professional oral health care on the elderly living in nursing homes
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(2002) Dental management considerations for institutionalized geriatric patients
J Prosthet Dent
(1994)An overview of nursing home facilities: data from the 1997 National Nursing Home Survey
(Advance Data from Vital and Health Statistics, No. 280; report no. 311.)
(2000)Characteristics of elderly nursing home current residents and discharges: data from the 1997 National Nursing Home Survey
(Advance Data from Vital and Health Statistics, No. 312.)
(2000)- et al.
The importance of oral health in the older patient
J Am Geriatr Soc
(1995) Review: xerostomia: a symptom which acts like a disease
Age Ageing
(1996)- et al.
Oral condition and health status of people aged 80-85 years
Geriatr Gerontol Int
(2006) - et al.
Periodontal disease, tooth loss, and incidence of ischemic stroke
Stroke
(2003) - et al.
Periodontal microbiota and carotid intima-media thickness: the Oral Infections and Vascular Disease Epidemiology Study (INVEST)
Circulation
(2005)
Gender differences in the relationship between periodontal disease, tooth loss, and atherosclerosis
Stroke
Radiographic measures of chronic periodontitis and carotid artery plaque
Stroke
Glycemic control of type 2 diabetes and severe periodontal disease in the US adult population
Community Dent Oral Epidemiol
The effect of periodontal treatment on glycemic control in patients with type 2 diabetes mellitus
J Clin Periodontol
Oral health and respiratory infection
J Can Dent Assoc
Respiratory infection: how important is oral health?
Curr Opin Pulmon Med
Nursing home-acquired pneumonia
Clin Infect Dis
Infectious complications of dental and periodontal diseases in the elderly population
Clin Infect Dis
Geriatric oral health and pneumonia risk
Clin Infect Dis
Aspiration pneumonia: dental and oral risk factors in an older veteran population
J Am Geriatr Soc
Predictors of aspiration pneumonia: how important is dysphagia
Dysphagia
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RITA A. JABLONSKI, PhD, RN, ANP, School of Nursing, College of Health and Human Development, The Pennsylvania State University, University Park, PA.
CINDY L. MUNRO, PhD, RN, ANP, FAAN, School of Nursing, Virginia Commonwealth University, Richmond, VA.
MARY JO GRAP, PhD, RN, ACNP, FAAN, School of Nursing, Virginia Commonwealth University, Richmond, VA.
CHRISTINE M. SCHUBERT, PhD, School of Medicine, Department of Biostatistics, Virginia Commonwealth University, Richmond, VA.
MARY LIGON, PhD, Behavioral Sciences Department, York College of Pennsylvania, York, PA.
PAMELA SPIGELMYER, MS, APRN-BC, CNS, CSN, School of Nursing, College of Health and Human Development, The Pennsylvania State University, University Park, PA.