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Race %
White, non Hispanic 15.47
Black, non Hispanic 24.47
Mexican American 24.20
The highest percentage of race is seen in black, non Hispanic and the least is in
white, non Hispanic. (4)
Gender %
Male 20.61
Female 14.40
The highest percentage of gender is seen in males. (4)
Education %
th
Less than 12 grade 28.24
12th grade 15.51
th
More than 12 grade 12.38
The highest percentage is seen in elderly that have completed less than a 12th
grade education. (4)
Smoking history %
Current smoker 32.01
Former smoker 19.25
Never smoked 14.08
The highest percentage is seen in current smokers and the lowest is in never
smoked. (4)
3. Dental Caries
Age %
65-74 93.25
75 or more 92.70
The highest percentage was seen between the ages 65-74 and the lowest was seen
with 75 and older. (4)
Sex %
Male 93.64
Female 92.49
The highest percentage with gender is seen with males and the lowest with females.
(4)
Race %
White, non-hispanic 94.86
Black, non-hispanic 80.20
Mexican American 83.82
The highest percentage seen within race is with white, non-Hispanic and the lowest
with black, non-Hispanic. (4)
The oral health of older Americans is very important and is getting more attention
and has improved. However there are certain factors that have an impact on the dental
health status of the elderly. For example these factors include, sex, age, social
economic status, and level of education. Being institutionalized also increases the risk
of poor oral health but could be improved by appropriate access to care. (5)
Goal:
Asses, develop, and enforce a dental health care program to educate the nurses and nursess aides
on how to properly clean and maintain their dentures and remaining permanent teeth to prevent
oral diseases of the residents.
Objectives:
Develop an oral health routine plan for the nurses and nursess aides to follow
during initial patient visit.
Educate the nurses and nurses aides to properly conduct an oral cancer
screening during patient assessment.
Demonstrate proper oral health techniques such as tooth brushing, flossing
and denture cleaning.
Increase the dental knowledge of the nurse, and nurses aides by 20%.
Develop a written instruction manual to provide accurate and complete
implementation of the program.
Rationale:
Oral health is an important and often overlooked component of an older persons general health
and well being (6). Nearly 1 in 5 of adults aged 65 or older have lost all of their teeth. Having
missing teeth or wearing dentures can affect nutrition, because people without teeth or with
dentures often prefer soft, easily chewed foods instead of foods such as fresh fruits and
vegetables (7). Quality dental prostheses (dentures) can help persons who have lost some
or all of their natural teeth improve their quality of life by restoring lost function and esthetics
(6). Among elderly nursing home residents in 1995-97, 80 percent of those who had lost all of
their natural teeth had both dentures; however, 18 percent did not usually use them (6). Dry
mouth can be a particularly harmful problem for older adults. More than 400 commonly used
medications, including antihistamines, diuretics, and antidepressants, can cause dry mouth. Dry
mouth can also be a sign of certain diseases and conditions, such as diabetes, Parkinsons
disease, and Sjogrens syndrome (8). Having a dry mouth can cause difficulty chewing,
speaking, and swallowing. It also increases the risk of developing cavities and soft tissue
problems. Dry mouth may also decrease the ability to wear dentures (6).
To further assist the residents that cannot leave the home, the nurses and nurses aids should be
educated in proper oral health and maintenance. According to the pretest, the nurse has limited
knowledge about how to provide proper oral health care (2). In general nurses show limited
dental knowledge related to oral health which makes them incapable of providing the appropriate
care by early detection and prevention of oral disease. Nurses, including registered nurses,
licensed practical nurses, make up the largest proportion of health care professionals. Therefore,
it is essential that these health care providers are familiar with the various risk factors to manage
oral care and make appropriate referrals and intervention decisions as recommended (9).
Program Design:
A.Activities
Thepurposeofourhealthcareprogramistoeducatetheresidentsandnursesonproperoral
health.Theactivitieswillincludedentalprosthesiscare,oralcancerscreening,oralassessment,
teachingbasicdentalhealthandoralhygienepractices.Theactivitysessionswillbeperformed
onaweeklybasisatTheLucasHouse.Thediscussionswillbepresentedinthefollowing:
1.Session1(week1)
a.AdministratorsandManager
Presentationoftheoverviewoftheoralhealthprogramasitrelatestotheoralhealthof
thenursinghomeresidents.
1. Discusstheneedforpreventivedentalhealthoralprogramforthepatients.
2. Assessthedentalknowledgeofthehomehealthnursesandresidentsbyshowingthe
writtenpretestandposttest.
3. Explaintheimportanceofgoodoralhygieneandhowtodevelopadailyoralhygiene
routine.
4. Explaintheimportanceofselfscreeningforearlydetectionoforalcancer.
5. Explaintheimportanceofkeepingdentalprosthesesclean.
Thesessionwillincludetheadministrationandmanagersandwillrequireanhour.
2.Session2(week1)
a.HomeHealthAides
Presentationoftheoverallhealthinformation,preventativeandmaintenancemethods.
Thissessionwillincludeapretesttoevaluatethedentalknowledgeofthenursesand
nursesaides.
1. Pretestwillbegiventodeterminethedentalknowledgeofeachindividual
2. Discussandreviewbasicoralhealthdependingontheindividualdentalknowledge.
3. Differentiatehealthy,soft/hardtissuescomparedtodiseasedbyusingvisualaids.
4. Demonstratepreventivemethods,suchas,brushandflossingbyusingatypodont.
Thesessionwillincludethenursesandnursesaidesandwillrequireanhouranda
half.
3.Session3(week2)
a.HomeHealthAides
Presentationwillbegiventothehomehealthaidesandthetopicswillincludescreenings
fororalcanceranddentalprosthesescleaningandmaintenance.
1. Reviewthetopicdiscussedintheprevioussession.
2. Demonstratehowtoprovideoralcancerscreenings.
3. Demonstratedenturecleaningusingadentalbrushandcleaner.
4. Demonstratedenturecleaningwiththeultrasoniccleaner.
Thesessionwillincludethehomehealthaidesandwillbehourandhalf.
4.Session4(week3)
a.Nurse,nursesaides
Observenurseand/ornursesaideswhiletheyprovideanoralhealthassessment,oral
cancerscreening,patienteducation,oralhygieneanddenturecleaningtotheresidents.
1. Observenurseandnursesaidesperformoralassessment
2. Observenurseandnursesaidesperformoralcancerscreening
3. Observenurseandnursesaidesprovidepatienteducationandoralhygiene
instruction
4. Iftheresidentsarewearingdenture(s),observethenursesand/ornursesaidesclean
thedenture(s).
Thesessionwillincludethenurseandnursesaidesandwillrequireanhour.
5.Session5(week4)
a.Administrators,manager,nurse,nursesaides.
Assessmentoftheoralhygieneprogram.
1. Posttestwillbegiventoreassessthenursesandnursesaidestodeterminetheiroral
healthknowledge.
2. Reviewprevioussessions
3. Askforquestionsandfeedbackregardingoralhealthprogram
Thesessionwillrequireadministrators,nursesandnursesaidesandwillrequirean
hour.
B.ConstraintsandAlternativeStrategies
1.Constraint:Theresidentsandnursesandnursessaidesmaynotbeinterestedinpresentation.
Alternative:1.Havethemparticipateinhandsonactivities.2.Includevisualaidsalongwiththe
presentationtokeeptheirattention.3.Keeptheresidentsandnursesengagedbyasking
questions.
2.Constraint:Theresidentsmaynotbeabletoaffordtokeepupwithdentalneedsandregular
dentalvisits.
Alternative:1.Gatheralistofalldentalclinicsthatassisttheunderprivilegedorindigent
population.2.GatheralistofalldentalofficesthatacceptMedicaid/Medicareaspayments.3.
Stresstothestafftheimportanceofinformationresidentsoftheimportanceofdentalneedsand
services.
3.Constraint:Theresidents,nurses,andnursesaidesmaynotwanttoattendthepresentation
duetovariousschedules.
Alternatives:1.Haveofficemanagermakeannouncementsaboutdatesandtimesof
presentation.2.Makeflyersandgivetoofficemanagertopostthathasthescheduleddates.
C.Resources
Thefollowingresourceswillberequiredfortheimplementationoftheoralhealthprogram:
1. Personnel:session1administratorsandmanager,session2and3homehealthaides,
session4familycaregivers,nurse,nursesaides,session5administrators,manager,
nurse,nursesaides
2. VisualAides:
a. PowerPointshowingdifferencesbetweenhealthandunhealthyoralcavity
b. Flipcharttohelpdemonstrateproperbrushingandflossing
c. Typodontandtoothbrush
3. Supplies:
a. Toothbrush,toothpaste,floss(12kits),Denturebrushanddenturecleaner(12kits)
b. Disclosingsolution,plaquescoreforms,cups,ultrasoniccleaner,denturesample,
gloves,cottonswabs,napkins,gauze,tonguedepressorprovidedbyLITDental
HygieneClinic
4. Evaluationforms:
a. Pretest
b. Posttest(sametestasthepretest)
c. Administratorevaluatorform
5. Supplements:
a. Outlineoftheprogramplanprovidedbytheclinicians
b. Brochuredevelopedbytheclinicians
D. Budget
Theestimatedcostforthedentalhealthprogramisasfollows:
a. Toothbrushkits $75.00
b. Plasticcups $5.00
c. Gloves $30.00
d. Denturecleaner $5.00
e. Denturebrushes $30.00
f. Ultrasoniccleaner(donatedbyLITDentalHygieneclinic)
g. Gauze,tonguedepressor,papernapkins,cottonswabs,anddisclosingsolution
(donatedbyLITDentalHygiene)
E. TimeTable
Alloftheneededresourceswillbeutilizedforeachsession.Therewillbefivetotal
sessionsoverafourweekperiodoftime.Thescheduleisasfollows:
Session1weekofMarch2731
Session2weekofApril37
Session3weekofApril1014
Session4weekofApril1721
F. Evaluation
A. ProcessEvaluation(formative)
1. Weeklymeetingwiththemanagertoevaluatethemasteryoftheskilland
progressoftheoralhealthprogram.
2. Weeklyreviewoftheoralhealthprogramtechniquesanddenture/partialcleaning
toassuremasteryoftheskill.
3. Weeklyreviewoforalcancerscreeningtoassureknowledge
4. Aweeklyreviewofthedentalknowledgeretainedofthenursesandnursesaids
B. ProductiveEvaluation(summative):
1. Apretestandposttestwillbegiventothenursesandnursesaidestoasses
andcomparetheirlevelofknowledgeindentalhealthcare.
2. Aquestionnairewillbegiventotheadministratorsandmanagertoassesthe
qualityiftheoralhealthprogram
3. Anannualcheckupwiththeadministratorwillbeconductedtoassurethe
nursesandnursesaidesarepracticingtheoralhealthprogram.
4. Provideawritteninstructionmanualtotheadministratorabouttheoralhealth
program.
5. Anannualcheckupwiththeadministratortoverifytheuseoftheoralcancer
screeningduringpatientassessment.
References
9. Oral & Dental Health Knowledge and Attitude among Nursing. Retrieved from:
www.scholink.org/ojs/index.php/wjer/article/download/602/563