Developing an Instrument to Measure Self-Efficacy, Challenges and Knowledge in Oral Care among Geriatric Home Care Nurses-A Pilot Study

Oral health care in older people in long-term care facilities: An updated systematic review and meta-analyses of implementation strategies

Introduction

Oral health care of older people in long-term care facilities is insufficient, stressing the need for clear evidence-based implementation strategies to improve oral care. In 2013, a systematic review was performed and new evidence was published. This study aimed to gain insights into implementation strategies used to promote or improve oral health care for older people in long-term care facilities, explore their effectiveness and uncover strategy content in behavioral change techniques, and report the differences between the current results and those of the 2013 study.

Methods

A systematic review of the literature according to PRISMA guidelines and meta-analyses of implementation strategies were performed. Cochrane Library, PubMed, and CINAHL databases were searched for papers published between 2011 and 2023. Strategies were identified using the Coding Manual for Behavioral Change Techniques. Meta-analyses of oral health outcomes ("plaque" and "denture plaque") were performed with random-effects models using R language for statistical computing.

Results

16 studies were included in the current results; 20 studies were included in the 2013 findings. More high-quality studies (67 %) were included in this review than in 2013 (47 %). Dental care professionals were involved in 14 of the 16 studies. Fourteen of the 16 studies used and/ or combined five or more different implementation strategies: knowledge, intention, awareness, self-efficacy, attitude, and facilitation of behavior. Implementation positively affected the knowledge and attitudes of the nursing staff; however, the oral health of older people did not necessarily improve. In the 2013 review, more studies indicated combined oral health measurements were effective (71 %) than in the current review (20 %-33 %). Meta-analysis of four studies on dental plaque (0-3 scale) showed a significant, statistically small mean difference of -.21 (CI -.36; -.07, Cohen's d -.29) between the control and treatment group. Meta-analysis of three studies on denture plaque (0-4 scale), showed a significant, statistically large mean difference of -.76 (CI -1.48; -.05, Cohen's d -.88).

Conclusions

In this review, more implementation strategies and combinations were used to implement oral care in long-term care. Implementation strategies positively affected the knowledge and attitudes of nursing staff; however, the oral health of older people did not necessarily improve. Meta-analyses on plaque showed that oral care implementations are effective; for denture plaque, the effect size was large and thus may have more clinical value than for dental plaque.

Factors associated with nurses' self-efficacy in oral care at Oulu University Hospital, Finland

OBJECTIVES

This study aimed to investigate factors associated with nurses' self-efficacy in oral care among infection-sensitive patients in a university hospital.

MATERIAL AND METHODS

All the nurses working in five wards of internal medicine and one department of oncology at Oulu University Hospital, Finland (n = 114) were recruited. Data were collected with a questionnaire containing 10 self-efficacy items (scored 0 to 10) and nine knowledge items (five-point Likert scale) that were validated in an earlier pilot study. Factor analysis was performed for the self-efficacy scale and a mean score was calculated for the knowledge scale. A multivariate linear regression model was used to analyze the association between explanatory variables and self-efficacy factor scores.

RESULTS

Factor analysis revealed self-efficacy factors: Practical skills, Self-confidence in taking care of patients' oral hygiene, and Confidence in detecting oral problems (factor scores varied between 4.9 and 8.8). A higher mean score for the knowledge scale was positively associated with the factor Practical skills (B = 0.5, p < 0.05). Longer working experience was associated with higher factor scores in Self-confidence in taking care of patients` oral hygiene and Confidence in detecting oral problems.

CONCLUSIONS

Better oral health-related knowledge and longer working experience were positively associated with oral health-related self-efficacy.

Implementation of oral hygiene practices in nursing homes - a qualitative approach among supervisor nurses

OBJECTIVES

This study describes daily oral health care in private enhanced service housing units and nursing homes in Finland using a qualitative method.

METHODS

Nineteen supervisor nurses were interviewed in the six largest cities in Finland. The interviews consisted of semi-structured questions. The interviews were then transcribed and analyzed using inductive content analysis.

RESULTS

The qualitative content analysis revealed five main categories: diet, education in the oral health of older people, oral care equipment and taking care of them, caring for the mouths of residents, and professional oral health care. The results revealed that sugary snacks were given daily in the units and there was a need for oral health care education. The dental equipment of residents was taken care of well and the oral health of the residents was taken care of moderately well. Furthermore, there was a need for co-operation between dental professionals and only half of the residents had an individual oral care plan.

CONCLUSIONS

It can be concluded that based on this qualitative study, the implementation of daily oral health care in most nursing homes and enhanced housing units seems to be at a sufficient level and more oral health-related practical and theoretical education is needed.