Supervising Nursing Administrators

Knowledge, Attitudes, and Practices

Related to Oral Care in Long-Term
Care Facilities
Janelle Urata, BA, Masters Candidate UCSF,
RDH
Elizabeth Couch, MS, RDH
Margaret Walsh, MA, MS, EdD, RDH
May 27, 2015

Research Problem
Geriatric adults living in long term care
(LTC) often depend on others to assist
them in daily activities and personal care
needs, including oral care.1-3 Without the
necessary care, residents are at greater
risk for general and oral complications1,4,5

Background
Untreated oral diseases can have a negative
impact on quality of life, malnutrition and
general health1-3

Certified Nurses Assistants (CNA) who provide

oral care in LTC facilities acknowledge the
importance of oral hygiene care for patients,
yet some reports indicate that minimal oral
care, ifany, is being done in practice2,8

Background (cont.)
One study suggests that Supervising
Nurse Administrators (SNA) are in a
powerful position to support CNAs
who provide oral care by providing
the necessary equipment as well as
offering advice with treatment7

What is Unknown
Little is known about SNAs involvement
in oral care and if they oversee the CNA
in oral health caregiving activities

It is unknown what protocols or

assessments CNAs use to address
residents oral needs and the level of
support provided by SNAs

What is Unknown
It is unknown if SNAs are aware of
other dental professionals like a
registered dental hygienist in
alternative practice (RDHAP) in
California, that can provide oral care
to residents

Study Purpose
To determine among SNAs in LTC, their
knowledge, attitudes, and practices
related to oral care provided to their
residents and the role of dental
professionals, using a self-administered,
anonymous, web-based survey

Study Design
Quantitative
Cross-sectional
Institutional Review Board at
UCSF approved study

Population & Recruitment

NADONA partnered to distribute to all
members in their email database (N=2359)

Drawing of 4 $50 Amazon gift cards to

participants of the study

Second mailing sent one month after initial

email

Pilot Testing
Convenience sample of 8 SNAs and 6
RDHAPs

Refined based on feedback

10

Survey Content
The 35-item survey consisted of closeended items comprising 4 different
sections:
Demographics: 12 multiple choice items
Knowledge: 3 true/false items
Attitudes: 4 Likert, 1 multiple choice, 1 yes/no
items
Practices: 7 multiple choice, 6 yes/no, 1 fill-in
items

11

Methods of Measurement
(cont.)
20 validated items were replicated
from 4 studies and modified to
accommodate an oral health focus 5-8

12

Results
13

Results: Demographics of SNAs

14

Demographics of SNAs
cont.

Northeast: CT, ME, MA, NH, RI, VT, NJ, NY, and PA.
Midwest: IL, IN, MI, OH, WI, IA, KS, MN, MO, NE, ND, and SD.
South: DE, FL, GA, MD, NC, SC, VA, DC, AL, KY, MS, TN, AR, LA, OK, and
TX.
Western: AK, AZ, CA, CO, HI, ID, MT, NV, NM, OR, UT, WA, and WY.

15

Demographics of SNAs
cont.

16

Facility Characteristics

17

Facility Characteristics cont.

18

Research Question #1
What is the level of awareness and support
for dental professionals providing services
in LTC facilities?

19

SNAs Awareness, Interest

and Support of RDHs

20

SNAs Awareness, Interest

and Support of RDHs cont.

21

SNAs Awareness, Interest

and Support of RDHs cont.

22

Research Question #2
What are the knowledge and
attitudes of SNAs related to oral care
provided to their LTC residents?

23

SNAs Response to Knowledge

Items

24

SNAs Responses to Attitude

Items

25

SNAs Responses to Attitude

Items cont.

26

SNAs Responses to Attitude

Items cont.

27

Research Question #3
Who is responsible for conducting
oral assessments, oral care training
and dental care for LTC residents?

28

Oral Care Practices as

Reported by SNAs

29

Oral Care Practices as

Reported by SNAs cont.

30

Oral Care Practices as

Reported by SNAs cont.

31

Oral Care Practices as

Reported by SNAs cont.

32

Discussion

33

Similar Findings in
Literature
Our study was consistent with Winch et
al.s findings regarding positive support
for RDHs providing services in LTC8:
Oral health training
Oral screening
Prophy or perio services
Fluoride varnish application

34

Similar Findings in
Literature cont.
Our studys findings were similar with Pyle
et al. 5:

In knowledge, and rating of residents

health as good/fair

Three quarters Executive Directors reported

residents go out of facility for dental care

35

Similar Findings in
Literature cont.
Similar findings with Smith et al.s7:
On the satisfaction with the way the oral hygiene
needs of residents are met at the facility

Other nurse performed oral assessments

majority of the

time

36

Inconsistent Findings in
Literature
Pyle et al.s study5:
Executive Directors reported majority had
dentist on staff

Our study only 41% reported having a dentist

on staff.

37

Inconsistent Findings in
Literature
Smith et al.s study7:
75% of respondents satisfied with the quality
of dental treatment provided
Our study: 48% of respondents were
satisfied
A possible explanation: Smith et al.s study
reported higher on-site dental treatments
provided at their facilities than those
reported in our study.

38

Inconsistent Findings in
Literature
Johnson et al. study6:
Majority of respondents unsure about
consideration for future on-site services
Our study, majority of respondents would
consider on-site services

39

Limitations
7% response ratepotential for biases

Limited to one organization

Those who responded might have been

more aware of oral care

40

Conclusion
This study helps to provide preliminary
evidence that SNAs are open to innovative
changes to improve residents oral health

To improve the oral health status of LTC

residents, inter-professional collaboration
is needed.

41

References
1. Weening-Verbree L, Huisman-de Waal G, van
Dusseldorp L, van Achterberg T, Schoonhoven L. Oral
health care in older people in long term care facilities: A
systematic review of implementation strategies. Int J Nurs
Stud. 2013; 50(4):569-82.
2. Dharamsi S, Jivani K, Dean C, Wyatt C. Oral care for
frail elders: Knowledge, attitudes, and practices of longterm care staff. J Dent Educ. 2009; 73(5):581-8.
3. Oral Health in America: A Report of the Surgeon
General (Executive Summary) [Internet]. cited 8/16/2014].

42

References (cont.)
4. Bassim CW, Gibson G, Ward T, Paphides BM,
Denucci DJ. Modification of the risk of mortality from
pneumonia with oral hygiene care. J Am Geriatr Soc.
2008 Sep;56(9):1601-7.
5. Pyle MA, Jasinevicius TR, Sawyer DR, Madsen J.
Nursing home executive directors' perception of oral
care in long-term care facilities. Spec Care Dentist.
2005 Mar-Apr;25(2):111-7.
6. Johnson TE, Lange BM. Preferences for an
influences on oral health prevention: Perceptions of
directors of nursing. Spec Care Dentist. 1999 JulAug;19(4):173-80.

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References (cont.)
7. Smith BJ, Ghezzi EM, Manz MC, Markova CP.
Perceptions of oral health adequacy and access in
Michigan nursing facilities. Gerodontology. 2008
Jun;25(2):89-98.
8. Wintch PM, Johnson T, Gurenlian J, Neil K. Executive
directors' perceptions of oral health care of aging
adults in long-term care settings. J Dent Hyg. 2014
Oct;88(5):302-8.

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