Download Teamwork Including Nursing and Dentistry

Teamwork Including Nursing
and Dentistry:
Interface of Systemic and Oral Health in Acute Care
Sally Decker, PhD, RN; Kitrina Cordell, DDS, MS; &
Molly Rosebush, DDS, MS
Saginaw Valley State University and Louisiana State University
Background: QSEN Competencies and IPEC
Competencies
QSEN
IPEC
•
Patient-Centered Care
•
Teamwork and
Collaboration
•
Roles/Responsibilities
•
Evidence-Based Practice
•
Interprofessional Communication
•
Quality Improvement
•
Teams and Teamwork
•
Safety
•
Informatics
• Values/Ethics for Interprofessional
Practice
Specific Objectives for the Assignment Related to QSEN
and IPEC Competencies
Teamwork and collaboration
• Follow communication
practices that minimize risks
among providers
• Recognize contributions of
other individuals and groups
to achieve health goals
• Initiate requests for help
when appropriate
• Value the perspectives and
expertise of other health
team members
Communication
• Choose effective communication
tools and technologies
• Express one’s knowledge and opinions ..
with clarity and respect
Teamwork
• Engage other health professionals.. in
shared problem-solving
• Reflect on individual and team
performance
Rubric - oral health assignment
Ability to communicate role in relationship
Ability to document patient-centered care
Ability to communicate evidence-based plan
Of care
Ability to reflect on role in team experience
Ability to demonstrate and reflect on plan of
Care using best evidence and unique patient
information
Scoring criteria
Respectful, timely, helpful,
Focused, appropriate scope
Of practice
Use of unique patient
Information in plan
Use of best evidence for
This patient
Substantial contribution to
Debriefing process related to
Team experience
Substantial contribution to
Debriefing process related to
Plan of care and learning of
Oral health in context of total
Health
score
/10
/10
/10
/10
/10
Relationship between Oral Care and Systemic Health
• Well- established relationship between oral care and
prevention of pneumonia in patients on ventilators (El-Rabbany, et
al. , 2015; Shi et al, 2013)
• Well- established relationship oral care and prevention of
pneumonia in long term care (El-Solh, 2011)
• Less well-established relationship between oral care and
pneumonia in non-ventilated patients in acute care (Kaneoka et
al., 2015)
Photo by Dr. Molly Rosebush
Dental Plaque in Acute Care
• Plaque index of 1.85 (scale of 0-3) in acute care versus 0.65 in
long-term care (Danckert, Ryan, Plummer & Williams, 2016)
• 91% of patients admitted to acute care had unmet oral needs
(Konradsen, Trosborg, Christensen & Pederson, 2012)
• Plaque increases during hospitalization and is associated with
increased incidence of nosocomial infection (Sachdev, et al, 2013 ;
Fourrier et al., 1998)
Nursing and Dental Hygiene
• The two professions do not routinely practice in the
same space
• Nurses have seen oral assessment and oral care as of
medium level importance (comfort measure) for nonventilator ICU patients (Lin, et al, 2011)
• Schools of Nursing have not taught an extensive oral
assessment (Buehner & Kwapis-Jaeger, 2014)
Method (this in not in “real time” so the patients were discharged by the end
of the assignment and this was not a research study)
37 teams (37 dental hygiene students and 87 nursing
students – at two universities)
• Nursing students, in teams of two or
three, completed oral assessments
for one of their assigned patients in
acute care
Smiles for Life and
Overcoming Obstacles For
Oral Health
• Nursing students used an ISBAR format
to communicate the written oral
assessment, patient-centered oral
care data and current oral care
treatment plan to dental hygiene
students
• Dental hygiene students responded
with additional questions, and
recommendations
• A final oral care plan (with supporting
evidence) was agreed upon by the team
– this included the plan for in acute care
and teaching at discharge.
• All teams completed a written debrief to
assess learning related to oral care and
teamwork.
What went well
What could have been done differently
(Consider communication, role definition, plan of care,
documentation and leadership)
Student 1
Student 2
Student 3
Summary: Agree on the two most
important "take-aways" from the
experience in terms of:
Oral Care
Teamwork/communication
Results
The most commonly identified learned elements
related to oral care were:
1. The overall interaction between oral health and
systemic health
2. Dry mouth and the influence on oral health and
systemic health
3. Specific diseases (especially diabetes) and
relationship to oral health
Results
The most commonly identified learning elements
related to teamwork/communications were:
1. Importance of clear and concise written
communication
2. Benefit of teamwork to quality of patient care
3. Importance of timely communication (this
referred to method of communication)
Observations- Faculty Debrief
• The method of communication is important
Students were allowed to select
They were given university email addresses and told they
could use phone, skype, or Google Docs but that we
needed a transcript of the communication – so most
selected email
• Reviewing all 37 papers and recommendations as well
as the interaction transcripts for role and evidence
and communication used a great deal of faculty
resources.
• Communications were mostly respectful and
encouraging to each other (especially dental hygiene
to nursing). Roles/practice environments were not
always clear (dental hygiene students did not realize
the nursing students could not just take pictures and
send them).
References
•
Beuhner, M &Kwapis-Jaeger, J (2014). Research investigation of competence of oral assessment and oral hygiene
care in nursing curriculums in the state of Michigan. Journal of Dental Hygiene, 88(5), 320-332.
•
Cronenwett, L, Sherwood, G, Barnsteiner, J, Disch,J…Warren, J (2007), Quality and safety education for nurses. Nursing
Outlook, 55(3), 122-131.
•
Danckert, R, Ryan, A., Plummer, V & Williams, C. (2016). Hospitalization impacts on oral hygiene: An audit of oral
hygiene in a metropolitan health service, Scandinavian Journal of Caring Sciences, 30(1), 129-134.
•
El-Rabbany, M Zaghlol, N Bhandari, M & Azarpazhooh, A. (2015). Prophylactic oral health procedures to prevent
hospital-acquired and ventilator-associated pneumonia. International Journal of Nursing Studies, 52, 452-464.
•
El-Solh, A (2011). Association between pneumonia and oral care in nursing home residents. Lung, 189, 173-180
•
Fourrier, F., Duvivier, B., Boutigny, H Roussel-Delvallez, M., & Chopin, C (1989). Colonization of dental plaque: A source
of nosocomial infections in intensive care unit patients. Critical Care Medicine, 26(2), 301-308.
•
Interprofessional Education Collaborative Expert Panel (2011). Core competencies for interprofessional collaborative
practice: Report of an expert panel. Washington, DC: Interprofessional Education Collaborative.
•
Kaneoka, A, Pisegna, J., Miloro, K.,Lo, M, Saito, H….Langmore, S. (2015). Prevention of healthcare-associated
pneumonia with oral care in individuals without mechanical ventilation: A systematic review and meta-analysis of
randomized controlled trials. Infection Control and Hospital Epidemiology, 36(8), 899-906.
•
Konradsen, H, Trosborg, I, Christensen, L. & Ulrich, P. (2012). Oral status and the need for oral health care among
patients hospitalized with acute medical conditions. Journal of clinical Nursing, 21, 2851-2859.
•
Lin, Y, Chang, J, Chang, T & Lou,M. (2011). Critical care nurses’ attitudes and practices for oral care for patients with
oral endotracheal intubation: A questionnaire survey. Journal of Clinical Nursing, 20, 3204-3214.
•
Sachdev. M, Ready, D., Brealey, D., Ryu, J, Bercades, G....Neeleman, I (2013). Changes in dental plaque following
hospitalization in a critical care unit: An observational study. Critical Care, 17 (5), R189
•
Shi, Z, Xie, H., Wang, P. Zhang, Q.Wu., Y….Furness, S. (2013). Oral hygiene care for critically ill patients to prevent VAP.
The Cochrane Collaborative, 8, art no: CD008367.