RNs lead the pro­ject to as­sist se­niors with oral health care

The Hamilton Spectator - - YOUNG AT HEART - Jackie Burns, RNAO

One of the first lessons we learn as chil­dren is the im­por­tance of good oral hy­giene, but it’s a prac­tice that of­ten gets lost on se­niors, and that has the po­ten­tial to lead to se­ri­ous con­se­quences.

It’s now one of the big­gest con­cerns fac­ing long-term health-care providers in On­tario, and it’s what led to a new pro­ject - Oral Care Com­mu­nity of Prac­tice - which aims to ed­u­cate nurs­ing home care­givers about the im­por­tance of oral health care in se­niors.

Reg­is­tered nurses Ibo MacDon­ald and Heather-Wood­beck are long-term care co-or­di­na­tors who are co-lead­ing the pro­ject, work­ing with nurs­ing homes across the prov­ince to de­liver the wake-up call that se­niors sim­ply can’t af­ford to let their oral health slide.

“Plaque is the cause of all oral health prob­lems and also has links to sys­temic prob­lems as well; as­pi­ra­tion, pneu­mo­nia, stroke, poor di­a­betic blood-sugar con­trol, heart at­tacks,” says MacDon­ald. “If you’re not re­mov­ing that plaque, that’s what lead­ing to these long-term prob­lems.”

She says be­cause of mo­bil­ity and dex­ter­ity is­sues, cou­pled with de­men­tia in many cases, res­i­dents are com­ing into nurs­ing homes with poor oral health al­ready, and it’s up to the care­givers to try and pre­vent it from get­ting worse through reg­u­lar clean­ings. In some cases, res­i­dents will have to be re­ferred to den­tal spe­cial­ists.

As part of their mis­sion to get ahead of the prob­lem, MacDon­ald and Wood­beck are host­ing ed­u­ca­tional we­bi­nars for nurs­ing-home pro­fes­sion­als and then make fol­lowup vis­its to the homes where they set up a team around oral care and an­a­lyze what needs to be im­proved.

They also ed­u­cate care­givers on how to look for ab­nor­mal­i­ties, such as gin­givi­tis, cav­i­ties and ab­scesses, as well as of­fer hands-on strate­gies for work­ing with se­niors on oral care.

“It’s a gen­tle, per­sua­sive ap­proach with a stop-and-go tech­nique, and lis­ten­ing care­fully to what the res­i­dent is say­ing,” says Wood­beck. “If a res­i­dent tells you to stop, you stop im­me­di­ately.”

She says lit­tle changes can make a big dif­fer­ence, too; like ap­proach­ing a res­i­dent from a 45-de­gree an­gle so they see the care­giver clearly and aren’t star­tled when they sud­denly find a tooth­brush in their mouth.

The pair is also en­cour­ag­ing nurs­ing homes to look at their daily brush­ing sched­ule, see­ing if maybe the tim­ing could be changed to im­prove the out­come.

They say many nurs­ing homes crush pills with some­thing sweet, like juice or jam, af­ter the res­i­dent has al­ready had their teeth brushed for the evening, lead­ing to in­creased risk of rot­ting and cav­i­ties.

Most homes also try to cram in teeth brush­ing dur­ing the morn­ing break­fast rush, which they say con­trib­utes to the ten­sion and anx­i­ety around the prac­tice.

“It’s ideal to do it af­ter break­fast and right be­fore bed,” says Wood­beck.

“If you were to or­ga­nize when you do this care, it might be more suc­cess­ful. And it might be eas­ier for staff to do it,” adds MacDon­ald.

Through their pro­ject, they also en­cour­age nurs­ing home care­givers to take the time and talk with res­i­dents who are re­luc­tant to open their mouths, to see what’s con­tribut­ing to their fear of get­ting their teeth brushed in the first place.

“If the res­i­dent doesn’t want oral health care done, try to fig­ure out why,” said MacDon­ald.

Reg­is­tered nurse Ibo MacDon­ald is co-lead­ing the Oral Care Com­mu­nity of Prac­tice pro­ject.

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