Impact of Oral Health Issues in Nursing Homes: A Comprehensive Study

This report investigates the critical issue of oral health within nursing homes and healthcare settings. It highlights the neglect of oral hygiene, driven by factors such as treatment costs and lack of awareness among staff and residents. The research employed a pre- and post-test design, collecting data through questionnaires administered to nursing staff before and after educational sessions focused on oral health practices. The study, conducted in a Sydney-based aged care facility, included 42 nurses who participated in two educational sessions. The data analysis revealed a significant improvement in the participants' knowledge of oral health, as evidenced by the paired samples t-test results. The report includes project methodology, data collection methods, and statistical analysis, aiming to evaluate and analyze the impact of oral health issues in nursing homes and propose strategies to improve oral hygiene practices and patient care. The study concludes with recommendations for enhancing oral health awareness and implementing effective interventions within nursing home environments.

Table of Contents
INTRODUCTION...........................................................................................................................1
Project Methodology........................................................................................................................3
Project design...................................................................................................................................3
Discussion ..................................................................................................................................7
REFERENCES .............................................................................................................................15

INTRODUCTION
Oral health is a important concern for public and in present time oral hygiene avoid
through nursing homes so that thing increase health issue in community. Nursing homes and
healthcare organizations failure in maintain oral hygiene and people also ignore this concern due
to increase cost of treatment, premature death, malnutrition (Barbe, 2017). Members of nursing
homes has not proper knowledge about health care and about oral hygiene so this issue also
increase. Many studies show that nursing homes does not provide daily oral check-up of aged
peoples. So they has to suffer due to inadequate treatment and care about oral hygiene. Long
term care facilities do not include oral care and due to high cost of treatment many aged peoples
do not afford cost for treatment and they suffer from pain (Jin, 2016). Members of nursing homes
have not proper knowledge about technologies that useful for oral check-ups.
Background :- this research topic take by researcher because oral health related issues increase
day by day. Through this many issue create and nursing homes avoid this problem. So researcher
take this topic for highlight issue for improve oral health condition.
Aim :- To evaluate and analyse effect of oral health issue that ignore by nursing homes and
healthcare system. So this project aim is remove this issue and provide knowledge to people.
Method :- For improve oral hygiene so nursing home members has need to understand to
process and get technical knowledge. Nurses can improve easily to this issue and overcome as
well because nurses avoid oral hygiene due to insufficient resources, complete documentation
before treatment and threat of dementia because it is a mental health issue. They have also need
to improve knowledge and remove ignorance related to oral hygiene through develop skills and
create effective strategies to tackle and handle dementia so these things helps in remove fear of
nursing home. This concern is important because through research found that day by day oral
health issues increase and public has to suffer from pain and premature death.
Results :- Researcher conduct research for analyse and evaluate this issue through survey,
interviews and found that numbers of patient and issue increase. It searches about reason of
increase this issue so that get oral health issue increase through cost of treatment is very high so
poor people cannot afford amount and malnutrition also very big reason because 62 % people
live in aged care homes (Leck and Randall, 2017). 80 % of people do not get daily health check-
up and they also has not proper and sufficient knowledge about oral care. Through research it
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found that 45 % of children 12 have decay in their teeth. So oral care service is very poor in
nursing homes so that thing direct affect to health of people in community.
This report will be cover that literature review and project methodology so this includes
design of project, population sampling, data collection method. This report also include Gantt
chart, challenges and outcomes of project related to oral healthcare. Reason of poor oral hygiene
in nursing home that avoid. This report will include all result that researcher finds through
surveys and research. Discussion about oral hygiene challenges and difficulties that find by
researcher in survey. Statistical data also will cover about poor oral health care in nursing homes.
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Project Methodology
For completing any research project it is very important to have proper information as well as
resources gathered. Project methodology is defined as a process of collecting data and
information which is necessary for research completion. The researcher has been using different
research design, sampling, data collection method for successful completion of this project
report.
Project design
In this research project, researcher has been using two form of project design viz. Pre test and
Post test design method. This design methods has been able to access impact of education level
as well as education level on oral hygiene in all the healthcare workers. This project is of
quantitative nature for SPSS tool has been used. For completion of project, both the design are
useful. In this project design, variable has been measured at the time of its implementation and
after implementation as well.
Project Setting
The project has been based on one of the age care situated in Sydney. This age care is having
facility of 98 beds which has been offering best and high care facility. On current basis, 54
nurses along with casual staffs have been giving their services in age care. Prior intimation as
well as consent has been taken from the DON and care manager. From this project, participants
will be get benefits. For more than 60% nursing staff, there has been two consecutive educational
sessions organised in one month period.
Population and sampling
Sampling is a process of collecting data and information with the help of sample taken from a
part of population. It is not possible to collect data from every individual, therefore sampling
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method is selected so as to save time, money and other resources. For completing this project
study, sample has been collected from a total of 70 to 80% nursing staff. But for better
completion and outcomes, recommendation has been made to increase the sample up to 75%
participants. The project includes 42 nurses approximately to whom 2 consecutive educational
sessions has been provided in 4 weeks time interval. Thus, the sample size has been bifurcated
into 2 groups of 21 participants selected each for educational sessions.
Intervention
Questionnaire has been provided to all the participants for determining their knowledge level
regarding oral hygiene. For this different shift nurses has been selected to provide 2 educational
sessions of 10 to 15 minutes as per availability of nurses. In this 10 to 15 minutes, a handbook
has been provided to all the participants for better understanding of topics such as oral and
systematic health, health problems related to poor oral health and current techniques of oral care.
Visual posters has been made and posted in places such as lift, walls, nurse station for defining
the importance of oral hygiene.
Data collection methods and instruments
For conducting this project study, data has been collected from both the primary as well as
secondary sources. A set of questionnaire has been prepared and filled in by all the participants
willingly after taking their consent in verbal form. Also, the prior approval has been taken from
the Director of Nursing and care managers. This questionnaire set has been given before
intervention and after completion of educational sessions to determine the level of knowledge
participants has gained related to oral hygiene. Score from questionnaire has been collected for
both pre as well as post process and this process has not included any patient and family
member.
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Data has been collected with the help of 12 questions made by the dental committee named
Healthy Smile for Veterans for pre and post assessment of knowledge level. Questionnaire
consist of multiple choices and data has been collected prior and after intervention. No disclosure
has been made about the name and any other detail of age care and participant nurses.
Project period
Activities Week
1
Week
2
Week
3
Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week
10
Selection of
title
Designing of
aims and
objectives
Undertaking
literature
review
Selection of
Research
method
Collection
of data
Analysis &
Discussion
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of data
collected
Conclusion
&
Recommend
ation
Changes as
per feedback
Final
Submission
Data analysis methods
The method used for analysing the data collected is related to the process of marking the score.
On correct answer 1 score has been provided. The criteria of score set – 0-3 insufficient, 4-7
satisfactory and 8-10 excellent. Microsoft excel has been used for making proper interpretation
of the data gathered.
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Discussion
For the above study there was 1 set of question prepared for pre and post purpose which
will help in judging the improvements that has been taken place in oral healthy care. The
questionnaire would be answer by 42 nurses and will be divided in 2 groups of 21 nurses each
for pre and post session.
According to (Listl, and et.al., 2015), the question started with asking importance of
teeth in which both the group answered all the above and there was no change in their answers
in pre ad post matter because obviously teeth are important as they allow people to speak
properly, allow individuals to eat variety of foods and enhances the appearance of the person.
After applying T test there was very less difference obtained in mean which was of .12 and as the
standard deviation is .377 means that data obtained are close to mean and are more reliable. As
per the views of (Laniado, 2017), the other question asked to the group is about Bristles which
protects the teeth and take out the dirt from the teeth. The response of first group was focused on
dost and square rounded whereas after the improvements have been done the answer shifted to
soft and end rounded as they remove the dirt and plaque flexibly which helps in keeping the teeth
clean and maintains hygiene. The mean varied a lot after pre and post judgements which shows
that using round Brussels really improved cleaning the plaque.
(Chen, and et.al., 2015) stated about the truth behind brushing the teeth of another person
in which the focus is on cleaning bacteria and plaque whereas on the contrary, (Wiener, and et.al
2016) feels that neglected teeth and overall care can affect individual and can worsen medical
conditions. The first group before any improvement in their knowledge chose goal of tooth
brushing is to remove plaque but after gaining knowledge the answer changed to both A and C as
ignoring teeth can cause serious medical conditions like gum bleeding, unable to eat etc. Again
the mean has huge difference and standard variation varies too which shows that improvements
has been done and as standard variation is low therefore the data are reliable.
With considering the views of (Valéra,,and et.al., 2015), preferred processes for daily oral
care need to include privacy in its processes, performing the care twice a day and involving
resident of the Veteran in case if its possible. In pre session, the nurses were not focused on
doing the processing privacy and they did not gave it importance but after improving their
knowledge about the oral hygiene they came to know about the importance of privacy in process
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so that the patients do not feel weird about their appearance and bad hygiene. Along with that,
the came to know about suggesting their patients about performing oral care twice a day. Again
the mean varied as the answer changed drastically which lead to difference in standard variation
as well.
The best discussion was held on the question which was based on negligence of residents
without natural teeth. The nurses was confused and answered non healing lesions but after post
question the answers were changed and as per the views of (Bruen, and et.al., 2016), even when
an individual do not have natural teeth it can lead to fungal infection, risk of aspiration
pneumonia and this lead to different mean values in both p-re and post sessions along with
different standard deviation.
(Baicker, and et.al., 201), stated that the nurses and people working in Dental clinic need
to wash their hands for 15 seconds before putting on the gloves but when asked from the nurses
in pre session , the nurses answered 5 minutes looking at the duration as they must have thought
higher the duration, higher it the hygiene level would be maintained but after post session the
answer changes to 15 seconds as the germs get vanish in 15 seconds ad saves time in treating the
patient. The mean error and deviation along with the mean varied even in this question as the
nurses got clear understanding about the use of gloves before treating a patient
According to (Tellez, and et.al., 2015), the correct process of performing mouth check on
individual is to first ask the resident itself in case if they are experiencing any trouble in their
mouth but when asked from nurses they gave priority to asking other resident to hold the flash
light in order to see inside the mouth but its wrong as unless and until the issue is not stated by
the resident, the nurses cannot do that. Therefore the pre and post answer varied under which the
pre mean was observed at .38 and post mean was .83 which means that answers got in sync after
post session.
As per the views of (Vujicic, 2016), the procedure that can cause damage to dentures are
using hot water to clean and store dentures. Dentures are the plate that holds one or more
artificial teeth and can be detached when needed. The answers included the combination of all
the 4 answers in which some said using bathing and regular hand washing soap to brush dentures
which is not correct and can cause all together some different disease. The other answer was
using a denture brush to clean dentures which was acceptable as an answer but was not true. At
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last few gave the answer as none of the above but after post session the answer changed to use of
hot water to clean the dentures.
With accordance to (Chrisopoulos, 2016), the safe and effective oral care techniques for
the resistive resident is to involve the resident in brushing their teeth as much as possible. The
answers given in the response to pre questionnaire was using a toothbrush that is hard to remove
then tarter as fast as possible. The other answers given by almost 12 nurses was brushing the
teeth once a week because it gets difficult to do it every day. After providing proper knowledge
to the nurses the answer changed to brushing teeth as much as possible.
The pre and post answered really varied and the improvement can be seen in the answers
of the nurses which shows that the level of knowledge has been increased.
Results and discussion-
Null hypothesis: There is no significant difference in the mean value of pre and post-test
assessment.
Alternative hypothesis: There is a significant difference in the mean value of pre and post-test
assessment.
T-Test
Paired sample t test is applied when the comparison in between the two mean that relates
with the same individual, units and the object (O'Malley, and et.al., 2016). Two mean represents
the two different times such as the pre test and the post test assessment to determine the
existence of the difference between both the tests. The major purpose for applying this test is to
identify if there is any statistical evidence present and analyzing that the difference between the
mean value of the paired observation on the specific outcome significantly different to that from
the zero.
With reference to the study, pairs are been made that are categorized into two sections
that is pre and the post assessment which involves 12 set of the questions in context of the topic
that is impact of the education on the oral healthcare. The questionnaire has been made filled by
the respondents that does not include the family members and the patients. The pre section of the
assessment states the responses before the study and the post section of the assessment indicates
the changing perspective of the respondents after the study has been made.
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