title: Behind the screens: care staff observations on delivery of oral health care in nursing homes.
abstract: OBJECTIVE
  To identify qualitatively carer staff attitudes, practices and critical comments related to oral health care of functionally dependent nursing home clients.
  
  
  METHODS
  Open-ended questions included in a longer quantitative questionnaire.
  
  
  METHODS
  22 randomly selected nursing homes in the Bristol area.
  
  
  METHODS
  416 carers employed in these homes.
  
  
  RESULTS
  The majority of carers thought that clients had a right to good oral health, accepted the carers' role in helping clients with oral and denture hygiene, but recognised that oral health care provision was deficient. However, some carers believed oral health care to be solely the clients' responsibility despite high disability levels. Main barriers to providing oral health care were low prioritization of oral health by nursing management, lack of co-operation from cognitively impaired clients, and lack of training. Carers were critical of homes' lack of arrangements for routine professional dental checks, lack of commitment to staff training, low standards of oral health care by colleagues, and lack of provision of oral hygiene aids and cleansing materials for clients. Many responses indicated ways in which nursing home oral health care could be improved. Carers reported contrasting experiences of dental treatment, and deplored recent decreased availability of subsidized dental care.
  
  
  CONCLUSIONS
  Carers' generally positive attitudes towards clients' oral health care should encourage health educators. Insights gained from qualitative data can help to identify the less obvious causes for poor oral care delivery, which can then be addressed in education and training initiatives in nursing home settings.
authors.affiliation: Department of Oral and Dental Science, University of Bristol Dental School, UK. h.frenkel@bristol.ac.uk
authors.forename: H F
authors.initials: HF
authors.lastname: Frenkel
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D017028:Caregivers / Q000193:education / Q000523:psychology*; D016321:Dental Care for Aged / Q000523:psychology; D017742:Dental Care for Chronically Ill / Q000523:psychology*; D006801:Humans; D009735:Nursing Homes; D011795:Surveys and Questionnaires; D006113:United Kingdom