Are the barriers to good oral hygiene in nursing homes within the nurses or the patients?
OBJECTIVE
To explore nursing home patients' oral hygiene and their nurses' assessments of barriers to improvement.


BACKGROUND
In nursing homes, nurses are responsible for patients' oral hygiene.


METHODS
This study assessed the oral hygiene of 358 patients in 11 Norwegian nursing homes. 494 nurses in the same nursing homes participated in a questionnaire study.


RESULTS
More than 40% of patients had unacceptable oral hygiene. 'More than 10 teeth' gave OR = 2, 1 (p = 0.013) and 'resist being helped' OR = 2.5 (p = 0.018) for unacceptable oral hygiene. Eighty percent of the nurses believed knowledge of oral health was important, and 9.1% often considered taking care of patients' teeth unpleasant. Half of the nurses reported lack of time to give regular oral care, and 97% experienced resistant behaviour in patients. Resistant behaviour often left oral care undone. Twenty-one percent of the nurses had considered making legal decisions about use of force or restraints to overcome resistance to teeth cleaning.


CONCLUSIONS
Oral hygiene in the nursing homes needed to be improved. Resistant behaviour is a major barrier. To overcome this barrier nurses' education, organisational strategies to provide more time for oral care, and coping with resistant behaviour in patients are important factors.
Dental Health Services' Competence East (TKØ), Norway. tiril@odont.uio.no
Tril
T
Willumsen
Line
L
Karlsen
Richard
R
Naess
Sissel
S
Bjørntvedt
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003071:Cognition / Q000502:physiology; D003430:Cross-Sectional Studies; D003704:Dementia / Q000145:classification; D003774:Dental Plaque Index; D004506:Education, Nursing; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007576:Jaw, Edentulous, Partially / Q000145:classification; D008297:Male; D008875:Middle Aged; D009664:Norway; D009723:Nurse-Patient Relations; D009726:Nurses / Q000523:psychology; D009728:Nursing Assistants / Q000193:education / Q000523:psychology; D009735:Nursing Homes; D009910:Oral Hygiene / Q000193:education / Q000451:nursing*; D010349:Patient Compliance; D010512:Periodontal Index; D013997:Time Factors; D014099:Toothbrushing