title: Extending dental nurses' duties: a national survey investigating skill-mix in Scotland's child oral health improvement programme (Childsmile).
abstract: BACKGROUND
  Childsmile is Scotland's national child oral health improvement programme. To support the delivery of prevention in general dental practice in keeping with clinical guidelines, Childsmile sought accreditation for extended duty training for dental nurses to deliver clinical preventive care. This approach has allowed extended duty dental nurses (EDDNs) to take on roles traditionally undertaken by general dental practitioners (GDPs). While skill-mix approaches have been found to work well in general medicine, they have not been formally evaluated in dentistry. Understanding the factors which influence nurses' ability to fully deliver their extended roles is necessary to ensure nurses' potential is reached and that children receive preventive care in line with clinical guidance in a cost-effective way. This paper investigates the supplementation of GDPs' roles by EDDNs, in general dental practice across Scotland.
  
  
  METHODS
  A cross-sectional postal survey aiming to reach all EDDNs practising in general dental practice in Scotland was undertaken. The survey measured nurses': role satisfaction, perceived utility of training, frequency, and potential behavioural mediators of, preventive delivery. Frequencies, correlations and multi-variable linear regression were used to analyse the data.
  
  
  RESULTS
  Seventy-three percent of practices responded with 174 eligible nurses returning questionnaires. Respondents reported a very high level of role satisfaction and the majority found their training helpful in preparing them for their extended role. While a high level of preventive delivery was reported, fluoride vanish (FV) was delivered less frequently than dietary advice (DA), or oral hygiene advice (OHA). Delivering FV more frequently was associated with higher role satisfaction (p < 0.001). Those nurses who had been practising longer reported delivering FV less frequently than those more recently qualified (p < 0.001). Perceived difficulty of delivering preventive care (skills) and motivation to do so were most strongly associated with frequency of delivery (p < 0.001 for delivery of FV, DA and OHA).
  
  
  CONCLUSIONS
  This study has provided insight into EDDNs' experiences and demonstrates that with appropriate training and support, EDDNs can supplement GDPs' roles in general dental practice in Scotland. However, some barriers to delivery were identified with delivery of FV showing scope for improvement.
authors.affiliation: Community Oral Health Section, Glasgow Dental School, Faculty of Medicine, University of Glasgow, 378 Sauchiehall Street, Glasgow G2 3JZ, UK. Wendy.Gnich@glasgow.ac.uk.
authors.forename: Wendy
authors.initials: W
authors.lastname: Gnich
authors.forename: Leigh
authors.initials: L
authors.lastname: Deas
authors.forename: Sarah
authors.initials: S
authors.lastname: Mackenzie
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Burns
authors.forename: David I
authors.initials: DI
authors.lastname: Conway
mesh_terms: D000328:Adult; D002327:Cariostatic Agents / Q000627:therapeutic use; D002648:Child; D002983:Clinical Competence; D003376:Counseling; D003430:Cross-Sectional Studies; D032022:Delegation, Professional / Q000331:legislation & jurisprudence*; D003726:Dental Assistants / Q000193:education / Q000331:legislation & jurisprudence*; D019140:Dental Care for Children / Q000331:legislation & jurisprudence*; D005247:Feeding Behavior; D005260:Female; D005460:Fluorides, Topical / Q000627:therapeutic use; D005792:General Practice, Dental / Q000331:legislation & jurisprudence; D006293:Health Promotion / Q000331:legislation & jurisprudence*; D006801:Humans; D007588:Job Satisfaction; D008875:Middle Aged; D009042:Motivation; D009909:Oral Health / Q000331:legislation & jurisprudence*; D009910:Oral Hygiene / Q000193:education; D012606:Scotland; D012649:Self Concept; D012944:Social Support; D013192:Staff Development / Q000331:legislation & jurisprudence; D055815:Young Adult
chemical_list: D002327:Cariostatic Agents; D005460:Fluorides, Topical