Interprofessional oral health guidance for doctor of nursing practice students

Oral diseases are one of the most prevalent conditions in the world and are largely preventable. In comparison with other professionals, nurses have more frequent and longer interactions with people in most health-care environments.¹ With frequent exposure to patients, nurses are ideal for assessing patients’ oral health needs. Nursing students’ involvement in an oral-health educational module could increase their skill set in early detection of oral-health issues and appropriate, timely referral to a dentist. This could significantly decrease the cost of treatment and improve patient care.

In general, studies have shown that nurses need to improve their knowledge about oral health. Therefore, more content should be created to address the oral-health education needs of nursing students.² Increased knowledge from interprofessional education experiences has been shown to lead to better skills and positive attitudes toward collaboration between health-care providers.³ Oral-health education and practical experience occur best in an interprofessional setting and provide the most effective environment for increasing confidence, motivation, knowledge, and skills.⁴

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The practice problem guiding this project was: How will an oral-health education seminar impact BSN (bachelor of science in nursing) to DNP (doctorate of nursing practice) nursing students’ confidence in utilizing the following four key factors in a patient population ranging from pediatric to geriatric?

Establishing general oral assessment skills
Identifying common oral pathology signs
Identifying signs/symptoms of xerostomia and products to treat this condition
Knowing when and how to refer

The outcome of interest was to have a reported increase in student confidence in these four key factors. For the purpose of this study, confidence was defined as “the quality or state of being certain.”⁵ Confidence was measured using a survey measurement tool before and after the intervention. Questions were scored on a five-point Likert scale, ranging from “very confident” (5) to “not at all confident” (1) with higher scores indicating higher confidence.

Eight peer-reviewed publications regarding oral-health education in nursing programs were evaluated to better examine necessity, obstacles, attitude, and outcomes of recent dental interprofessional education (IPE) projects.

Methods

Intervention(s)

The project facilitator provided a 60-minute oral-health guidance seminar to all students using a didactic PowerPoint, presented live on Microsoft Teams. The event was recorded for those who couldn’t attend, as well as for future reference. The seminar was divided into three sections, with the first and second sections being 15-20 minutes in length each with content designed to highlight pediatric through geriatric patient oral-health needs, along with how nurses can make a difference in the oral-care regimen for their patients. The third section of the seminar was 10 minutes in length and was focused on when and how to refer to a general dentist or specialist such as a pediatric dentist or oral surgeon.

Measures

The pre- and post-survey assessment tool was created specifically for this project by the investigator and measured the confidence level of participants in the oral-health guidance seminar. The survey consisted of five questions designed to address participants’ confidence in the four key factors. Each of the five questions was presented as a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree).

Question number five of the survey was designed to measure participants’ perceived value of incorporating the oral-health guidance seminar into their didactic course. The survey came at no cost to the students or to the institution.

Analysis

Excel software was used to organize and analyze pre- and post-survey results. Each survey item was coded using an ordinal scale ranking and totaled for the pre- and post-survey results. Survey answers were assigned a numerical value that resulted in a score based on a five-point Likert scale: 1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, 5 = strongly agree. A comparison of the pre- and post-survey responses was used to analyze the data along with an unpaired t-test.

Results

Out of 20 DNP students, six participated in the pre-survey and four participated in the post-survey. The five statements that were rated on both the pre- and post-survey were:

I feel confident in my skills/knowledge to perform a limited oral-health assessment for a patient under my care.
I feel confident in my skills/knowledge to identify common oral pathology signs for a patient under my care.
I feel confident in my skills/knowledge to recognize the signs and symptoms of xerostomia in a patient under my care.
I feel confident in my skills/knowledge in referring a patient under my care to an oral health-care specialist.
The oral-health guidance seminar would benefit future students in this course.

All questions showed improvement in mean scores after the intervention, showing indications of approaching the highest rating on the Likert scale utilized in this study. The average mean score from the pre-survey to the post-survey is visually represented in Figure 1.

Figure 1: Pre- and postsurvey mean scores, questions 1–5.

The two-sample unpaired t-test was performed, showing a statistically significant difference of 95% CI, with p = .03. The study determined that a statistically significant difference occurred after the presentation of the interprofessional oral health guidance seminar.

Limitations

Several important limitations need to be considered. A relatively small sample size limited

the strength of the findings. Given the few responses, the interprofessional oral-health guidance model intervention looks promising, and it is recommended that another intervention is studied with a larger subject population to evaluate the statistical results. Additionally, the subjects did not follow the directions correctly on creating a unique identification code. This caused data to be unpaired and although improvements were noted, they could not be statistically evaluated to the individual subjects.

Conclusions

With the nursing profession taking on a greater degree of responsibility in the health-care system, the oral-health component in the curriculum needs to be further evaluated. The online oral-health educational module offered through this project demonstrated improvement in student knowledge of dental needs and increased confidence in identifying, treating, or referring their patients. The project lays the groundwork for future studies to examine the impact of educational courses in oral-health guidance for nursing students, including the potential for the permanent inclusion of a dental educational module into the curriculum.

Editor's note: This article appeared in the October 2023 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.

References

Poortaghi S, Raiesifar A, Bozorgzad P, Golzari SE, Parvizy S, Rafii F. Evolutionary concept analysis of health seeking behavior in nursing: a systematic review. BMC Health Serv Res. 2015;15:523. doi:10.1186/s12913-015-1181-9
Kent KA, Clark CA. Open wide and say a-ha: adding oral health content to the nurse practitioner curriculum. Nurs Educ Perspect. 2018;39(4):253-254. doi:10.1097/01.NEP.0000000000000252
Bagge JR, Harbaugh TC, Tabora IG, Aponte MA, Hakobyan A, Johnson DL. Dental hygienists' interprofessional education and collaboration experiences: a survey of current behaviors and attitudes. J Dent Hyg. 2021;95(4):32-40.
Bhagat V, Hoang H, Crocombe LA, Goldberg LR. Incorporating oral health care education in undergraduate nursing curricula - a systematic review. BMC Nurs. 2020;19:66. doi:10.1186/s12912-020-00454-6
Confidence definition. Merriam-Webster. https://www.merriam-webster.com/dictionary/confidence