Evidence-Based Concept Map In Healthcare

Evidence-Based Concept Map In Healthcare

Guiding Questions: Concept Map

This document is designed to give you questions to consider and additional guidance to help you successfully complete the Concept Map assessment. You may find it useful to use this document as a pre-writing exercise, as an outlining tool, or as a final check to ensure that you have sufficiently addressed all the grading criteria for this assessment. This document is a resource to help you complete the assessment. Do not turn in this document as your assessment submission.

Part 1: Concept Map

Develop an evidence-based concept map that illustrates a plan for achieving high-quality outcomes for a condition that has impaired glucose or metabolic imbalance as related aspects.

· Does your concept map fully illustrate the case study, the diagnostic and treatment connections for the condition in the case study, the specific metabolic or glucose-related aspects of the condition, and interprofessional strategies?

o Does your concept map contain all the relevant sections and connections that are present in the example concept map that is most closely related to yours?

· Does your concept map illustrate the desired high-quality outcomes of treatment in the context of your chosen case study?

· Did you use at least 3–5 sources of scholarly or professional evidence as the basis for your concept map?

Note: You will need to further discuss the value and relevance of this evidence in your narrative. However, be sure to cite where specific evidence or sources were used in your concept map.

o The evidence you cite should be no more than five years old.

Part 2: Additional Evidence (Narrative)

Justify the value and relevance of the evidence you used as the basis for your concept map.

· Have you noted why the evidence you have presented in your concept map is valuable and relevant to the case study you are using as the basis for the concept map?

o Have you explained why each particular piece of evidence is appropriate to the case study you are using?

o Have you explained the linkage between the evidence and the specific metabolic or glucose-related aspects of the condition from your chosen case study?

o Have you explained why the evidence you have used is the best available? In other words, how is it linked to best practices, professional or regulatory guidelines, et cetera?

Analyze how interprofessional strategies applied to the concept map can lead to achievement of desired outcomes.

· What interprofessional strategies in assignment help are most applicable to the context of the case study that you are using as the basis for the concept map?

o Why are these interprofessional strategies appropriate in  the context of the case study and your concept map?

· What are the desired outcomes in your concept map (or for the case study that you are using)?

o How will the interprofessional strategies you deemed appropriate and applicable help to achieve the desired outcomes?

o What potential challenges might you need to address to best implement the interprofessional strategies and achieve the desired outcomes?

· Remember, the evidence you cite should be no more than five years old.

Address Generally Throughout Both Parts

Construct concept map and linkage to additional evidence in a way that facilitates understanding of key information and links.

· Is your concept map clearly presented?

· Are the links between the evidence and your diagnostic, treatment, or other care decisions clear and justified?

· Is your writing in both the concept map and the narrative clear and professional?

· Is your writing free from errors?

· Is your narrative submission 2–3 pages (not including the title page and reference list)?

· Are you communicating in an ethical way?

o Are you communicating honestly?

Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style.

· Did you use 3–5 sources in your assessment?

o Are the sources you used no more than five years old?

· Are your sources cited in APA format throughout the concept map and narrative?

· Have you included an attached reference list?

· Did you use the APA Work Template for the proper formatting and to include a running head and title page?

o No abstract is needed for this assessment.

·   COLLEGE OF BANKING AND FINANCIAL STUDIES

· DEPARTMENT OF PROFESSIONAL STUDIES

· Assignment front sheet

· Assignment – 1

· Qualification  Unit number and title

· Pearson BTEC Level 5 HND Diploma in Business

· Human Recourses Management Specialization  Unit 45: Business Ethics

· Semester  Batch

· IV  Fall 2016-17

· Student name  Assessor name

·  Ms. Kifah Al-Saleh

· Student No.  Internal Verifier (IV) name

·  Mr. NiranjanShetty

· Date issued  Completion date  Submitted on

· 20.10.2016  04.11.2016

· Assignment title  Understand different ethical perspectives in business & business objectives from an ethical perspective

·    In this assessment you will have the

· Learning  Learning Assessment opportunity to present evidence that  Task Evidence

· Outcome  outcome Criteria  shows you are able to:  no. (Page no)

·  Understand  1.1  Explain the background and development

· 1   different of theoretical ethical approaches

·  ethical

· 1.2

·  perspectives in  Compare and contrast absolute and  2

·  LO1  relative ethics

· business

·  1.3  Explain the ethical issues which can affect

· 3 the operational activities of a business

· Understand  2.1  Explain how business objectives are  4   business  affected by ethical considerations

·  LO2

· objectives 2.2  Evaluate the implications for a business  5

· from an ethical  and its stakeholders to operate ethically perspective

·  Learner declaration

·   I certify that the work submitted for this assignment is my own and research sources are fully acknowledged.

·  Student signature:  Date:

·  In addition to the above PASS criteria, this assignment gives you the opportunity to submit evidence in order to achieve the following

· MERIT and DISTINCTION grades

·   Grade Descriptor

· Indicative characteristic/s

· Contextualisation

· M1 Identify and apply strategies to find appropriate solutions

· Effective judgements have been made.

·   Effective approach to study and research

·  To achieve M1, you will make effective judgements while comparing and contrasting absolute and relative ethics (task 2).

·  To achieve M1, you will have made an effective approach to study and research for studying the background and development of theoretical ethical approaches (task 1)

·   M2 Select / design and apply appropriate methods / techniques  A range of sources of

· information has been used

·   To achieve M2, you will have used a range of sources of information while explaining the background and development of theoretical ethical approaches (task 1).

·   M3 Present and communicate appropriate findings  The appropriate structure and approach has been used  To achieve M3, you will have produced your answer with appropriate structure and approach while explaining the ethical and operational issues of Oman Arab Bank (task 3)

· D1 Use critical reflection to evaluate own work and justify valid conclusions  Conclusions have been arrived at through synthesis of ideas and have been justified  https://onlyessayhelp.com/tag/economics-assignment-help/

· To achieve D1, you will have reached cconclusions through synthesis of ideas while evaluating implications for stakeholders and company of operating ethically (task 5).

·  To achieve D1, you will have arrived at conclusions through synthesis of ideas and have been justified the effect of objectives on ethical considerations (task 3).

·  · D2 Take responsibility for

· managing and organising activities  Demonstrated autonomy/independence  To achieve D2, you will have demonstrated autonomy/independence while explaining the objectives and ethical considerations for ABC company (task 4)

· D3 Demonstrate creative thinking  Ideas have been generated and decisions taken  To achieve D3 you will have generated ideas and decisions taken while evaluating the implications for stakeholders and company of operating ethically (task 5).

· Page 2 of 7

· Source: Customised by CBFS@PSD@HND based on Pearson BTEC format: Annexure 5

·  · Assignment brief

· Purpose of this assignment

·   This assignment will develop learner to understand different ethical perspectives in business & to understand business objectives from an ethical perspective

·  Task 3 – LO1 – Assessment Criteria 1.3 (M3/D1):

·   “Oman Arab Bank attaches considerable importance to the good corporate governance practices and the Board of Directors committed to applying the highest standards of professional competence in all its activities. The Bank follows the guidelines of the Central Bank of Oman, Basel Committee recommendations, Accounting and Auditing Standards, it also apply the Capital Market Authority that match with the Bank legal form”.

·   To achieve PASS you must;

·   Explain three ethical issues of Oman Arab Bank

· • Explain the operational activities of Oman Arab Bank

· • Explain how these three ethical issues can affect the operational activities of Oman Arab Bank.

·   To achieve M3, you will have produced your answer with appropriate structure and approach while explaining the ethical and operational issues of Oman Arab Bank.

·   To achieve D1, you will have arrived at conclusions through synthesis of ideas and have been justified the effect of objectives on ethical considerations.

·   Task 4 – LO2 – Assessment Criteria 2.1 (D2):

·  ABC is a national company and its main objective is to increase its profits by cutting costs and going international. With the current economical conditions and recession phase for the company, the CEO has been faced with some difficult issues for decision making that affects the company’s different business operations to reach to its main objective, Profit!

·  · To achieve PASS you must;

·   • Explain the rationality of few objectives for ABC company

· • Explain the ethical considerations for ABC company

· • Explain how the objectives can affect the ethical considerations of ABC company

·  To achieve D2, you will have demonstrated autonomy/independence while explaining the objectives and ethical considerations for ABC company.

·   Task 5 – LO2 – Assessment Criteria 2.2 (D1/D3):

·  Mohammed and Mohammed (M&M) is a global company at growth phase in its business cycle. Mr. Ali being the CEO of the company is trying to balance the objectives of the company’s different stakeholders by applying the quote “bigger is always better”. Applying such a business practice to the company’s operations to reach to the peak will cause the company’s management of using poor business ethics.

·  To achieve PASS you must;

· • Find three stakeholders for Mohammed and Mohammed company

· • Evaluate the implications for these stakeholders of M&M Company operating ethically.

·  To achieve D1 you will have reached conclusions through synthesis of ideas while evaluating implications for stakeholders and company of operating ethically.

·   To achieve D3 you will have generated ideas and decisions taken while evaluating the implications for stakeholders and company of operating ethically.

·   Guidance notes:

·   1. Use standard document formats and structures.

· 2. Word process the documents.

· 3. Use 12 point Arial or Times New Roman script.

· 4. Provide a list of references and use the Harvard referencing system.

· 5. Complete the title page and sign the statement of authenticity.

· 6. Upload the entire assignment in MS word format only on Turnitin.

· 7. Staple only once to keep the pages of your work together.

· 8. Late submission, late work will only be marked on the next occasion the unit is taught.

· 9. Submit the work along with the Turnitin report to the respective assessors in their offices.

· 10. Collect the assignment submission form duly signed by the assessor and the learner.

·   Achievement Summary

·· Qualification

· Pearson BTEC Level 5 HND Diploma in

· Business

· Human Recourses Management

· Specialization

· Assessor

· name

·  Ms. Kifah Al-Saleh

·  Unit Number and title  Unit 45: Business Ethics   https://onlyessayhelp.com/tag/language-and-culture-assignment-help/

· I.V. name

· Mr. NiranjanShetty

·  Student

· Number

· Student name

·  · Criteria

· Reference  To achieve the criteria the evidence must show that the student is able to:  Achieved? (tick)

· LO1

·   1.1  Explain the background and development of theoretical ethical approaches

· 1.2

·  Compare and contrast absolute and relative ethics

· 1.3  Explain the ethical issues which can affect the operational activities of a business

· LO2

· 2.1

·  Explain how business objectives are affected by ethical considerations

· 2.2

·  Evaluate the implications for a business and its stakeholders to operate ethically

·   Higher Grade achievements (where applicable)

·   Grade descriptor

·  Achieved?

· (tick)

· Grade descriptor

· Achieved?

· (tick)

·  · M1: Identify and apply strategies to find appropriate solutions

·   D1: Use critical reflection to evaluate own work and justify valid conclusions

·· M2:  Select/design  and  apply

· appropriate methods/techniques

·  D2: Take responsibility for managing and

· organising activities

·  M3:  Present  and  communicate

· appropriate findings

·  D3:  Demonstrate

· convergent/lateral /creative thinking

·  Assignment Feedback

·  Formative Feedback: Assessor to Student

·  Action Plan

· Summative feedback

·  · Feedback: Student to Assessor

·  · Assessor Signature

·  Kifah Al-Saleh

· Date

·  IV Signature

· Date

·  Student Signature

· Date

·   Reacting to Parents or Caregivers Who Display a Sense of Entitlement Nursing Assignment Help

· The teachers should recognize their right to teach professionally without disruptions as suggested by Charles (2011) and use this position to address the problem. Like teachers, parents and caregivers have their rights in fostering the education of their children. However, parents and caregivers should avoid evoking a climate that would undermine the development of students as stated in the Bible (Colossians 3:20-21). In this history assignment help, some parents might overstep their rights and display a sense of entitlement. Teachers have a responsibility to intervene based on the best interests of students. The appropriate reaction from teachers is to engage the parents in dialogue to achieve an understanding of relevant rules and policies as well as their roles as partners in promoting the development of their children.

· The dialogue should entail three key elements. In the first element, the teachers should listen to the perspectives and attitudes of the parents towards the students. This element would help the teachers to avoid yelling or arguing with the parents (Emmer & Evertson, 2013). As teachers operate in increasingly more diverse classroom environments, it becomes easier to overlook the diverse perspectives of the parents and caregivers about teaching and school at large. Some attitudes of the parents and caregivers might encourage them to display a sense of entitlement and diverge from the policies of the school. Seeking to understand such attitudes would be an important initial step for the teachers in addressing the problem.

· In the second element, the teachers should explain the roles, policies, rules, and procedures to the parents. Upon gaining an understanding of the attitudes of the parents, the teachers would be in a strong position to provide explanations or parent education that would improve the situation. Perhaps a lack of understanding on the part of the parents or caregivers regarding their role might be a contributing factor in displaying a sense of entitlement. Teachers might be dealing with parents from diverse backgrounds, but the established policies, rules, and procedures provide an opportunity to foster common ground. An explanation of the roles of the parents as partners with teachers in the learning environment, as well as the rules, policies, and procedures, might influence the parents to adopt a cooperative approach rather than display a sense of entitlement (assignment help).

· The final element regards the teachers taking specific measures to cultivate a relationship of trust and respect with the parents. These values are consistent with the Christian worldview and would help the teachers to reach a consensus with the parents. Overall, the dialogue would help teachers and parents or caregivers to build solidarity and create a environment of collective agreements, mutual-respect, and collective responsibility for the education of the students.

·   References

· Charles, C. M. (2011). Building classroom discipline(10thed.). Boston, MA: Pearson Education, Inc. https://historyassignmenthelp.com/tag/writing/

· Emmer, E. T. & Evertson, C. M. (2013). Classroom management for middle and high school teachers. Boston, MA: Pearson Education, Inc.

· Colossians 3:20-21 20“Children, always obey your parents, for this pleases the Lord. 21Fathers, do not aggravate your children, or they will become discouraged.” https://learnedwriters.com/category/assignment-help/

 

Nurse Practitioner

Individual Professional Practice Document: Nurse Practitioner

Instructions

After passing your certification exam, the next step is to obtain your Nurse Practitioner (RN/NP) license. Then you should apply for prescriptive authority in the state in which you plan to practice. In some states, this requires a collaborating/ supervising physician; in some states, there are restrictions for NP prescribing. After you obtain a state prescriptive license, you must apply for a federal drug enforcement administration (DEA) certificate so that you can prescribe controlled substances. Use the following resources to complete this week’s IPPD assignment

· Nurse Practitioner Interactive Map

· Drug Enforcement Administration (DEA)

· DEA Forms and Applications

Using the document you started in Week 1 Assignment 2: Individual Professional Practice Document: NP Title, Definition, and Consensus Model and added to in Week 5 Assignment 1: Individual Professional Practice Document: Scope of Practice,, please add the following information to the Week 6 area. Using the  Nurse Practitioner Interactive Map , select the state or states where you plan to practice and become familiar with each state’s regulations related to NP prescriptive authority. In some states, prescriptive authority is explained in the Board of Nursing (BON) and the Department of Public Health (DPH), so you might have to search the DPH website as well. You must also meet the federal DEA regulations for your state to be licensed to prescribe controlled substances.

· What are the prescriptive authority requirements for the state in which you intend to practice? Is there a MD collaborative or supervisory regulation related to non-controlled substances or controlled substances? Are there any restrictions for NP prescriptive practice? Does the state utilize a system-wide drug monitoring program to assist with the prevention of overprescribing?

· Include a hyperlink to the state prescriptive authority regulations.

· Does the state allow DEA licensure? What are the requirements to obtain a DEA certificate? Are there any MD collaborative/ supervisory regulations related to controlled substance prescribing? Are there any restrictions to prescribing controlled substances, including opioids and naloxone authority?

· Include the federal DEA hyperlink.

prescriptive authority regulations in the state

Week 6 Discussion 1: Prescriptive Authority: State Regulations

Initial Post

To get started, review the Nurse Practitioner Interactive Map.

In your initial post, please identify the prescriptive authority regulations in the state where you are going to practice. Are there any restrictions, supervision, or collaboration required from a physician? If so, please explain. If you will be practicing in multiple states, do the regulations in those states differ? If you are in a clinical placement, please ask your preceptors about the prescriptive regulations and if an agreement is needed. If so, ask to see a copy of the agreement so that you can review what will be required when you begin to practice. Share with one another on the discussion board what you have found. If you are precepting at more than one facility, discuss whether these agreements differ at all, what your thoughts are about any differences, and which agreements you like best.

Reply Posts

Reply to at least one of your classmates. In your reply post, compare and contrast the state regulatory requirements of the state in your initial post with a different state. Discuss with your colleague rationales behind these differences and how the difference affects healthcare access, quality and cost.

Journal

Journal #2

What are the consequences of short staffing in a hospital. How can management help reduce the number of patient to nurse ratio, also explain how over working can negatively effect the nurse in their daily life.

The Pathogens

The Pathogens

Compare the pathogens discussed in the previous chapters with zoonotic pathogens.

Nurs practioner problem

 

Nurs

Module 05 Content

  1. You will perform a history of a nose, mouth, throat, or neck problem that your instructor has provided you. You will perform an assessment including nose, mouth, throat, and neck. You will document your subjective and objective findings, identify actual or potential risks, and submit this in a Word document to the drop box provided.
  2. Patient is a 17 year old male that came to the clinic with his father after feeling ill for 2 days. The patient has throat pain and drainage from his nose. Both he and his father are answering questions. You will document your subjective and objective findings (what did they tell you, what do you see…. Be DETAILED!) Identify actual or potential risks, and submit this in a Word document to the drop box provided.

Title:

Documentation of problem based assessment of the nose, throat, neck, and regional lymphatics.

 

Purpose of Assignment:

Learning the required components of documenting a problem based subjective and objective assessment of nose, throat, neck, and regional lymphatics. Identify abnormal findings.

 

Course Competency:

Demonstrate physical examination skills of the head, ears, and eyes, nose, mouth, neck, and regional lymphatics.

 

Instructions:

 

Content: Use of three sections:

· Subjective

· Objective

· Actual or potential risk factors for the client based on the assessment findings with description or reason for selection of them.

 

Format:

· Standard American English (correct grammar, punctuation, etc.)

 

Resources:

Chapter 5: SOAP Notes: The subjective and objective portion only

Sullivan, D. D. (2012). Guide to clinical documentation. [E-Book]. Retrieved from http://ezproxy.rasmussen.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=495456&site=eds-live&ebv=EB&ppid=pp_91

 

Smith, L. S. (2001, September). Documentation do’s and don’ts. Nursing, 31(9), 30. Retrieved from http://ezproxy.rasmussen.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=107055742&site=eds-live

 

Documentation Grading Rubric- 10 possible points

Levels of Achievement
Criteria Emerging Competence Proficiency Mastery
Subjective

(4 Pts)

Missing components such as biographic data, medications, or allergies. Symptoms analysis is incomplete. May contain objective data.

 

Basic biographic data provided. Medications and allergies included. Symptoms analysis incomplete. Lacking detail. No objective data. Basic biographic data provided. Included list of medications and allergies. Symptoms analysis: PQRSTU completed. Lacking detail. No objective data. Information is solely what “client” provided. Basic biographic data provided. Included list of medications and allergies. Symptoms analysis: PQRSTU completed. Detailed. No objective data. Information is solely what “client” provided.
Points: 1 Points: 2 Points: 3 Points: 4
Objective

(4 Pts)

Missing components of assessment for particular system. May contain subjective data. May have signs of bias or explanation of findings. May have included words such as “normal”, “appropriate”, “okay”, and “good”.

 

Includes all components of assessment for particular system. Lacks detail. Uses words such as “normal”, “appropriate”, or “good”. Contains all objective information. May have signs of bias or explanation of findings. Includes all components of assessment for particular system. Avoided use of words such as “normal”, “appropriate”, or “good”. No bias or explanation for findings evident Contains all objective information Includes all components of assessment for particular system. Detailed information provided. Avoided use of words such as “normal”, “appropriate”, or “good”. No bias or explanation for findings evident. All objective information
Points: 1 Points: 2 Points: 3 Points: 4
Actual or Potential Risk Factors

(2 pts)

 

Lists one to two actual or potential risk factors for the client based on the assessment findings with no description or reason for selection of them. Failure to provide any potential or actual risk factors will result in zero points for this criterion. Brief description of one or two actual or potential risk factors for the client based on assessment findings with description or reason for selection of them. Limited description of two actual or potential risk factors for the client based on the assessment findings with description or reason for selection of them. Comprehensive, detailed description of two actual or potential risk factors for the client based on the assessment findings with description or reason for selection of them.
Points: 0.5 Points: 1 Points: 1.5 Points: 2

 

 

 

Interactive Case Study

Interactive Case Study

After you view the case study, reflect upon what you have learned and how it is related to the learning materials. Compare the case study to your nursing practice and give a similar example from your experience in which you might have run into staffing issues.

Your reflection content should be a minimum of 500 words, equal to five to six paragraphs.

Pamphlet

Pamphlet #1

Create a pamphlet using any type of publisher software you choose to educate clients on a current patient safety issue.

For example:

· How aging adults can care for themselves at home

· Medication–polypharmacy and how a patient cannot make a self-medication error,

· Or other appropriate safety issues.

If you have a question about a specific topic, check with your instructor. It is recommended that you save your pamphlet as a PDF for submission.

Your pamphlet must include the following items:

1. At least five tips for preventive care for the patient.

2. Information that should be shared with family or caregivers.

3. Local resources in the community that might be available for this type of safety concern.

At least three APA-formatted references published within the last five years.

Pamphlet

Pamphlet #1

Create a pamphlet using any type of publisher software you choose to educate clients on a current patient safety issue.

For example:

· How aging adults can care for themselves at home

· Medication–polypharmacy and how a patient cannot make a self-medication error,

· Or other appropriate safety issues.

If you have a question about a specific topic, check with your instructor. It is recommended that you save your pamphlet as a PDF for submission.

Your pamphlet must include the following items:

1. At least five tips for preventive care for the patient.

2. Information that should be shared with family or caregivers.

3. Local resources in the community that might be available for this type of safety concern.

At least three APA-formatted references published within the last five years.

Giving prompts and verbal instructions on effective oral healthcare

This is an academic, professionally written exercise consisting of a minimum of 3 to 4 paragraphs in length.

Each paragraph to contain of a minimum of 4 to 5 sentences.

To consist of 750 to 1000 words. (No Less no more.)

No other reference, can only use article, 0 plagiarism

Example: INTRODUCTION: First review and summarize the journal article. Describe what the article is about. Present a clear, non-biased understanding of the article’s topic. Mention the article name and source. What makes the article important? “The main topic of this journal article is ….”

MAIN BODY: Critically review the article. Analyze the evidence. Was the research presented in the article objective or bias? Describe the article’s strength and weakness. Highlight the positive or negative points. “This article presents the material (well / not well) because …

” Do not give your opinion on the article’s topic, we are not experts. Why should or should not the article be recommend reading? Was the article successful or a failure in relaying information based on the topic?  “I (recommend/ don’t recommend) reading this article because…”

CONCLUSION: Conclude with what you learned from analyzing the article. What knowledge was gained from reading this article? What do the results cited in the article indicate? Do not present new or additional information in the conclusion, stay focused on the article topic at hand. “After reading and analyzing this article I learned that …. “

 

| PEER-RE VI E WED |evidence & practice / CPD / mouth care

Aims and intended learning outcomes This article aims to provide information for nurses and other healthcare professionals on evidence-based practice to support people with intellectual disabilities with their oral healthcare needs and access to dental services. Such knowledge is essential to enhance the oral health of this population. The article emphasises the importance of nurses being aware of the latest evidence about oral healthcare interventions for

people with intellectual disabilities and explains how this should inform their practice. After reading this article and completing the time out activities you should be able to: » Evaluate knowledge of oral healthcare that can be applied to evidence-based practice and supports people with intellectual disabilities. » Recognise the oral healthcare needs that people with intellectual disabilities commonly experience.

Citation Hartnett L, McNamara M (2021) Oral health and supporting people with intellectual disabilities to get access to dental treatment. Learning Disability Practice. doi: 10.7748/ldp.2021.e2123

Peer review This article has been subject to external double-blind peer review and checked for plagiarism using automated software

Correspondence liz.hartnett@dcu.ie

Conflict of interest None declared

Accepted 4 November 2020

Published online February 2021

Why you should read this article: ● To improve your knowledge of the barriers that people with intellectual disabilities experience when accessing dental services ● To understand how to support people with intellectual disabilities with their oral healthcare ● To familiarise yourself with latest evidence about optimal practice in oral healthcare for people with intellectual disabilities

Oral health and supporting people with intellectual disabilities to get access to dental treatment Liz Hartnett and Martin McNamara

Abstract Oral health is an important aspect of a person’s overall health and well-being. People with intellectual disabilities have poorer oral health than the general population, so it is essential that service users and their carers are supported to address this. This article provides information for nurses and other healthcare professionals on how to provide evidence-based practice that supports people with intellectual disabilities with their oral healthcare and assists them to access dental services. The authors examine the latest evidence about optimal practice in oral healthcare for people with intellectual disabilities, emphasising the importance of a person- centred approach. The article also discusses the barriers that people with intellectual disabilities experience when accessing dental services and how these barriers can be addressed.

Author details Liz Hartnett, lecturer, School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Republic of Ireland; Martin McNamara, professor, School of Nursing Midwifery and Health Sciences, University College Dublin, Dublin, Republic of Ireland

Keywords clinical guidelines, evidence-based practice, learning disability, nursing care, oral health, oral hygiene, professional

learningdisabilitypractice.com volume 24 number 2 / April 2021 / 3 3

Permission To reuse this article or for information about reprints and permissions, contact permissions@rcni.com

 

 

| PEER-RE VI E WED |evidence & practice / CPD / mouth care

» Understand the importance of a person- centred approach when supporting people with intellectual disabilities with their oral healthcare needs. » Identify the issues that people with intellectual disabilities may experience when accessing oral healthcare support and dental services. » Outline evidence-based guidance on making oral healthcare and dental services increasingly accessible to people with intellectual disabilities.

Introduction It has been identified that people with intellectual disabilities have poorer oral health than the general population (Wilson et al 2018). For example, Anders and Davis’ (2010) systematic review revealed higher levels of dental caries and periodontal disease in people with intellectual disabilities compared with the general population. Similarly, Public Health England (PHE) (2019) guidance also recognises that this group has greater unmet oral healthcare needs and reduced access to dental services compared with the general population. Oral healthcare can affect a person’s overall health and well- being (Waldron et al 2019), so it is essential that people with intellectual disabilities receive the necessary support.

Knowledge to support evidence-based practice To support people with intellectual disabilities with their oral healthcare needs effectively, it is important that nurses can access and appraise knowledge that can be applied to evidence-based practice. One of the themes of The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates (Nursing and Midwifery Council (NMC) 2018) is to practise effectively, and this involves nurses using evidence to support their practice. Continuous development of the evidence base through research is important to enable nurses to select the most relevant

and up-to-date knowledge to ensure that their practice is effective.

Another theme of the Code (NMC 2018) is to promote professionalism and trust, which includes the requirement for nurses to keep their knowledge and skills up to date. An important aspect of this is the development of the profession’s knowledge base, which is vital in providing evidence for clinical practice. Young (2013) asserted that specialised knowledge is at the core of any professional group. This article focuses on the development of the specialised knowledge required to support people with intellectual disabilities with their oral healthcare needs and to facilitate their access to dental services.

Oral healthcare needs Evidence from several studies has indicated that this population has higher levels of untreated tooth decay compared with the general population (Anders and Davis 2010, Wilson et al 2018). Mac Giolla Phadraig et al (2015a) found that people with intellectual disabilities are more likely to have teeth extracted than restored and that about one third of those aged over 50 years did not have any teeth or dentures. Anders and Davis (2010) also identified that people with Down’s syndrome may have suboptimal oral health. In addition, people with intellectual disabilities often have low awareness of oral health issues, and may rely on others to assist with their oral healthcare and to arrange dental appointments (Cumella et al 2000, PHE 2019).

Box 1 lists some of the common oral health issues in people with intellectual disabilities.

Suboptimal oral health Oral health affects a person’s overall health status, and experiencing oral health issues can affect all areas of their life (PHE 2019). Suboptimal oral health may cause pain, potentially leading to serious issues for some people with intellectual disabilities who have difficulty communicating their pain (PHE 2019). Suboptimal oral health

Key points ● It has been identified that people with intellectual disabilities have poorer oral health than the general population

● People with intellectual disabilities often have little awareness of oral health issues, and may rely on others to assist them with their oral healthcare

● One significant barrier to effective oral healthcare in this population is a lack of specific training for dentists

● Oral healthcare delivered using a person-centred approach has an essential role in improving the overall well-being of people with intellectual disabilities

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has also been associated with cardiac disease, aspiration pneumonia, diabetes mellitus and stroke (Wilson et al 2018, Ward et al 2019). It may also have a negative effect on an individual’s self- esteem, communication and ability to socialise (PHE 2019). In addition, having no teeth limits a person’s food choices, has a negative effect on their ability to chew and on their nutritional intake, and can be associated with obesity (Davies et al 2008, Wilson et al 2018). Oral health issues can also diminish a person’s enjoyment of eating (PHE 2019).

Evidence suggests that people with intellectual disabilities often have additional risk factors for suboptimal oral health, some of which are detailed in Box 2.

Reasonable adjustments need to be made to address the barriers that people with intellectual disabilities may experience when accessing dental services (PHE 2019). Considering the risk factors and barriers to dental services, as well as the evidence relating to suboptimal oral health, it is crucial that people with intellectual disabilities are supported with this aspect of their care and facilitated to access dental services. However, Mac Giolla Phadraig et al (2013) found that healthcare staff supporting people with intellectual disabilities often do not have the knowledge and skills required to provide effective oral healthcare.

Mac Giolla Phadraig et al (2018) analysed data from a cross-sectional survey of adults with intellectual disability who were aged over 40 years. They identified that many people with intellectual disabilities find it challenging to cope with the dental treatment that they require and may have difficulties in expressive communication, which can lead to behaviours that challenge.

Gum disease and dental decay are the most common oral diseases and can lead to the loss of teeth and oral functional impairment (Mac Giolla Phaidraig et al 2015b, 2018). Oral healthcare and dental treatment can prevent or manage these conditions. However, it has been identified

that people with intellectual disabilities in the Republic of Ireland have poorer outcomes in relation to gum disease and dental decay than the general population (Mac Giolla Phadraig et al 2015b), as well as a higher incidence of untreated dental caries and periodontal disease (Anders and Davis 2010). Furthermore, oral health issues in people with intellectual disabilities can be more complex than in the general population (Wilson et al 2018). Therefore, it is important that existing evidence is disseminated among nurses and other healthcare professionals, and that further research is undertaken to generate evidence on what interventions are most effective for this group to improve their oral health outcomes.

Evidence in relation to oral health interventions Wilson et al (2018) emphasised that further research is required to improve healthcare professionals’ understanding of effective

Box 1. Common oral health issues in people with intellectual disabilities

» Greater incidence of gum inflammation » Reduced preventive dentistry » Increased plaque levels » Untreated tooth decay » Greater use of extraction rather than restorative interventions » Increased rates of toothlessness » Greater numbers of missing teeth, no teeth and no dentures » Reliance on others for oral health care » Low awareness of oral health issues

(Adapted from Anders and Davis 2010, Mac Giolla Phadraig et al 2015b, Wilson et al 2018, Public Health England 2019)

Box 2. Risk factors for suboptimal oral health in people with intellectual disabilities

» Medicines that reduce saliva flow, for example antidepressants » Medicines that increase gum inflammation, for example some anticonvulsants » Enteral feeding » Gastroesophageal reflux disease » Issues with accessing dental services » Lack of understanding of the need for daily oral health care » Lower income and education levels » Dexterity issues that may hinder an individual’s tooth-brushing abilities

(Adapted from Davies et al 2008, Anders and Davis 2010, Wilson et al 2018, Public Health England 2019, Joint Formulary Committee 2020)

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oral healthcare interventions for people with intellectual disabilities, since each person will experience different challenges in relation to their oral care needs. Further research is necessary to develop existing knowledge and understand its application to nursing practice (Waldron et al 2019).

Wilson et al (2019) conducted a systematic review to collate the existing evidence and identify interventions that improve oral health outcomes for people with intellectual disabilities. They found that one intervention that could improve care for this population was education for healthcare professionals on providing oral healthcare support. The provision of outreach oral health services to support access to dental services has also been shown to have positive effects on oral health (Wilson et al 2018). In addition, the use of general anaesthesia to facilitate dental treatment was considered to increase the efficacy of treatments for some people with severe and profound intellectual disabilities or with dental- related behaviours that challenge. However, further research is required in relation to the use of specific tooth-brushing methods to improve oral health, since existing outcome findings remain uncertain.

Wilson et al’s (2019) systematic review identified that a uniform approach to supporting oral health in this population is not recommended. Instead, there is a need for an approach that acknowledges the diverse needs of people with intellectual disabilities, their carers and the service context.

Waldron et al (2019) reviewed the effectiveness of oral hygiene programmes for people with intellectual disability, concluding that the evidence relating to the benefits of these programmes for this population remains unclear. They identified that there is a need for further research to evaluate interventions and stated that studies with increased sample sizes could add to the evidence base. Waldron et al (2019) also emphasised the importance of developing research that focuses on the

effects of suboptimal oral health on overall health and quality of life of people with intellectual disabilities.

Evidence-based oral health interventions for people with intellectual disabilities include (Wilson et al 2018, 2019, PHE 2019, Waldron et al 2019): » The provision of outreach oral health services to support improved access to oral health services. » General anaesthesia to facilitate dental treatment for some people with severe and profound intellectual disabilities or with dental-related behaviours that challenge. » Approaches where the diverse needs of people with intellectual disabilities, their carers and the service context are acknowledged and addressed.

TIME OUT 1 Read the following documents: » PHE (2019) Oral Care and People with Learning Disabilities guidance » Faculty of Dental Surgery, The Royal College of Surgeons of England (2021) Clinical Guidelines and Integrated Care Pathways for the Oral Health Care of People with Learning Disabilities

How could these documents inform your practice in supporting people with intellectual disabilities with their oral health?

Waldron et al (2019) recommended that, given the uncertainty about the evidence for the clinical effectiveness of oral healthcare interventions, high-quality randomised controlled trials are needed to clarify and develop the findings in their review. In the absence of such studies, Waldron et al (2019) recommended the use of professional expertise and emphasised that oral healthcare should be based on the individual needs of the person and their carers.

Taking a person-centred approach One theme of the Code (NMC 2018) is to prioritise people, and taking a person- centred approach to oral healthcare is consistent with this. The issues that people with intellectual disabilities experience in

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relation to their oral health are specific to each individual (Wilson et al 2018); therefore, nurses should ensure that they understand how to take a person-centred approach to their care.

Some individuals with intellectual disabilities experience challenges because of sensory sensitivities, such as feeling uncomfortable when encountering the clinical smell of a dental practice; others have risk factors, such as reliance on enteral feeding. In addition, some individuals may be afraid of attending dental appointments or be anxious about any change in their normal daily routine that is required to address their oral healthcare needs. Some people may display behaviours that challenge or may have limited ways in which to express themselves. Support for the individual also needs to take into consideration the service context and carers’ particular characteristics and needs (Waldron et al 2019), as well as the barriers that each person experiences in accessing dental services.

The Code (NMC 2018) specifies that nurses need to listen and respond to the choices of each individual and respect their diversity. It also states that nurses must listen to the person’s individual preferences and concerns and that they should be involved in any decisions about their care. Similarly, the Nursing and Midwifery Board of Ireland (2014) Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives details the need for nurses to ‘respect each person as a unique individual’ and emphasises the need to provide the person with support and time to make their own choices and decisions.

Many people with intellectual disabilities can become anxious and upset during oral healthcare interventions (Wilson et al 2018). The Code (NMC 2018) states that nurses need to recognise when people are distressed or anxious and to respond to this with compassion. Therefore, knowing the person, the way they communicate, their preferences, likes and dislikes and baseline disposition is essential to ensure

that a person-centred approach to care is maintained. Assessment tools such as the Disability Distress Assessment Tool (DisDAT) (Regnard et al 2007) can be used to provide an understanding of an individual’s baseline disposition and to recognise when they are likely to become increasingly distressed.

TIME OUT 2 In the context of oral healthcare and access to dental services, how might an assessment tool, such as the DisDAT be useful in your practice? Discuss this with your colleagues, for example, asking them how they identify when an individual may be in distress

The Code (NMC 2018) states that nurses must ‘pay special attention to promoting well-being, preventing ill-health and meeting the changing health and care needs of people during all life stages’. Nurses need to be able to adapt and respond to the needs of people with intellectual disabilities in different settings and at various points across their lifespan (McCarron et al 2018) to provide person-centred care. McCarron et al (2018) detailed the various lifespan stages (infancy, childhood, adolescence, young adult, adult, middle age, older adult and end of life) and described a person-centred model that outlines the different forms of nursing care and support that an individual may require at each of these stages.

The need to treat people with respect, kindness and compassion is also emphasised in the Code (NMC 2018). Brown et al (2016) developed a model of compassionate, person-centred care in the context of intellectual disability liaison nursing in the acute hospital setting. This model is particularly suitable for supporting the oral health care needs of people with intellectual disabilities, for example, ensuring that clear communication pathways are established and maintained between the patient, healthcare providers and family members.

Another person-centred care model that could be used to support this population is Moulster et al’s (2019) intellectual

FURTHER RESOURCES Trinity College Dublin has developed the Brush My Teeth website, which provides several resources to support people with intellectual disabilities and their carers with oral care, as well as the following videos: Trinity College Dublin (2018) Brush My Teeth www.brushmyteeth.ie Normal Brush and No Help youtu.be/qQj0ajzomZk Normal Brush and a Little Help youtu.be/Gmkqk_hv3FI Normal Brush and A Lot of Help youtu.be/Xbt0yFuN_N4

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disability nursing practice model. This model emphasises the benefits for nurses of reflecting on their care, providing evidence- based care and promoting care that focuses on outcomes. Considering the lack of clear evidence in relation to oral healthcare for people with intellectual disabilities, this model can support the development of evidence-based person-centred oral healthcare in this population. Waldron et al (2019) also stated that individualised oral healthcare plans have been shown to be effective in meeting the needs of people with intellectual disabilities.

TIME OUT 3 Consider how Moulster et al (2019) and Brown et al’s (2016) models could be used to structure a person- centred approach to oral healthcare in your practice setting. What changes might you need to make to your practice to ensure the care provided was person-centred?

Accessing oral healthcare support and dental services It is important for nurses to be able to identify the challenges that people with intellectual disabilities experience in accessing oral healthcare support and dental services. Nurses should be able to consider how using evidence-based guidelines such as PHE’s (2019) guidance on oral care can improve access to appropriate dental services for people with intellectual disabilities.

The Code (NMC 2018) emphasises the need to work in partnership with the person to access the healthcare that they need. It also emphasises the need to advocate for vulnerable people and to challenge any discriminatory behaviour and attitudes relating to their care. The role of intellectual disability liaison nurse is crucial in ensuring mainstream healthcare services are accessible to this population. These nurses support the person with an intellectual disability to communicate with others and educate mainstream healthcare professionals on how to make services more accessible (Brown et al 2016).

McCarron et al (2018) stated that specialisation in intellectual disability nursing should be influenced by the changing needs of this population, and emphasised the importance of evidence- based practice in this field. Considering the limited evidence on oral health and the unmet oral healthcare needs of people with intellectual disabilities, it could be suggested that there is a vital role for intellectual disability liaison nurses who specialise in access to mainstream dental care. This role could support people to address and overcome the challenges they experience when accessing dental care.

TIME OUT 4 Discuss with a colleague how the development of the role of an oral healthcare intellectual disability liaison nurse could ‘bridge the gap’ between the people with intellectual disabilities and mainstream dental services. Consider any benefits that access to a liaison nurse could provide for this population

Mac Giolla Phadraig et al (2015b) undertook a focus group with six people with intellectual disabilities to discuss access to dental services in Ireland. The study participants expressed feelings of disempowerment when interacting with mainstream dental services. Mac Giolla Phadraig et al (2015b) questioned the appropriateness of mainstream services for meeting the oral healthcare needs of people with intellectual disabilities, but recognised that their unmet needs represented a complex issue which cannot be attributed solely to a lack of resources in mainstream services.

Mac Giolla Phadraig et al (2015b) also stated that the inclusive focus group method they employed enabled them to access the views of people with intellectual disabilities and could be used in the future to enable the voices of vulnerable groups to be articulated and heard. They also recommended that Irish dental services should ensure equal access for people with intellectual disabilities and emphasised the importance of including the perspectives of service users when redesigning services.

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One significant barrier to effective oral healthcare is a lack of specific training for dentists to support this population, which can limit access (Smith et al 2010). For example, people with intellectual disabilities having limited access to dental services may result in them experiencing long waiting times for a general anaesthetic when undergoing dental procedures (Irish Society of Disability and Oral Health 2012, McGeown et al 2012).

Box 3 provides recommendations for supporting people with intellectual disabilities with their oral healthcare.

There is a need for training and education to improve oral healthcare and dental services for people with intellectual disabilities. This training and education are necessary for family carers, professional carers, dental professionals and dental surgery staff, as well as for people with intellectual disabilities. Box 4 details the training and education required for carers and dental professionals to support this population.

TIME OUT 5 Watch the following Well Connected video, which features people with intellectual disabilities taking on the role of dental ambassador to encourage others to access dental services: youtu.be/ WUsENGNs0e8. Do you think that such an initiative could be useful in your practice setting to support people with intellectual disabilities to access mainstream dental services?

Conclusion Oral healthcare delivered using a person- centred approach that is adapted to the person’s preferences and living circumstances has an essential role in improving the overall well-being of people with intellectual disabilities.

At present, the availability of, and access to, person-centred oral healthcare is inadequate. Access to services and support for people with intellectual disabilities needs to be improved not only at a local practice setting level, but also at a national level. Evidence indicates that, in addition to the lack of access to person-centred support with oral healthcare, people with

intellectual disabilities do not have equal access to mainstream dental health services.

Nurses need to support this population to express their need for improved access to oral healthcare and dental services. They also need to be aware of the evidence concerning the unmet oral healthcare needs of people with intellectual disabilities, the oral health risk factors for this population and interventions associated with improved

Box 3. Recommendations for supporting people with intellectual disabilities with their oral healthcare

General recommendations » Supporting the person to have control and choices in their care and treatment can reduce their anxiety » People with intellectual disabilities should be viewed as active participants rather than passive recipients of their dental care » Appointments need to provide sufficient time for adequate and appropriate explanations of the dental care and treatment being undertaken » Easy-read booklets and other information can be provided for people with intellectual disabilities before the appointment to assist them to prepare » Cognitive behavioural interventions, for example coping strategies and relaxation techniques, can assist in reducing a person’s anxiety concerning dental care and may need to be adapted using a person-centred approach » It is important to communicate to the person about any delays while waiting for their appointment » Where possible, arrangements should be made to avoid the waiting room since this may cause the person to become anxious

Developing an effective relationship Factors that can assist people with intellectual disabilities to develop trust in their dentist include: » A positive attitude towards people with intellectual disabilities, being respectful and patient » Adapting communication to accommodate the person » Knowledge of specific dental issues common in people with intellectual disabilities » A person-centred approach to oral healthcare and dental services

Reasonable adjustments In relation to dental care for people with intellectual disabilities, reasonable adjustments may include: » Use of the first appointment in the morning » Longer appointments » Use of easy-read materials and other resources to support the person to understand what the dental appointment will involve » Non-verbal communication resources such as picture cards to assist the person to communicate » Desensitisation work, for example reproducing the clinical smell of a dental surgery and introducing this to a person in a relaxed environment » Pre-visits to the dental surgery to prepare for an appointment. Photos can be taken and reviewed later at home. Pre-visits can also involve meeting the dental surgery staff » Use of sedation » Use of gaseous induction rather than needles to administer anaesthesia » Use of distraction techniques, such as mobile phones, tablet devices, singing or projector lights on the ceiling » Reassuring the person

(Adapted from Cumella et al 2000, Lees et al 2017, Public Health England 2019)

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References

Anders P, Davis E (2010) Oral health of patients with intellectual disabilities: a systematic review. Special Care in Dentistry. 30, 3, 110-117. doi: 10.1111/(ISSN)1754-4505

Brown M, Chouliara Z, MacArthur J et al (2016) The perspectives of stakeholders of intellectual disability liaison nurses: a model of compassionate, person-centred care: a model of compassionate, person-centred care. Journal of Clinical Nursing. 25, 7-8, 972-982. doi: 10.1111/jocn.13142

Cumella S, Ransford N, Lyons J et al (2000) Needs for oral care among people with intellectual disability not in contact with community dental services. Journal of Intellectual Disability Research. 44, Pt 1, 45-52. doi: 10.1046/j.1365-2788.2000.00252.x

Davies G, Chadwick D, Cunningham DJ et al (2008) The dental health of adults with learning disabilities – results of a pilot study. Journal of Disability and Oral Health. 9, 3, 121-132.

Faculty of Dental Surgery, The Royal College of Surgeons of England (2012) Clinical Guidelines and Integrated Care Pathways for the Oral Health Care of People with Learning Disabilities. bsdh.org/ documents/pBSDH_Clinical_Guidelines_PwaLD_2012.pdf (Last accessed: 1 February 2021.)

Irish Society of Disability and Oral Health (2012) Access to Special Care General Anaesthetic Facilities: Results of a National Informal Information Gathering Exercise. ISDH, Dublin.

Joint Formulary Committee (2020) British National Formulary. No. 80. BMJ Group and the Royal Pharmaceutical Society of Great Britain, London.

Lees C, Poole H, Brennan M et al (2017) Adults with learning disabilities experiences of using community dental services: services and carer perspectives. British Journal of Learning Disabilities. 45, 2, 114-120. doi: 10.1111/bld.12181

Mac Giolla Phadraig C, Griffiths C, McCallion P (2018) Pharmacological behaviour support for adults with intellectual disabilities: frequency and predictors in a national cross-sectional survey. Community Dentistry and Oral Epidemiology. 46, 3, 231-237 doi: 10.1111/cdoe.12365

Mac Giolla Phadraig C, Guerin S, Nunn J (2013) Train the trainer? A randomized controlled trial of a multi-tiered oral health education programme in community-based residential services for adults with intellectual disability. Community Dentistry and Oral Epidemiology. 41, 2, 182-192. doi: 10.1111/cdoe.12006

Mac Giolla Phadraig C, McCallion P, Cleary E et al (2015a) Total tooth loss and complete denture use in older adults with intellectual disabilities in Ireland. Journal of Public Health Dentistry. 75, 2, 101-108. doi: 10.1111/jphd.12077

Mac Giolla Phadraig C, Dougall A, Stapleton S et al (2015b) What should dental services for people with disabilities in Ireland be like? Agreed priorities from a focus group of people with learning disabilities. British Journal of Learning Disabilities. 44, 4, 259-268. doi: 10.1111/bld.12152

McCarron M, Sheerin F, Roche L et al (2018) Shaping the Future of Intellectual Disability Nursing in Ireland. Health Services Executive, Ireland.

McGeown D, Mac Giolla Phadraig C, Nunn J (2012) The effects of waiting lists on oral health changes for a special care population. Does being placed on a waiting list lead to harm for Special Care Patients? Journal of Disability Oral Health. 13, 3, 101.

Moulster G, Ames S, Iorizzo J et al (2019) A flexible model to support person-centred learning disability nursing. Nursing Times. 115, 6, 56-59.

Nursing and Midwifery Board of Ireland (2014) Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives. NMBI, Dublin.

Nursing and Midwifery Council (2018) The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates. NMC, London.

Public Health England (2019) Guidance: Oral Care and People with Learning Disabilities. www.gov.uk/government/publications/oral-care-and-people-with-learning-disabilities/oral-care- and-people-with-learning-disabilities (Last accessed: 1 February 2021.)

Regnard C, Reynolds J, Watson B et al (2007) Understanding distress in people with severe communication difficulties: developing and assessing the Disability Distress Assessment Tool (DisDAT). Journal of Intellectual Disability Research. 51, Pt 4, 277-292. doi: 10.1111/j.1365-2788.2006.00875.x

Smith G, Rooney S, Nunn J (2010) Provision of dental care for special care patients: the view of Irish dentists in the Republic of Ireland. Journal of the Irish Dental Association. 56, 2, 80-84.

Waldron C, Nunn J, Mac Giolla Phadraig C et al (2019) Oral hygiene interventions for people with intellectual disabilities. Cochrane Database of Systematic Reviews. Issue 5. CD012628. doi: 10.1002/14651858.CD012628.pub2

Ward LM, Cooper SA, Hughes-McCormack L et al (2019) Oral health of adults with intellectual disabilities: a systematic review. Journal of Intellectual Disability Research. 63, 11, 1359-1378. doi: 10.1111/jir.12632

Wilson NJ, Lin Z, Villarosa A et al (2018) Oral health status and reported oral health problems in people with intellectual disability: a literature review. Journal of Intellectual & Developmental Disability. 44, 3, 292-304. doi: 10.3109/13668250.2017.1409596

Wilson NJ, Lin Z, Villarosa A et al (2019) Countering the poor oral health of people with intellectual and developmental disability: a scoping literature review. BMC Public Health. 19, 1, 1530. doi: 10.1186/s12889-019-7863-1

Young M (2013) Powerful Knowledge. youtube.com/watch?v=r_S5Denaj-k (Last accessed: 1 February 2021.)

outcomes. Moreover, there is a need for further research into oral healthcare for people with intellectual disabilities to inform evidence-based practice.

TIME OUT 6 Consider how supporting people with intellectual disabilities with their oral healthcare needs relates to the Code (NMC 2018) or, for non-UK readers, the requirements of your regulatory body

TIME OUT 7 You may want to complete the multiple-choice quiz and write a reflective account as part of your revalidation. To find out more go to: rcni.com/reflective-account

Box 4. Training and education required for carers and dental professionals

Training and education for carers This should cover topics such as: » Giving prompts and verbal instructions on effective oral healthcare » Providing direct assistance with tooth brushing » Using strategies such as reassurance, distraction and encouragement » Establishing oral care routines » Providing information on equipment such as modified toothbrushes » Being able to recognise dental issues » Accessing specialist support

Training and education for dental professionals This should include: » Particular oral health care needs of people with intellectual disabilities » Disability awareness, communication and reasonable adjustments » Safe sedation » Involving people with intellectual disabilities in the delivery of training

(Adapted from Cumella et al 2000, Lees et al 2017, Public Health England 2019)

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Test your knowledge by completing this multiple-choice quiz

1. Which of the following is not an oral health issue commonly experienced by people with learning disabilities?

a) Greater incidence of gum inflammation c

b) Untreated tooth decay c

c) Greater use of restorative interventions rather than tooth extraction c

d) Increased rates of toothlessness c

2. Suboptimal oral health has been associated with: a) Cardiac disease c

b) Hypotension c

c) Tendonitis c

d) Increased enjoyment of eating c

3. One risk factor for suboptimal oral health in people with intellectual disabilities is:

a) Medicines that increase saliva flow c

b) Dexterity issues that may hinder tooth-brushing abilities c

c) Medicines that decrease gum inflammation c

d) Oral feeding c

4. Which of these are the most common oral diseases? a) Gum disease and dental decay c

b) Oral cancer and oral herpes c

c) Thrush and hyperdontia c

d) Temporomandibular disorder and burning mouth syndrome c

5. Evidence-based oral health interventions do not include: a) The provision of outreach oral health services c

b) A uniform approach to supporting oral health c

c) General anaesthesia to facilitate dental treatment for some people with intellectual disabilities c

d) Approaches where the diverse needs of people with intellectual disabilities, their carers and the service context are acknowledged and addressed c

6. Which of the following is an aspect of a person-centred approach to oral health?

a) Knowing the person, their communication preferences, likes and dislikes, and baseline disposition c

b) Adapting and responding to the needs of people with intellectual disabilities in different settings and at various points across the lifespan c

c) Developing individualised oral healthcare plans d) All of the above c

7. Moulster et al’s intellectual disability nursing practice model emphasises:

a) The 6Cs of nursing c

b) Reflection on care, evidence-based care and an outcome focus to care c

c) The importance of providing standardised care for all patients c

d) Reflection-in-action and reflection-on-action c

8. Which statement is false? a) One significant barrier to oral healthcare is a lack of

training for dentists to support people with intellectual disabilities c

b) The role of intellectual disability liaison nurses is crucial in ensuring mainstream healthcare services are increasingly accessible c

c) Unmet oral healthcare needs in people with intellectual disabilities can be attributed solely to a lack of resources in mainstream dental services c

d) It is important to include the perspectives of people with intellectual disabilities when redesigning services c

9. Which of the following is not considered to be a reasonable adjustment for people with learning disabilities who require dental care?

a) Longer appointments c

b) Pre-visits to the dental surgery to prepare for an appointment c

c) Use of needles rather than gaseous induction to administer anaesthesia c

d) Use of easy-read materials c

10. Training and education for carers should cover topics such as:

a) Giving prompts and verbal instructions on effective oral healthcare c

b) Using strategies such as reassurance, distraction and encouragement c

c) Providing information on equipment such as modified toothbrushes c

d) All of the above c

learningdisabilitypractice.com volume 24 number 2 / April 2021 / 41

evidence & practice / CPD / multiple-choice quiz

How to complete this assessment This multiple-choice quiz will help you test your knowledge. It comprises ten multiple choice questions broadly linked to the previous article. There is one correct answer to each question.

You can read the article before answering the questions or attempt the questions first, then read the article and see if you would answer them differently.

You may want to write a reflective account. Find out how at rcni.com/ reflective-account

You can go online to complete this multiple- choice quiz at rcni.com/ cpd/test-your-knowledge and save it to your RCNi portfolio to help meet your revalidation requirements

This multiple-choice quiz was compiled by Alex Bainbridge

Oral healthcare

1. c, 2. a, 3. b, 4. a, 5. b, 6. d, 7. b, 8. c, 9. c, 10. d

The answers to this multiple- choice quiz are:

 

 

Reproduced with permission of copyright owner.