NURSING PRACTICE AND HEALTH CARE

It has been noted that the rate of oral care practice by home health care nurses is lower than that of excretory care in Japan. Disparities in oral care practice by home health care nurses and their collaboration with dentists exist at their discretion. This study examines the current status of oral care practice by home health care nurses and the determinants of oral care practice. Oral care was practiced more often with older patients, in the care level of 4/5 (the higher the number, the more severe the care requirement in cerebrovascular disease patients, and with patients who used ventilators. Factors that influenced home health care nurses’ discretion to practice oral care were assessment Implementation, use of a tongue brush, working with physical therapists, and age. 

Oral care practice; Home health care nurses; Visiting nurses; Oral care

In Japan, nurses and other professionals visit people of all ages at home to provide nursing care for them so that they can live in the community and do not need to hospitalized. The services include observation of the patient’s condition, home care, consultation and guidance on medication, and medical treatment under the doctor’s orders. However, it is up to the nurse to decide whether or not to provide oral care.

Oral flail is one of the leading causes of death in the elderly, and is associated with pneumonia and dysphagia [1-3] sarcopenia [4] and dementia [5]. It has also been reported that older adults who receive proper oral care have a better quality of life [6]. Therefore, it is extremely important to implement oral care.

To investigate the current status of oral care practices by home health care nurses and examine the determinants of oral care practices.

Of all home health care station offices (11,618) in Japan, 1,000 randomly selected offices were requested to complete a survey, and all home health care nurses who answered and returned the questionnaire were included in this study

Rates of oral care practice by home health care station, nurse demographics, age or developmental stage of patients, level of care, disease and treatment status were calculated. Multiple regression analyses were conducted for factors that correlated with the level of oral care practice. Significance levels were set at less than 5%.

Oral care was practiced more often with older patients, in the care level of 4/5 (the higher the number, the more severe the care requirement in cerebrovascular disease patients, and with patients who used ventilators. Factors for oral care practice are assessment implementation, use of a tongue brush, and working with physical therapists, and age (Table 1 and 2).

1. Japanese home health care nurses provided oral care to patients with high medical needs, such as cancer, cerebrovascular disease, intractable disease, dementia, old age patients, care level       4 and 5, and treatment conditions such as tube feeding, ventilator, and tracheostomy.

2. Factors that influenced home health care nurses’ discretion to practice oral care were assessment Implementation, use of a tongue brush, working with physical therapists, and age.

Grant-in-Aid for Scientific Research (JSPS:19K11291)/ Ministry of Education, Culture, Sports, Science and Technology

1. Shitara S, Tejima Y, Magara J, Taniguchi H, lnoue M. The improvement in the oral function contributed to the achievement of the recovery in swallowing function. Niigata DentJ. 2014;44(2):25- 30. 
2. Furuta M, Yamashita Y. Oral Health and Swallowing Problems.Curr Phys Med Rehabil Rep. 2013 Sep;1(4):216-222.  
3. Chiba Y. Short-term effectiveness of a swallowing exercise for theelderly using day care services. J Nurs Care 2013. 
4. Abe Y, Takahashi O, Honda O, Kanehira T, Takehara J, et al. Relationship of oral frailty to sarcopenia and metabolic syndrome in community-dwelling elderly. Hokkaido J Dent Sci. 2018;38:234-242. 
5. Yamamoto T. Contribution by Dentistry to Derrlentia Prevention. JSOI 2017;30(4):230-234. 
6. Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in theelderly. Chest 2003;124(1):328-336. 
7. Yamamoto N, Okamoto Y, Tsujimura M, Kanagawa K, Masaki H, etal. An Examination for Developing the Quality Indicators of HomeHealthcare Nursing for Older Adults; A National Self-EvaluationSurvey of Nurses Working at Home Care Nursing Stations. J JpnAcad Nurs Sci. 2008;28(2):37-45. 
8. Miyasaka K, Matsuo R, Yamanaka T, Miyazono M. A study aboutthe Oral Care of Elderly People at Home that Literature Reviewand Issues of Nursing in Japan and Abroad. J Nurs Oral HealthCare. 2019;2(1):16-21. 
9. Yoshida R, Kubota K, Haresaku S, Aoki H, Monji M, et al. A StudyRegarding Trends in Oral Healthcare Research in the NursingField and the Association between These Trends and OralHealthcare Policies. J Dent Hlth. 2018;68:28-35. 
10. Haresaku S, Miyoshi M, Kubota K, Aoki H, Kajiwara E, et al. Effectof interprofessional education on oral assessment performanceof nursing students. Clin Exp Dent Res. 2020;6:51-58. 
11. Haresaku S, Aoki H, Makino M, Monji M, Akino K, et al. Practices,attitudes, and confidence of nurses in the performance of oralhealth checkups for elderly patients in a Japanese hospital. OralHealth Prev Dent. 2018;16(6):517-524. 
12. Yamanaka T, Haresaku S, Miyazono M, Kubota K, Kakumori T, et al. Practice of an Oral Assessment and Associated Factors among Visiting Nurses. J Dent Hlth 2020; in press. 
13. Tanaka N, Tamura F, Kikutani T, Suda M, Fukui T, et al. Investigationof the Desensitization Technique for the Elderly Requiring LongTerm Care with Rejection of Oral Health Care. J JGerodont.2007;22(2):101-105.