Studying Organisational Resilience in Oral Care for the Dependant Elderly in Scotland

Selveindran, S., Ross, A. and Sherriff, A. (2018) Studying Organisational Resilience in Oral Care for the Dependant Elderly in Scotland. 23rd Congress of the European Association of Dental Public Health, Palma, Mallorca, 18-20 Oct 2018.

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Abstract

Background: There is limited evidence for improved clinical oral health outcomes in Care Home residents through staff education and guidance alone. Care provision remains difficult due to residents’ complex needs, and multiple competing tasks and priorities among care home staff. Aims: The study of Organisational Resilience examines how organisations flexibly adapt to variable conditions to achieve successful outcomes. This study aimed to investigate oral care in 851 Care Homes in Scotland to identify: a) variable conditions, resource challenges, and successful adaptions; and b) opportunities for intervention to improve the oral health of older people. Methods: Five case study sites were purposively recruited to ensure a range of provision. Ethnographic procedures included: targeted observations; examination of care documents; semi- structured interviews with 20 nurses and care assistants and five focus groups with service providers, regulators and residents. NHS ethical review deemed the project as service evaluation. Data were analysed with QSR NVivo v11.0 using dedicated resilience analysis frameworks. Results: Oral care is co-ordinated and broadly conceptualised as oral hygiene rather than oral health, the latter viewed as the responsibility of dental services. This means there can be notable omissions, such as formal oral health risk assessments and regular mouth examinations to assess any oral health needs. The core activity across all sites was brushing/cleaning teeth and dentures. The level of support/supervision required varied widely with resident cognitive capacity. There is a tension between demands of person-centred and evidence-based care (e.g. where residents refuse denture care or wish to rinse their mouth out after tooth brushing). Documenting resident information updates and associated actions can be delayed due to time pressures and competing priorities. Conclusions: In the study sites, oral care was challenging and varied. Clinical guidance might be supported with structured implementation training whereby staff can be supported to address commonly observed challenges and make safe, effective priority decisions.

Item Type:Conference or Workshop Item
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Sherriff, Dr Andrea and Selveindran, Dr Santhani and Ross, Dr Alastair
Authors: Selveindran, S., Ross, A., and Sherriff, A.
Subjects:R Medicine > RK Dentistry
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Dental School
Research Group:Community Oral Health

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
705781Improving Systems of Care for the Older PErson (I-SCOPE)Alastair RossDunhill Medical Trust (DUNHILLM)R462/0216SM - DENTAL SCHOOL