Letter to the EditorReluctance of Caregivers to Perform Oral Care in Long-Stay Elderly Patients: The Three Interlocking Gears Grounded Theory of the Impediments
Section snippets
Organizational Attributes
Caregivers perceive that general in-service or general hospital organizational attributes have serious negative consequences for their working conditions. Likely because of financial or other constraints, units experience unsafe staffing levels. Caregivers perceive this as leading to erosion in the quality of care, threatening patient safety and well-being and contributing to caregiver stress and burnout. They repeatedly evoked the notion of “hospital’s dehumanization.” As a consequence,
Inadequacy of Training, Education, and Knowledge
We noticed poor standards and scientifically inadequate oral hygiene practices, often based on their own personal oral habits, with no observance of in-service protocols and no consideration for patients’ conditions (such as level of autonomy and edentulism). For instance, many caregivers used their fingers to perform oral care, using mouthwash not meant for daily use or lemon glycerin; toothpaste was saved for denture cleaning. Foam swabs/toothettes were in general use instead of soft-bristle
Caregivers’ Behaviors, Perceptions, and Misconceptions Regarding Oral Care in the Elderly
As caregivers are pressured to observe rigid schedules, any reason was plausible for not performing the oral care, which was perceived as time-consuming. However, we observed that even when caregivers did not feel overworked, oral care was still often not performed. Caregivers admitted being disgusted by food leftovers, spits, saliva, and bad breath. Thus, they did not look inside the mouth. The obligation to perform oral care seems to get the upper hand. Moreover, to handle heavy workloads,
Acknowledgments
The authors thank all the participants in this study, in particular Anne-Céline Guyon, MSocSc, Magali Lemaitre, MPH, PhD, Fabrice Carrat, MD, PhD, and Odessa Petit dit Dariel, RN, as well as all the experts who agreed to discuss the study’s results: Louis Maman, DDS, PhD, Cathy Nabet, DDS, PhD, Frauke Muller, MD, PhD, Françoise Bouchayer, MSocSc, PhD, and Jérôme Pellerin, MD. This study was supported by Colgate-Palmolive and the national “Programme Hospitalier de Recherche Clinique” (2003).
References (16)
- et al.
Impact of bucco-dental healthcare on the prevention of pneumonia in geriatrics: A cluster-randomised trial
J Hosp Infect
(2011) - et al.
Nursing education and improvement in oral care delivery in long-term care
J Am Med Dir Assoc
(2009) - et al.
Long-term care and oral health knowledge
J Am Med Dir Assoc
(2009) - et al.
Mouth care in nursing homes: Knowledge, beliefs, and practices of nursing assistants
Geriatr Nurs
(2009) - et al.
The tongue, oral hygiene, and prevention of pneumonia in the institutionalized elderly
J Am Med Dir Assoc
(2010) - et al.
Oral care provided by certified nursing assistants in nursing homes
J Am Geriatr Soc
(2006) - et al.
The discovery of grounded theory: Strategies for qualitative research
(1967) - et al.
Basics of qualitative research
(1998)