By Jimmy Creed
University of Alabama at Birmingham (UAB) School of Nursing Professor Rita Jablonski, PhD, CRNP, FGSA, FAAN, has been awarded a $1.7 million grant from the Centers for Medicare & Medicaid Services to provide oral hygiene training to caregivers in local nursing homes in an effort to improve the quality of care for residents with dementia.
The seven Birmingham-based nursing homes participating in the project include: Birmingham Nursing and Rehabilitation Center, Fair Haven, Fair Haven North, Brookdale of University Park, Fairview Health and Rehabilitation Center, Terrace Oaks Care and Rehabilitation Center, and Oak Trace Care and Rehabilitation Center.
The three-year project, “Brushing Away Infections,” will provide the nursing home staff with training and coaching in techniques known to minimize care-resistant behaviors in older adults with cognitive impairments.
“The majority of patients residing in nursing homes are frail, functionally dependent and up to 80 percent of them have some type of cognitive issue; yet, many still have their own teeth,” Jablonski said. “Because of their confusion, many resist mouth care, which can lead to painful, swollen gums, gum disease, pneumonia and other respiratory infections.
“While we will never eradicate these behaviors, with training and care we can manage them and improve oral and systemic health outcomes, which is the main focus of this project.”
Jablonski and a team, including a dentist and two full-time nurse coaches, will go into the nursing homes, one at a time, for approximately six months. The MOUTh protocol will be used to educate the staff on providing mouth care, especially when resisted by residents. The team will also work with administrators to improve each facility’s mouth-care policies and procedures.
“This program brings evidence-based practice, coaching techniques and the most recent research findings directly to the bedside,” Jablonski said.
It incorporates findings from Jablonski’s $1.4 million National Institutes of Health, National Institute of Nursing Research R01 study, “Reducing Care-Resistant Behaviors During Oral Hygiene in Persons with Dementia.” The study successfully tested Managing Oral Hygiene Using Threat Reduction (MOUTh) protocol. It incorporated evidence-based mouth care specific to older adults and behavioral approaches to minimize refusal of care by persons with dementia. The study also showed that nursing home residents who received mouth care from providers trained in behavioral-resistant techniques were twice as likely to agree to the mouth care and twice as likely to complete it, including brushing and flossing.
Jablonski also is engaging undergraduate students in the School’s Honors Program and graduate students in its Doctor of Nursing Practice (DNP) and Doctor of Philosophy in Nursing (PhD) Programs to assist in this CMP project.
“This project involves the application of fresh research findings to a difficult clinical problem and will provide great insight for our undergraduate and graduate students into how to best care for people with dementia,” Jablonski said. “After having this important hand’s-on experience, the students will be well prepared to treat patients who exhibit care-resistant behavior due to moderate to severe dementia or become the next generation of researchers in this area.”
This oral care project supports the National Partnership to Improve Dementia Care in Nursing Homes. In March 2012, CMS launched the National Partnership to improve comprehensive dementia care and find new ways to implement practices that enhance the quality of life for people with dementia.
Jablonski was part of the working group that contributed to this national effort, including assembling the “Nursing Home Toolkit: Promoting Positive Behavioral Health,” which included some of the strategies she tested in her randomized clinical trial.
“Ultimately, I would like to see the same techniques that help reduce resistance during mouth care be applied by nursing home staffs for other behaviors that occur during bathing and dressing,” Jablonski said. “It would be a beneficial and logical extension of this important work.”