Building future workforce capability: nursing students’ attitudes and knowledge of older Australians’ oral healthcare and strategies to improve students’ competency
Creators: name: Bhagat, Vandana
Publisher: name: University of Tasmania
Year: 2024

description: The oral health of many Australian older adults, aged 65 years or over, has been widely identified as poor. Poor oral health adversely affects older people’s nutritional intake (ability to eat, drink and swallow), and complicates existing chronic health conditions. The associated pain and discomfort affect their self-esteem. The increasing size of the older population, changes in the type of oral healthcare older people require, and the need to provide collaborative care in an effective and timely manner have raised concerns about the oral health of older people for educators, policymakers, and health professionals. <br>Nurses are frequently the ongoing point of contact for older people – in community-based care, hospitals, and residential care. Nurses who understand the association between maintaining older people’s oral and general health can take a leading role in facilitating collaborative oral healthcare. Such integrated care can reduce oral and associated systemic diseases, improve older people’s quality of life, and decrease the economic and psychosocial burden of care. Evidence shows that educating nurses about oral health improves their understanding and attitude towards oral healthcare. Infusing such education into nursing curricula would be ideal. However, evidence about this is limited. <br>This research aimed to (1) evaluate the knowledge and attitude of nursing students regarding providing oral healthcare to older people, and (2) explore the perspectives of nursing educators and students on how knowledge and clinical competence in oral healthcare could be infused effectively into undergraduate nursing curricula.<br>Following a systematic review, a mixed-methods research design included a quantitative component with a survey conducted with nursing students and a qualitative research component with semi-structured interviews with nursing students and staff. The 49-item survey was organised into seven sections: (1) demographic information; (2) experience providing oral healthcare for older people; (3) perception of self-efficacy; (4) knowledge; (5) attitude; (6) personal oral health behaviour; (7) open-ended questions to identify strategies to strengthen oral health education and clinical preparation. Sections 4, 5, and 6 used 5-point Likert-type scales. <br>Of 36 Australian universities offering an accredited Bachelor of Nursing and Midwifery program, 16 universities agreed to distribute research invitations to their final-year nursing students and nursing educators. Online cross-sectional survey data were collected from nursing students. Interview data were collected from nursing students and nursing educators until data saturation was reached. <br>Quantitative data were analysed using IBM SPSS Statistics (Version 28). The association of socio-demographic factors with students’ perception, knowledge, and attitude about oral healthcare was investigated with t tests (for two factors) and with ANOVA (for multiple factors). Spearman’s correlation coefficients tested the association between students’ perception of self-efficacy in providing oral healthcare and their knowledge of older people’s oral health. Qualitative data, including responses to open-ended questions from the survey, were analysed thematically using NVivo 12<sup>TM</sup> software. <br>In total, 416 students completed the survey and follow-up interviews were conducted with 12 of these students. Analysis of the survey results showed that students felt the nursing curriculum in which they were enrolled was not providing them with sufficient knowledge and clinical competence to undertake essential oral health checks, develop oral healthcare plans, and make needed referrals. Mean scores showed that more than half of the participants felt they lacked confidence (55%, n=229) and had limited knowledge about oral healthcare for older people (73.1%, n=304); however, their attitude towards providing such care was favourable (88.7%, n=369). A positive correlation was found between students’ confidence in providing oral healthcare to older people and their perceived knowledge <i>(r</i> = 0.13, <i>p</i> &lt;0.01). Results revealed statistically significant associations between students’ mean perception scores of awareness of oral healthcare for older people and socio-demographic factors, including nationality [<i>t</i> = -3.41, <i>p</i> &lt;0.001], location in the past 10 years [<i>F</i> (3, 412) = 2.86, <i>p </i>&lt;0.05], experience in providing oral healthcare to older people <i>[t</i> = 4.52, <i>p</i> &lt;0.001], oral healthcare education in their current program [<i>t</i> = 3.32, p &lt; 0.001], previous oral health education and training [<i>t</i> = 7.28, <i>p</i>&lt;0.001], and students’ flossing habit [F (3, 412) = 5.67, p &lt;0.001]. Regarding students’ knowledge of oral healthcare, factors such as age [<i>t</i> = -2.18, <i>p</i> &lt;0.05], gender [<i>t</i> = 2.28, <i>p</i> &lt;0.05], and experience in providing oral healthcare to older people [<i>t</i> = 2.87, <i>p</i> &lt;0.01] showed statistically significant associations. Students’ attitudes towards providing oral healthcare were significantly associated with nationality [<i>t</i> = -3.54, <i>p</i> &lt;0.001], age [<i>t</i> = 2.10, <i>p</i> &lt;0.05], experience in providing oral healthcare [<i>t</i>= 2.65, <i>p</i> &lt;0.01], and previous oral health education and training [t = 3.59, <i>p</i> &lt;0.001]. <br>Students’ responses to open-ended survey questions and follow-up interviews showed they understood the important role of nurses in maintaining older people’s oral health. However, they identified three areas in which their education and clinical preparation needed improvement: (i) understanding the relationship of the health of the mouth to the body to prevent oral and related systemic diseases; (ii) facilitating effective routine care addressing the particular needs of older people; and (iii) gaining competence in oral health assessment to identify risk factors, and know when, why, and to whom to refer. When asked how their competency to deliver evidence-based oral care could be strengthened, students emphasised the value of learning through interprofessional education and collaborative practice and the importance of being supervised by registered nurses in clinical placements.<br>Interviews conducted with 13 nursing educators highlighted inconsistencies in curricular content regarding oral healthcare of older people. While nurse educators perceived education about oral health as important, their comments identified significant gaps in nursing students’ clinical and academic preparation, internal and external barriers that affected this preparation, and the need to develop and promote an explicit and standardised oral health curriculum. The necessity of defining the role of nurses in providing and maintaining the oral health of older people was a major reason underpinning these opinions.<br>In summary, the inclusion of oral health in undergraduate nursing curricula was expected rather than required. Both nursing students and educators viewed the role of nurses in providing oral healthcare to older people as important. National recognition of the importance of oral health would facilitate its inclusion in accreditation standards for nursing programs, along with funding to support interprofessional education, and the development of effective oral healthcare policies to ensure that oral health is a regular part of nursing care for older people.