Abstract
BackgroundUnregulated care aides provide up to 80 % of direct resident care in nursing homes. They have little formal training, manage high workloads, frequently experience responsive behaviours from residents, and are at high risk for burnout. This affects quality of resident care, including quality of oral health care. Poor quality of oral health care in nursing homes has severe consequences for residents and the health care system. Improving quality of oral health care requires tailoring interventions to identified barriers and facilitators if these interventions are to be effective. Identifying barriers and facilitators from the care aide’s perspective is crucial.MethodsWe will systematically search the databases MEDLINE, Embase, Evidence Based Reviews—Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. We will include qualitative and quantitative research studies and systematic reviews published in English that assess barriers and facilitators, as perceived by care aides, to providing oral health care to nursing home residents. Two reviewers will independently screen studies for eligibility. We will also search by hand the contents of key journals, publications of key authors, and reference lists of all the studies included. Two reviewers will independently assess the methodological quality of the studies included using four validated checklists appropriate for different research designs. Discrepancies at any stage of review will be resolved by consensus.We will conduct a thematic analysis of barriers and facilitators using all studies included. If quantitative studies are sufficiently homogeneous, we will conduct random-effects meta-analyses of the associations of barriers and facilitators with each other, with care aide practices in resident oral health care, and with residents’ oral health. If quantitative study results cannot be pooled, we will present a narrative synthesis of the results. Finally, we will compare quantitative findings to qualitative studies to identify hypothesized associations or effects not yet tested quantitatively.DiscussionThis review will advance the development of effective strategies for improving quality of oral health care and highlight gaps in research on barriers and facilitators to providing oral health care to nursing home residents, as perceived by care aides.Systematic review registrationPROSPERO CRD42015032454Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0231-7) contains supplementary material, which is available to authorized users.
Highlights
Unregulated care aides provide up to 80 % of direct resident care in nursing homes
An estimated 70 to 80 % of paid direct care to residents in North American nursing homes is provided by care aides, including the important task of oral health care
A high workload combined with lack of time for tasks is associated with reduced job satisfaction [11] and burnout [12], which negatively affects staff health and the quality of care [13]
Summary
Unregulated care aides provide up to 80 % of direct resident care in nursing homes. They have little formal training, manage high workloads, frequently experience responsive behaviours from residents, and are at high risk for burnout. This affects quality of resident care, including quality of oral health care. An estimated 70 to 80 % of paid direct care to residents in North American nursing homes is provided by care aides, including the important task of oral health care. A high workload combined with lack of time for tasks is associated with reduced job satisfaction [11] and burnout [12], which negatively affects staff health and the quality of care [13]
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