Abstract
BackgroundChildsmile is Scotland’s national child oral health improvement programme. To support the delivery of prevention in general dental practice in keeping with clinical guidelines, Childsmile sought accreditation for extended duty training for dental nurses to deliver clinical preventive care. This approach has allowed extended duty dental nurses (EDDNs) to take on roles traditionally undertaken by general dental practitioners (GDPs). While skill-mix approaches have been found to work well in general medicine, they have not been formally evaluated in dentistry. Understanding the factors which influence nurses’ ability to fully deliver their extended roles is necessary to ensure nurses’ potential is reached and that children receive preventive care in line with clinical guidance in a cost-effective way. This paper investigates the supplementation of GDPs’ roles by EDDNs, in general dental practice across Scotland.MethodsA cross-sectional postal survey aiming to reach all EDDNs practising in general dental practice in Scotland was undertaken. The survey measured nurses’: role satisfaction, perceived utility of training, frequency, and potential behavioural mediators of, preventive delivery. Frequencies, correlations and multi-variable linear regression were used to analyse the data.ResultsSeventy-three percent of practices responded with 174 eligible nurses returning questionnaires. Respondents reported a very high level of role satisfaction and the majority found their training helpful in preparing them for their extended role. While a high level of preventive delivery was reported, fluoride vanish (FV) was delivered less frequently than dietary advice (DA), or oral hygiene advice (OHA). Delivering FV more frequently was associated with higher role satisfaction (p < 0.001). Those nurses who had been practising longer reported delivering FV less frequently than those more recently qualified (p < 0.001). Perceived difficulty of delivering preventive care (skills) and motivation to do so were most strongly associated with frequency of delivery (p < 0.001 for delivery of FV, DA and OHA).ConclusionsThis study has provided insight into EDDNs’ experiences and demonstrates that with appropriate training and support, EDDNs can supplement GDPs’ roles in general dental practice in Scotland. However, some barriers to delivery were identified with delivery of FV showing scope for improvement.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6831-14-137) contains supplementary material, which is available to authorized users.
Highlights
Childsmile is Scotland’s national child oral health improvement programme
Once registered with a general dental practice, Childsmile advocates that families receive tailored preventive care comprising tailored dietary advice (DA), oral hygiene advice (OHA), and the clinical intervention of fluoride varnish application (FVA)
This study investigated the contribution of role supplementation by extended duty dental nurses (EDDNs), to skill mix in general dental practice across Scotland, by investigating: EDDNs’ satisfaction with their extended role, their views on the extended duty training they received and their experiences of delivering preventive care to children and their families
Summary
To support the delivery of prevention in general dental practice in keeping with clinical guidelines, Childsmile sought accreditation for extended duty training for dental nurses to deliver clinical preventive care. Dental registration rates are relatively low for very young children with only 47.2% of 0–2 year olds currently registered [2] and limited preventive dental care being delivered to children registered with a National Health Service (NHS) dentist [3]. To address these issues, in 2005, a national oral health programme for children living in Scotland (Childsmile) was funded by the Scottish Executive [4]. Childsmile’s recommendations are in keeping with recent clinical guidelines stating that all children (irrespective of caries risk status) should receive, OHA at least once per year (with hands-on toothbrushing instruction in the early stages of providing care), DA at least once per year and if aged over two years (and not contra-indicated) fluoride varnish (FV) applied to their teeth at least twice a year in practice [6,7]
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