Reluctance of Caregivers to Perform Oral Care in Long-Stay Elderly Patients: The Three Interlocking Gears Grounded Theory of the Impediments

Abstract

A clustered randomized controlled trial was previously carried out in long-stay facilities to assess the impact of oral care in the prevention of pneumonia and oral candidosis. 1 Bourigault C. Lietard C. Golmard J.L. et al. Impact of bucco-dental healthcare on the prevention of pneumonia in geriatrics: A cluster-randomised trial. J Hosp Infect. 2011; 77: 78-80 Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar However, despite an education program focusing on optimal oral care delivery practices 2 Gammack J.K. Pulisetty S. Nursing education and improvement in oral care delivery in long-term care. J Am Med Dir Assoc. 2009; 10: 658-661 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar and oral health knowledge improvement in the interventional arm, 3 Boczko F. McKeon S. Sturkie D. Long-term care and oral health knowledge. J Am Med Dir Assoc. 2009; 10: 204-206 Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar , 4 Coleman P. Watson N.M. Oral care provided by certified nursing assistants in nursing homes. J Am Geriatr Soc. 2006; 54: 138-143 Crossref PubMed Scopus (106) Google Scholar , 5 Jablonski R.A. Munro C.L. Grap M.J. et al. Mouth care in nursing homes: Knowledge, beliefs, and practices of nursing assistants. Geriatr Nurs. 2009; 30: 99-107 Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar oral care seemed to be often underperformed or inadequately performed in both groups. Consequently, reluctance of caregivers to perform oral care emphasized the need for an analytical monitoring of the process of oral health care performed by registered nurses (RNs) and certified nursing assistants (CNAs). Therefore, we sought to develop a multivariate conceptual framework of the implicit impediments hampering the process of oral care by caregivers in the elderly.