Interdisciplinary health education, utilized increasingly during the last decade,1'2 assists professional practitioners in delivering comprehensive health care. Leininger3 challenged large university centers to find creative ways to implement this practice so that students might be socialized into cooperative role acceptance and collaboration in health care delivery. Busse2 observed that dental disease is one of the most prevalent health problems in our society. The elderly have significant dental needs. A large proportion of older persons are edentulous; nevertheless they require meticulous care and observation of intraoral soft tissues. More recently this trend toward loss of all natural teeth has declined.4 Therefore, a growing number of the elderly have remaining teeth that become vulnerable to serious periodontal disease. This problem is compounded by the lack of dental personnel. Recognition of the importance of good oral hygiene by other health team members, such as nurses, is important to total care. Faculty members of the University of Maryland School of Nursing and Department of Dental Hygiene proposed sharing a commitment to these goals through a program of interdisciplinary teamwork in the junior year undergraduate curriculum.
As the major desired outcome of this joint venture was to provide concrete interaction with another discipline in caring for the older adult, overall mutual objectives included: (a) comparison and contrasting of the roles of nursing and dental hygiene as providers and collaborative health team members; and (b) an assessment of the health needs of elderly clients in the agencies. Faculty members met periodically to plan the offering and evaluate student critiques of the experience.
Observation in the Dental Hygiene Department
In the Fall, after a lecture about proper brushing and flossing techniques, the nursing students visited the dental hygiene clinic. This aspect was primarily observational for the nursing students. The dental hygiene student perform in an ideal setting with proper equipment and dental hygiene faculty supervision. The clients in this environment usually are healthy, and are seen on an outpatient basis. The nursing students had opportunities to see the actual work of another discipline, observed an extra-oral and intra-oral assessment, attended history taking and screening procedures, and compared procedures with those taught in the School of Nursing. Interpersonal and communication skills were contrasted. Appropriate dental consultations and medical referrals were requested when necessary. Dental hygienists interacted with dental students. By this mechanism student nurses were able to scrutinize the roles of other health team members.
The dental school visit for the nursing students was divided into three activities. During a preliminary discussion, the students were encouraged to think about and discuss what they wanted to gain through this experience. This led to questions about the specific role of a dental hygienist. Following this, a tour of the dental clinic was conducted. On this tour the nursing students observed the dentist and the dental hygienists in various phases of dental care delivery. Included in the tour was a trip to the anatomy laboratory, where the nursing students viewed a cadaver. They discussed with the anatomist the significance of the relationship between oral conditions and the entire body. This helped validate the common background between the two professions. Finally, during a wrapup discussion the dental hygiene faculty member answered questions and encouraged students to reflect on their experiences, espedaily to project ways in which these activities might impact on their future nursing practices.
FlGURE 1: Dentai hygiene student, client, and nursing student work together to implement total care of the client.
Implementation in the Nursing Setting
In the Spring, an adult long-term care facility was utilized for student learning. Nursing care of the elderly is paramount to the client's maintenance and recovery. The nursing student assessed assigned clients and transmitted this information to the dental hygiene student by telephone. For this exchange, both students considered the general condition of the client, mental status, diagnosis, drug use, and oral history.
Drugs or diagnoses often can be significant to oral hygiene. For instance, diphenylhydantoin (Dilantin) can cause hyperplasia of the gums; both nursing and dental hygiene students were instructed to be alert to this in their assessments. An individual diagnosis may be remarkable, for example, a client who has had a cerebrovascular accident may suffer from reduced mobility and not be able to implement an oral hygiene program. For this client the staff often must be involved, either to continue oral hygienic care or to provide equipment to make the client as independent as possible. The nursing students performed elementary oral examinations and shared these kinds of information. This communication permitted dental hygiene students to design appropriate oral health care education plans and to select the proper equipment - toothbrushes, modified tooth brushes, denture brushes, and models to teach technique.
Together the students implemented client care. Usually the dental hygienists felt the disadvantage of lack of running water at the bedside; this educated them to the realities of bedside care. Often, dental hygiene students were amazed at the type of care implemented at the bedside. For example, turning clients, care of catheters, and various treatments implemented by nurses provided new information and became "eyeopeners" for dental hygiene students.
Ultimately, the beneficiaries of this cross-disciplinary implementation were the elderly clients. Many expressed enjoyment at the attentiveness of the students. All clients stated that the interaction was valuable to them. They appreciated not only increased oral care, which unfortunately at times becomes lower priority for nursing personnel, but their self-esteem was elevated also. Because of the one-toone relationship with the students, the clients were able to tell their stories and receive added attention and quality care. This interaction developed more fully the individual student's understanding of comprehensive health care, and it broadened the quality of the students' educations by exposing them to the competence of more than one teacher in different disciplines. Modifications of the care plans were made when the students encountered realistic situations in meeting the elderly client's needs.
Nursing staff members at the sites specifically benefited through subsequent inservice programs held by student-led teams, generally through heightened awareness of the magnitude of dental needs that exist among elderly clients. Coincidentally, the students supplied quality caregiving at the site.
In postclinical sharing the students were asked to relate the problems they encountered at the bedside and the necessary modifications used to implement their care. Then the instructor asked the dental hygiene students to demonstrate extraoral-intraoral examination and assessment of the head and neck. Only selected students were exposed to this experience during the first semester exchange; therefore, the demonstration enabled the nursing students to have their learning reinforced or to receive added details that would help to increase their clinical skills in this area.
Ensuing discussions included the value of tracing systemic disturbances to undetected problems or poor oral care. Drugs may contribute to problems of the gingiva. Screening for oral cancer is important, because the mouth may be overlooked in a cursory health assessment.5'* The dental hygiene students realized that priorities for nursing may be quite different from those for other health care disciplines.
Finally, the dental hygiene students attended a remaining conference devoted to problem-solving and a discussion of pertinent pathophysiology and general health promotion measures germane to the nursing students' learning. It is of interest that communication between the two disciplines increased. The students realized that they do many things in common; this added cohesiveness to the group. In contrast the dental hygienists realized, sometimes for the first time, what the nursing role entails. Surprise and admiration resulted from this awareness of role difference. Dialogue was promoted, and respect for each other's functional areas and how they are fulfilled was generated.
At the end of the experience the nursing students were expected to evaluate the entire experience. Dental hygiene students kept a log of their field experiences and also evaluated this exposure. Feedback from both groups indicated that the learning experience was valuable and positive. Some statements or suggestions included: "Good experience;" "Made me realize the importance of oral hygiene;" "Taught us how different disciplines work together;" "My client really enjoyed this experience;" "Head and neck assessment during post-conference really helpful."
One of the most valuable benefits was better utilization of faculty time both in fall and spring semesters. If the content were included in the separate schools of nursing and dental hygiene, then there would be duplication of faculty time and effort. It was found educationally sound to broaden students' viewpoints by exposing them early to interdisciplinary experiences. This experience with the elderly appears to respond to Leninger's challenge3 that faculty members find creative ways to implement interdisciplinary practice and collaboration in health care delivery.
In view of the high degree of positive evaluation from students, nursing and dental hygiene faculty are committed to the continuation of this program. However, even though highly effective, efficiency was not measured; this requires further study.
Plans for the coming semester are undergoing revision based on student evaluative input. Although positive, student critique repeatedly stated that no resource provided the necessary informational background for this experience. This feedback was the primary impetus for faculty sharing of the curriculum with our students and other readers. In addition, we encourage readers to utilize local dental professionals as resources when planning specific programs of oral health care for clients. We shall continue our search of the literature for additional ideas, and solicit discussion from other professionals.
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