At Marquette University an interdisciplinary learning experience is offered to combined classes of community health nursing and dental students. These students perform physical and oral health appraisals on pre-school age children in day care centers located throughout the Milwaukee community. There are three major objectives of the experience: 1) collaboration with another health team member, 2) interaction with healthy children, and 3) participation in the screening program.
Dental students traditionally practice with dental hygienists, whereas nursing students usually practice with members of the health team, i.e., doctors, physical therapists, nutritionists, etc. The importance of nursing and dental collaboration has been documented; however, the activities have not been presented as interdisciplinary learning experiences. Slattery (1976) described tooth decay in very young children, emphasizing the critical role of nurses in promoting dental health. Levine and Grayson (1973) emphasized the important teaching role of nurses in the prevention and recognition of oral disease. Shmarak and Stewart (1976) described the efforts of school health nurses, dentists, and health educators in saving a school dental health program in New Jersey. Their efforts resulted in a continuing program utilizing dental students to provide services, with other professionals also participating.
The Marquette team approach allows nursing and dental students to become acquainted with their mutual roles and to encourage development of assessment skills. The child is examined in a holistic manner. Heretofore, nursing students had rarely performed oral assessment in health appraisal, whereas dental students traditionally considered only the mouth, and sometimes the head and neck. In the Marquette program, the combined teams of students have the opportunity to examine the total child.
Previously, most nursing and dental students had limited or no professional experience with healthy pre-school children. Even when studying expected norms and reviewing developmental milestones, students still find that communicating with a pre-school child can be quite a challenge! A one-on-one approach during the appraisal offers the best method for developing rapport. Providing an atmosphere less fearful than the hospital or practitioner's office assists in eliciting the child's cooperation during the appraisal.
The dental and nursing students go through the steps of health screening to identify children in the population who need professional attention. All children who may possibly need intervention are identified, since the entire day care center population is screened. For each item to be screened, there is a definition of normal, deviation from which requires a referral or re-check. Thus, students are exposed to and perform the basic principles of screening.
In the morning of the day care experience, a faculty member in Community Dentistry and one in Community Health Nursing co-teach an orientation class.
There are usually five to eight pairs of nursing and dental students in attendance. The nursing students are seniors enrolled in community health nursing. Not all of them have completed their pediatrie rotation prior to this assignment. The dental students are juniors who are beginning patient care in the school's dental clinics. Some of the dental students have had clinical Pedodontics, but for many, this is their first experience with children.
Faculty begin the orientation with a discussion which includes the philosophy and objectives of the program. Attention is then given to the physical and oral health appraisal guidelines, which have been distributed to the students prior to the session. These include a step-by-step description and analysis of the assessment.
A videotape, prepared by our faculty, is then viewed. The 30-minute tape depicts faculty performing each step of the appraisal, with the help of a very cooperative four-year-old. Following the viewing, questions are answered regarding any of the techniques or procedures demonstrated. Students are reminded to review the children's health records, if available. Height, weight, and blood pressure percentile charts are explained. A review of expected norms and behaviors of the age group to be assessed are presented. Particular emphasis is directed toward positive interaction with the children. Task-orientation in order to ensure satisfactory completion of the appraisal is also emphasized. However, students are reminded that the actual sequence and completion of the appraisal will be determined largely by the allowance and tolerance of each child, which can depend upon several variables, including minor illness, fear, or simply missing a nap.
Nursing and dental students are paired, and together, they explain the procedures to each other, offering a rationale for the inclusion of particular items in the appraisal. This session is valuable, as it encourages students to share their skills and expertise while promoting the ability to comfortably engage in role reversal during the actual experience.
In the afternoon, the students and faculty convene at the day care center. Usually a quiet setting is provided, where tables and chairs have been set up for each team. The faculty introduce the children to the students, sharing any special concerns observed or reported from the day care teacher. Faculty then interact with the screening teams, offering assistance, validating findings or answering questions. The screening generally follows the physical and oral health appraisal guidelines. The physical appraisal guidelines were adapted from Chinn and Leiten (1979); the oral health appraisal guidelines are basic methods from the World Health Organization (1977). The last form to be completed is the letter to the parent.
Each team usually examines three to four children individually. Toward the end of the session, the children are grouped with their original screeners for a demonstration of tooth brushing. The children terminate the exercise by demonstrating toothbrushing techniques using a 1.23*2 acidulated phosphate fluoride topical gel.
The program described is successful and both dental and nursing students are quite enthusiastic about it. Surprisingly, students who register initial doubts usually become full and cooperative team participants after 15 to 20 minutes in the day care center. Indeed, it is not unusual for students to request permission to repeat their assignment.
From the results of the screening, the day care center health coordinator is able to determine which children need health referral. In general, fewer than five percent of the children in a typical day care center need follow-up attention for medical problems. Dental problems, on the other hand, are found in a significantly larger proportion of children. This is consistent with an evaluation of pre-school age children in Milwaukee by Ayers, Abrams & Lausten (1979), who found that 53^ required some type of dental treatment.
The fact that so many children require dental treatment could make follow-up difficult for the day care centers. In attempting to facilitate follow-up care, children are assigned into one of three groups. In this manner, thildren exhibiting the most urgent need for dental services are treated first. This system has worked well and most children in need of dental care receive treatment.
Our interdisciplinary program has been in operation for several years, and has achieved the proposed objectives. The day care center program has been helpful and valuable for our students, as well as for Marquette University. The University has acquired a reputation for service, and this program has enhanced this reputation. This is important to us. The program that has been developed is one which could be duplicated quite easily and effectively.
- Ayers, C.S., Abrams, R.A. & Lausten, L.L. (1979). Oral health assessment of inner city preschoolers. Journal of Dental Hygiene, 53(10 ):465-468.
- Chinn. P. & Leitch, C. Í1979). CAtVd health maintenance. St. Louis, C.V. Mosby Company.
- Levine, P & Grayson. B. 11973). Safeguarding your patients. RN, 7, 38-41.
- Shmarak, K. & Van Stewart, A. (1976). A school dental program utilizing student dentists. The Journal of School Health, 46(2). 106-108.
- Slattery, J. (1976). Dental health in children. American Journal of Nursing, 76(7), 1159-1161.
- World Health Organization. (1977). Oral health surveys, basic methods, 2nd Ed., Geneva: Author.