Dental Hygiene Process of Care Model

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Dental Hygiene Process of Care Model

• B.Leggett

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What is this model?

• It provides a logical, systematic approach to
  care
• It is characterized by its client-centered
  collaborative concept of care
• It is based on the Human Needs Conceptual model
  (Darby, 1990)

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OUTCOMES
EVALUATION
IMPLEMENTATION
PLANNING
ASSESSMENT
ASSESSMENT
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Human Needs Theory

• Explains that
• human activity is motivated by a perceived need
• AND
• Human behaviour is GOAL directed

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A Human Needs Approach

• There are 11 human needs relevant to dental
  hygiene care
• If these needs are unfulfilled, specific
  behaviours will be activated in order to
  eliminate any perceived deficit

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1.. Safety

• Freedom from potential harm
• Unmet need may be indicated by
• Abnormal vital signs
• Potential for antibiotic premedication

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2 Pain and Stress

• Freedom from physical/emotional discomfort
• Unmet need may
• Be displayed by verbal OR non-verbal behaviour
• Involve fear or anxiety or
• Discomfort prior to or during care

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3 ..Wholesome facial image

• Client may express dissatifaction with appearance
  of teeth,or concerns re breathe odour

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4 ..Head and Neck Integrity of tissues

• Deficits may be discovered during extra/intraoral
  examination such as
• Presence of lesions
• Gingival inflammation
• Bleeding on probing

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5.. Functional dentition

• A biologically sound and functionally intact
  dentition
• Signs of need deficit could include
• Difficulty in chewing
• Teeth with signs of abrasion, caries, trauma
• Presence of plaque, calculus or stains

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Unmet Oral Health Needs
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6 Adequate Nutrition

• The need to ingest adequate nutrients for body
  growth, repair and maintenance
• Deficits may include signs of
• Eating disorders
• Rampant caries
• Malnutrition

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7 ..Appreciation and Respect

• Involves the following aspects of the dental
  hygienist - client relationship
• Using empathic communication skills
• Acting as client advocate
• Understanding and accepting clients attitudes
  and emotions

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8 .. Conceptualization and Problem
solving

• The need to grasp ideas and concepts
• Make sound judgements about own oral health
• D.H. should
• Measure clients oral health knowledge
• Explain disease process
• Explain rationale for care
• In order to
• Promote clients self-evaluation
• Enable client to understand rationale for
  treament

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9 .. Self-determination and Responsibility

• Involves the need for accountability for ones
  own health behaviours
• Client must be a committed and active participant
  in oral wellness
• Involvement in setting goals
• Facilitate decision making about role in oral
  health

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10 .. Territoriality

• Respect for the clients personal space
• Awareness of diverse cultures
• Recognize issues with personal information

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11 .. Value System

• Involves the need to develop ones own priorities
  through experience and culture
• Care providers can advocate the importance of
  optimum wellness
• Exert influence in order to increase the value
  placed on oral health maintenance

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Phases of the dental hygiene process of care

• Assessment
• Information gathering on current health status
• Sources
• Observation
• Clinical exams
• X-ray
• Reports from family
• Lab tests etc.

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Diagnostic Statement

• formal statement regarding the actual or
  potential problems of a client that are amenable
  to treatment through the DH Process of Care (
  Mueller-Joseph, and Petersen)
• Provides the foundation for preparing the care
  plan
• Must respect the DH scope of practice

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DH Diagnosis

• Is a two part statement which describes
• An oral condition
• Possible etiology
• Is based on both subjective objective data
• Is validated with the client

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DH Diagnosis

• FORMAT of STATEMENT
• Describes clients current condition related to
  contributing factors
• eg .. potential for clinical attachment loss
  related to high levels of periodontal pathogens

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Diagnostic Statements

• Generalized dental abrasion related to traumatic
  toothbrushing techniques
• Generalized brown stain related to cigarette
  smoking
• Inflamed palatal mucosa related to improper
  denture care

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Planning Care

• Focus of care is meeting clients needs as
  identified in diagnostic statements
• Goal is to resolve oral health problems
  (deficits)
• Involves analysis and synthesis of data to
  develop strategies and interventions

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Stages of Planning

• Setting priorities in collaboration with client
• Develop goals and establish desired outcomes
• expected outcomes language gtgtgt each should
  begin with
• Client willdemonstrate, perform, eliminate,stop,
  choose, remove etc.

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Planning Care

• D.H. Diagnostic statement
• Increased potential for root exposure related to
  incorrect brushing technique
• Goal
• Decrease potential for root exposure
• Intervention
• educate client and demonstrate correct
  toothbrushing method

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Planning Care

• Expected outcome(s)
• Client will demonstrate correct method at next
  appoinment
• Attachment levels will remain unchanged over next
  12 months
• Documentation
• Outcomes should be specific and measurable (
  action language) and prioritized with time
  guidelines

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Implementation of D.H. Care Plan

• Preparation of treatment area
• Performance of skills plus
• All educational interventions
• Information and OHI
• Counselling ( dietary, Smoking cessation)
• Post treatment care
• Record keeping

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Evaluation Phase

• Failure to evaluate the clients oral health
  status after care may be considered professional
  negligence (Darby Walsh, 1995)
• Each goal should be reviewedwas it
• Fully met?
• Partially met?
• Not met at all?

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Evaluation Phase

• Partially or completely unmet Goals
• Goals unrealistic?
• Time frames too short?
• Client non-compliance?
• Inaccurate diagnosis?

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Evaluation Phase

• Goals Fully Met
• Client goes on Supportive care plan
• Recare intervals will vary
• Process is on-going at every appointment
• Always refer back to baseline data
• Accurate documentation for continuing maintenance
  of oral health

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D.H. Process of Care
Assessment
Evaluation
D.H. Diagnosis
Planning
Implementation