Listening to paediatric primary care nurses: a qualitative study of the potential for interprofessional oral health practice in six federally qualified health centres in Massachusetts and Maryland

Abstract

ObjectivesTo explore the opportunities for interprofessional collaboration (IPC) to improve paediatric oral health in federally qualified health centres (FQHCs), to identify challenges to IPC-led integration of oral health prevention into the well-child visit and to suggest strategies to overcome barriers.SampleNurse managers (NMs), nurse practitioners (NPs), paediatric clinical staff and administrators in six FQHCs in two states were interviewed using a semistructured format.DesignGrounded theory research. Topics included feasibility of integration, perceived barriers and strategies for incorporating oral health into paediatric primary care.MeasurementsQualitative data were coded and analysed using NVivo 10 to generate themes iteratively.ResultsNurses in diverse roles recognised the importance of oral health prevention but were unaware of professional guidelines for incorporating oral health into paediatric encounters. They valued collaborative care, specifically internal communication, joint initiatives and training and partnering with dental schools or community dental practices. Barriers to IPC included inadequate training, few opportunities for cross-communication and absence of charting templates in electronic health records.ConclusionsNMs, NPs and paediatric nursing staff all value IPC to improve patients' oral health, yet are constrained by lack of oral health training and supportive charting and referral systems. With supports, they are willing to take on responsibility for introducing oral health preventive measures into the well-child visit, but will require IPC approaches to training and systems changes. IPC teams in the health centre setting can work together, if policy and administrative supports are in place, to provide oral health assessments, education, fluoride varnish application and dental referrals, decrease the prevalence of early childhood caries and increase access to a dental home for low-income children.

Caries risk assessment tool and prevention protocol for public health nurses in mother and child health centers, Israel

“…These findings are coherent with those reported by Bernstein et al. (). Nevertheless, the majority of them do not perform routine children's mouth examination and caries prevention measures.…”

“…That study found that nurses in diverse roles (i.e., nurse managers, nurse practitioners, and registered nurses), understood the importance of integrating oral health prevention into primary care settings but listed several barriers such as lack of electronic medical record systems, time limitation, lack of oral health knowledge, and more. Several of these findings are coherent with our findings and emphasize the limitations which must be overcome in order to implement oral health prevention by nurses (Bernstein et al., ).…”

Improved oral health knowledge in a primary care pediatric nurse practitioner program

“…The incidence of untreated dental caries is high in these children and can have an adverse effect on their systemic health and affect their ability to eat, speak, and learn (CDC, 2019; Golinveaux et al, 2013). Despite the availability of public dental insurance for low-income children, families continue to not prioritize or understand the need for preventative oral health visits in young children (Bernstein et al, 2017). Additionally, many barriers to dental care have been reported, including lack of parental knowledge of oral health care in young children, lack of access to pediatric dental care providers, and dental providers not accepting public insurance (Bradbury-Jones et al, 2013; Close et al, 2010).…”

Children’s Oral Health and Barriers to Seeking Care: Perspectives of Caregivers Seeking Paediatric Hospital Dental Treatment

“…Studies have shown the oral health benefits of initiatives that involve both medical and dental professions ( Biordi et al 2015 ; Braun and Cusick 2016 ; Clark et al 2016 ). Non-dental primary care health professionals are well positioned to improve access to dental care ( Bernstein et al 2017 ). More initiatives in early oral health screening and referrals, education and intervention for children and their caregivers by non-dental professionals who have access to priority populations may reduce the inequities in oral health.…”