SUA 9 Accesibilidad

Recently, there has been increasing awareness in Japan of the importance of adequate nutritional uptake in the management of illness and disability. This is reflected in the creation of independent nutrition support teams (NST) in hospi- tals’ inpatient wards, with an increasing number of facilities looking to provide appropriate nutritional management. Such teams are typically composed of phy- sicians, nurses, nutritionists, pharmacists, and clinical technologists, who assess patients’ nutritional status at an early stage following admittance to provide ap- propriate management of subjects’ nutritional status. This allows patients identi- fied as suffering from poor nutrition to undergo an appropriate examination and treatment (such as oral, enteric, and intravenous alimentation), and be provided with nutritional support to improve their nutritional status. Nursing care facilities that provide rehabilitation for patients affected by problems with swallowing and achieving adequate nutrition have also been increasing in number. This team

care approach to providing support for dietary function requires the incorporation of a wide range of different healthcare professionals, with teams consisting of nurses and caregivers, as well as speech therapists, physical therapists, occu- pational therapists, dentists, and dental hygienists (fig.4).

Figure 4. Support for eating

From its very inception, the nursing care facility Sendan-no-Oka (fig.5) has em- ployed a dedicated dental hygienist responsible for performing oral care for resi- dents, although the content of these duties has gradually changed since the ini- tial appointment.

Figure 5. Facility user’s condition of Sendai-no-Oka

At first, the dental hygienist’s main duties were in improving residents’ oral hy- giene, but together with the addition of an additional dental hygienist, nutritionist, and speech therapist, this team formed the facility’s “Oral Nutrition Section.” This is at the center of the facility’s efforts to bring each healthcare professional’s specialist skills to bear on the issue of dietary support. Long-term residents of the facility were provided with support for oral hygiene care, enabling improve- ments in oral hygiene conditions as this took on the nature of an everyday habit. This in turn allowed the dental hygienist to focus more on assessing the oral hy- giene conditions of new residents and providing support for dental treatment (Watanabe, Wakoh and Abe 2006). This increase in dental hygienists enabled the implementation of specialist care for oral hygiene for regular users of the fa- cility, and through nursing prevention seminars and training, enabled the active dissemination of oral hygiene care and preventative measures. The facility was also able to monitor residents at mealtimes, allowing for the development of a system that could examine approaches to helping residents with eating from the

perspective of nutrition, eating and swallowing function, and oral hygiene. (See fig. 6.)

Figure 6. Transition of oral health care services in Sendan-no-Oka (20002007)

These developments have resulted in an easier exchange of information be- tween the dental hygienist, speech therapist, and nutritionist. Having the care unit meeting with other contact persons, including the providers of the facility’s meal service, to discuss management of the meal service, allows for the resolu- tion of any problems concerning the dietary habits of the facility’s residents. This can be seen as giving expression to the development of an interdisciplinary team in which the members continue to reinforce each other through sharing in- formation among themselves and with outside professionals with the overall aim of supporting residents’ dietary habits while continuing to maintain the dental hy- gienists’ specialist skills. In terms of opportunities for sharing information, in ad- dition to holding regular meetings about the provision of institutional food, there are also regular case conferences where the goals and policies for each individ- ual resident are determined. Each care unit is also equipped with a notebook for

recording data, and detailed instructions for carrying out oral hygiene care are located near the wash areas of each resident room or unit so that information can be shared between team members. Conscious efforts are also made to hold regular study sessions and provide direct advice for new employees.

In playing a crucial role in such a team and putting such measures into action, the dental hygienists, in addition to answering questions regarding correct post- meal brushing habits, have also seen an increase in the number of times in which they respond to questions regarding approaches to dietary support, the best way to thicken food to make it easier to swallow, and other related tech- niques. As there are limitations to the number of residents to whom the dental hygienists can provide direct care among the 100 residents of the nursing home, one unit (20 persons) is seen each day, with each of the five units being seen on a different day of the week. The development of this system, in which residents know the dental hygienist will be present on a certain day, is also very clear for other healthcare professionals, and is thought to contribute to easier cooperation and improved efficiency in the facility.

The role of other professionals during the facility’s mealtimes, such as the moni- toring of meals by care workers, allows the staff to determine whether residents are actually eating their meals with enthusiasm. The occupational therapist de- termines whether residents are eating their meals properly and also looks at the necessity of self-help devices for residents. The national registered nutritionist’s role focuses on the current nutritional status of residents, while nurses carry out detailed nutritional management and physical care management. The speech therapist evaluates the residents’ swallowing function, and provides subjects who need help with swallowing training to ensure that they can safely ingest their meals. The resident physician is primarily responsible for the overall health management of the facility’s residents, with appropriate drug administration management at mealtimes being an especially important part of this role. The dental hygienist performs oral hygiene management, in addition to oral function management. These are all part of the effort to ensure residents maintain a standard of oral hygiene that enables them to eat their meals properly. When seen from the perspective of the necessity of medical care, residents who do not use their oral cavity for a certain period of time can be subject to lowered pro- duction of saliva, increased dryness, and a deterioration of oral hygiene. When viewed as an entry point for nutritional uptake, then the oral cavity needs to be maintained and provided with support to allow it to be able to take in food. At this facility, dental treatment was provided by outpatient dental visits after obtaining

consent from the subject or his or her family, and post-operative care was sub- sequently carried out.

Besides providing preventative oral care treatment as a measure to prevent the need for nursing care, the dental hygienists also provide oral care treatment as an element of dietary support, and this is an essential function of the facility. In the future, the placement of such dental hygienists in nursing care facilities and institutes is something that should be considered necessary (Watanabe 2006). The following is a case study of the role of the dental hygienist at Facility Sen- dan-no-Oka, examining the role of the dental hygienist in performing oral care for elderly sufferers of severe dementia who require nursing care.

A case study - oral health care for the demen-