SNPG 902 Assignment: School Of Nursing

SNPG 902 Assignment: School Of Nursing

SNPG 902 Assignment: School Of Nursing



On completion of this subject, students should be able to:

1. identify and critically appraise theories of management in order to locate management issues as they arise;

2. demonstrate a knowledge and comprehension of theories of personal development towards effective leadership;

3. demonstrate a knowledge and comprehension of personality differences in perception and decision making in the health care sector;

4. recognise and analyse personal changes in relation to health care settings as well as respond to change within the organisation and changing management goals within the organisation;

5. critically evaluate multi-cultural factors in health care settings;

6. plan the effective use of personnel’s time for individuals and groups within the work environment;

SNPG 902 Assignment: School Of Nursing  – Sample Solution Draft:


Aged care facilities refer to special-purpose health facilities that are designed in a way that helps in providing accommodation and different other kinds of support to older adults. This commonly includes assistance in their intensive care, daily living, and independence of aged and frail person (Broad et al., 2013). In other words, aged care facilities are aimed for providing assistance to those individuals who are no longer able to live in their homes, due to bereavement, illness, disability, and emergency. Their immediate carers are not usually able to address these conditions properly, without help. Dementia is an umbrella term that is used for describing a range of symptoms that are associated with a gradual and progressive decline in memory functions and thinking skills. These symptoms are severe enough to lower the ability of an affected person to perform activities of daily living (Prince et al., 2013). The condition most commonly arises due to physical alterations in the brain. Oral hygiene and health is often overlooked by adults having dementia in, during their stay in aged care centres. Good oral health has been identified imperative for the overall health, quality of life and wellbeing of all individuals. This report will draw evidences from scholarly articles in the form of a literature review, followed by recommendations to manage oral hygiene in dementia affected patients in an aged care.

SNPG 902 Assignment: School Of Nursing

Literature Review

The primary aim of the literature review was to draw evidences from scholarly paper that contained substantive findings and theoretical contributions to the concept of oral health maintenance in dementia patients. The research question for the review was as follows:

What is the relationship between oral health and poor outcome in dementia patients?

The search strategy was developed by the identification of essential key words and terms that matched the research question. Each component of the research question was evaluated for identification of the search terms. The keywords used were ‘dementia’, ‘Alzheimer’s’, ‘older’, ‘elder’, ‘frail’, ‘aged’, ‘oral health’, ‘hygiene’, ‘wellbeing’, ‘maintain’, and ‘manage’. The singular, plural and variant spellings of the terms were also taken into consideration (if any). These terms were combined with the use of boolean operators ‘AND’ and ‘OR’. Combining them with ‘OR’ broadened the retrieved hits, while ‘AND’ helped in narrowing down the extracted results (McGowan et al., 2016). Two databases namely, Google Scholar and PubMed were used for extracting articles that were relevant to the research question. Following an evaluation of the abstracts and full-texts, eight articles were selected for inclusion in the review.

Upon comparing the oral health between older adults with and without dementia, it was found that elderly people diagnosed with dementia most often show a dependence on the nursing professionals and their caregivers. They frequently encounter oral care resistance from the patients that contributes to oral health shortcomings. Univariate analysis conducted for the major target variables and indicated the presence of high amount of plaques in dementia patients, when compared to the non-dementia group. Furthermore, the mean community periodontal index of treatment needs for dementia group reported significant worsening than the counterparts, and all dementia patients reported presence of periodontitis in one of the sextants, thereby proving the correlation between dementia and poor oral health (Zenthöfer, Schröder, Cabrera, Rammelsberg & Hassel, 2014).

Similar findings were illustrated by Noble, Scarmeas and Papapanou, (2013) who presented evidences for the epidemiological associations between reduced oral health and cognitive impairment in dementia. Inattention to oral health was identified as a precursor to old age and was associated with impairment in physical movements, and cognitive difficulties among person aged more than 75 years. The authors also elaborated on the fact that aged people who are less likely to make dental visits on a regular basis are more vulnerable to incidence of dementia. Other authors also presented similar views in relation to the link between risks of dementia and poor oral hygiene. Following the acceptance of proinflammatory states as factors that increase the risks of dementia and cognitive impairment, poor oral health was recognised as a potential exposure that exists in close correlation with systemic inflammatory responses. Gingival bleeding, tooth loss, and loss of periodontal attachment were closely associated with poor cognitive function. The authors were also able to establish a link between psychomotor speed, poor attention, gingival bleeding and absence of periodontal attachment (Stewart et al., 2015).

The impact of oral healthcare on the well-being and quality of life of Alzheimer’s disease patients were measured in another study that successfully illustrated the findings that individuals suffering from AH report more dental decay, fewer teeth and poor oral hygiene. Periodontal disease was also identified as the key factor that resulted in an increase in the OHIP value among dementia patients. Furthermore, the relation between poor quality of life with probing depth less than 4mm and gingival bleeding were clearly established in the literature, thus providing adequate evidence for the failure of dementia patients in maintaining their oral health. Foltyn, (2015) also supported the aforestated evidences in stating that delirium and a decline in neurocognitive capabilities, as commonly observed in dementia patients with poor oral health. The author stated that older adults diagnosed with dementia have often been found to report frailty, falls, incontinence, vision and hearing impairment, and medication noncompliance.

All of these are found to directly interfere in their capabilities in taking self-care such as, grooming, dressing and showering, which in turn contributes to their failure to maintain adequate oral hygiene. Mouth pain was also identified as a common problem in dementia patients that directly led to devastating effects in the elderly such as, compound psychosocial issues, disruption in family dynamics and poor appearance. Hence, chronic periodontal infection, rapid dental decay and dry mouth were some common symptoms found in dementia affected person. Tooth loss has also been recognised as a major factor that increases the susceptibility of cognitive decline and dementia among patients. In other words, older men and women with less teeth are considered more likely to develop dementia at a later stage in their life. Lowered masticatory capability was found to impair the nutritional intake, thereby resulting in inflammation that acted as a risk factor for progressive decline in memory (Batty et al., 2013).

Furuta et al., (2013) also gave similar opinion on the association between the two factors and stated that cognitive ability and nutritional status are found in direct correlation with the swallowing function and oral health status among older patients. Upon conducting path analysis, the authors found that cognitive impairment and poor status of oral health create a direct negative impact on the denture wearing, and subsequent dysphagia. All of the aforementioned factors were thus found to directly interfere with the activities of daily living. Controlling bacterial dental plaque with maintenance of oral hygiene was also identified essential, in order to prevent the onset of oral diseases such as, periodontal disorder and caries. The older adults, suffering from mild impairment in their cognitive capabilities are always at an increased risk for such oral disease. The findings elaborated on the fact that gingival inflammation, bacterial plaque accumulation and deficient oral hygiene act as major indicators for cognitive impairment, a characteristic feature of dementia (Gil?Montoya et al., 2017).


Hence, the findings illustrated above state that older patients suffering from cognitive decline due to dementia are unable to maintain proper oral health. The primary recommendation is to implement Tuckman’s teamwork theory to make all the professionals involved in the aged care facility adopt essential strategies for oral health maintenance.

Team management- The four stages of Tuckman’s teamwork theory will be effectively utilised in this scenario. The forming stage might show discrepancies between the opinions and ideas of the healthcare professionals in the team (Betts & Healy, 2015). However, upon utilisation of the theory, gradually all the members will develop a sense of belonging with the team in the storming stage and develop processes and ground rules, thereby clarifying each member’s role in the norming phase. This will be followed by the final performing stage where a due focus will be placed on the team relationship and the intended task of improving the oral hygiene. This theory will focus on the role of a nutritionist in ensuring that the dementia patients are not given food that are rich in sugar content, both at mealtimes and between meals. The storming stage will also make the nutritionist learn the need of restricting consumption of drinks that are not labelled sugar-free (Pretty et al., 2014).


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