Ch. 1 professional DH

Interpretation

critical thinking to identify significance analysis synthesis inductive reasoning deductive reasoning diagnosis

ethical issues

governing practice act, laws, acceptable standarts

VIII. Interprofessional Collaborative Patient Care

growing number of facilities • 4 competency domains developed

STANDARDS FOR CLINICAL DENTAL HYGIENE PRACTICE

Dental Hygiene Process of Care: Assess Diagnose Plan Implement Evaluate Document -ADPIED-

Examples of assessment

-x-rays -periocharting -health history -psychological(afraid) -restorative H(charting) -oral cancer screening -Nutrition analysis

Steps in Resolution of Ethical issue or Dilemma

1.DH situation 2.Individual preferences 3. Choices vs Alternatives 4.Case parameters

A. Advanced Dental Hygiene Practitioner or Advanced Dental Therapist

2009 Minnesota master's level degree program for advanced dental therapists • Undeserved populations • Collaborative management agreement with supervising dentist • CODA

social trust

A bond of trust between DH, patient, dentist, and public

Nonmalifecence

A core value- non harm of others

Dental therapist

A mid- level oral health care provider with expanded training who provides direct patient care under an expanded scope of practice that includes the ability to diagnose and perform restorative services, they provide safe, quality dental care in many countries around the world.

Reciprocity

A mutual exchange of favors or privileges. "I'll scratch your back if you scratch mine." A mutual or cooperative exchange

II. Ethical Dilemma

A problem that may involve two morally correct choices or courses of action. • May not have a single answer and, depending on the choice, the outcomes can differ. • To resolve a dilemma, the facts are gathered, ethical principles and theories are applied, and options are explored

Cotherapist

A therapist who coleads group therapy sessions with another therapist

3 domain- inter professional com-n

Ability & openness to express Kwoledge&appreciation of the role and value of other health professions Willingness to work together and share

License by credential

Acceptance for licensure by a regulatory body( state, province) based on evidence from a license obtained in another state with equivalent standards and requirements are also called reciprocity.

Universal Precautions

Actions taken to prevent the spread of disease by treating all blood as if it were contaminated.

ADH

Advanced Dental Hygiene From 1971-1976 University of Iowa and of Kentucky both trained dental hygienists with advanced skills in restorative dentistry

ADHP

Advanced Dental Hygiene Practitioner Anew mid- level oral health care provider in 2009 PEW report

ADT

Advanced dental therapist

ADHA

American Dental Hygienists' Association

4domain -teams & team work

Become a part of small system & share positive health outcomes Share expertise functioning & accountability Give a professional autonomy to share a decision making

Personal Factors in Practice

Attitudes • Traits • General health • Oral health • Cleanliness • Appearance • Mental health

Confidentiality

DH protect patient's privacy

CDHA

Canadian Dental Hygienists' Association

B. Clinical Role of the Advanced Dental Therapis

Caries removal, placement, finishing • Composite/resin and amalgam • Space maintainers • Stainless steel crowns & temporaries • Pulpotomy • Pulp vitalitiy testing • Simple extractions primary teeth • ADT collaboration

Step 4

Case parameters: -Does the scope of practice apply to the sit.? -W financial, legal, or cultural factors? -Compare done actions w standards -Is there a conflict between the patient, dental provider, or others? -outside source to be consulted!

critical thinking skills used to interpret Clinical Data

Classification Interpretation Validation

Professional Roles of DH

Clinician Corporate Public Health Researcher Educator Administrator Entrepreneur

V. Dental Hygiene Specialties

Continuing education • Private practice orthodontics, pediatric dentistry & periodontics • Continuing education specific to specialty • Bachelor's degree; degree completion • Enhance opportunities outside of clinical practice • Master's degree • Variety of Sciences • Doctoral degree • Variety of Sciences

CEU

Continuing education unit; 1 unit commonly refers to 1 clock hour of instruction

III. Dental Hygiene Diagnosis

Critical thinking • Identify health behaviors • Provide basis on which DH care plan is designed, implemented, evaluated • Justify tx proposed • Challenge DH responsibility for patient care

II. Supervision and Scope of Practice

DH Practice Act by each state • Supervision • Collaborative practice legislative initiatives for underserved

Factors to teach the Patient

DH is cotherapist ( work w patient dentist& others) -Moral&ethical nature of DH -Scope of DH defines by Practice Acts -interrelationships -improve and maintain optimal patient's oral health

Legal factors of DH

DH must study and respect Law depends from st,country -changes in Practice Act can be change from time to time

I. Roles of the Dental Hygienist

Dental hygienists support oral health through their work in many settings including: • General and specialty dental practices. • Public health programs. • Research centers. • Professional education institutions. • Hospital and institutional care facilities. • Federal programs, including the armed services. • The dental corporate industries.

The Code of Ethics

Describes professional conduct • Outlines responsibilities and duties of each member toward • Patients • Colleagues • Society

VI. Evaluation

Determines whether patient needs • Retreated • Referred • Continuing care -through the treatment the problem is fixed -EX: 4week follow up for a perio after SRP

History of the Dental Hygiene Profession

Dr. Alfred C. Fones • Dentist in Bridgeport realized most children already had decay by the time they reached the dental chair. • Irene Newman • Dr. Fones dental assistant, trained to demonstrate value of education and prevention to reduce disease • Prevention rather than treatment • Dr. Fones invented the name "dental hygienist" • Term would create an association with prevention, rather than tx of disease.

Scope of Dental Hygiene Practice

Dr. Alfred C. Fones • Father of dental hygiene • Education MOST important role • Primarily education early but the scope of practice has developed and broadened

Personal factors in practice

Each DH represents the entire profession !! DH express attitude towards all health services Including General physical health &oral health care -general HCare:healthy diet, nice sleep, ex, routine exams for hearing sight &com. Disease -oral health: clean healthy mouth like a model to prevent & control of oral disease -Mental health: inspire confidence, participation in professional and community activities contribute to optimum mental health

Educator

Edu competent OH professionals Provide CEU for licensed providers -DH clinical or classroom instructions Corporate educator

Corporate

Employment in a company promoting health products & services -product sales -corporate educator & admin

III. Clinical Practice Goals

Evidence based knowledge • Personalize, individualize and adapt • Plan and carry out DH interventions • Care for special needs patients • Universal precautions

Example of primary prevention

Example: Fluoridation of community water supplies -sealants -mouth guard for athletes -home care instructions

I. Purposes of the Dental Hygiene Process of Care

Framework individualized needs • Causative and risk factors • Reduce, eliminate, prevent

Public health

Funded health care program Non profit organizations -clinician : in community clinics, gov. Health services, school sealant program, oral health care admin

justice/fairness

fair treatment according to an equitable distribution of benefits and burdens; impartiality

Personal Goals

Highest degree of professional ethics and conduct • Interpersonal relationships • Self evaluation throughout professional life • Lifelong learning • Professional memberships

Objectives for Professional Practice

I. Overall Goals II. Personal Goals III. Clinical Practice Goals

VI. Alternative Practice Settings

In 2014, 37 states allowed Direct Access for Dental Hygienists to provide care in a variety of community setting. • Means the DH can tx, plan and initiate tx based on pt assessment w/out specific authorization of the dentist • Depends on state practice act. • Schools • Public health settings • Headstart settings • Nursing home facilities • Free clinics • Community centers

Step 2

Individual Preferences: W are the rights of ind.? in a clinical case: iINFORMED CONSENT!

Core values in DH practice

Individual autonomy and respect to others Confidentiality Societal trust Nonmalifecence(не вредный) Beneficence Justice fairness Veracity

IX. Advocacy for Oral Health

Influence legislators, health agencies etc • Analyze barriers to change • Implement/evaluate policy/programs • Promote lifestyle change

Ind. autonomy & respect

Informed consent Ability to make a choice Autonomy for both DH and patient

Entrepreneur

Initiate improvement projects; identify new ideas, delegate idea responsibility to others Finance new oral enterprise -practice management -product development -independent clinician -consulting -professional speaker or writer

IV. Summary: The Final Decision

Is the decision/action that is selected morally defensible • Can the choice to solve the dilemma be defended

Tertiary prevention

Methods to replace lost tissues and to rehabilitate the oral cavity to a level where function is as near normal as possible after secondary prevention has not been successful -dentist

VII. Advanced Practice Dental Hygiene

Mid-level dental provider • Dental therapist • Dental Health Aide Therapist

Ethical Applications

Moral situations • Ethical situations • Legal situations • Delimmas

I. Ethical Issue

More clearly defined than a dilemma. • A common problem wherein a solution is grounded in the governing practice act, recognized laws, or accepted • Standards of care based on the standard rules of practice

dental hygienist

Oral health specialist whose primary concern is the maintenance of oral health and prevention of oral disease

Administrator

Org skills, resources, communicative objects -Program director

1st domain value/ethics

Patient centered with a community orientation Shared purpose to support good health A shared commitment to safe and efficient systems of care

IV. The Dental Hygiene Care Plan

Present to dentist for integration with comprehensive dental care plan • Present to patient • Understanding of interventions • Informed consent

III. Types of Clinical Services

Prevention to promote and maintain • Educational • Preventive and therapeutic services • Prevent disease • Theraputic arrest and control disease, maintain oral health • DH treatment services integral part of overall dental treatment plan

3 categories of preventive services

Primary Secondary Tertiary

Clinician

Provide direct patient care with other professionals Private dental practice Community clinics Hospitals Long term facilities Schools

III. The Patient First

RDH ethically, morally and legally responsible without discrimination • Ethical decision making and professional behavior

Example of secondary prevention

Removal of calculus and dental biofilm while debriding a root surface in relatively shallow periodontal pocket to prevent continued attachment loss and the formation of a deep pocket -Calculus -biofilm screenings (pap smears) -prophylaxis -cancer screening -still give Fluoride,homecare instructions !Catching the disease to heal it!!!

example of tertiary prevention

Replacement of a missing tooth using a fixed partial denture or implant and therefore restoring function -partials -remove deposits -using instrumentation -SRP

II. Dental Hygiene Codes

Responsible for study and application of codes of associations in which memberships are held

Dental Hygiene Ethics

Standards of right and wrong • Guides behavior • Members of a profession • Have extensive specialized education • Possess intellectual body of knowledge • Provide services for common good • Maintain organization of members -MORAL DUTIES & OBBLIGATIONS of PROFESSIONALS TO CLIENTS, colleagues & society

Legal Factors in Practice

State Practice Acts

Primary prevention

Stop smth. Before the disease will start So that disease doesn't occur is truly prevented Example: Fluoridation of community water supplies

Researcher

Studies on new products procedures theories -gov agency -universities -corporations

Veracity

Tell the truth

CODA

The Commission on Dental Accreditation serves the public and profession by developing and implementing accreditation standards that promote and monitor the continuous quality and improvement of dental education programs.

Supervision and scope of practice DH

The professional DH is responsible to provide only those services allowed within the scope of practice outlined within the DH Practice Act of each state

Dental hygienist care

The science and practice of the prevention of oral diseases; integrated preventive and treatment services administrated for a patient by a dental hygienist

IV. Lifelong Learning: an Ethical Duty

To maintain competency • To learn scientific advances from new research • To provide evidence-based patient care. • To apply consistent ethical reasoning. • To ensure fulfillment of each patient's rights

Secondary prevention

Treatment of early disease to prevent further progression of potentially irreversible conditions that if not arrested, can lead eventually to extensive rehabilitation treatment or even loss of teeth Hygienist

OSHA (Occupational Safety and Health Administration)

US a government agency in the Department of Labor to maintain a safe and healthy work environment Helps employers protect their workers and reduce workplace deaths, injuries, and illnesses

2nd Domain-roles & responsibilities

Understand how professional roles and responsibilities complement e.o.

4 competency domains for inter professional collaborative Practice

Values/ ethics for interprofessional Practice Roles/ Responsibilities Inter professional communication Teams and teamwork

moral

a principle or habit with respect

ethical dilemma

a problem between 2correct choices, answers can be different

core value

basic values of a professional guide to choices or actions deemed to be acceptable in the profession

virtue

character traits, EXamples: -honesty -compassion -care -wisdom

Step 3

choices vs alternatives: w core values on this case? describe existing alternatives explain +&- of all outcomes

DH summary

collect all the assessments

Learning Objectives

dentify and define key terms and concepts related to the professional dental hygienist. • Describe the scope of dental hygiene practice. • Identify and describe the components of the dental hygiene process of care. • Identify and apply components of the dental hygiene code of ethics • Explain legal, ethical and personal factors affecting dental hygiene practice. • Apply concepts in ethical decision making

Beneficience

doing good

Step 1-DH situation

is this sit. Ethical issue or Dilemma? w is the chief concern/problem? Summarize history of sit. List all the facts from all the people involved

Example of ethical dilemma

medicaid pts get less time bc of money -not giving enough time foe a proper cleaning

Example of DH Diagnostic statement

problem-cause(risk factors and etiology) -potential for dental caries-deep occlusal pits and fissures -bleeding on probing-marginal dental biofilm -anxiety-dental phobia

SRP

scaling and root planning

ethics

sense of moral obligation, principles of professional conduct -principles of morality

Classification of critical th.skills

sort info into specific categories such as general systemic, oral soft tissue, periodontal, dental, oral hygiene

Example of personal factor could affect DH practice

tell pt not to smoke while DH is a smoker

Dr. Alfred C. Fones

the father of dental hygiene. emphasized the imprtant role of education.

Validation

verify an accuracy of data interpretation recognizing errors isolate discrapencies need for additional info

C. Impact of Advanced Dental Therapist

• 2011 DT graduated in Minnesota • Increase in number patients served • Reduced waiting times • Decreased travel time • Possible ER visits • Increased productivity of dental team • Improved patient satisfaction

V. Implementation

• Activation phase of care plan -put TREATMENT PLAN in action

VII. Documentation

• Assessment data • Diagnosis • Care plan • Treatments • Patinet education • Evaluation • Condensed, consistent -The last step in the process of CARE!!

I. Overall Goals

• Attain and maintain oral health • Aid individuals and groups • Self assessment to attain goals of perfection for service

Factors To Teach The Patient

• Cotherapist • Moral and ethical nature • Scope of service • Instructional and clinical services • Patient state of oral health

Factors to Teach the Patient

• Cotherapist • Moral and ethical nature • Scope of service • Instructional and clinical services • Patient state of oral health

IV. Patient Education

• Daily self care • Regular appointments • Educational & clinical services • Mutually dependent & inseparable • Scientific information • Public awareness

II. Assessment

• First component • Subjective and objective data

Core Values

• Selected principles of ethical behavior • Heart of the code of a profession

I. Purposes of the Code of Ethics

• To increase awareness of and sensitivity to ethical situations in practice • To define standard of conduct • Strong sense of ethical consciousness

II. Personal Values

• Value development begins early age • Influenced by familial, social, economic • Life experiences • Successes and failures • Periodic self assessment • Values, attitudes, responsibilities