Ch. 46: Principles of Evaluation
A "Critical Incident" Approach
"A formal approach used to evaluate dental hygiene practice takes the form of answering questions about a specific situation, often called a critical incident, that prompts the practitioner to look for answers. ■Three steps, sometimes referred to as the *"What? So What? Now What"* approach, can be used to structure written reflective journal entries or can also be used to guide a less formal means of thoughtful personal self- assessment. ■The approach to reflective self-assessment includes a basic progression of reflective actions with questions"for each step that can help guide thinking about the situation from a variety of perspectives.
Self-Assessment and Reflection
"Self-assessment and reflective evaluation of personal professionalism and learning can be documented in several ways. Two suggestions are as follows: ■Regular written entries in a professional practice reflection journal that describe and critically analyze a variety of clinical, ethical, and professional situations the dental hygienist has found meaningful. Over time, this ongoing record will reflect how the practitioner's professional skills, actions, and knowledge have been enhanced through the process of reflective practice. ■A clinical practice portfolio can be developed that documents a variety of factors related to professional development and self-evaluation of dental hygiene practice. A portfolio may contain artifacts such as: ■Case presentations describing care provided for patients with special needs. ■A personal practice philosophy that indicates ethical parameters that impact how the dental hygienist provides care. ■Goals for future continuing education and courses taken or planned for reaching those goals."
This is performed and documented using a form that allows comparison with pretreatment assessment data
A complete periodontal probing
When is the final evaluation of dental hygiene treatment outcomes made?
After initial therapy (SRP) has been completed, when the response of the gingival tissue to therapy is apparent.
When a treatment sequence consists of multiple appt.'s evaluation of the previously treated areas at each subsequent appt. allows for what?
Allows for immediate intervention in an area that shows poor response to the previous treatment.
Analysis and comparison of pretreatment and evaluation data determines the relative success of the therapy.
Analysis of evaluation findings and comparison with findings from initial assessment can help determine whether the pt.: -Is able to be managed for the present care of the DH -Has not responded adequately to NST and referral for specialized perio care may be necessary -On the basis of the findings, a determination is made as to recommended intervals for subsequent maintenance appt.'s
What does the treatment, education, and self care instruction goals listed in the pt's care plan provide the basis for?
Basis for evaluating whether expected outcomes have been achieved at each level.
These are noted as probings are made and documented in the periodontal record
Bleeding points
Information collected during the evaluation procedure that is analyzed to determine oral health outcomes related to dental hygiene interventions
Data
The professional dental hygienist recognizes that standards of care change over time as new knowledge is introduced and becomes commonly accepted by the profession and the public.
Dental hygienists need to update and have knowledge of current practice standards
A systematic determination of worth, value, or significance. Includes: Assessment of outcomes for both treatment and preventive interventions. Enacted at each step in the DH process of care
Evaluation
Communication that occurs among all individuals participating in the pt's care, including the dentist, the dental hygienist, the pt. and the pt's physician or caregiver, if necessary. Giving and receiving this creates trust and ensures that those involved in all aspects of pt. care stay informed at every step.
Feedback
Information collected during any DH appointment, provides ongoing feedback that will allow the dental Hygienist to monitor pt. needs and adapt to changes in the pt's general health or oral health status during care.
Formative Evaluation
Ongoing evaluation to monitor each step in the dental hygiene process of care; ongoing feedback that determines any needed changed in the dental hygiene care plan prior to the completion of a treatment sequence.
Formative evaluation
Use of an explorer to check for residual calculus or to make sure there has been no undue tissue trauma at the end of SRP and will help make sure pt. care goals have been met at each appt.
Immediate evaluation
Benchmarks used to measure or test changes. In evaluating dental hygiene interventions, indicators can be quantitative (such as measurement of probing depth or plaque scores) or qualitative (such as pt's expressions of satisfaction or ability to perform self-care routines)
Indicators
What does the dental hygiene care plan establish?
Individualized immediate and long-range pt. goals for each DH intervention.
Measurable goals; the expected outcomes of clinical treatment, pt. education, counseling, or oral hygiene instruction/home care interventions identified in the pt. care plan.
Objectives
Evaluation of tissue changes and pt. self care abilities during a multi appt. treatment sequence can provide information regarding the need for modification in pt. care plan
Ongoing evaluation
A measure of the effectiveness of dental hygiene clinical and educational interventions in meeting oral health goals identified in the pt. care plan.
Outcomes assessment
Criteria or protocols that define the minimal quality of care required to defend against a legal dispute against the practice of on'e profession; usually established by federal laws, state and local statutes and codes and/or testimony from an "expert witness," and is supported by guidelines or recommendations documents published by professional associations.
Standard of Care
Done at the end of a sequence of planned DH interventions determines whether the oral health goals state in the pt's care plan have been met.
Summative evaluation
Formal, standardized evaluation procedures conducted at the end of a treatment series; includes determination of periodontal maintenance interval and/or identification of further treatment needs.
Summative evaluation
-Pt. biofilm control is evaluated using the same dental indices used to determine original biofilm levels. -Self-care skills are evaluated by observing a demonstration of each skill by the pt.
Visual Inspection
Visual Inspection
■ Obtain biofilm score after the soft tissue visual inspection has been completed so that use of disclosing solution does not interfere with soft tissue examination ■ Gingival examination looks for changes in tissue color, size, shape (contour) and consistency and compares them to examination findings documented prior to treatment. ■ Visual examination can also determine whether a goal related to caries risk, such as restorative treatment or sealants has been completed.
Evaluation Process
■ When writing the dental hygiene care plan, indicators (evaluation measures) that will evaluate each oral health goal and objective set in the plan can be determined. ■ Following treatment, new complete assessment data is documented. ■An evidence-based decision-making approach1 is used to determine any necessary modifications to the ongoing treatment sequence or to plan maintenance care. ■ Document in the patient's record all assessment findings and any planned modifications for treatment or oral health education."
Evaluation Design
■A plan for evaluation of patient care outcomes includes informal monitoring, feedback, and modifications in patient care provided during each patient appointment. ■ Methods for evaluating the success of dental hygiene treatment have traditionally included re-collection of the new clinical data, such as probing depths and areas of bleeding that are used to compare with the patient's health status at the beginning of treatment. ■ The evaluation process includes measures that assess the extent to which disease prevention and health promotion interventions have been effective. ■ A comparison of pre- and post treatment values indicates areas of success or areas of need for further intervention."
Tactile Evaluation
■All tooth surfaces, particularly in areas demonstrating bleeding points, are assessed with a periodontal explorer for residual calculus deposits and other iatrogenic factors. ■Use of an explorer with a long terminal shank is needed for areas with pockets of 5 mm or deeper. ■Residual calculus can be expected on any subgingival surface that demonstrates bleeding on gentle probing. ■Smooth root surfaces that are free of calculus create a biologically compatible root surface that can support healing in the overlying tissues. ■Special checks for difficult-to-access areas include: ■concavities and depressions of the root anatomy, ■subgingival margins of crowns, fixed partial denture, or overhanging restoration, ■furcation invasions."
Documentation
■Evaluation of such factors as patient comfort, communication efforts, and treatment safety and efficacy is ongoing and occurs at each patient appointment. Documentation in the patient record provides guidance for future patient interactions. ■Documentation of outcomes evaluation following clinical dental hygiene treatment is similar to the documentation of clinical data during initial assessment. Evaluation data following treatment are recorded in an identical format to the pretreatment assessment data, which facilitates comparison and analysis of outcomes.
Standard of Care
■In addition to evaluating individual patient outcomes at all points in the dental hygiene process of care, the dental hygienist is responsible for evaluating personal adherence to a professional standard of practice . ■Standards of care in dentistry evolved from early court cases that established a ruling of negligence when health- care providers failed to possess a minimum standard of special knowledge and ability, as well as adhere to reasonable and recognized standards while providing patient care.7 ■There are Three sources for determining standard of care in a legal dispute. ■Failure to provide a minimally acceptable level of patient care is considered to be professional negligence.
Skills and Methods
■Key skills for reflective practice include: ■perceptive self-awareness, ■judgment and self-assessment, ■critical analysis and synthesis, ■access to and application of new knowledge, ■feedback and evaluation (continued reflection). ■Methods for informal assessment of professional practice include individual reflection (thinking about one's own practice habits) or discussing clinical issues with colleagues. ■Reflective practice can also take on a more formal aspect, as in maintaining a written "critical incident" journal."
Interview Evaluation
■Patient interviewing techniques can be used to determine whether each goal established by the patient for health behavior change and daily self-care has been met. ■Patient interview and discussion can be used to evaluate the success of factors associated with patient comfort during treatment, patient understanding of recommendations and self-care instructions, or effectiveness of the clinician's communication approaches."
Purpose of Self-Assessment and Reflective Practice
■Self-assessment of personal clinical and communication skills and knowledge can guide the dental hygiene practitioner toward an evidence-based approach to finding new information that supports best-practice interventions for patient care. ■Reflecting on clinical experiences contributes to development of critical thinking skills that can help the practitioner determine and implement new and more successful approaches for patient care. ■ Self-assessment can assist the dental hygienist to determine a need to enhance specific clinical skills and abilities, or develop a plan for continuing education that supports personal professional goals.
