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) -Moralðical 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
