Implementation

Question 1

what are the 4 stages of developing a dental hygiene care plan

Answer 1

1. setting priorities
2. developing goals/outcomes
3. dental hygiene care plan (who what when…)
4. documentation

Question 2

what is the blue print

Answer 2

• focus on specific needs and strategies to solve problems in the dh diagnosis

Question 3

how can we identify alternatives

Answer 3

• weigh all options: select different paths dependent on the pt presentation and desire
• there are different ways to get to the same goal
• patient’s past experiences
• watch stereotype judgments – low income, some pt might be saving to get an implant instead of a partial
• avoid same hard sell (try to sell a cruise to someone who likes a hike)

Question 4

what are the 2 routes an individual can be influences

Answer 4

1. central route: pt is influenced by education (info he gets on an issue), pt thinks deeply about the topic, careful thought and consideration of the arguments. attitude more long lasting, predictive behaviour
2. peripheral route (are influenced by): external cues, lack of informed knowledge, reward (cute hygienist, hot dentist). unpredictable behaviour, message easily forgotten

Question 5

when sending a message, the source of the message must be

Answer 5

• quality of the argument
• scientifically based
• manner of the presentation
• listening to the pt
• the issue must have personal importance/value
• susceptibility, the pt needs to believe that there actions will impact disease

Question 6

what is fear arousal

Answer 6

• controversial technique
• ex ‘smarten up or you will lose all your teeth’
• can be effective
• a pt who is moderately anxious about a current or potential condition is more likely to be ready to accept involvement in care plan
• does not work well with fearful patients

Question 7

what is the what if game

Answer 7

• a tool for making decisions
• educate client on determining consequences
• to find options based on the goal
• create a win/win vs yes/no (pt has pockets, low income, can’t go to specialist, ins not covering 3m scale, educate good home care, not expensive, create win/win situation) situations that are preventive rather than reactive
• educate and then decide together
• weight pros and cons

Question 8

what are the 7 steps in decision making

Answer 8

1. what is the issue? what are the consequences
2. state your purpose. what are you trying to achieve
3. set criteria. what needs to happen to reach goal
4. establish priorities. do this with pte
5. search for solutions
6. look for alternatives if necessary
7. troubleshoot what can go wrong? implications, realistic, pros and cons

Question 9

what must be done for the 7 steps of decision making to work

Answer 9

• rapport was established
• understanding was given
• validation for past feelings and behaviours was given
• not judged as a failure
• ‘best’ alternatives were established together

Question 10

what is the dh diagnosis on the care plan

Answer 10

• 1st part: problem: this relates to your goal

- 2nd part: etiology/cause: this relates to your interventions

Question 11

what are interventions

Answer 11

• designed to assist the patient in reaching a goal
• specific and easy for other dh and pt to follow
• ex. goal: increase tooth surface resistance (decrease risk to caries)
• overall desired result
• interventions: home fluoride rinse, plaque control, dietary counselling, caries progression education, in office fluoride

Question 12

how do we state the goal

Answer 12

• state desired effect of dh interventions
• tx required to correct the problem
• ex: decrease risk to caries or increase tooth resistance and improve OHI, interventions will state how (expected outcomes are how you measure achievement of a goal)

Question 13

what are short and long term outcomes

Answer 13

• short goals to eventual long term outcomes
• flossing 2x/wk to eventual 7x/week
• specific performance and target date (can be added into outcomes)
• mutually agreeable, work with pt to set goals, ensure it is reasonable/achievable

Question 14

how do we state expected outcomes

Answer 14

• must be concise, measurable, understandable

Question 15

what 6 things should the expected outcome statement be

Answer 15

1. client centered
2. clear and concise
3. observable and measurable
4. time limit
5. realistic
6. determined by client and DH

Question 16

what are the guidelines for writing expected outcomes

Answer 16

• performance+: learning
• conditions+: with which they will do the performance (ie using spool method/pics)
• criteria+: when accomplished, how well (5x/wk)

Question 17

what are the 3 learning categories

Answer 17

1. cognitive: intellectual process (define, list, etc)
2. psychomotor: physical, visual (demonstrate, use)
3. affective: values, beliefs (incorporate, appraise), most difficult one to alter

Question 18

what are the expected outcomes

Answer 18

• written interventions
• written goal statements
• written expected outcomes: increase detail in pt’s performance, conditions and criteria; increase detail in evaluation method

Question 19

what is the sequence of interventions

Answer 19

• simple
• complex: dependent on amount of interventions, status, severity and extent of condition/amount of appts required
• philosophy of the dh and client: scaling before OHI, OHI integrated

Question 20

what are time management skills

Answer 20

• appt plan is dependent on time
• procedures
• operators and client needs

Question 21

what is implementation

Answer 21

• 4th stage of dh care plan

- care plan: presented, consent gained if not done in care planning stage (P)

Question 22

how do we present the care plan

Answer 22

1. state in understandable terms: appropriate level of communication, layman’s terms like tartar, professional terms if they have dental IQ, do not offend, visual aids
2. describe plan: pros and cons, cost, insurance coverage (% and flexibility, scaling units bs recalls per year, ignoring insurance…. not great)
3. identify alternative tx options: ‘best plan’ (for pt needs and values), plan that actually meets client needs

Question 23

before talking about the plan, one needs to establish what

Answer 23

• the ‘whys’ of the plan

- have pt tell us what they know so we can determine how to build on their understanding

Question 24

what are the 4 steps of the implementation process

Answer 24

1. pro the operatory
2. performance of procedures
3. after care
4. recording tx

Question 25

what does preparing the operatory include

Answer 25

- proper infection control: personal equipment, tx room, instruments, standard precautions (sterilized, disinfection) - reduce aerosols - radiographic equipment: proper disinfections, developing rad, effective and efficient procedure, easily compromised in daily office, well prepared and organized

Question 26

what does the performance of procedures mean

Answer 26

- achieve the expected outcomes - clinical 50% - educational 50% (most difficult to achieve, requires pt participation)

Question 27

what is the pt performance of expected outcomes dependent on

Answer 27

1. adequate knowledge (dh dependent) 2. adequate skill 3. adequate motivation

Question 28

what are the 7 aspects of learning

Answer 28

1. requires perceiving -- important to them 2. unique characteristics of learner: we learn in different ways, need alternative strategies (analogies) 3. environment: dental chair, stress of environment, take information home 4. motivation of learner 5. positive reinforcement: positive about small successes 6. similar message in old and new situations: continual improvement, consistent message from same heath care provider and same message from others 7. practice: at and in between appts, keep motivation going

Question 29

what does the after care process include

Answer 29

- recap appt with client - instructions: must be written down, client will not remember - update improvements with client - explanation of next appt

Question 30

what does the recording process include

Answer 30

- tx rendered or progress notes - brief description of procedures - legal document - must contain: subjective findings, object findings, medication, local anaesthetic given, complications, results, clients reactions and performance, tx complete or incomplete

Question 31

what is DAR and what does it stand for

Answer 31

- format used to record info - D: data: observations of client status, subjective and objective, assessment phase of care plan - A: action: consent given, interventions performed and further action, planning and implementation steps of care plan - R: response: client response to interventions, client measurements and behaviours, evaluation step of care plan * always include next appt

Question 32

what is SOAP and what does it stand for

Answer 32

- S: subjective data: client's perceptions, complaint of problem. not always relevant? always relevant -- need to ask more questions - O: objective data: measured and observed data - A: assessment: interpretation of data (obj and subj), diagnosis and client's condition and progress - P: plan: specific dental hygiene interventions, instructions given, goals for future, results, successes, future appts, plan to resolve the stated problem - can also include I = interventions and E = evaluation, always include next appt