JMIR Publications

ABSTRACT

Background:

The aging population and increasing prevalence of natural teeth among older adults have escalated the demand for oral health care, especially in nursing settings. Impaired oral health in elderly individuals is closely linked to systemic conditions such as diabetes and cardiovascular diseases. The expert standard “Promoting Oral Health in Nursing” was developed in Germany to enhance the quality of oral care and address future challenges in geriatric nursing. It comprises a series of recommended interventions targeting oral health promotion in nursing care. However, significant barriers, including high patient-to-nurse ratios and staff shortages, often result in missed or rationed nursing care, limiting the feasibility and implementation of such interventions. Evaluating the acceptability of this standard is critical to its successful integration into routine nursing practice.

Objective:

To assess the acceptability of the expert standard among nursing staff providing care for elderly individuals, identify factors influencing its adoption, and examine the relationship between nursing competence, Care Rationed or Missed (CROM), and the standard's acceptability.

Methods:

This quantitative cross-sectional study will collect data from nursing staff in 25 hospitals and long-term care facilities in North Rhine-Westphalia, Germany, using standardized survey instruments. Based on the template of the generic TFA (Theoretical Framework of Acceptability), a questionnaire to measure acceptability of interventions across seven domains was created. Oral health knowledge will be assessed using the Oral Health Literacy Profile (OHLP) and competence in mouth care using the questionnaire developed by the German Network for Quality Development in Nursing (DNQP). Barriers to implementation will be evaluated according to the Acute Care Nurses’ Questionnaire on Oral Hygiene and CROM using the oral care related question from Basel Extent of Rationing of Nursing Care instrument. Statistical analyses consist of firstly calculating mean acceptability with 95% confidence interval for each recommended intervention of the expert standard. Secondly, repeated measures ANOVA are used to examine mean differences of acceptability between these interventions. Thirdly, linear regression analyses are used to test the impact of nursing competence on acceptability and lastly chi square tests of independence are used to compare CROM with already published rates in German speaking countries.

Results:

Results are anticipated to provide insights into the acceptability of the expert standard and its determinants, including nursing competence and perceived barriers. They will inform strategies to optimize the integration of oral health interventions in nursing settings.

Conclusions:

This study evaluates the acceptability of the expert standard for oral health in nursing. The findings will support evidence-based strategies to enhance feasibility, reduce CROM prevalence, and improve oral health in the elderly. By focusing on acceptability as a prerequisite for implementation, the study emphasizes the need to align interventions with the realities of nursing care to achieve effective outcomes.