Dental Team Companion E-Book

• Herausgeber: Quintessence Publishing Co. Ltd.
• Kategorie: Fachliteratur
• Serie: QuintEssentials of Dental Practice
• Sprache: Englisch

Seitenzahl: 234

Veröffentlichungsjahr: 2019

Beschreibung

The dental team approach is the future of oral healthcare provision. Team members must have shared goals, understand their roles and responsibilities and must react to situations as a team. This QuintEssential promotes the adoption of the team approach so important in modern oral healthcare provision.

Leseprobe

Quintessentials of Dental Practice – 36Clinical Practice – 6

Dental Team Companion

Authors:

Carole Brennan

Jenny Gallagher

Marina Harris

Michael Martin

Gail Vernon

Nairn Wilson

Liana Zoitopoulos

Editors:

Nairn H F Wilson

Mabel Slater

Quintessence Publishing Co. Ltd.

London, Berlin, Chicago, Paris, Milan, Barcelona, Istanbul, São Paulo, Tokyo, New Delhi, Moscow, Prague, Warsaw

British Library Cataloguing in Publication Data

Dental team companion. - (Quintessentials of dental practice) 1. Dental teams. I. Series II. Brennan, Carole. 617.6'023-dc22

ISBN: 1850973385

Copyright © 2009 Quintessence Publishing Co. Ltd., London

Illustrators: Elizabeth and Paul Ducker

All rights reserved. This book or any part thereof may not be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, or otherwise, without the written permission of the publisher.

ISBN: 1-85097-338-5

Inhaltsverzeichnis

Titelblatt

Copyright-Seite

Foreword

Preface

Chapter 1 Putting the patient first Changing society: moving with the times

Aim

Outcome

Introduction

Changing society

The values of society

Demography

Trends in health and illness

Trends in oral health

Impact of oral conditions

Attitudes to oral health and accessing dental care

Dental caries

Periodontal diseases

Toothwear

Oral cancer

Current challenges

Healthcare in a changing society

Globalisation

Patient-centred healthcare

Healthcare delivery

Where care is delivered

The funding of dental care

Cultural sensitivity

Quality of care

Delivering better oral health

Who delivers care?

When care is delivered

Access to care

Access to oral health

Responding to the changing environment

References

Further reading

Chapter 2 Understanding and respect: caring for patients with special needs

Aim

Outcome

Introduction

Definitions

Changing views of people with disability and special needs through time

Disability Discrimination Act 1995

Disability Discrimination Act 2006

Mental Capacity Act 2005

Provision of oral care for disabled people

Physical disability

Medical disability

Intellectual disability

Mental illness

Sensory disability

Anxiety and phobias

Treatment issues

General considerations

Dental considerations

Consent

Care of the patient in the surgery

Domiciliary care

Conditions requiring specific approaches

Multiple sclerosis

Parkinson’s disease

Disabling heart disease

Deafness

Autism

Alzheimer’s disease

Conclusions

Further reading

Chapter 3 Patient interaction: engendering trust and confidence

Aim

Outcome

Introduction

Communication

Verbal communication

Non-verbal communication (Fig 3-2)

Equality and diversity

Language

Attitude issues

Cultural habits and beliefs

Positive actions

Trust and confidence

Reference

Further reading and useful websites

Chapter 4 Handling patient complaints: negative to positive outcomes

Aim

Outcome

Introduction: recognising imperfection

Complaints can be opportunities

What do patients expect when making a complaint?

The complaint procedure

Listen

Sympathise

Do not justify

Make records

Agree on a course of action

Follow through

Risk management

Further reading and useful websites

Chapter 5 Making the working environment safe

Aim

Outcome

Safety in general

Personal protection

Introduction

History taking and confidentiality

Personal and team protection

Protective clothing

Eye protection

Face protection

Hand protection

Sharps injuries

Environment

Disposal of contaminated waste

Decontamination of dental instruments

Introduction

Decontamination

Assessment of instruments for risk

Instrument cleaning

Manual cleaning

Enzyme cleaning

Ultrasonic cleaning

Washer disinfectors

Sterilisation

Storage of instruments

Dental handpieces

Creation of a central or in-surgery local decontamination area

Conclusions

Further reading and useful websites

Chapter 6 Culture of the workplace The workplace

Aim

Outcome

Introduction

Types of organisational culture

The power culture

The role culture

The task culture

The person culture

Coexisting cultures

Finding a preferred cultural organisation

Working in a power culture

Working in a role culture

Working in a task culture

Working in a person culture

Conclusions

Further reading

Chapter 7 Team roles and responsibilities

Aim

Outcome

Introduction

What is a team role?

Factors in team role behaviour

Types of team role

Strengths and weaknesses

Who is occupying which role?

Interpersonal chemistry in the workplace

Shaper relationships

Plant relationships

Specialist relationships

Monitor evaluator relationships

Completer relationships

Implementer relationships

Resource investigator relationships

Coordinator relationships

Team worker relationships

Conclusions

Further reading

Chapter 8 Efficiency and effectiveness

Aim

Outcome

Time

Finding the time

Managing time well

Current use of time

Activity logs

Establishing priorities

Time management grid

Using the time management grid

Taking control of your time

Identifying goals

Establishing priorities

Planning use of time

Planning grids

Making lists

Eliminating time wasting

Procrastination (negative delay)

Positive delay

Distractions

Learning to delegate

Learning to say ‘No’

Decluttering the working environment

Remembering to relax

Conclusions

Further reading and useful websites

Chapter 9 Stress avoidance

Aim

Outcome

What is stress?

Stress at work

Understanding stress and its affects

The fight or flight response

The general adaptation syndrome

Signs and symptoms of stress

Managing stress

Identifying personal stressors: awareness and reaction

Making a stress diary

Identifying personal symptoms of stress

Taking control of your stress

Beliefs and stress

Faulty thinking (inner dialogues) and stress

Learn to communicate assertively

Maintain good health

Learn to relax

Develop an effective support system

Improve self-esteem

Conclusions

Reference

Further reading and useful websites

Chapter 10 Handling disputes

Aim

Outcome

Introduction

Aggressive behaviour

Levels of aggression

Handling aggressive behaviour

Step one

Step two

Step three

Step four

Step five

Step six

Non-assertive behaviour

Effects of non-assertive behaviour

On the individual

On others

On the workplace

Different forms of non-assertive behaviour

Silent non-assertion

Tentativeness

Doubting

Avoidance

Indecision

Complaining

Uncertainty

Helplessness and self-pity

Self put-downs

Sacrificing

Handling non-assertive behaviour

The use of feedback techniques to manage behaviour

Why feedback?

Planning a feedback meeting

Preparation

Making the most of the meeting

Identifying solutions

Concluding the meeting

Conclusions

Further reading

Chapter 11 Companies and commerce

Aim

Outcome

Introduction

Choosing a company to do business with

Dental trade associations

Benefits of working with companies

Interactions with companies

Visits from company representatives

Lunch and learn events

Loyalty schemes

Exhibition support

Advertising

Marketing to patients

New products

Further reading and useful websites

Chapter 12 Working with company representatives

Aim

Outcome

Introduction

Do we receive regular visits?

Do we have a knowledgeable representative?

Does the representative provide new information and added value at each visit?

Does the representative understand and meet the needs of the team?

Does the company get back to the team when additional information is requested?

Does the representative respect time?

Do they give good service?

Do the products and services meet needs and expectations?

Does the company support reasonable requests for samples?

Does the company have information resources to share with the patient?

Is the company a member of the national dental trade association?

Further reading and useful websites

Chapter 13 Professionalism What is professionalism?

Aim

Outcomes

Introduction

Professionalism: a way of life

Professionalism in working life

Professionalism in personal life

Health and behaviour

Duty of care

Child protection

Business transactions

Managerial responsibilities

Whistle blowing

Professional fulfilment

Further reading

Chapter 14 Confidentiality, consent and record keeping

Aim

Outcome

Duty of confidentiality

Policy statement

Safeguards

Releasing information

Releasing information in the public interest

Children and mentally compromised patients

Consent

Forms of consent

Voluntary decision making

Ability to give consent

Record keeping

Written records

Computerisation

Patient access to records

Further reading and useful websites

Chapter 15 Observing regulations

Aim

Outcome

Introduction

Indemnity

Conclusions

Further reading and useful websites

Chapter 16 Keeping up to date

Aim

Outcome

Introduction

Forms of continuing professional development

Record keeping: portfolios

Conclusions

Further sources of information

Foreword

The dental team approach is the future of oral healthcare provision. As with any team, members must have shared goals, together with a clear understanding of the roles and responsibilities of each member. In addition, to be effective, a team must react and deal with situations as a team rather than as a group of individuals. This companion promotes the adoption of the team approach considered necessary for success in modern oral healthcare provision.

Putting the patient first in a patient-centred approach to the provision of oral healthcare is critical to the success of a dental team. To meet the needs and expectations of the patient, with favourable clinical outcomes, requires a concerted team approach to achieve continuing quality improvement in the quest for excellence. Success in this venture, as set out in this thought-provoking addition to the nearly complete highly acclaimed Quintessentials of Dental Practice Series, requires an understanding by the dental team of patients’ attitudes in our ever-changing society, the culture and dynamics of the workplace and the many, varied facets of contemporary professionalism.

As with all the other volumes in the Quintessential of Dental Practice Series, this companion is intended to be read in a few hours and to have an immediate impact on the reader’s approach to clinical practice. The dental team approach has many advantages and benefits, but these can only be realised through strong professional team working focused on doing the very best for each and every patient in a safe, confidence-inspiring practice environment – the thrust of this book.

To some, this Quintessentials volume may be a revelation; to others, it may provide reassurance that their dental team has the right approach to success. Whatever is taken from this book, it can only enhance benefits to patients and dental professionalism.

Nairn Wilson Editor-in-Chief

Preface

Since the mid 1990s, there have been major changes to almost every aspect of dentistry. Scientific contributions to clinical and laboratory practice have resulted in dramatic advances. Together with a move to evidence-based practice, we can now offer our patients an ever-increasing range of choices as to their treatment options.

The ethos of dentistry has changed and everyone has now signed up to the concept of teamwork, offering the optimum dental care. Dentists nowadays no longer consider working single-handedly. Indeed, the vast majority could not work without the support of a wide range of dental care professionals.

This book gives all members of the dental team the chance to explore how their roles have developed and to gain insight into the opportunities that are emerging to further extend their working practices. These innovations will offer improved patient care and help to enhance the day-to-day working lives of the dental team.

There are three main chapter groups within this book. The first chapters look at how we continue to put the patient first, both in the context of the wider society and also within the clinical setting. Offering understanding and respect to our patients, let alone other members of the dental team, helps us to realise the importance of the good communication practices that are essential for all interactions with our patients and colleagues. Sometimes things may go wrong. It is important that we recognise this and our role in handling patient’s complaints, hopefully with positive outcomes.

The second group of chapters deals with the culture of the workplace, encouraging us to look at ourselves in our day-to-day working environment. Sometimes we lack the opportunity to take time out of our busy working lives to reflect on how we can develop and improve our approach to work. This group of chapters will hopefully stimulate our thought processes and enable us to avoid conflict, reduce stress and, when all else fails, reflect on how to make things better.

The final chapters concentrate on professionalism and, as members of the dental team, how we can recognise the importance of maintaining high standards both at work and in our personal lives. Continuing professional and personal development allows us to keep up to date in a rapidly changing working environment. We can no longer be expected to retain all the information we gained during our professional education and training, and as ideas, materials and working practices move forward, we need to keep up to date actively.

This book has been designed to give an overview of team working for all dental team members. It aims to contribute to the core skills and understanding required of oral healthcare professionals in today’s world.

This Quintessentials volume should also be beneficial to all those considering returning to work after a career break. The book may be read from cover to cover or dipped into to read and learn about areas of special interest. It should stimulate further reading and associated personal development.

All members of the dental team will be aware that changes to legislation can affect their working livee. The roles and responsibilities of the members of the dental team are, in many countries, quite fluid. This book gives you an outline of current arrangements, although these may be subject to change. Being alert to such changes is important to you and your patients.

Enjoy this book and continue to enjoy the work that you do in the knowledge that you are making a great contribution to the dental care of your patients and, in turn, their quality of life.

Mabel Slater

Chapter 1

Putting the patient firstChanging society: moving with the times

Jenny Gallagher

Aim

The aim of this chapter is to outline how and why society is changing, examine trends in oral health and discuss the implications of both for contemporary healthcare and health professionals.

Outcome

Having read this chapter, readers should have a greater understanding of the challenges of providing healthcare in modern society and have considered how oral healthcare professionals should respond to changing times.

Introduction

The world is in a period of intense change. Those in contemporary industrial societies are surrounded by a myriad of ‘choices’, which can be bewildering. We are bombarded with advertising about the latest fashions, food and lifestyle accompaniments so that we can keep up to date in terms of what we wear, do, think and act. Whatever our background, our lifestyles are very different from those of our parents, let alone our grandparents. There are greater opportunities for making and keeping contact with others through modern telecommunications, yet more people than ever live on their own, disconnected from their family networks. Thus paradoxically at one level, the world seems more ‘connected’ through the internet and population movement, but at another level is can be fragmented and lonely. Change is one of the constants of modern-day living.

Changing society

The values of society

Sociologists comment on the changes in the structure and nature of society and its values. The values important for guiding us through the complexity of life are strongly influenced by the prevailing culture. The ‘wants’ of individuals are constantly escalating, driven by advertising and what others have. Consequently, we find ourselves living in an increasingly ‘individualistic’ and ‘commercialised’ society.

Sociologists suggest that we have never had it so good or lived so long; however, major inequalities exist. One of the impacts of these changes is that we are faced with a range of choices and we have to make many, varied decisions about our lifestyle. Therefore, developing personal values is very important to help navigate life in present-day society.

Health professionals complain that they are increasingly bombarded with information and choice. There are pressures to use new materials, develop new skills and adopt new techniques and systems as they endeavour to keep up to date professionally. Patients are becoming more knowledgeable. Both patients and health systems are becoming more demanding and health professionals are required to be more accountable for what they do. Workforce roles in the dental team are expanding and health systems are reforming around the world. Standing back and reflecting on society can help the healthcare professional to manage the daily challenges of professional life.

This chapter draws on public health and behavioral and social sciences, which includes the study of society and how it functions, and the study of behavior and experience. The implications for healthcare are examined in the course of the chapter. Finally, it examines how we as health professionals should respond to changing times.

Demography

The population of high-income countries has changed dramatically over the past 100 or so years; overall the birth rate has reduced but people are living longer and the population is growing in size. A very clear visual demonstration of this dramatic change in the UK population is shown in Fig 1-1. As shown in Fig 1-2, the rate of change is set to increase and population growth is anticipated to increase more rapidly than expected because of longevity, rising immigration and higher birth rates amongst immigrant families. Assessments of social diversity, based on social class, income and education, suggest that the gap between the most affluent and the poorest in society is increasing. Furthermore, societies are becoming more multicultural, a fact that is very apparent in many large urban areas, but is not exclusive to such areas. Hence, populations are increasingly characterised by age and ethnic diversity. If a dental practice is located in an area in which there are a lot of young people, then it is likely that the patient base will involve many families. Dental practices in areas where people retire will have many older people as patients. If this link between the patient demographics and the local demographics is not apparent, then the dental team may wish to consider if it is serving the local community and whether changes are necessary to enable it to do so. Each section of the community will have particular oral health needs and expectations, cultural needs in the way care is provided and different barriers to accessing care.

Fig 1-1 UK Population structure by age and sex in (a) 1951, (b) 2001 and (c) as predicted in 2031. WW2, World War II. (Adapted from the Office for National Statistics, Census 1951 and Census 2001.)

Fig 1-2 National populations in the countries of the UK. Population of the UK is projected to rise to 71 million by 2031. (Reproduced from the Office for National Statistics, 2007.)

Trends in health and illness

In high-income countries, disease patterns and mortality rates have changed. This is associated with improvements in living conditions and healthcare. Together with these changes, there has been a reduction in acute conditions, but an increase in chronic health problems. Death in childhood is now uncommon compared with a century ago. Most people will live into old age and, over time, develop a range of chronic conditions that will require specific management. Internationally, the key general health challenges are associated with cardiovascular disease, cancers, mental and sexual health problems and conditions such as diabetes. However, marked inequalities in health exist according to social, ethnic and sexual demography within and between countries across the world.

Trends in oral health

Patterns of oral health change over time. They also vary between and within countries, as well as across age groups and social groups. In the UK, as in a number of other countries, national oral health surveys play an important role in monitoring oral diseases and conditions. They also examine reported health behaviours and expectations of the population. The data are collected through clinical epidemiological surveys of a random sample of children and adults, plus associated questionnaires or interview. The information from such surveys is important to inform practice and policy relating to dentistry. The broad trends in oral and dental diseases and conditions are examined below. These highlight the different patterns of care required for children and young people, adults and older individuals. Of all the oral conditions addressed by the dental team, dental caries, and its long-term effects, remains the most common. As people live longer, and retain more of their teeth, they have an increased risk of developing caries, together with all the related conditions from gum diseases to toothwear, at some stage in their remaining life.

Impact of oral conditions

Approximately one in five children and one in two adults in industrialized countries report that their oral health impacts on their daily living. Pain and psychological impacts are most common, with a small proportion of adults feeling handicapped and unable to cope with their condition. This demonstrates the importance of good oral health and healthcare for general well-being.

Attitudes to oral health and accessing dental care

Overall, the UK population has positive attitudes towards oral and dental health, as demonstrated by, for example, the desire to retain teeth into old age, parents taking their children for oral healthcare and more regular dental attendance amongst middle-aged adults. It is also reflected in the increasing use of oral hygiene products. Barriers to dental care are well recognised to be fear, cost, fear of cost, lack of perception of need and features of the dental surgery. The latter includes how patients are managed at reception, waiting times and the personalities of the dental professionals. All of these factors can be reduced by good communication skills and patient-centred care.

Dental caries

Recent decades have seen significant reductions in the level of dental caries in high-income populations. Until relatively recently, having tooth decay in such populations was accepted as a fact of life and few adults had not experienced tooth decay or tooth loss. Denture wearing in middle-aged and older people was common. Another change is the pattern of tooth decay; whereas in the past many restorations involved the mesial, occlusal and distal surfaces, perhaps with buccal and lingual extensions, now, they are most likely to affect only the occlusal surface. These changes are largely attributed to fluoride in toothpaste (used by the majority) and, where available, fluoridated water.

Despite improvements in oral health, many children continue to experience tooth decay. Few other diseases are as common in children and young people and it is particularly amongst those living in social deprivation. Improvements in oral health tend to have slowed and have reached a plateau in young children (Figs 1-3 and 1-4). Further improvements will require a greater emphasis on health promotion and prevention.

Fig 1-3 Trends in average levels of caries in children. Average number of missing and filled teeth by age in children in England and Wales 1973–1993 and in the UK in 2003. (Data from UK Child Dental Health Surveys: O’Brian (1994), Pitts and Harker (2004).)

Fig 1-4 Trends in prevalence of dental caries in children. Percentage of children with decay experience in England and Wales 1973–1993 and in the UK in 2003. (Data from UK Child Dental Health Surveys: O’Brian (1994), Pitts and Harker (2004).)

Amongst adults in most countries, there are growing expectations of retaining a functioning dentition into old age, preferably without recourse to dentures. Overall, fewer teeth are being extracted; however, most adults are locked into the restorative cycle and require more complex dentistry as the size and complexity of replacement restorations increase. Middle-aged and older people are well placed to understand the risks of oral disease and, with the desire to retain their teeth, may be highly motivated to adopt preventive approaches to their dental care. Older people, 55 years of age and over, are prone to chronic health conditions. Medication may increase the risk of oral disease in association with reduced salivary flow and changes in diet.

Periodontal diseases

Periodontal diseases affect the majority of the population to some extent. The more severe forms of periodontal diseases, which may be the principal cause of tooth loss, only occur in a minority (5–15%). There is some evidence that periodontal diseases are related to age and social status. The disease is cumulative and, therefore, as more people retain their natural teeth, more are at risk of periodontal diseases. National surveys show that the level and severity of disease rises with increasing age.

Toothwear

As teeth remain in the oral cavity for longer, they are at risk of toothwear. Toothwear is a natural consequence of ageing and will increasingly be a problem in older people who retain their natural teeth. There is some worrying evidence that this type of wear is increasing in young people, with one third of 15 year olds having tooth surface loss on their incisors lingually and 4% having dentine or pulp exposure on their first permanent molars (Chadwick and Pendry, 2004). This is associated with a range of intrinsic factors, such as bulimia or gastric reflux, and extrinsic factors, such as the consumption of large quantities of acidic and carbonated drinks.

Oral cancer

Oral cancer is the most serious of the oral conditions likely to present in a dental surgery. The risk of developing oral cancer increases with age. It is strongly related to social and economic deprivation, with the highest rates occurring in the most disadvantaged sections of the population. Risk factors include smoking and excessive consumption of alcohol, particularly when combined, and low intake of vitamins. Preventive advice and support are important for people with these risk behaviours.

Current challenges

Oral health in many countries has never been better; however, major inequalities persist. There are wide variations in oral health across age groups and geographically and socially. Much of the impact of dental caries is seen in middle-aged and older people, who will have expectations of retaining their dentition while at risk of restorative failure, periodontal diseases and toothwear. Many of the preventive and reparative procedures in children and young adults with relatively good oral health are increasingly simple. Challenges for dental teams, therefore, relate to the dental care of middle-aged and older people and vulnerable groups, who require holistic care including skillful management of their medical and social challenges.

A major challenge is the need to convert irregular attendees to regular users of primary dental care services.

Healthcare in a changing society

Globalisation

Globalisation is the growing interdependence between different peoples, regions and countries. The effects of globalisation are seen in the worldwide sale of specific products such as Coca-Cola, which can be found on a remote African roadside stall and in an American superstore. It is seen in the manufacture of goods such as cars, where individual components will be manufactured in different countries and continents and then transported and assembled in another country to produce an ‘international product’. People increasingly move around the world in search of jobs and opportunities, bringing with them their culture and diversity. All of these changes are breaking down traditional ways of doing things, thus presenting individuals with the challenge of creating and recreating self-identities.

Patient-centred healthcare

The relationship between health professionals and patients has changed dramatically over recent decades. Societies are moving away from a paternalistic approach, where the healthcare professional knows best and is in charge, to one in which the patient is centre stage. As a result, there is an increasing emphasis on involving patients in treatment planning decisions and the public in fashioning health policy.

At the individual level, empowerment of patients is demonstrated by making it easy for patients to have appointments of their choice, discussing care options and plans, seeking informed consent and allowing choice over referral to specialist or hospital care. Empowerment of patients, therefore, includes choices, rights and participation in decision making about their health and healthcare. This is especially important in dentistry, where adult patients are typically required to pay for some or all of their treatment and are, therefore, consumers as well as patients.

Empowerment of patients includes choice, rights and participation in decision making.

The internet explosion has had a major impact on healthcare. It facilitates self-diagnosis and self-treatment at home. Furthermore, the chronic nature of most health problems means that the patient readily becomes expert in relation to his/her condition. Patient support groups for particular conditions contribute to this process, further changing the patient-professional relationship.

Healthcare delivery

There is increasing awareness that wider issues, such as how, when, where and by whom care is delivered, are just as important as what care is delivered. Governments look at it in terms of providing quality, access and choice, or value for money. However, many aspects are judged in terms of process as well as outcomes.

Where care is delivered

Contemporary influences mean that there is greater emphasis on self-care, moving care out of hospitals, and developing outreach services for vulnerable groups. At one end of the spectrum, it is recognised that care is provided in all settings from home to hospital. Promoting self-care, in particular preventive care, is really important in support of a healthy society. Analysts suggest that to optimise the health of the population, let alone achieve the most cost-effective care, people need to be fully engaged with their health.

In contrast to medicine, in which a large part of care has traditionally been in hospitals, the majority of dental care has always been provided in a primary care setting. However, to achieve equity of access and outcome, some vulnerable groups may require outreach services. This can take the form of mobile services for homeless people or providing domiciliary care for people who are housebound.

The funding of dental care

For many patients, cost and fear of cost are important barriers to dental care. This is why state-funded care, as provided by the National Heath Service (NHS) in the UK, is important in the provision of healthcare. One of the greatest political and professional challenges ahead is to ensure that the resources going into dental care are sufficient to meet public needs and are used to provide the greatest benefit possible. This should include funding for health promotion, including preventive care.

Cultural sensitivity

There are cultural and language barriers to the delivery of healthcare. An understanding of society can assist in providing culturally sensitive healthcare and so reduce barriers to dental care. Scully and Wilson (2006), in the Quintessentials of Dental Practice