Transcript Treatment Plan & Assessment

DH Treatment Plan & Presentation
Patient Communication
Lisa Mayo, RDH, BSDH
DH102 Clinic Sciences II
Concorde Career College
Topics for Today
1. Tx Planning
2. DH Care Plan/Tx Plan
3. Communication & Patient Learning
#1: Tx Plans
Tx Plans
Dependent on many factors
1. Oral issues
2. Systemic Issues
3. Capability
4. Autonomy
5. Reality
Tx Plans
1. Oral issues
 Teeth
 Restorations
 Periodontium
 Pulp status
 Oral mucosa
 Saliva flow
 Occlusion
 Tongue
 Alveolar bone
Tx Plans
2. Systemic Issues
 Age concerns
 Medical conditions
 Meds
 Communication issues
Tx Plans
3. Capability




Self-care
Functional ability
Transportation to appts
Mobility within dental office
4. Autonomy
 Decision making ability
 Dependence on alternative caretakers
Tx Plans
5. Reality



Patient priority of their oral health
Financial constraints
Significance to life span
#2: DH Care Plan
Yellow Form in Clinic
DH Tx/Care Plan
Components of a Care Plan
1. Periodontal/Gingival Health


Primary objective: restore & maintain health of
periodontal tissues
Interventions that can reduce risk factors for
developing perio disease or regain control of perio
progression
2. Dental Caries Control


CAMBRA
Remineralization program
DH Care Plan
Include the following:
1. Plans care for patient needs based on
assessment data collected
2. Flexible and realistic
3. Contains tx and education goals that address
problems and risk factors identified during the
assessment phase
4. Provides interventions and recommendations
based on current scientific evidence (next slide)
5. Expected outcomes (prognosis): good, poor,
referral
DH Care Plan
• Interventions & recommendations
▫ Clinical Tx: SCRP, Px
 How long each procedure will take
 How many appts to complete
▫ Preventive measures: sealants, fluoride, mouthrinses,
home care aids (more next class), xylitol, etc….
▫ Education and counseling so the patient understands
and accepts their conditions (more next class)
▫ Follow-up care needed to maintain health and ensure
success of tx rendered
DH Care Plan
• Provide evidence-based care
• Each plan will be highly individualized
• Goals
▫ Eliminate or control etiological and predisposing
disease factors
▫ Eliminate signs and symptoms of disease
▫ Promote oral health and prevent recurrence of
disease
#3: Communication & Patient Learning
Types of Communication
• Verbal
• Nonverbal: body language, eye contact,
appearance
• Media: internet, phone, etc…
What is body language tell you?
What is body language tell you?
Good eye contact, engaged in patient
conversation
Communication Barriers
• Wilkins p.26, table 3-1
• Cultural, physical, psychological, lack of interest,
lack of knowledge, etc…
Health Literacy
• Set of cognitive and social skills that determine the
ability of a patient to obtain, understand, or respond
to health messages and be motivate to make health
decisions that promote & maintain good health
• Skills that support health-learning capacity (table 32, p.27)
1. Cognitive: attention, information processing,
memory, reasoning ability
2. Combined cognitive/psychosocial: ability
w/numbers, verbal, reading ability
3. Psychosocial: self-efficacy, communication ability,
previous hl care experience
Communication Theories (NBQ)
1. Health Belief Model (p.27-28, Table 3-3)
 Concept that one’s belief directs behaviors
 Models used to predict health behaviors &
acceptance of health recommendations
 Emphasis is on perceived world of the patient (not
the actual world)
 To make a behavior change, people MUST believe
that they are
1)
2)
3)
4)
SUSCEPTIBLE to disease
Disease is a SERIOUS threat to life
Disease can be PREVENTED
They are CAPABLE of CHANGE
Communication Theories (NBQ)
2. Theory of Reasoned Action (p.27)
 Based on premise that individuals form an intention
to make health-related changes on the basis of
knowledge, personal values, & 2 different kinds of
beliefs:
1) Behavioral beliefs: attitude of individual
2) Normative beliefs: attitude influenced by social
norms & expectations
Communication Theories (NBQ)
3. Self-Efficacy (p.28)
 Belief actions affect the outcome
Communication Theories (NBQ)
4. Locus of Control (p.28)
 Perception of personal control over issues related to
health
 Internal LOC: Belief that personal actions determine
their health status
 External LOC: health and wellness determined by
external factors and that changing behaviors will not
really have a positive effect overall
Things are happening to me vs things happen because of me
Communication Theories (NBQ)
5. Transtheoretical Models & Stage of Change
(p.28, table 3-4)
 Conceptualizes behavior change through a series of 6
steps
 Progression through the steps is dependent on the
balance of the adv vs disadv of the decision
 Framework to determine appropriate interventions
to assist patients in improving their health behaviors
Communication Theories (NBQ)
5. Transtheoretical Models & Stage of Change (p.28,
table 3-4)
1)
2)
3)
4)
5)
6)
Precontemplation: no intention of making a change
w/in next 6mo
Contemplation: intends to make a change in the next
6mo
Preparation: patient intends to make a change w/in
next 30 days, taken some steps to initiate change
Action: patient practiced change behaviors <6mo
Maintenance: patient practiced changed behaviors
6+mo
Termination: total change in behavior like the old
behavior did not exist
NBQ
The transtheoretical model of behavior
change is concerned with:
a. Hierarchy of needs
b. Health belief model
c. Theory of reasoned action
d. Stages of readiness
NBQ
The transtheoretical model of behavior
change is concerned with:
a. Hierarchy of needs
b. Health belief model
c. Theory of reasoned action
d. Stages of readiness
DH Care Plan Presentation
Learning Ladder or Decision-Making
Continuum: HEAVY ON BOARDS!
1. Unawareness: little concept of dental needs
and prevention/controlling issues
2. Awareness: patients have a good knowledge
of the scientific facts but do not apply the
facts into action
3. Self-Interest: realization of the problem,
indicates a tentative inclination toward
action
4. Involvement: Attitude & feelings affected,
desire for additional knowledge increases
5. Action: testing new knowledge, change in
behavior toward solving the problem
6. Habit: new behaviors are practiced over a
period & lifestyle change occurs
Unawareness
• Not been to dentist in 2-10 years
• Spouse made the appointment for them
• Unaware of dental needs and sometimes medical
status
• Ex: NP with HBP reading and they say “Wow, I
didn’t realize my BP was that high. I have not
been my doctor in over 4 years!”
Awareness
• Saw the dentist and they explained oral
condition and tx needs
• Pt has no plans to proceed with anything
Self-Interest
• Saw the dentist and they explained oral
condition and tx needs
• Pt understands and sees the need for perio
treatment – internal motivation beginning
Involvement
• Saw the dentist and they explained oral
condition and tx needs
• Pt understands and sees the need for perio
treatment
• Sets appointment for SCRP (attitude is
influenced and pt beginning action)
Action
• Pt completes SCRP and starts to accept the need
for frequent maintenance visits
• Commits themselves to maintain oral health
Habit
• Sees RDH every 3mo for perio main
• Maintains good OH habits at home daily
NBQ
What behavioral theory explains that patients with
the internal desire to change a behavior strive to
accomplish it and the behavior usually lasts
longer?
a.
b.
c.
d.
Attribution
Locus of control
Motivation
Self-efficacy
NBQ
What behavioral theory explains that patients with
the internal desire to change a behavior strive to
accomplish it and the behavior usually lasts
longer?
a.
b.
c.
d.
Attribution
Locus of control
Motivation
Self-efficacy
NBQ
Effective oral health education programs should
include all of the following EXCEPT which one?
a. Assess the patient’s risk for oral disease
b. Include strategies for effective control of plaque
biofilm
c. Address current disease activity
d. Unwillingness of patient to practice preventive
behavior
NBQ
Effective oral health education programs should
include all of the following EXCEPT which one?
a. Assess the patient’s risk for oral disease
b. Include strategies for effective control of plaque
biofilm
c. Address current disease activity
d. Unwillingness of patient to practice preventive
behavior
NBQ
Ms. Ivory is a 45-year-old female who has just arrived for
her first dental hygiene care visit in 11 years. Ms. Ivory
recently acquired dental insurance and is interested in
improving her oral health. Her physician is treating her for
anxiety, hypertension, type 2 diabetes, and seasonal
allergies. She takes Xanax (alprazolam) for anxiety and
migraines; Atenolol (tenormin) for hypertension;
Glucotrol (glipizide) for diabetes and an over-the-counter
antihistamine product for seasonal allergy relief.
Where on the learning ladder is Mrs.Ivory?
a.
b.
c.
d.
Unawareness
Awareness
Action
Habit
NBQ
Ms. Ivory is a 45-year-old female who has just arrived for
her first dental hygiene care visit in 11 years. Ms. Ivory
recently acquired dental insurance and is interested in
improving her oral health. Her physician is treating her for
anxiety, hypertension, type 2 diabetes, and seasonal
allergies. She takes Xanax (alprazolam) for anxiety and
migraines; Atenolol (tenormin) for hypertension;
Glucotrol (glipizide) for diabetes and an over-the-counter
antihistamine product for seasonal allergy relief.
Where on the learning ladder is Mrs.Ivory?
a.
b.
c.
d.
Unawareness
Awareness
Action
Habit
DH Care Plan Presentation
• Best to teach before clinical tx has begun
• Emphasize self-care: makes your job easier in
the end!!
• Patients gums don’t hurt because you poked
them!
• Do not do OHI at end of appt – they are tired
and ready to leave
DH Care Plan Presentation
• Most important because if patient does not accept tx
from you or understand their conditions, they will
not get the help they need
• Difference between an EXCELLENT hygienist an
OK hygienist – which do you want to be
• Need to read your patients and tailor your education
to their level of understanding?
▫ Do NOT talk above or below a person’s understanding
▫ How I educate a surgeon will be different then a senior
in high school
DH Care Plan Presentation
Presenting findings to the dentist
▫ Purpose: integrate the DH care plan/findings to the
overall tx plan. Provide the dentist with the
information they need to make a good diagnosis and
thus an accurate tx plan
▫ Procedure
Summarize patient demographic data
Summarize systemic health status
Summarize discovered risk factors
Indicate your thoughts for intervention strategies and
periodontal needs
 Be prepared to answer any questions they may have
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DH Care Plan Presentation
Presenting findings to the patient
▫ RDHs with good verbal skills and ability to build
trusting relationships will greatly influence patient
acceptance of tx - thus increase production
▫ Intraoral cameras & visual aids “Picture is worth a
thousand words”
▫ Ability to identify radiographic calculus and decay
▫ Understanding of tx constraints: financial, anxiety
▫ Link oral health with systemic health
▫ Speak with confidence: “Fake it until you make it”
DH Care Plan Presentation
Learning Process
▫ More effective when an individual is ready to learn
(Motivation is essential)
▫ What a person learns in a given situation depends
on what is recognized & understood
▫ People learn based on what they actually use
▫ Learn better in environments where feelings of
satisfaction occur
Communication with Patients: Mosby
• Communication
▫ Giving or exchanging info, signals, messages through
facial expression, behavior, talking, gestures, writing
• Intrapersonal Communication
▫ Processing a message within one self
▫ Often affected by a person’s attitude, personal
experiences, culture, religion, values
• Interpersonal Communication
▫ Message between 2 or more people
▫ Focus on interpretation of a conversation with
nonverbal & spoken words
▫ Effectively done = reduce miscommunication
Communication with Patients: Mosby
• Acceptance
▫ Accepting without judgment
• Comfort
▫ Ability to deal with embarrassing or emotionally
painful topics related to an person’s health
• Concreteness
▫ Communicating in a clear & precise manner w/terms
understandable to a patient
• Empathy
▫ Listening, understanding the emotions and feelings of
a person
Communication with Patients: Mosby
• Genuineness
▫ Communication in open & honest manner
• Respect
▫ Ability to convey honor & esteem for a person
• Responsiveness
▫ Ability to reply to messages at the very moment they
are sent
• Self-Disclosure
▫ Sharing personal experiences with a patient
• Warmth
▫ Displaying personal feelings & empathy
Communicating
Establishing and Building trust
▫ Assume most patients are anxious, worried or
down right scared of you!!
▫ Establish rapport quickly
 Rapport is the ability to enter someone’s world and
make them feel like you understand them and that
there is a strong connection between you and them
Communicating
Establishing and Building trust
▫ Most people tend to relate to other like-minded
people who have similar experiences and interests
 You have kids, me too!
 You have tooth problems, me too!
 You hate your mother-in-law, me too!
Communicating
Patient values
▫ Will help determine the approach you take in
presenting perio diagnosis and tx options
▫ Perio typically asymptomatic – so not know they
have until you tell them: may make accepting
condition difficult
▫ To understand their values, can ask open-ended
questions:
 “What’s most important to you about your teeth?”
 “What’s most important to you about your dentist or
dental office?”
Communicating
• Presentation Management
▫ Prioritize tx into categories for the patient
 Ex: Urgent, Preventive, Cosmetic
▫ NBQ: first step in appointment planning is
starting with patient chief complaint!
Communicating
The power of words!
▫ Use them with care and thoughtfulness
▫ Can be powerful, positive or negative
▫ Change one word in a sentence and it changes the
whole tone of a conversation
Don’t Use
Replace With
Inflammation
Infection
Deep cleaning
Periodontal Therapy
‘Just’ a ‘little’ bleeding
There is bleeding hense
infection
Communicating Perio
Protocols To Patients
▫ Mass media attention
▫ Public more informed
▫ RDH need to know more than the public and stay
one step ahead
Communicating & Different
Personalities
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Extrovert
Introvert
Intuitive
Sensitive
Thinking
Feeling
Judging
Perceiving