Perspectives of Australian nursing educators on the preparation of nursing students for the care of older people's oral health

Nurses can and need to take a leadership role in improving and maintaining older Australians' oral health in community, hospital, and residential care settings. [...]it is important to investigate the perspectives of nursing educators on the preparation of nursing students for the care of older people's oral health. Keywords: aged care, oral health, nursing, older people, nursing curricula, dental care, interprofessional and collaborative practice INTRODUCTION The oral health of many older Australians (65 years and above) remains poor despite an increased understanding of the importance of oral health and its association with general healths 2 Due to blood-borne pathogens from the mouth, oral diseases worsen heart problems, diabetes, and pneumonia, leading to unplanned hospitalisations.3"5 Poor oral health also increases the severity of complications arising from viral infections, including COVID-19.6,7 Predominant oral health issues for older people include tooth decay, gum diseases, dry mouth, tooth wear, and oral cancer.8 Poor oral health leads to oral pain, difficulties in eating, speaking, and swallowing as well as lower self-esteem due to bad breath and poor facial and dental appearance.9 Maintaining oral health - a mouth free of pain, discomfort and disease - is key to maintaining the quality of life and general health of older people.10 In providing oral healthcare, nurses need to understand the factors affecting people's oral health and oral healthrelated quality of life, ensure daily oral care practice, and be able to complete an oral health screening to identify issues needing timely referral to a dentist, doctor, or allied health specialist.11 Oral healthcare for older people has been promoted by Australian government-funded learning resource packages such as "Better Oral Health in Residential Care" and "Better Oral Health in Home Care".12 These resources were developed a decade ago to educate and assist nurses, nursing assistants, and allied health professionals to collaborate with dental professionals to ensure effective oral healthcare for the older population.12 However, the uptake of these learning resource packages appears limited, and the report of the Royal Commission into Aged Care Quality and Safety highlighted the continuing neglect of older people's oral health, particularly in residential care.13 Similar concerns have been raised about the oral healthcare of older people in hospitals in Australia.14 As people age, many become frail and require assistance with oral care. The importance of nurses in providing oral healthcare has been acknowledged in international reports and studies.15-18 Restrictions to dental services during the COVID -19 pandemic have highlighted the need for the leadership of nurses in oral healthcare, working closely with dentists, doctors, and allied health professionals to maintain older adults' oral and general health.19 Nursing curricula need to specify the knowledge and clinical competence requirements for the effective provision of oral healthcare to ensure that all graduating students are well-prepared to provide such care.11 Despite the acknowledged association between poor oral health and general health, 13, 20-22 there is little known about the extent of the preparation of nursing students in Australia to provide oral healthcare for older people.11 A review of the curricula of Australian Bachelor of Nursing programs, as presented on university websites, by the first author (VB) showed no information regarding the inclusion of units and clinical practice addressing the care of older people's oral health. Competence in oral healthcare may be implied in current Australian Nursing and Midwifery Accreditation Council (ANMAC) Standards (Standard 3.6 does require nursing programs to integrate principles of interprofessional learning and practice in content and learning outcomes) but there is no particular focus on oral healthcare learning objectives.23 To address this apparent lack of focus on oral healthcare, this study aimed to assess the perceptions of nursing educators regarding the preparation of nursing students to understand and provide effective oral healthcare, particularly for older people.