Bulletin of Dental Education

Learning and Exchange: Dental, Dental Hygiene and Nursing Students Embrace IPE in Indiana to Become Better Health Professionals

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By LaShell Stratton-Childers, ADEA Senior Editor

Each health profession serves its purpose in maintaining and improving the overall health and well-being of patients. In order to gain a greater understanding of what each profession does, it sometimes requires health professionals to work together, reaching over the walls that traditionally keep them apart. 

Many dental institutions are offering interprofessional education (IPE) experiences for their dental and allied dental students to broaden their perspectives and make them better at their own professions and better members of the health care team. Two schools in Indiana—the Indiana University School of Dentistry (IUSD) and the University of Southern Indiana’s (USI) Dental Hygiene Program—collaborated with nursing programs within their respective universities to create IPE programs that both hope will help their students in the years to come.

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The Indiana University School of Dentistry worked with the University’s School of Nursing to develop an IPE program for dental and pediatric nurse practitioner students whereby they measured and analyzed children’s blood pressure and body mass index and conducted oral examinations. Photo courtesy of Indiana University School of Dentistry.


 

It started with Goldfish® . . .

In 2017, dental and pediatric nurse practitioner students at Indiana University (IU) started working together to measure and analyze children’s blood pressure and body mass index (BMI) and conduct oral examinations, but only after Joan E. Kowolik, B.D.S., IUSD Director of Admissions, Recruitment and Student Support and Associate Professor Pediatric Dentistry, had a candid conversation with a counterpart in nursing.  

“I had a discussion with one of my nurse friends, talking about teaching parents how to look after children’s teeth,” Dr. Kowolik said. “For diet, we say don’t eat Goldfish crackers because they become soggy and stick in the teeth and cause dental decay.” But Dr. Kowolik’s nursing friend countered with “‘Well, we tell the parents and encourage them to tell their children to eat Goldfish because it is a good carbohydrate for them and it’s not particularly sweet.’ So here we were disagreeing about a fundamental thing . . . just a Goldfish,” Dr. Kowolik said. “So then, I asked how much education do you get about dentistry or give your students about dentistry? She said really not that much.”

Dr. Kowolik said that’s when the wheels began to spin, and she wondered if there was an opportunity to bridge this gap in understanding how each profession works with pediatric patients. At the same time, the School of Dentistry was teaching its students how to take patients’ blood pressures. 

“Well, with adults, its easy, but there was a whole discussion of could we take blood pressure of children,” she said. “Nursing students are taught how to take the blood pressure of children and our students are finding it difficult, so is there a way that you could teach our students about blood pressure and BMI, and we could teach the nursing students about oral hygiene/oral health?” 

From this, a new IPE program was born. Dr. Kowolik and Kathleen Kent, D.N.P., APRN, CPNP-PC, Assistant Dean for Graduate Programs and Clinical Associate Professor at the IU School of Nursing and the Pediatric Nurse Practitioner Program Coordinator, started the program with just lectures: one lecture about nutrition to dental students in a pediatric dental course, the other lecture to the nurse practitioner students about oral health, tooth brushing and diet. 

But it seemed to be an “isolated punch that we gave with nothing to follow up,” Dr. Kowolik said. Subsequently, to have more impact, they decided to shift the interprofessional education from the didactic to a clinical environment by inviting children who participated in other studies to come to the clinic and work with both the dental and nurse practitioner students.

“We showed the nurse practitioner students how to lift the lip and look at the teeth and what to look for, what caries look like and what plaque around the teeth looks like,” Dr. Kowolik said. “And then they taught our students how to take the height, weight and do the calculations so that they got BMI with the blood pressure.” 

The schools decided to expand the program to all their pediatric dental clinics and had plans to expand it to the adult clinics as well—then the COVID-19 pandemic struck.

“We reduced the number of people in the clinic to just essentials, and we haven’t taken it up again,” Dr. Kowolik said, though IUSD is working to resume the IPE program with nursing soon.

She said they are also hoping to expand the program beyond dental clinics in the next incarnation.

“We were trying to see how we could get our dental students out of the dental clinic into where the nurse practitioner students were working, but that was a whole legal thing,” she said. Nurse practitioner students are considered students of the IU hospital, but dental students don’t have the same designation, Dr. Kowolik explained. 

“So, that was one of the complications of the next stages we were planning: how could we get the dental students to be covered at the IU hospital as students?” she said.

An environment geared toward learning and collaboration

USI’s Dental Hygiene and Nursing programs were able to surmount a similar challenge of getting dental hygiene students into spaces where nursing students work by having pre-existing agreements with the two local hospitals. The students have participated in an IPE collaboration since 2016 in the hospitals’ dedicated education units (DEUs).

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The interprofessional education (IPE) program at USI began after a study of local area hospitals revealed that oral care was the third highest missed nursing care. The College’s Nursing and Dental Hygiene programs worked together to create an IPE collaboration that would help address this need. Photo courtesy of University of Southern Indiana.


 

The university signed the agreements with the hospitals in 2013, said Susan Seibert, D.N.P., M.S., RN, Instructor in Nursing at USI. “It’s an academic partnership with a contract with certain units where they have set a mandate that this is a learning environment. So, we don’t have a medical school in town, but it’s kind of like collaboration where the unit, the staff, even the providers that are coming to that unit—surgeons, specialists—they know that this is a learning environment and there will be a lot of students there and we include the students as part of the care team.” 

Dr. Seibert said in these units, students are encouraged to ask questions to “stimulate their critical thinking. We connect them with a certain patient that we know will be a good teaching case. It was an optimal little learning environment that we put our students in on those units and it was designed with the intent that we would pilot it with nursing students and as soon as the pilot demonstrated good outcomes, we were going to incorporate IPE,” she said. “So dental hygiene students come there. The Department of Mental Health [students] come there. Respiratory therapy students come there. It’s like a perfect little utopia for IPE, but dental hygiene was the first other profession we had come to those units and participate.” 

Dr. Seibert said dental hygiene students were the first IPE largely because of a research consortium at USI that included a study on missed nursing care. “We surveyed five to seven area hospitals in southern Indiana and western Kentucky about missed nursing care. Oral care was third on the list.”

She said nurses omit this kind of care for various reasons. “Low staffing. Too busy. All kinds of reasons,” Dr. Seibert said. “When I saw that, I thought we have an opportunity here and about 15 years ago dental hygiene students went to the oncology unit and went around to every patient room and offered oral care, and I thought we could bring that back with IPE.”

Dr. Seibert contacted her counterpart at the College of Nursing and Health Professions, Lorinda L. Coan, RDH, M.S., Associate Professor of Dental Hygiene, to start a new IPE program.

“We came up with this plan and it’s been in practice ever since,” Dr. Seibert said.

Before the students could enter the units for IPE exercises, they had to complete the Agency for Healthcare Research and Quality TeamStepps program online modules. They also took didactic courses where nursing students could familiarize themselves with the basics of oral health, oral assessments and common findings, and both nursing and dental hygiene were familiar with the Oral Health Assessment Tool (OHAT) by Dr. Jane M. Chalmers of The University of Iowa College of Dentistry & Dental Clinics.

“Dr. Chalmers designed it for use in residential care and for looking at any patient that’s been in the hospital for a while,” Prof. Coan said. “It was just a good tool that could be used anywhere. So, I adopted the OHAT as the screening tool that we use in all our community outreach. Whether we’re doing our screenings at a hospital or at a nursing home, if we’re doing them at a health fair or school systems . . . wherever it is, if we’re screening, we’re using the OHAT.”

Armed with the OHAT, training modules and course curriculum, the students were ready to begin their work.

Nursing students were assigned patients on their unit. They reviewed their patients’ medical histories, including their reason for admittance, assessed the patients’ overall health needs and provided care to the patients under the supervision of staff and nursing faculty. The nursing students then selected one patient each to recommend for a consultation to a dental hygiene student. The selection was based on a preliminary assessment of oral health concerns from conversations conducted between the patients and the nursing students or the patients and supervising nursing staff. The nursing students would then obtain permission from the selected patients for participation in the oral health assessment for later that day. 

When dental hygiene students and faculty arrived at the unit, they not only got a verbal report from the nursing students about the patient, but also spoke directly to patients with the nursing students in tow. Prior to the consultation with patients, they were able to ask the nursing students questions for clarification and share their knowledge regarding the oral implications associated with the patient’s current health status and what they believed to be the primary oral concerns for that respective patient. Each nursing and dental hygiene student pair developed a preliminary oral health care plan for their patient, including appropriate dental products. They also discussed whether the patient would be able to handle the oral home care alone or would need a caregiver’s assistance.

The IPE program between dental hygiene and nursing was so successful at USI that it expanded to other units, including the intensive care unit (ICU) at one of the hospitals. Prof. Coan said she and eventually her students started to do oral assessments of intubated patients using OHAT and “documenting whether or not there are additional preventive things that might be done, whether it is administration of fluoride or whether they’re noticing lesions or candidiasis, or whatever it might be.” 

Prof. Coan noted that “nurses do a great job doing oral care because they have to every two hours if a patient is intubated, but sometimes they aren’t sure what they’re looking at or when to identify a problem.”

But noticing these things can be incredibly important, especially when the patients are immunocompromised and have life-threatening conditions, Prof. Coan said.

Having a bigger impact

The success of these IPE programs at IUSD and USI has not only had an impact on the students and faculty, but has also fomented future IPE projects and encouraged institutional changes and additions within the hospitals themselves.    

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At University of Southern Indiana’s (USI) College of Nursing and Health Professions, dental hygiene and nursing students consulted with one another about the oral care of patients on units. Photo courtesy of University of Southern Indiana.
















"So, the discussion has been that we should have pharmacy students come in from Butler University, look at the medications dental patients are on and help make sure the medication is proper and adequate, and also teach our students that type of communication,” Dr. Kowolik said.

Prof. Coan said USI’s Dental Hygiene Program helped change what dental products are offered at one of the hospitals where it conducted IPE. “We ended up helping one the administrators make it possible to change some of the dental products available to their patients with more emphasis on having more variety and better quality dental products than what was standard offering there,” she said.

Prof. Coan conducted studies regarding the best oral care products to encourage implementing these changes. Her findings were presented to the hospital’s evidence-based practice council, then to the administration and, finally, to the purchasing division. 

“And it takes a lot to move that mountain to change purchasing, but they did it,” Dr. Seibert said. “They got the correct type of toothbrushes and other dental products that were on that unit.” 

Dr. Seibert said they also obtained a grant that allowed them to buy goodie bags filled with oral health care products that could be given to patients. 

In addition to changing the dental products offered, Dr. Seibert said they also asked both hospitals if they would consider having a dental hygienist on staff to make rounds on the units and consult on the different oral care assessments and findings. 

“And that’s been talked about, but it hasn’t been initiated yet because we had that halt during the pandemic,” Dr. Seibert said.

Getting buy-in

To replicate similar successful IPE programs at other dental schools, both programs encourage getting buy-in from the faculty and staff.

“One of the reasons the whole process worked well was because where we implemented it, both hospitals were on board with having students in the hospitals as a learning experience,” Prof. Coan said. The DEUs were “the key piece in not only getting nursing and all the other health professions there, but specifically making it easy for our students to go to a hospital and find there are BSN students to partner with and do the assessments together.”

Dr. Kowolik said it’s important to make sure the faculty that are going to be involved understand their roles and what’s going on. It’s also important that most of the faculty support the overall mission of IPE. “Have faculty on board that understand why we need it—not just in an isolated course, but to take it into clinics as well,” she said. “I think that’s the thing I would express to others. Make sure it is integrated into the curriculum and not just an add-on.”

Published June 8, 2022

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