DH Treatment Plan & Presentation Patient Communication Lisa Mayo, RDH, BSDH DH102 Clinic...

DH Treatment Plan & PresentationPatient Communication Lisa Mayo, RDH, BSDHDH102 Clinic Sciences II Concorde Career College

Topics for Today

1. Tx Planning2. DH Care Plan/Tx Plan 3. Communication & Patient Learning

#1: Tx Plans

Tx Plans

Dependent on many factors1. Oral issues2. Systemic Issues3. Capability4. Autonomy5. 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 PlanYellow Form in Clinic

DH Tx/Care Plan

Components of a Care Plan1. 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 PlanInclude the following:

1. Plans care for patient needs based on assessment data collected

2. Flexible and realistic3. 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 3-2, p.27)1. Cognitive: attention, information processing,

memory, reasoning ability2. Combined cognitive/psychosocial: ability

w/numbers, verbal, reading ability3. 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) SUSCEPTIBLE to disease2) Disease is a SERIOUS threat to life3) Disease can be PREVENTED4) 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 individual2) 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) Precontemplation: no intention of making a change

w/in next 6mo2) Contemplation: intends to make a change in the

next 6mo3) Preparation: patient intends to make a change w/in

next 30 days, taken some steps to initiate change4) Action: patient practiced change behaviors <6mo5) Maintenance: patient practiced changed behaviors

6+mo6) 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 needsb. Health belief modelc. Theory of reasoned actiond. Stages of readiness

NBQ

The transtheoretical model of behavior change is concerned with:

a. Hierarchy of needsb. Health belief modelc. Theory of reasoned actiond. Stages of readiness

DH Care Plan PresentationLearning 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. Attributionb. Locus of controlc. Motivationd. 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. Attributionb. Locus of controlc. Motivationd. 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 diseaseb. Include strategies for effective control of

plaque biofilmc. Address current disease activityd. 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 diseaseb. Include strategies for effective control of

plaque biofilmc. Address current disease activityd. Unwillingness of patient to practice

preventive behavior

NBQMs. 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. Unawarenessb. Awarenessc. Actiond. Habit

NBQMs. 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. Unawarenessb. Awarenessc. Actiond. 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 PresentationPresenting 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

DH Care Plan PresentationPresenting 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

•Extrovert•Introvert•Intuitive•Sensitive•Thinking•Feeling•Judging •Perceiving