Oral Health Nursing Education and Practice Program

Abstract

Millions of Americans have unmet oral healthcare needs and profound oral health disparities persist in vulnerable and underserved populations, especially poor children, older adults, and racial and ethnic minorities. Nurses can play a significant role in improving the quality of oral health including access to care with appropriate education and training. The purpose of this paper is to describe New York University College of Nursing's response to this challenge. The Oral Health Nursing Education and Practice (OHNEP) program is a national initiative aimed at preparing a nursing workforce with the competencies to prioritize oral disease prevention and health promotion, provide evidence-based oral healthcare in a variety of practice settings, and collaborate in interprofessional teams across the healthcare system. The overarching goal of this national initiative is to create an educational infrastructure for the nursing profession that advances nursing's contribution to reducing oral health disparities across the lifespan.

Full text

Hindawi Publishing Corporation
Nursing Research and Practice
Volume 2012, Article ID 149673, 5pages
doi:10.1155/2012/149673
Research Article
Oral Health Nursing Education and Practice Program
Maria C. Dolce,1Judith Haber,1and Donna Shelley2
1New York University College of Nursing, 726 Broadway, 10th Floor, New York, NY 10003, USA
2New York University School of Medicine, 227 East 30th Street, 6th Floor, New York, NY 10016, USA
Correspondence should be addressed to Maria C. Dolce, maria.dolce@nyu.edu
Received 2 February 2012; Accepted 5 March 2012
Academic Editor: Mary George
Copyright © 2012 Maria C. Dolce et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Millions of Americans have unmet oral healthcare needs and profound oral health disparities persist in vulnerable and underserved
populations, especially poor children, older adults, and racial and ethnic minorities. Nurses can play a significant role in improving
the quality of oral health including access to care with appropriate education and training. The purpose of this paper is to describe
New York University College of Nursing’s response to this challenge. The Oral Health Nursing Education and Practice (OHNEP)
program is a national initiative aimed at preparing a nursing workforce with the competencies to prioritize oral disease prevention
and health promotion, provide evidence-based oral healthcare in a variety of practice settings, and collaborate in interprofessional
teams across the healthcare system. The overarching goal of this national initiative is to create an educational infrastructure for the
nursing profession that advances nursing’s contribution to reducing oral health disparities across the lifespan.
1. Introduction
Over a decade ago, the United States (US) Surgeon General’s
landmark report, Oral Health in America, profiled the poor
oral health status of the nation as a “silent epidemic” and
linked oral health to overall health and well-being [1]. While
overall improvements in oral health have been reported in
the US population, millions of Americans have unmet needs
related to oral health and profound oral health disparities
persist in vulnerable and underserved populations, especially
poor children, older adults, and racial and ethnic minorities
[1–3]. For example, today, dental caries (tooth decay), an
infectious and highly preventable disease, remains a common
chronic disease across the life cycle and disproportionately
impacts vulnerable and underserved groups [3].
One of the many barriers to quality oral healthcare in-
cludes a lack of attention to oral health by nondental health
care professionals (e.g., nurses, pharmacists, physicians, phy-
sician assistants) [1–3]. For example, oral health has not
been a high priority for nurses in practice [4]. Another
barrier is the inadequate education of nondental health care
professionals in basic oral health [3]. To address these chal-
lenges, the Committee on Oral Health Access to Services
recommended the development of a core set of oral health
competencies and curricula for nondental health care pro-
fessionals to enhance their role in oral health promotion and
disease prevention [3]. In response to this recommendation,
nursing programs will need to prepare graduates with core
competencies to identify risk for oral disease, conduct oral
examinations, provide oral health information, connect oral
health information with diet and lifestyle counseling, and
make referrals to dental professionals [3]. There are over 3
million licensed registered nurses including approximately
140,000 nurse practitioners (NP) in the US health care
workforce [5]. With adequate education and training in oral
health, the nurse workforce has the potential to have a major
impact on improving access and quality of oral health care.
New York University (NYU) College of Nursing is strate-
gically engaged with NYU College of Dentistry in an inno-
vative organizational partnership to advance an interprofes-
sional model for health professions oral-systemic education
and practice. The purpose of this paper is to describe the
NYU College of Nursing’s program on Oral Health Nursing
Education and Practice (OHNEP), an outgrowth of the NYU
College of Nursing and College of Dentistry academic part-
nership and interprofessional collaborations with colleagues
in Pediatrics and Family Medicine. The OHNEP program is
a national initiative aimed at preparing the nurse workforce

2Nursing Research and Practice
with the competencies to prioritize oral disease prevention
and health promotion, provide evidence-based oral health
care in a variety of practice settings, and collaborate in inter-
professional teams across the health care system to improve
access to care and reduce oral health disparities.
2. Materials and Methods
2.1. Setting the Stage. The NYU College of Nursing proposed
to develop and demonstrate the impact of a replicable model
for implementing and disseminating a comprehensive oral
health curriculum in nursing programs and integrate oral
health best practices in nurse-managed primary care settings
throughout the United States. Several landmark reports
published in 2011 set the stage for NYU College of Nursing’s
program to enhance nursing’s role in reducing the burden
of oral disease in America. These reports, Advancing Oral
Health in America [2], Improving Access to Oral Health Care
for Vulnerable and Underserved Populations [3], National Pre-
vention Strategy: America’s Plan for Better Health and Wellness
[6], and Core Competencies for Interprofessional Collaborative
Practice [7], underscored the centrality of the nursing
profession in improving oral health outcomes, nurses’ role
in health promotion and prevention, and the importance
of interprofessional education and collaborative practice in
improving oral health. In 2011, NYU College of Nursing
launched a national initiative, Oral Health Nursing Education
and Practice (OHNEP), funded by DentaQuest Foundation,
Washington Dental Service Foundation, and Connecticut
Health Foundation. Oral Health Nursing Education and Prac-
tice is a constituent of the National Interprofessional Initia-
tive on Oral Health (NIIOH), a consortium of clinicians and
funders whose mission is to engage primary care clinicians
to partner with dental professionals in providing oral health
preventive services and to eliminate dental disease.
2.2. Program Aims. The overarching goal of this national ini-
tiative is to create an infrastructure for the nursing profession
that advances nursing’s contribution in reducing oral health
disparities across the lifespan. The OHNEP initiative focuses
on the development of a replicable model for integrating
oral health in nursing curricula and implementing and
disseminating oral health best practices in nurse-managed
primary care settings. The specific aims of the OHNEP
initiative are to
(1) engage national nursing stakeholders representing li-
censure, accreditation, certification, education, prac-
tice, and policy in advancing an action plan and rec-
ommendations that will support oral health nursing
education, clinical practice, and policy changes,
(2) implement a strategy for developing oral health
competencies in undergraduate and graduate nursing
programs,
(3) implement a strategy for integrating best practices
in oral health care in registered nurse (RN) and
advanced practice nurse (APRN) clinical settings,
(4) disseminate these strategies nationally including
nursing programs, healthcare organizations, nurse
managed primary care settings, and professional
nursing organizations.
2.3. Program Approach
2.3.1. Aim 1. Engaging stakeholders and creating a shared
vision are critical underpinnings of the program approach.
To further this aim, in May 2011 a National Invitational
Nursing Summit was convened in Washington, DC, to
launch the OHNEP initiative. Over 35 representatives from
25 national nursing and professional organizations respon-
sible for licensure, accreditation, certification, education,
practice, and policy participated in the Summit. Summit
participants were engaged in discussions about nursing’s role
in improving oral health and expanding access in the context
of interprofessional collaboration. These key nursing stake-
holders contributed ideas and strategies for advancing an
oral health agenda in nursing.
2.3.2. Aim 2. To achieve this aim a faculty development
train-the-trainer approach was designed to enhance nursing
curricula and disseminate best practices in oral health. The
train-the-trainer workshop, Oral Health Nursing Education
and Best Practices: Enhancing Faculty Capacities, was specially
tailored to assist faculty with integrating oral health into
existing courses in the baccalaureate and graduate nursing
programs at NYU College of Nursing. The train-the-trainer
workshop was approved by NYU College of Nursing’s Center
for Continuing Education in Nursing, an accredited provider
of continuing nursing education by the American Nurses
Credentialing Center’s Commission. The purpose of the
workshop was to provide faculty with teaching-learning
resources to facilitate the integration of oral health into
didactic, clinical, and simulation learning environments. The
Smiles for Life: A National Oral Health Curriculum [8]was
presented as a comprehensive, interprofessional curriculum
for nurse faculty enrichment and competency development
in oral health across the lifespan [9]. At the completion of
the train-the-trainer workshop, participants were expected
to (a) articulate the importance of oral-systemic health
and nursing’s call to action, (b) discuss interprofessional
education and collaborative practice as a framework for
improving oral-systemic health outcomes, (c) describe the
comprehensive features of Smiles for Life, and (d) implement
a variety of teaching-learning strategies that facilitate the
development of nurses’ oral health competencies and imple-
mentation of oral health best practices across the lifespan.
2.3.3. Aim 3. An oral health documentation or chart tem-
plate was developed to prompt nurse practitioner (NP)
providers to adhere to best practices in oral health care.
The chart system will prompt NP providers to assess risk
factors for oral disease, provide brief intervention, and make
appropriate referrals. This new office system will be pilot
tested in a nurse-managed primary care setting to assess the

Nursing Research and Practice 3
feasibility and preliminary effect on NP adherence to best
practices in oral health promotion and disease prevention.
2.3.4. Aim 4. Laying the groundwork for an effective dis-
semination plan required extensive outreach to the executive
directors, presidents, and conference planning committees of
national nursing organizations. Abstracts for preconference
train-the-trainer workshops and concurrent sessions were
submitted for consideration at national nursing conferences.
The target audiences included nurse faculty, professional
development specialists, registered nurses, and advanced
practice nurses.
3. Results and Discussion
3.1. Outcome 1. A short film, Expanding Access to Oral Health
Care—Nurses Make a Difference [10], featuring Dr. David
Satcher, former US Surgeon General, was produced to vividly
depict the burden of oral health in America and NYU College
of Nursing’s response to the challenge of improving oral
health. The purpose of the film was to begin a dialogue and
create a shared vision about the role of nurses in improving
oral health care and access. The film was first presented at
the Summit and was highly acclaimed. Since the Summit, the
film has been made widely available on the Internet.
3.2. Outcome 2. An outcome of the Summit was the devel-
opment of a national nursing action plan. The action plan
identified short-, mid-, and long-range nursing strategies to
advance a national oral health agenda. Priority areas were
outlined and included policy, education, practice, interpro-
fessional partnerships, outreach, and communication.
3.3. Outcome 3. One of the first priorities identified by key
nursing stakeholders was to establish a National Nursing
Workgroup on Oral Health. A national call for members
was issued and resulted in nominations from nursing edu-
cation, practice, research, and policy. The National Nursing
WorkgrouponOralHealthwasfirstconvenedinDecember
2011. The Workgroup, comprised of 18 members, serves
as an expert advisory committee providing input related to
nursing’s role in advancing a national oral health agenda.
3.4. Outcome 4. To keep local, regional, and national con-
stituents up-to-date regarding OHNEP activities, an elec-
tronic newsletter, Oral Health Matters,wasdevelopedfor
nurses and other health professionals. The inaugural issue
was released in Fall 2011 and has been widely disseminated
through print media and the Internet.
3.5. Outcome 5. The Smiles for Life (http://www.smilesfor-
lifeoralhealth.org/) curriculum [8] was promoted as a com-
prehensive oral health resource for competency development
and integrated into faculty development train-the-trainer
workshops. The curriculum consists of eight individual
courses: (1) The Relationship of Oral to Systemic Health, (2)
Child Oral Health, (3) Adult Oral Health, (4) Acute Dental
Problems, (5) Oral Health and the Pregnant Patient, (6)
Fluoride Varnish, (7) The Oral Examination, and (8) Geri-
atric Oral Health. The NYU College of Nursing’s Center for
Continuing Education in Nursing, accredited as a provider of
continuing nursing education by the American Nurses Cre-
dentialing Center’s Commission on Accreditation, approved
the Smiles for Life curriculum. Each individual course was
approved for 1.0 contact hour and was made available free to
individual users.
The Geriatric Oral Health course was the most recent
addition to the curriculum. Prior to the launch of the
geriatric course in October 2011, a member of the NYU
College of Nursing faculty with specialization as an adult
and geriatric nurse practitioner conducted an expert review
of the content. The OHNEP project director was invited to
serve on the National Association of School Nurses National
Oral Health Expert Panel and provided consultation related
to the implementation of Smiles for Life curriculum for
the professional development of school nurses. To date, the
OHNEP initiative including Smiles for Life curriculum has
received organizational board recognition from the Ameri-
can Association of Colleges of Nursing, National League for
Nursing, National Organization of Nurse Practitioner Fac-
ulties, National Association of Pediatric Nurse Practitioners,
Association of Faculties of Pediatric Nurse Practitioners, and
Gerontological Advanced Practice Nurses Association.
3.6. Outcome 6. The train-the-trainer workshop was piloted
at NYU College of Nursing for faculty teaching in the
baccalaureate and graduate programs. Four workshops were
conducted in the Fall 2011 semester. A total of 24 faculty
members and 6 students enrolled in the Master’s of Science
nursing education program completed the workshop. At the
end of the workshop, blank index cards were distributed to
the participants. The participants were instructed to identify
and indicate on the card at least two teaching-learning strate-
gies or resources that they planned to implement in their
curriculum as an outcome of the workshop. Participants
completed a program evaluation providing feedback on
teaching effectiveness and achievement of learning outcomes.
Using a five-point likert rating scale ranging from “strongly
disagree” to “strongly agree,” participants were asked to rate
the following outcomes: (1) I am able to articulate the impor-
tance of oral health and nursing’s call to action. (2) I am
able to discuss interprofessional education and collaborative
practice as a framework for improving oral health outcomes.
(3) I am able to describe the comprehensive features of
Smiles for Life. (4) I am able to implement a variety of
teaching-learning strategies that facilitate integration of oral
health nursing education and practice across the lifespan.
These data were collected at the end of each train-the-
trainer workshop. Evaluation data were analyzed to improve
the quality of the workshops in meeting faculty learning
needs and expectations. Follow-up surveys with workshop
participants are conducted to assess how the training has
impacted their courses and curriculum.
3.7. Next Steps. The OHNEP initiative will build upon
the outcomes achieved in its first year, and focus on the

4Nursing Research and Practice
national dissemination of strategies for developing oral
health competencies in undergraduate and graduate nursing
education and integrating oral health best practices in RN
and APRN clinical settings. The dissemination plan includes
the spread of curricular innovations and best practices across
nursing programs, healthcare organizations, nurse-managed
primary care settings, and professional organizations. Train-
the-trainer workshops will be offered to nurse faculty, profes-
sional development specialists, and clinicians and will feature
the Smiles for Life curriculum as a resource for competency
development. Faculty and clinician train-the-trainer sessions
to disseminate strategies for enhancing nursing curricula,
developing oral health competencies, and implementing best
practices will be presented at select national nursing con-
ferences and meetings beginning in 2012. These conferences
will include the American Association of Colleges of Nursing,
National League for Nursing, National Organization of
Nurse Practitioner Faculty, and American Academy of Nurse
Practitioners.
The next phase will also focus on the implementation
of oral health best practices in nurse-managed primary care
settings. A best practice protocol will be first implemented
in the NYU College of Nursing Nurse Practitioner Faculty
Practice, with expansion into its Mobile Health Van Program
and Diabetes Care—Lifestyle Center for Older Adults. The
implementation will be evaluated for effectiveness and
disseminated nationally. The NYU College of Nursing’s
OHNEP initiative will continue to demonstrate the capacity
to advance interprofessional education and collaborative
practice in oral health. Program activities will be planned
around aligning leadership, leveraging information technol-
ogy, and supporting curricular development.
To continue the dialogue and momentum that began at
the National Nursing Summit, a nursing leadership collo-
quium will be convened in 2012. Members of the National
Nursing Workgroup on Oral Health, along with other
nursing stakeholders, will be invited to participate in a
nursing leadership colloquium on oral health. The goals of
the colloquium will be to align nursing leaders on key pri-
ority areas: licensure, accreditation, certification, education,
practice, and policy, and to build consensus about nursing’s
role in an interprofessional agenda to improve oral health.
An expected outcome of the nursing leadership colloquium
will be individual and collective ownership of strategic
actions that advances a national policy agenda to improve
oral health. An initial strategy will be to attain formal
recognition and support from the Tri-Council of Nursing.
An important strategy for the dissemination of oral
health nursing education and best practices will be the devel-
opment of a website to serve as the “knowledge center”
for faculty development, competency development, and best
practices in oral health across the lifespan. The website
will provide open access to online curricular resources. The
OHNEP website, under the umbrella of NIIOH, will facilitate
the dissemination of oral health nursing education and
practice resources for nurses and other health professionals,
including the Smiles for Life curriculum.
Curricular development awards will be available to
nurse faculty and clinicians to support the development,
implementation, and evaluation of oral health instructional
resources. Curricular resources will be used for educating
nurses in undergraduate- and graduate-level programs and
clinical practice settings. The curricular resources will be
peer-reviewed, published, and disseminated through the
OHNEP website. An example of an oral health instructional
resource is the use of a standardized patient case for
simulation learning designed to supplement the Smiles for
Life curriculum.
4. Conclusion
New York University College of Nursing, leveraging a novel
organizational partnership with NYU College of Dentistry,
is uniquely positioned to advance innovative models of
interprofessional education and collaborative practice that
enhance oral health outcomes. The Oral Health Nursing
Education and Practice initiative has gained tremendous
momentum with its focus on faculty and professional
development using a train-the-trainer approach. Building
on this initial momentum, the next phase will focus on
the expansion of professional development train-the-trainer
programs nationally and implementation of a strategy for
integrating oral health best practices in nurse-managed
primary care settings. It is in this context that NYU College
of Nursing is poised to develop, implement, and evaluate the
effectiveness of strategies that facilitate the dissemination of
oral health nursing education and best practices.
Acknowledgments
New York University College of Nursing’s Oral Health
Nursing Education and Practice initiative is supported by
funding from DentaQuest Foundation, Washington Dental
Service Foundation, and Connecticut Health Foundation.
The authors gratefully acknowledge the support from Ms.
Tracy Garland, Program Director, National Interprofessional
Initiative on Oral Health.
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