CHAPTER 6 Patient Care and Special Groups
The dental nurse provides a key link between the dental clinician and patient and partner, family or friends, by supporting the patient as well as assisting clinically. The dental nurse also undertakes several other routines that are more fully explained in Chapters 37 and 15.
The CRB is an executive agency of the Home Office, which vets applications for people who want to work with children and vulnerable people. People working in the UK healthcare sector also require CRB checks. The role of this agency has been enhanced by the Safeguarding Vulnerable People Act (2006) in response to the recommendations of the Bichard Inquiry.
The Foster Review on the regulation of the non-medical healthcare professions, when describing ‘good character’, referred to objective tests to measure this, such as the absence of criminal convictions and adverse decisions by regulatory bodies, and the information about likely criminal activity contained in a CRB disclosure.
These disclosures reveal details of any convictions, cautions, reprimands and final warnings the applicant has received, regardless of length of time since the incidents. They also reveal details of whether that person is banned from working with children or vulnerable adults (if these details have been requested). The CRB aims to issue Standard Disclosures within 10 days of receipt of the application.
These disclosures are for positions involving greater contact with children or vulnerable adults (e.g. most health professionals) and involve an additional check with the police. The police then check if any other information is held on file that may be relevant (for instance, investigations that have not led to a criminal record). The police will decide what (if any) additional information will be added to the Disclosure. The CRB aims to issue enhanced disclosure within 28 days of receiving the application.
According to the Institute of Healthcare Management: ‘customer care fundamentally depends very much on good management and organisation, but individual staff contacts and conducts are crucial to success.’
Patients have a right to receive attention and to be treated with respect. Remember that like everyone, patients are the experts on their lives, cultures and experiences. If you treat them with respect and sensitivity, they will usually tell you how best to provide care for them. They will usually also tell you if asked, how they wish to be addressed. Many patients are aware of their rights and willing to enforce them if they feel that they are not being cared for appropriately.
Under many codes (Box 6.1.1), clinical staff must tie back long hair, but not with ribbons or combs. Jewellery is limited to simple earrings and one ring, and any clothing that exposes the midriff or cleavage is banned. Nose studs should be covered with a fresh plaster each day. Some codes also cover above-the-knee skirts and high heels. Shoes that are low-heeled, soft-soled, supportive and closed are generally agreed to be best for work. Shoes with holes in the top or side may carry a risk of injury from falling scalpels and needles, or the risk of catching an infection from blood or fluids dropping through the holes.
BOX 6.1.1 Dress Codes in Practice
Dress codes can be controversial. At least one hospital banned nurses from wearing Croc shoes, suggesting they might be dangerous. But some surgeons use Crocs in the operating theatre, believing they are easier to clean. Even NHS rules can vary. In England and Wales for example, bare-below-the-elbows dress code for clinicians is recommended since it ‘helps to support effective hand-washing and may reduce the risk of patients catching infections’. Other codes have caused considerable controversy and even made newspaper headlines. See the Daily Mail archive for example, for the article ‘Don’t forget to wear socks and make sure your shoelaces match’ (31 December 2007).
Whatever is the prescribed code in your workplace, as a healthcare worker, your clothing should clearly conform to health and safety standards. In some organisations, breaching the code could lead to disciplinary action.
Personal hygiene is achieved by using personal hygiene products including: soap, shampoo, toothbrushes, dental floss, toothpaste, deodorants, nail clippers and files, razors, and shaving cream. Things that people might wish to think about are:
Drugs, particularly those that act on the central nervous system (CNS; e.g. sedatives and anaesthetic agents) are potentially dangerous and must be carefully administered. Most dental procedures can be carried out under local anaesthesia (LA, sometimes called local analgesia) with minimal morbidity. Conscious sedation (CS) is not as safe as LA alone. CS must be carried out:
General anaesthesia (GA) with intravenous or inhalational agents is only permitted in a hospital with appropriate resuscitation facilities. It is not often needed for dental treatment, and then only in a hospital setting: because of its potential dangers it must be carried out by a qualified anaesthetist. CS is considerably safer, and is thus preferred.
Surgical procedures are generally the most hazardous. In the dental environment, operative procedures that involve use of LA and CS, and operative interventions such as drilling teeth and cutting tissues and bone are the main ones that can be hazardous.
An adequate risk assessment endeavours to anticipate and to prevent trouble. This topic was covered in the context of a medical emergency in Chapter 2. This chapter explains its relevance in day-to-day practice.
A patient’s ‘fitness’ for a procedure depends on several factors (see Chapter 2, Box 2.1 and Table 2.1). Many patients with life-threatening diseases now survive as a result of advances in surgical and medical care. Such diseases can significantly affect the dental management of the patient. A patient attending for dental treatment and apparently ‘fit’ may actually have a serious systemic disease. Or they may be taking drugs (including recreational drugs). Both of these might influence the healthcare that can be delivered to the patient.
Personal details (first and last names, the name by which the patient wishes to be known, date of birth, gender (sex), religion, occupation, relationship status, address and contact details) are necessary information for administrative purposes. This information may be collected by the dental nurse or receptionist. In fact, obtaining this information provides the patient with the opportunity for a gentle introduction to the dental team, and an opportunity for individual introduction suitable to the particular culture. As stated above, it is usually helpful to ask the patient how they would wish to be addressed.
When taking a medical history, the dental clinician will usually ask a structured set of questions, such as those shown in Box 6.1.2. Patients are often also given a form for them to supply all the information they can about their health and any medication they are receiving. The history may significantly change with time. Therefore, it is essential to ask about any changes and update the history before each new course of treatment, every sedation session and especially before surgery or GA. For example, a female patient who is not pregnant at one course of treatment could well be at the next. Table 2.2 (p. 47) lists some important medical issues that would affect the dental treatment of a patient.
BOX 6.1.2 Essentials of History Taking
It is helpful for nurses to have basic knowledge about the essential components of a medical history. Many of the items below may be included on the form that is handed out to the patient to fill in before they see the dental clinician. The completion of such a form provides: