Date of Graduation

Fall 12-12-2014

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions



First Advisor

Dr. Juli Maxworthy

Second Advisor

Dr. Jenice Guzman

Third Advisor

Dr. Marla Weiss


A review of the literature focusing on oral care within long-term care (LTC) suggests positive resident care outcomes occur when standardized practices are employed. Studies of staff education programs, trained oral hygiene aides, and dental hygienists working within LTC, have linked regular oral hygiene practices to decreased pneumonia rates. While these studies make the connection between good oral hygiene and reducing risk for pneumonia, best practices focused on implementing and sustaining an oral hygiene program in LTC facilities are lacking. The aim of this quality improvement project was to ensure that dependent residents in LTC receive assistance with daily oral hygiene by implementing an education program, verifying staff competency in provision of oral care, and developing a standard of practice (SOP) for oral hygiene with input form direct care staff. Specifically, a staff education program developed by a Veterans Health Administration (VHA) dental committee was used to provide education to nursing staff. Competency validation was then done while the nursing staff performed oral hygiene care as part of their resident-care assignment. Finally, nursing assistants were invited to develop of a standard of practice (SOP) document for an oral hygiene program specific to their facility. Future plans for dissemination include a presentation of the nursing assistant developed oral hygiene program SOP and identified best practices during the National Nursing Assistant Culture Change Collaborative, as well as, the Office of Nursing Services Gerontological Nursing Field Advisory Committee and the Associate Chief Nurse LTC Steering Committee monthly calls for consideration as a national oral hygiene SOP for all 135 VHA LTC facilities.