Development of oral simulators with oral diseases and symptoms for nursing oral assessment education

doi:10.21203/rs.3.rs-2465442/v1

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Development of oral simulators with oral diseases and symptoms for nursing oral assessment education

https://doi.org/10.21203/rs.3.rs-2465442/v1

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Background: This study aimed to investigate the effectiveness of the newly developed oral simulators with oral diseases and symptoms for nursing students’ oral assessment education to promote their collaboration with oral healthcare professionals after qualification.

Methods: The participants were first-year students (n=105) at a nursing school in Japan. Ten oral simulators with angular cheilitis, missing teeth, dental caries, calculus, periodontitis, hypoglossal induration, food debris, and crust formation were created by a team of dentists. After a 45-minute lecture programme for oral assessment performance with the Oral Health Assessment Tool (OHAT), the ability test with the simulators and the OHAT and the test feedback were conducted in a 30-minute practical programme. To evaluate the effectiveness of the programmes, questionnaire surveys regarding confidence and perceptions of oral assessment performance and ability tests with slides of oral images were conducted at baseline and after the programmes. A Wilcoxon signed-rank test was used to compare their baseline survey results with their postprogramme results.

Results: Ninety-nine students (94.3%) participated in this study. The results of the ability test with the simulators and the OHAT in the practical programme showed that the correct answer rates of assessing tongue, gingiva, present teeth, and oral pain were less than 40%. Their levels of confidence, perception, and ability of oral assessment performance were significantly higher after the programmes than they were at baseline (P<0.05). Their level of confidence in assessing the need for dental referral had the largest increase in scoring level from the lowest scoring level at baseline in the nine postprogramme assessment categories.

Conclusions: This study identified several problems with nursing students’ oral assessment skills and showed that oral assessment education with simulators might be effective in improvingtheir oral assessment confidence, perceptions, and performance.

Oral assessment

nursing student

oral simulator

Oral Health Assessment Tool

collaborative education

Elderly people with psychiatric diseases such as dementia are more likely to have severe oral diseases than healthy elderly people [1, 2], and the number of people with severe oral diseases will increase in the future as the number of people with dementia is expected to increase from 55 million in 2020 to 139 million in 2050 [3]. However, they have difficulty receiving oral treatment and oral healthcare services from oral healthcare professionals because of their lack of motivation and because of apathy, limited cooperation, low adaptability to new prostheses, fear of treatment, poor communication, and mobility difficulties [4–6].

A previous systematic review regarding advanced dental disease in people with severe mental illness suggested that their management should include oral assessment using standard checklists that can be completed by non-oral healthcare professionals [1]. Oral assessment tools have been developed and used to enable non-oral healthcare professionals to easily perform oral assessments [7, 8].

Nurses play an important role in caring for such patients and performing oral assessments, dental referrals through physicians, and collaborative oral healthcare practices with oral healthcare professionals [9–11]. A previous study reported that their higher oral assessment performances were more likely to encourage their patients to see a dentist [11]. Therefore, nursing students should be educated about oral assessment performance to promote their oral assessment performance for patients, dental referral, and collaborative oral healthcare with oral healthcare professionals after their qualification.

However, some studies reported that nurses had limited oral healthcare knowledge and inadequate understanding of the crucial elements of an oral health assessment [11, 12]. In addition, a recent study reported that nursing students could not perform student-on-student and patient-based training in oral assessment and healthcare owing to the risk of SARS-CoV-2 transmission [13]. This problem may have a negative impact on nursing students’ oral assessment performance and collaboration with oral healthcare professionals after their qualification.

To tackle those problems, oral simulators with oral diseases and symptoms were developed for nursing oral assessment education. There have been few studies regarding the use of oral simulators for nursing oral assessment education, although some studies have reported that nursing students’ oral assessment performance was improved by interprofessional education and collaborative education between nurses and oral healthcare professionals [14–16].

This study aimed to investigate the effectiveness of the developed oral simulators with oral diseases and symptoms for nursing students’ oral assessment education to promote their collaboration with oral healthcare professionals after qualification.

Design and sample

This study was a before–and-after survey study with oral simulators which simulated oral disease and symptoms. The participants consisted of first-year nursing students (n = 105) from a nursing school in Fukuoka City, Kyushu Island, southwestern Japan. The school had a 45-minute lecture and 30-minute practical programme of oral assessment performance for first-year students in the Bachelor of Nursing curriculum. The practical programme included student-on-student oral assessment training before 2019; however, it was discontinued in 2020 and 2021 owing to the risk of SARS-CoV-2 transmission infection and was replaced by a new programme with oral simulators and the Japanese version of the oral health assessment tool (OHAT) [17] in 2022. The lecture and practical programmes were conducted on 12 and 19 October 2022, respectively (Fig. 1). To evaluate the effectiveness of the programmes, questionnaire surveys regarding confidence and perceptions of oral assessment performance and ability tests with slides of oral images and the OHAT were conducted at baseline, after the lecture programme, and after the practical programme (Fig. 1).

Oral simulator with oral diseases and symptoms

Ten identical oral simulators with missing teeth, dental caries, calculus, periodontitis, induration of the sublingual region, food debris, and crust formation on the palate (Fig. 2) were made by 2 dentists who were affiliated with the section of geriatric dentistry in a dental school that was in the same school cooperation as the nursing school. The simulators had 3 dental caries (26, 36, 37) and 5 missing teeth (12, 21, 25, 27, 35). Induration of the sublingual region and crust formation on the palate were made from resin, and food debris was made from cotton with yellow ink. Artificial dental calculus (Nissin Ltd, Tokyo, Japan) was placed on the entire mandibular lingual teeth. The simulators were wrapped in artificial oral mucosa (Nissin Ltd, Tokyo, Japan) with red ink on the left side of the angle of mouth as angle cheilitis, set in the manikins, and attached to the hospital bed table (Fig. 3).

Lecture and practical programmes

The 45-minute lecture programme was conducted by a dentist who belonged to the nursing school and whose profession was preventive dentistry. The dentist instructed the students on oral assessment performance with the OHAT while following the manual to the nursing students. The OHAT has eight assessment categories, lip, tongue and tongue coating, gingiva and oral mucosa, saliva, present teeth, removable dentures, oral cleanliness, and oral pain, and the oral status is scored as 0 (healthy), 1 (changes), or 2 (unhealthy) in each assessment category [7]. Following the category, there is the assessment of the need for dental referral as the ninth category, and it is scored as 0 (no need) or 1 (need). The OHAT sheet was used in the oral assessment education at the school because there are images of oral diseases and symptoms on the sheet to facilitate assessment by non-dentists and because it is the assessment category that is used for the need for dental referral.

In the practical programme, the participants were divided into 3 groups: an oral assessment and healthcare group and 2 other basic nursing care groups. Every 60 minutes, they were rotated. The 30-minute oral assessment and 30-minute oral healthcare performance programmes were conducted by the dentist and 3 nurses. First, an ability test of oral assessment performance with the simulators was conducted in subgroups of three to four students. The students in the subgroup, one by one for 5 minutes each, assessed the oral simulator with a dental mirror and the OHAT sheets. After finishing the assessments in all subgroups, the feedback of the test was conducted with the instructors. In the feedback education, by checking correct answers and reassessing the simulator, they were taught that if they missed patients’ oral diseases or symptoms in the assessment, then the patients’ oral disease might worsen and affect their systemic health and quality of life. After the oral assessment programme, the oral healthcare programme was conducted.

Ability tests with the oral simulator and slides of oral images

Tests using the oral simulator and slides of oral images were conducted to evaluate the students’ ability to assess oral status. OHAT sheets were distributed to the students before the tests.

The test with the oral simulator was conducted in the practical programme. First, they were asked the number of present teeth, excluding wisdom teeth, missing teeth, and decayed teeth, in the oral simulator and filled the numbers on a form. Then, they assessed the oral status of the simulators and scored 0, 1, or 2 in each assessment category on the sheet. After assessing the categories, they assessed the need for dental referral as no need (0) or need (1). The numbers for the correct answers were used to compare to the students’ responses.

In the ability tests with the slides, the eight images of oral status to assess each of the eight assessment categories were projected sequentially for 30 seconds on the LCD screen. During the projection of the images, the students assessed the images and scored them in each assessment category. After completing the assessment categories, they assessed the need for dental referral. The percentages of correct answers according to the oral assessment categories in the tests and the total number of correct answers (0–9) were calculated. The second and third tests with the slides were conducted in the same way as the first tests.

Structured questionnaires

The questionnaire was based on a previously developed questionnaire used in a previous study to investigate the effectiveness of oral assessment education programmes [16]. The questionnaire consisted of 3 parts: characteristics (sex and age), confidence in oral assessment performance, and perceptions regarding oral assessment.

Regarding confidence in oral assessment performance, they were asked about their confidence in assessing oral status in each oral assessment category. A 5-point Likert scale was used, allowing for confidence scores to range from 1 (no confidence) to 5 (strong confidence). A mean score of 3 points or more was considered to indicate confidence, and a score of less than 3 points was considered to indicate no confidence.

Regarding perceptions of oral assessment, they were asked about their level of agreement with the statements that (1) nurses can assess the oral status of their patients, (2) nurses should perform oral assessments, and (3) they hope to perform oral assessments. A 5-point Likert scale was used for strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree; the attitude scores ranged from 1 (strongly disagree) to 5 (strongly agree).

Cronbach’s alpha value was used to assess the reliability of the questionnaire. The Cronbach’s alpha values of the questionnaire in the domains of confidence and perceptions of oral performance were 0.811 and 0.933, respectively.

Data procedure

The questionnaire data were collected on 12 October, 19 October, and 24 November 2022, the oral simulator test data were collected on 19 October, and the data from the test with the slides were collected on 12 October before and after the lecture programme and 24 November after the practical programme (Fig. 1). The consent form was distributed to them before the lecture programme. They were informed about the research by the researchers and asked to sign the content form if they agreed to participate.

All the procedures involving human participants that were performed in this study were approved by the Ethics Committee of Fukuoka Gakuen, Fukuoka, Japan (approval No. 596) and were in accordance with the Ethical Guidelines for Clinical Research (the Ministry of Health, Labour and Welfare, Tokyo, Japan, No. 415 of 2008) and the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Statistical analyses

A chi-squared test was used to compare the correct answer rates of the ability test with the slides between baseline and postlecture, between postlecture and the practical programme, and between baseline and practical programme.

A Wilcoxon signed-rank test was used to compare the levels of confidence and perceptions of oral assessment performance between baseline and postlecture and between postlecture and the practical programme.

Data were analysed with 5% significance. The statistical analyses were performed using the IBM SPSS Statistics software program (Version 21.0; IBM Corporation, Armonk, NY, USA).

Ninety-nine students (12 male and 87 female students) participated in this study. The participation rate was 94.3%.

Table 1 shows the range and distribution of the number and score selected by the nursing students in the oral assessment ability tests with oral simulators in the practical programme. The numbers of present, missing, and decayed teeth selected by dentists (number of correct answers) were 23, 5, and 3, respectively, and the ranges of the numbers selected by the nursing students were 20–24, 1–8, and 0–7, respectively. The percentages of correct answers in present, missing, and decayed teeth were 83.8%, 66.7%, and 59.6%, respectively. In the assessment categories, more than 60% of the students assessed lip, saliva, oral cleanliness, and need for dental referral correctly; however, less than 40% assessed tongue and tongue coating, gingiva and oral mucosa, present teeth, and oral pain correctly. Approximately half of them selected a score of 0 (healthy) in the category of tongue and tongue coating, and 16.2% did so in the category of gingiva and oral mucosa, although the correct scores were 2 (unhealthy).

Table 1

Range and distributions of numbers and scores in the oral assessment ability tests with oral simulators
Number of teeth	CA^*	Range^**	Distribution of the selected number (%)
			<CA^*	CA^*	CA^*<
Number of present teeth	23	20–24	11.1%	83.8%^†	5.1%
Number of missing teeth	5	1–8	17.2%	66.7%^†	16.2%
Number of decayed teeth	3	0–7	38.4%	59.6%^†	2.0%
Assessment category	CA^*	Range^**	Distribution of the selected score (%)
			Score 0	Score 1	Score 2
Lip	1	0–2	7.1%	78.8%^†	14.1%
Tongue and tongue coating	2	0–2	49.5%	26.3%	24.2%^†
Gingiva and oral mucosa	2	0–2	16.2%	47.5%	36.4%^†
Saliva	2	0–2	14.1%	25.3%	60.6%^†
Present teeth	1	1, 2	0.0%	36.4%^†	63.6%
Removable dentures	0	0–2	88.9%^†	6.1%	5.1%
Oral cleanliness	2	1, 2	0.0%	10.1%	89.9%^†
Oral pain	0	0–2	28.3%^†	19.2%	52.5%
Need for dental referral	1	1	0.0%	100.0%^†	-
^*: correct answer determined by dentists
^**: range of numbers or scores selected by the nursing students
^†: percentage of correct answer

Table 2 shows the comparisons of the percentages and the mean number of correct answers in the oral assessment ability tests with slides between the baseline and postprogramme timepoints. Less than 60% of them correctly assessed lip, tongue and tongue coating, gingiva and oral mucosa, saliva, and removable dentures at baseline. The percentages of correct answers increased significantly in five assessment categories after the practical programme compared to baseline (P < 0.05). The mean number of correct answers also increased significantly after both the lecture and practical programmes (P < 0.05).

Table 2

Comparisons of percentages and mean number of correct answers in the ability tests with slides between the baseline and postprogramme timepoints
Assessment category	CA^*	Baseline (A)	After lecture (B)	After practical (C)	A vs. B	B vs. C	A vs. C
Assessment category		(%)	(%)	(%)	P value^**	P value^**	P value^**
Lip	2	52.5%	64.6%	70.7%	0.083	0.362	0.009
Tongue and tongue coating	1	59.6%	68.7%	54.5%	0.182	0.041	0.473
Gingiva and oral mucosa	2	46.5%	76.8%	80.8%	< 0.001	0.487	< 0.001
Saliva	2	41.4%	74.7%	83.8%	< 0.001	0.114	< 0.001
Present teeth	2	94.9%	97.0%	98.0%	0.470	0.651	0.248
Removable dentures	2	53.5%	63.6%	78.8%	0.149	0.019	0.000
Oral cleanliness	2	91.9%	97.0%	94.9%	0.121	0.470	0.389
Oral pain	2	61.6%	67.7%	75.8%	0.372	0.207	0.032
Need for dental referral	1	99.0%	100.0%	100.0%	0.316	-	0.316
		Baseline (A)	After lecture (B)	After practical (C)	A vs. B	B vs. C	A vs. C
		Mean ± SD	Mean ± SD	Mean ± SD	P value^†	P value^†	P value^†
Mean number of correct answers		6.0 ± 1.5	7.1 ± 1.2	7.4 ± 1.2	< 0.001	0.040	< 0.001
^*: correct answer determined by dentists
^**: chi-square test
^†: Wilcoxon signed-rank test

Table 3 shows a comparison of the nursing students’ confidence level in performing oral assessments according to assessment category between the baseline and postprogramme timepoints. The mean confidence levels were more than 3 in all assessment categories after the practical programme, although they were less than 3 at baseline. The level of assessing the need for dental referral was the highest in the assessment categories after the practical programme, although it was the lowest at baseline. The confidence levels were significantly higher in all assessment categories after both the lecture and practical programmes (P < 0.05).

Table 3

Comparisons of confidence level* of performing oral assessment between the baseline and postprogramme timepoints
Assessment category	Baseline (A)	After lecture (B)	After practical (C)	A vs. B	B vs. C	B vs. C
Assessment category	Mean ± SD	Mean ± SD	Mean ± SD	P value^**	P value^**	P value^**
Lip	2.8 ± 1.1	3.3 ± 1.0	3.7 ± 0.9	< 0.001	0.001	< 0.001
Tongue and tongue coating	2.5 ± 1.0	3.2 ± 0.9	3.4 ± 0.9	< 0.001	0.021	< 0.001
Gingiva and oral mucosa	2.5 ± 1.1	3.0 ± 1.0	3.3 ± 1.0	< 0.001	0.001	< 0.001
Saliva	2.3 ± 1.1	2.9 ± 1.1	3.4 ± 1.0	< 0.001	< 0.001	< 0.001
Present teeth	2.5 ± 1.0	3.1 ± 1.0	3.6 ± 0.9	< 0.001	< 0.001	< 0.001
Removable dentures	2.8 ± 1.3	3.3 ± 1.3	3.8 ± 1.0	< 0.001	< 0.001	< 0.001
Oral cleanliness	2.7 ± 0.9	3.0 ± 0.9	3.6 ± 0.9	0.002	< 0.001	< 0.001
Oral pain	2.7 ± 1.2	3.2 ± 1.1	3.6 ± 0.9	< 0.001	< 0.001	< 0.001
Need for dental referral	2.3 ± 1.0	3.0 ± 1.1	3.9 ± 1.0	< 0.001	< 0.001	< 0.001
^*: no confidence = 1 and strong confidence = 5
^**: Wilcoxon signed-rank test

Table 4 shows a comparison of nursing students’ perception level regarding oral assessment performance between the baseline and postprogramme timepoints. The mean perception levels were more than 4 in all categories after the practical programme, although they were less than 4 in four categories at baseline. The levels of nurses’ perception that they can assess the status of oral hygiene, dental caries, periodontal disease, and oral cancer were significantly higher after the practical programme than after the lecture programme (P < 0.05). The levels of nurses’ perception that they should encourage their patients with dental problems to see a dentist and that they hope to perform oral assessment and encourage patients with dental problems to see a dentist after qualification were significantly higher after the programmes compared to baseline (P < 0.05).

Table 4

Comparisons of perception levels regarding oral assessment performance between the baseline and postprogramme timepoints
Category	A: baseline	B: after lecture	C: after practical	A vs. B	B vs. C	A vs. C
Category	Mean ± SD	Mean ± SD	Mean ± SD	P value^**	P value^**	P value^**
Nurses can assess the status of oral hygiene in their patients.	4.0 ± 0.7	4.0 ± 0.8	4.2 ± 0.7	0.749	0.015	0.058
Nurses can assess the presence of dental caries in their patients.	3.5 ± 1.0	4.0 ± 0.9	4.3 ± 0.7	0.000	0.000	0.000
Nurses can assess the presence of periodontal disease in their patients.	3.5 ± 1.0	3.7 ± 0.8	4.0 ± 0.9	0.120	0.005	0.001
Nurses can assess the presence of oral cancer in their patients.	3.4 ± 1.2	3.6 ± 1.0	4.0 ± 1.0	0.177	0.000	0.000
Nurses should perform oral assessment to provide appropriate oral healthcare for their patients.	4.3 ± 0.9	4.3 ± 0.9	4.5 ± 0.7	0.610	0.112	0.350
Nurses should encourage their patients with dental problems to see a dentist.	4.2 ± 0.9	4.4 ± 0.8	4.5 ± 0.7	0.017	0.091	0.000
I hope that I perform oral assessment for my patients after qualification.	3.9 ± 0.9	4.1 ± 0.9	4.1 ± 0.9	0.012	0.873	0.008
I hope that I encourage patients with dental problems to see a dentist.	4.1 ± 0.9	4.3 ± 0.8	4.3 ± 0.8	0.001	0.635	0.029
^*: strongly disagree = 1 and strongly agree = 5
^**: Wilcoxon signed-rank test

This study is the first to develop oral simulators with oral disease and symptoms for nursing oral assessment education and to investigate the effectiveness of their use in nursing education.

Several problems regarding nursing students’ abilities in oral assessment performance in the test with the simulators were revealed in the present study. Approximately one-third of them could not count the correct number of missing teeth, and 40% could not count that of decayed teeth in the practical programme after the lecture programme. Dental caries is the main cause of tooth loss [18] and contributes to oral hypofunction [19], frailty [20], dementia [21], and pneumonia mortality [22] among elderly people. Therefore, they should be educated about counting them correctly so that they can refer patients with dental caries and missing teeth to dentists to provide dental treatment to the patients.

The oral simulators had an 8 mm diameter induration model on the sublingual region, and a score of 2 was selected in the assessment category of tongue and tongue coating. However, approximately half of them selected a score of 0, and the results indicated that they could not find induration. Oral mucosal cancer may appear as an indurated raised nodule, often with an ulcerated surface that may cause little pain [23]. The most common subsite of oral squamous cell carcinoma is the oral tongue, and the estimated frequency of oral tongue squamous cell carcinoma is 60% [24]. Therefore, they should be educated to have the ability to assess induration so that they can identify it and immediately refer the patient to a dentist after their qualification. In addition, the ability to assess the tongue and tongue coating was not improved significantly in the ability tests with the slides of oral images. Mild tongue coating on dorsum of tongue was in the oral image and they seemed not to be able to assess it correctly; therefore, the programmes should be improved so that they can assess tongue coating correctly.

The oral simulators had gingivitis in the whole maxillary and mandibular periodontal tissue. However, approximately two-thirds of the students could not correctly assess the components of the category of gingiva and oral mucosa, and approximately 16% of the students assessed the gingiva and oral mucosa as healthy. The results suggested that it might be difficult for them to assess the periodontal condition. Periodontal disease affects systemic diseases such as cardiovascular disease [25] and diabetes [26]. Therefore, programmes for the assessment of periodontal conditions should be enhanced using oral simulators, images, and real patients.

The simulators had a crust formation model on the palate. The students were taught in the lecture programme that it is caused by xerostomia and that the score in the assessment category of saliva is 2 [27]. As a result, approximately 60% of them could assess the category of saliva correctly. However, as it is impossible to measure the quantity of saliva in simulators, training programmes with images, videos, and real patients should be developed to enable them to assess the status of saliva in clinical settings.

Approximately half of the students assessed mannequins with normal facial expressions as unhealthy. The Wong-Baker Faces Pain Rating Scale is widely used to assess pain in children and elderly individuals because it is easy to understand, using a series of face images ranging from a happy face at 0, or "no hurt", to a crying face at 10 [28]. Therefore, the programmes including the use of the scale might be effective in improving the ability to assess oral pain.

Their abilities, confidence, and perceptions of assessing oral status and the need for dental referral were improved significantly through those programmes. A previous study showed that nurses’ positive oral assessment performances were associated with their positive encouragement of patients to see dentists [11]. Therefore, the improvements might contribute to promoting their oral assessment performance and dental referral for their patients in clinical practice after qualifications.

In Japan, the use of oral assessment tools by nurses was not widespread [11], and less than one-fourth of nursing schools in Japan conducted oral assessment education with the tools [29]. Therefore, it is suggested that oral healthcare professionals should support nursing assessment education to promote the students’ ability to correctly assess dental diseases and symptoms, make dental referrals, and provide collaborative oral healthcare with oral healthcare professionals. Dentists can make well-designed oral simulators with oral disease and symptoms as support for education.

There are several limitations associated with this study. First, as the participants were all first-year students, further studies are needed to continuously investigate whether the improvement of abilities, confidence, and perceptions regarding oral assessment performance can contribute to nursing students’ performances in clinical practice and after their qualification.

A control group was not included in this study because all students needed to take these programmes at the same time. A previous study reported that oral assessment education with both a lecture programme and a student-on-student programme was effective in improving abilities, confidence, and perceptions [16]. However, most students might have no severe dental diseases or symptoms in the present study. In addition, a recent study regarding nursing education reported that student-on-student training could not be conducted at nursing schools, including the investigated school, owing to the risk of SARS-CoV-2 transmission [13]. Therefore, it is suggested that oral assessment programmes with oral simulators may be more effective and useful for assessing oral diseases than student-on-student training under the current situation amid the spread of COVID-19.

The values of domains in the questionnaire of the present study were reliable, as a Cronbach’s alpha coefficient value of > 0.7 was considered reliable [30].

The effectiveness of oral assessment education programmes with oral simulators was investigated in only one nursing school in Japan. Therefore, further studies are needed to investigate those programmes in other populations to assess their effectiveness in other nursing schools worldwide.

This study identified several problems with nursing students’ oral assessment skills and showed that oral assessment education with simulators might be effective in improving their confidence, perceptions, and abilities in oral assessment performance. Further studies are needed to investigate those programmes in other populations to assess their effectiveness in other nursing schools worldwide.

OHAT

Oral Health Assessment Tool

Ethics approval and consent to participate

All procedures performed in studies involving human participants were approved by the Ethics Committee of Fukuoka Gakuen, Fukuoka, Japan (approval No. 596) and the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Written informed consent was obtained from all the students.

Consent for publication

This is not applicable.

Availability of data and materials

The datasets generated and/or analysed during the current study are not publicly available, as ethical approval was granted on the basis that only the researchers involved in the study could access the deidentified data however it can be available on reasonable request from corresponding author. The raw data have been stored securely at Fukuoka Nursing College.

Competing interests

All the authors declare no conflicts of interest.

Funding

The study was supported by Grants-in Aid for Scientific Research (JP 17K12001 and 21K10292) from the Japan Society for the Promotion of Science (KAKENHI).

Authors’ contributions

SH searched and reviewed the literature, analysed the data, and wrote the manuscript. TN and YU designed and created simulators with oral disease and symptoms and contributed to creation of the educational programmes. MM1, MM2, AN, YK and MK participated in the educational programmes and instructed the nursing students, assisted in finding documents and issuing the questionnaires, contributed to analysing the data, and examined the manuscript. HA and KK critically reviewed the manuscript and supervised the entire study process. All authors read and approved the manuscript.

Acknowledgements

Not applicable

Authors' information

SH, Dentist, Professor.

TN, Dentist, Professor.

HA, Nurse, Professor.

MM, Nurse, Associate professor.

AN, Nurse, Assistant Professor.

YK, Nurse, Assistant Professor.

MK, Nurse, Assistant Professor.

YM, Dentist, Associate professor.

KK, Nurse, Professor.

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No competing interests reported.

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Development of oral simulators with oral diseases and symptoms for nursing oral assessment education

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Abstract

Figures

Background

Methods

Design and sample

Oral simulator with oral diseases and symptoms

Lecture and practical programmes

Ability tests with the oral simulator and slides of oral images

Structured questionnaires

Data procedure

Statistical analyses

Results

Discussion

Conclusions

Abbreviations

Declarations

References

Additional Declarations

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