Non-Pharmalogical Behaviour Management Techniques - Student Copy PDF

Introduction to Non-Pharmacological Interventions Foundation in Clinical Skills Practice Intended Learning Outcomes AIM: To introduce students to non-pharmacological interventions used in behaviour management. By the end of the session, students will be: Describe common non-pharmacological inte...

Introduction to Non-Pharmacological Interventions Foundation in Clinical Skills Practice Intended Learning Outcomes AIM: To introduce students to non-pharmacological interventions used in behaviour management. By the end of the session, students will be: Describe common non-pharmacological interventions used for behaviour management Reflect on how and when to use these techniques in the clinical setting 2 Assessment Formative Group discussions during lecture session Workbook Glossary of terms Summative OSCE – drawing on communication skills Clinical care Future Dental Therapy Effective and quality oral health care provision 3 CONTEXT FOR NON-PHARMACOLOGICAL INTERVENTIONS IN CLINICAL CARE 4 Definition Non-pharmacological interventions (NPIs) are techniques used to: Manage behaviour Instill positive attitudes towards oral health care and behaviours To ultimately improve oral health. Link back to Psychology in Clinical Practice, Pain management and communication lectures 5 Purpose – why? Signs of dental anxiety? Types of pain Poor behaviour management? examples? 6 Intervention Types 7 NON-PHARMACOLOGICAL INTERVENTIONS 8 Evidence-base and guidance  British Society of Paediatric Dentistry (Campbell et al 2011) updated Royal College of Surgeons Guidelines (2002).  Systematic review protocol on NPIs for managing dental anxiety (Anthonappa et al 2017)  Systematic review evidence demonstrated NPIs were effective at reducing mental distress in adults (Burghardt et al 2018). 9 Communication skills  OARS (open questions, affirmations, reflections and summaries)  Non-verbal skills  Language – age and patient appropriate (vs professional) – glossary of terms  Tone of voice The power is in the conversation 10 Communication with children and special needs patients 11 Tell – Show - Do 12 Activity 1 Apply the tell-show-do technique for: Placement of a fissure sealant for a 6 year old patient Injection of local anaesthetic for a 16 year old patient Root surface debridement for a 55 year old patient BPE for an adult patient with austism aged 30 years 13  Distraction Help shift patient’s focus from the procedure/environment that may be unpleasant to something/somewhere else more pleasant. 14 Guided imagery  Use visual imagery to distract a patient – think of a happy place Photo Credit: Lauren Stockham 15  Relaxation  Reduce anxiety with guided breathing techniques  ‘Just relax’ VS guide patient to take 5 deep breaths  There may be other ways that the patient uses to relax ie listen to music, have a conversation to find out. 16 Positive reinforcement  Acknowledge appropriate behaviour to increase it being repeated  Ignore inappropriate behaviour so as not to draw attention to it and discourage it being repeated. 17 Enhancing control  Patient’s can feel out of control during a dental visit therefore this can give back some control  Rehearse to gain your patients’ trust 18  Modelling  Learning by observation of someone important to them ie sibling, parent, favourite toy, tv character etc  Could form part of preparatory information ie video of dental visit Image credit: https://get.pxhere.com/photo/person-model-spring- fashion-catwalk-runway-footwear-fashion-show-39923.jpg 19 Structured time  Patients’ tolerance of a procedure can increase if they know how long it will take  ‘Just a bit more’ vs 5 seconds count down  Needs to be appropriate to patients’ development 20 Activity 2 Building on the previous activity scenarios, discuss what other techniques you could use in conjunction to the tell-show-do approach?: Placement of a fissure sealant for a 6 year old patient Injection of local anaesthetic for a 16 year old patient Root surface debridement for a 55 year old patient BPE for an adult patient with austism aged 30 years 21 When to apply NPI? Apply for first time clinical encounters? 22 How to apply? No single intervention works effectively in isolation – a combination of interventions is usually appropriate. Every patient is different therefore not appropriate for every situation. Some will be applied without thinking as is natural, however others need some more thought and conversation. 23 Other advanced techniques  Systematic desensitisation  CBT  Hypnosis  Clinical holding  …  More will be covered in Year 2 Psychology 24  Environment…  Do you notice any NPIs throughout the clip?  Reflect on the impact of the patients in the reception area… Video extract from Finding Nemo 25 Summary Non-pharmacological interventions: Context Evidence-base and guidelines Types How & when to apply Future Learning Dental Psychology in Year 2 Paediatric oral health care in Year 2 and 3 Clinical care 26 Workbook + glossary of terms  Complete table in workbook – add definitions, examples and situations for when you might use non-pharmocological interventions  Glossary of Terms to include language appropriate terms 27 References SCDEP Guidance Chapter 4 page 29: Scottish Dental Clinical Effectiveness Program (SCDEP). (May 2018). Prevention and Management of Dental Caries in Children, 2nd Edition. Available online: https://www.sdcep.org.uk/published-guidance/caries-in-children/ [Accessed 20 August 2021]. British Society of Paediatric Dentistry: Campbell C , Soldani F , Busuttil-Naudi A and Chadwick B. (2011). Updated of non-pharmacological behaviour management guideline. British Society of Paediatric Dentistry. Available online: https://www.bspd.co.uk/Professionals/Resources/BSPD-Guidelines [Accessed 20 August 2021] Earlier Guidance: Faculty of Dental Surgery. (2002) Non-pharmacological behaviour management. Royal College of Surgeons. [Available online: https://www.rcseng.ac.uk/library-and-publications/rcs-publications/docs/non-pharmacological-behaviour- management/ ] [Accessed 20 August 2021]. Systematic review adults Burghardt, S., Koranyi, S., Magnucki, G., Strauss, B. and Rosendahl, J. (2018) Non-pharmacological interventions for reducing mental distress in patients undergoing dental procedures: Systematic review and meta-analysis, Journal of Dentistry, 69 , pp. 22-31. DOI: https://doi.org/10.1016/j.jdent.2017.11.005. Systematic Review Protocol (not yet published?) – useful definitions Anthonappa RP, Ashley PF, Bonetti DL, Lombardo G, Riley P. Non‐pharmacological interventions for managing dental anxiety in children. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD012676. DOI: 10.1002/14651858.CD012676. 28