September 4th, 2012 at 10:00 am
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NICHE program helps hospitals care for elders

by Dorian Martin

Mom was hospitalized several times during the two years that I served as her caregiver. I found that both hospitals where she was admitted were not set up to adequately serve the needs of an elderly patient, much less one who had Alzheimer’s disease. As a result, I’ve worried about which of the area hospitals to select if Dad experiences a major health issue. But my decision was made much easier when I read that one of our local hospitals has earned a special designation for improving care for older adults.

The designation, entitled Nurses Improving Care for Healthsystem Elders (NICHE), was established in 1992 by the Hartford Institute for Geriatric Nursing at New York University’s College of Nursing. This initiative seeks to improve the care of older adults who are hospitalized, through systematic changes of nursing practices. Approximately 300 hospitals in North America have received this designation.

4 principles of NICHE program

NICHE’s guiding principles derive from gerontology and are based on research with patients, families, clinicians and administrators:

  1. Evidence-based geriatric care at the bedside. Best practices focus on preventing and managing pain, pressure ulcers, adverse reactions to medication, delirium and urinary incontinence. Additionally, the model works to prevent falls.
  2. Patient/family-centered environments. Hospitals strive to create physical and social environments that address the needs of elderly patients and their families. The physical setup should make it easier for patients to get around, with a focus on enhanced lighting, flooring, furniture, fixtures and beds. The social atmosphere grows from respectful communication, therapeutic interaction and individualized interventions to lessen patient anxiety and stress.
  3. Healthy and productive practice environment. This model allows patients to have a say in their care. Interdisciplinary teams work toward comprehensive and effective care, providing access to geriatric-specific resources.
  4. Multi-dimensional metrics of quality. These measures include the satisfaction levels of patients, families and staff, as well as cost efficiencies and compliance with regulations.

NICHE models focus on supporting elders

NICHE offers two nursing care models for hospitals. The Geriatric Resource Nurse Model, considered the foundation of the program, prepares staff nurses to be clinical resources concerning geriatric issues. Training covers how to identify and address specific geriatric issues such as falls and confusion. Nurses learn strategies to limit the use of restrictive devices while encouraging patient mobility. Hospitals have tried this type of model in various specialty areas, including critical care, oncology and emergency departments.

Another model — the Accurate Care of the Elderly Medical-Surgical Unit — includes environmental adaptations such as flooring to decrease visual glare and noise, enhanced lighting, clocks and calendars in patient rooms, and communal areas for activities and meals. The nursing staff receives training to develop special expertise in geriatrics, and an interdisciplinary team focuses on preventing geriatric syndromes.

In case a loved one needs to be hospitalized in the future, I’d encourage you to check the NICHE registry to see if any of your area hospitals have earned certification. This designation could make a hospital stay easier for both your elder and for you.

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