The health care of seniors differs from that of younger folks due to the physical changes that occur as the body ages, as well as complex emotional and social factors related to each individual’s perceptions and experiences throughout the aging process. The NICHE program has been adopted by several local hospitals to raise awareness of issues in the care of older people, establish protocols for their treatment, and improve staff competency for geriatric care. NICHE is an abbreviation for “Nurses Improving Care for Healthsystem Elders.” This concept was developed and tested throughout the 1990’s, and now boasts over 575 participating hospitals and healthcare facilities in 46 states, Canada, Bermuda, and Singapore.
The vision of the program is for “all patients 65 and over to be given sensitive and exemplary care” (www.nicheprogram.org). Organizations pay a fee to participate, and must complete a specific process in order to achieve NICHE designation and to progress through the various levels of the program. For other quality of care designations, facilities must demonstrate the achievement of certain standards of care before receiving the designation. The NICHE program provides resources and tools for organizations, interdisciplinary teams, and individual professionals to help improve the care provided to seniors throughout the implementation of the program. Through NICHE, patients and families also have access to educational materials that explain the realities of hospitalization and care transitions.
How is NICHE changing the care practiced by our local providers? PinnacleHealth Harrisburg and Community General Osteopathic Hospitals (CGOH) received their NICHE designations in the spring of 2013, and PinnacleHealth West Shore Hospital has already begun the process. Dawn Hippensteel, Gerontological Clinical Nurse Specialist at PinnacleHealth, has been coordinating the program for Harrisburg Hospital and CGOH. She reports that seniors over age 65 comprise 50-60% of CGOH’s adult patient population, and 40% of Harrisburg Hospital’s adult patient population. Staff nurses expressed a need for additional knowledge regarding issues that older adult patients experience; including sleep disturbances, incontinence, confusion, agitation, delirium, and dementia. Within one model of the NICHE program nurses can choose to complete 20 hours of education in these and other areas related to the care of seniors, and become Geriatric Resource Nurses (GRN) for their units. In this position, they are able to provide guidance and assistance on geriatric issues for all nurses on the unit.
PinnacleHealth’s goal is to have 25% of the nurses on the pilot units participate in the GRN training. Geriatric specific education is also available for patient care assistants (PCAs), and has been incorporated into PinnacleHealth’s required annual PCA education day. Various components of NICHE’s geriatric care education program have also become part of the general orientation program for all clinicians at these hospitals. In the ICU at CGOH, dramatic results were seen when NICHE protocols were combined with those of another program in the treatment of delirium. The use of physical restraints was reduced by 94% in the first six months, and patient length of stay in the ICU was also significantly reduced. Adapting to new evidence-based practices and standards of care for seniors is not a change that can occur overnight, nor will all changes demonstrate and sustain this level of success. Through NICHE PinnacleHealth will be working over the next three to four years to implement senior focused care throughout all of their hospitals.
Holy Spirit – A Geisinger Affiliate, achieved NICHE designation last year. With the pilot, three areas have been chosen for immediate focus; delirium, mobility, and falls. Holy Spirit Hospital also is utilizing a Geriatric Resource Nurse model. Ann Hendrickson, RN, Medical-Surgical Clinical Nurse Specialist, stated, “Our goal is to provide at least three registered nurses who will serve as geriatric resource nurses on each unit by 2016. We also plan to provide basic geriatric nursing education for all RNs.” PCA training will play an integral role in Holy Spirit’s NICHE program implementation. As the program expands throughout the hospital, the NICHE interdisciplinary team plans to work with each unit to develop goals which are specific to the needs of the staff and patients of the particular unit.
The unique needs of seniors in our community are being recognized by these health care organizations. An improved understanding by consumers of our health care system and the changes that are occurring allows individuals to better advocate for themselves and for their loved ones, which in turn can contribute to greater effectiveness for NICHE and other programs designed to promote quality care.
Karen Kaslow, RN