The implementation challenges associated with multiple sites completing a long online survey have also not been studied. NICHE membership indicates your organizations dedication to improving the quality of care older adult receive. (314) 427-2500. The interprofessional team of workers of 10 units were trained in identifying frailty risk among their patients using the SPICES tool. We explored topics related to the NICHE practice model, including evidence-based practice, clinical leadership, care coordination and management. For example, the Institute for Healthcare Improvement (2018) is an entity that provides health care organizations with goal-oriented framework to create such solutions called the Quadruple Aim. BWH is pleased to provide Geriatric Resource Nurse (GRN) training on a monthly basis in the Center for Nursing Excellence. Capezuti et al. CVPH has taken a significant step in enhancing the care of older adults by adopting the Nurses Improving Care for Healthsystem Elders (NICHE) program. One of the goals of a scoping review is to provide researchers a method to explore a common phenomenon studied via multiple research questions and designs (Wilson, 2014). A limitation of this RCT was related to unequal training of nurses with NICHE education materials; more nurses completed geriatric nursing care training in the intervention group and a thorough description of the study design was lacking, specifically regarding randomization procedures. Resources for Nurses. 1625 Eye Street NW Patients with IUCs were followed for a 6-month period; days with an IUC totaled 16,105 for the 4,524 individuals in the sample. For example, NICHE nurses learn best practices regarding caregiver readiness and other important nursing considerations when preparing an older adult for discharge from an inpatient care setting. This model was also considered highly favorable among NICHE program hospitals, as 69% of hospitals reported it as excellent to very good (Mezey et al., 2004). Other aspects of worker job satisfaction and well-being also merit exploration for the differences between NICHE and non-NICHE facilities. Increase implementation of evidence based clinical practice. Third, recognizing the importance of well-coordinated transitions of care, the NICHE program positions nurses to lead patients and families to prepare for transitions. We promote wellness and preventive care for aging adults. In order to train nursing professionals to become geriatric care experts within the SAFE care model, the organization became a NICHE program member to gain training and leadership expertise in specialized older adult care. These nurses were trained with an institution-specific hybrid model including the training administered by the NICHE program. 4 The NICHE practice model supports exemplary nursing care by employing four major levers: the Geriatric Resource Nurse (GRN) role; practice standardization and clinical guideline use; coordinated care transitions; and a . We identified themes and trends in the publications as they related to (a) how the program influenced patient outcomes through specialized care of the older adult and (b) and provided an overview of implementation of the NICHE program across organizations as well as its impact on nursing professionals and the geriatric work environment. Enhance the nurse/patient relationship and patient satisfaction. By operationalizing the goals set forth by IHIs Quadruple Aim, health care organizations can design care delivery models to improve all patients experiences with health care services. Nurses are encouraged to obtain national certification as gerontological nurses to continue their professional development after completing the GRN educational modules (Boltz, Capezuti, Wagner, Rosenberg, & Secic, 2013c). Briefly, articles were included if they provided an analysis of NICHE-related data or organizational tools, validation of a specific NICHE tool or service, detailed account of NICHE program implementation, review of institution-specific NICHE program growth, impact of the NICHE program on older adult care within an institution, or provided expert opinion about the NICHE program. Nurses Improving Care for Healthsystem Elders (NICHE) is the leading nurse driven program designed to help hospitals improve care by providing principles and tools to stimulate a change in culture to achieve patient centered care for older adults. The future of NICHE and other programs geared toward improving care and outcomes of older adults and supporting interprofessional geriatric specialists in the workforce is itself critical for delivering sustainable care over time for older adults. Specialized Older Adult Care is the category that encompasses NICHE program-related literature that discusses patient outcomes resulting from specialized older adult care, the first objective of this study. Data were extracted from the articles prior to analysis (Supplementary Table 1). Studies using the GIAP survey also had low survey participation rates, with some as low as 10% of eligible staff. She favors entrepreneurial approaches and thrives in complex environments that require creative and flexible solutions. Overall, during the study duration, evidence-based CAUTI prevention methods were increased and CAUTI numbers were low in study units. Lastly, in all patient-centered studies involving NICHE facilities and organizational comparisons, assessing for disparities in outcomes based on Medicares social risk model will be critical as there is strong potential for these studies to capture where structural sources of health disparities occur within systems. A., Min, S. -J., & Capezuti, E. A. NICHE webinars focus on new, collaborative approaches to practice innovations promoting better outcomes for older adult patients. This article addresses the NICHE/GRN model and its implementation at Palomar Pomerado Health. NICHE is not yet a MeSH heading search term so we used a Boolean keyword search approach in collaboration with a medical librarian. Fox and colleagues (2017) examined perspectives of the geriatric nursing practice environment among registered nurses and practical nurses in teaching and nonteaching hospitals. Boltz et al. (, Bilyeu, K. M., Gumm, C. J., Fitzgerald, J. M., Fox, S. W., & Selig, P. M. (, Boltz, M., Capezuti, E., Bowar-Ferres, S., Norman, R., Secic, M., Kim, H., Fulmer, T. (, Boltz, M., Capezuti, E., Bower-Ferres, S., Norman, R., Secic, M., Kim, H., & Al., E. (, Boltz, M., Capezuti, E., Kim, H., Fairchild, S., & Secic, M. (, Boltz, M., Capezuti, E., Kim, H., Fairchild, S., & Secic M. (, Boltz, M., Capezuti, E., & Shabbat, N. (, Boltz, M., Capezuti, E., Shabbat, N., & Hall, K. (, Boltz, M., Capezuti, E., Shuluk, J., Brouwer, J., Carolan, D., Conway, S., Galvin, J. E. (, Boltz, M., Capezuti, E., Wagner, L., Rosenberg, M-C., & Secic, M. (, Boltz, M., Resnick, B., Capezuti, E., & Shuluk, J. The study by Wald and colleagues (2014a) employed a study design only useful in hospitals with electronic medical records and the cluster randomization did not yield comparison groups of adequate sizes. This is accomplished through education, clinical rounds, and consultation with the NICHE program (Mezey et al., 2004). The fourth component of the NICHE model is centered on providing older adults with a population-focused care environment, set forth in the Acute Care of the Elderly (ACE) unit model. However, while the NICHE program appears to facilitate implementation of interventions, there are too few outcomes focused studies from which to draw conclusions. The researchers retrospectively analyzed associated data regarding training of the interprofessional team, frailty assessment and workflow along with details of the intervention. Develop incentives and improve morale for nurses caring for the older adult. Try looking up a doctor, a clinic location, or information about a condition/treatment. . This core measure generates baseline and (after implementation) comparable data for NICHE member organizations to assess the geriatric practice environment and then guide clinical improvement projects (Capezuti et al., 2012). (2013) included all participants in NICHE who had completed a survey during a 3-year period, but only emphasized the development and testing of the benchmarking methodology and did not include further reliability and validity analyses. The next step of the full text screen involved excluding editorial pieces or opinion papers about NICHE. NICHE also offers a course for PCAs. The GRN serves as the gerontological nursing expert to assist other clinicians in assessment, care provision, and care coordination. NICHE (Nurses Improving Care for Healthsystem Elders) is the leading nurse-driven program designed to help hospitals and healthcare organizations improve the care of older adults. Many organizational-level interventions are aimed at improving older adult care; the NICHE program is among the oldest evidence-based programs (NICHE, 2019). It provides the clinical leadership of NICHE member organizations with tools, strategies, and resources to assist teams to think critically and strategize to develop a system-wide program for improving care for older adults (NICHE, 2019). Nurses were qualitatively interviewed in only three studies, limiting the ability to draw conclusions about the lived experience of a nurse caring for the older adult (Boltz et al., 2011b; Dillworth et al., 2016; Fitzpatrick et al., 2004). NICHE membership is only available to facilities that provide care. Eleven studies examined the use of specialized geriatric nursing care in NICHE hospitals (Boltz et al., 2008b; Boltz et al., 2013b; Boltz et al., 2013c; Dillworth et al., 2016; Fitzpatrick et al., 2004; Fox, Sidani, Butler, & Tregunno, 2017; Mezey et al., 2004; Meako et al., 2011; Pfaff, 2002; Rosenfeld, Kwok, & Glassman, 2018; Wallace, Reiner, Grossman, Lange, & Lippman, 2006). Currently, there are approximately 500 NICHE-member hospitals and post-acute care organizations in the U.S., Canada and Singapore. The 2023 NICHE Conference highlighted clinical innovations and new research in the care of older adults. The study included 25 units at 20 NICHE hospitals. The GRN model emphasizes specialized geriatric care education and consultation. Ansryan and colleagues (2018) found that nurses identified a decline in functional status in half of all study participants. "The principles of the 4Ms were being done. NICHE's positive impacts on patient, staff and organizational outcomes are well documented.7 For example, evidence shows that implementing NICHE resulted in decreases in restraint use and hospital-acquired urinary incontinence as well as increases in nurse satisfaction caring for older adults and a marked improvement in the overall nursing practice culture.8 Similarly, other NICHE members have reported clinical and organizational outcomes associated with NICHE including reduced falls, improved patient satisfaction, decreased use of inappropriate medication, improved cultural competence, improved detection and management of delirium, decreased lengths of stays and associated costs, and reductions in avoidable staff turnover.9 As Terry Fulmer, PhD, RN, noted during a recent IHI National Nursing Home Huddle, NICHE is the backbone of Age-Friendly Health Systems, and its long-standing success makes it an obvious choice for organizations seeking to provide the best possible care to older adults. An RCT by Wald et al. For more information about the NICHE Program at Addison Gilbert, BayRidge and Beverly Hospitals, please call Shirley Conway, MSN, MBA, RN-BC . Notably, geriatric nursing knowledge was superior in institutions that valued specialized older adult care. This methodology, therefore, proved suitable to meet the aims of this study. NICHE is headed by Mattia J. Gilmartin PhD, RN, FAAN. McKenzie et al. For Those Who Work in Catholic Health Care, https://acl.gov/sites/default/files/Aging%20and%20Disability%20in%20America/2019ProfileOlderAmericans508.pdf, http://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Pages/default.aspx. A presence of two or more risk factors including skin integrity, problems eating, incontinence, confusion, evidence of falls, and sleep disturbance was associated with high frailty risk in older adults. Geriatric nurses are also in high demand due to an aging population. Stay Informed. The Author(s) 2019. Once registered, all NICHE courses are available to BWH nurses. Differentiating the effects of Magnet status and the NICHE program warrant investigation. For more information about these cookies and the data Results confirmed that the electronic surveillance system was feasible; however, no statistically significant findings were generated due to the very low standardized incidence rates at baseline for the organizations involved in the study. (2012) that studied the perspectives of NICHE hospital chief nursing officers regarding nonpayment for hospital-acquired conditions. Pfaff (2002) showed that implementing the GRN model resulted in a significant culture change within in an institution regarding specialized older adult care. Furthermore, Burhenn, Ferrell, Johnson, & Hurria (2016) demonstrated that providing specialized geriatric care education and training improves nurses knowledge about caring for older adults with cancer. A., Guan, C., Cortes, T., & Galvin, J. E. (, Burhenn, P. S., Ferrell, B., Johnson, S., & Hurria, A. The Nurses Improving Care for Healthsystem Elders (NICHE) is a nurse-led education and consultation program designed to help health care organizations improve the quality of care for older adults. Forty-three articles met the final inclusion criteria. Using a content analysis, the researchers identified four thematic categories in the research: specialized older adult care, the geriatric resource nurse model, work environment, and NICHE program . Upon gaining membership, your hospital or long-term care facility will receive access to resources and tools to implement the NICHE program and achieve and sustain better care and outcomes for older adult patients. Many of the observational studies were unable to account for confounding factors such as patient acuity, nurse staffing ratios, unit culture or hospital characteristics. (6.1) in the hospital. collected, please refer to our Privacy Policy. Any disagreements regarding quality were addressed and reconciled by these two individuals. Improvements in the geriatric nurse work environment as measured by perceptions of the practice environment, quality of care, and aging-sensitive care delivery have been reported. I, Catherine O. DAmico, believe that I have no financial or personal conflict of interest as it relates to this article. For health care professionals, and in particular nurses, the NICHE program helps organizations address key issues that affect worker job satisfaction and influence organizational turnover. In 2022, she was named an American Academy of Nursing Edge Runner for her contributions to improving nursing care for older adults. Common strengths of the RCTs included having study designs with a comparison group as well as strong statistical analyses. Finally, we were unable to systematically capture unpublished documents about the program, an additional limitation. Personal details Dolors Selis i Masnou, born in Vidreres (Catalonia) on 15th December 1967 Academic background Graduate of Law of Universitat Oberta de Catalunya (June 2005), specialised in business law Graduate of Translation and Interpretation of Universitat de Vic We use cookies and other tools to enhance your experience on our website and The American Nurses Credentialing Center offers three voluntary certification options in gerontological nursing. General Information: Nurses Improving Care for Healthsystems Elders (NICHE) can enable nurses to do just that. The majority of the analyses were conducted in urban settings, limiting generalizability to rural health settings. Educational Opportunities within the first year of employment include: CPR, NICHE Geriatric Resource Nurse (GRN) Course, Stroke Boot Camp, Charge Nurse and Nurse Preceptor Training. Approximately 240 HHC nurses will receive the "Intro to Gerontology" course curriculum, 120 will become Geriatric Resource Nurses who will mentor and influence 1200 others, 40 RNs are expected to become certified Geriatric Specialists, and a dozen senior nurses will participate in the NICHE Leadership Training Program. More analyses of patient outcomes or claims data linked with NICHE survey data are needed and have the potential to provide new insights into the patient-level impact of the program. Conference schedule, presentations, and photos can be found here. Health care organizations will need to employ a variety of programs and strategies specifically aimed at addressing the needs of their older adult clients. to analyze our web traffic. By linking NICHE survey data with human resources data, researchers could examine the effects of turnover rates on nursing and health care. The evidence reflected a common bias found in research publications as no negative results were found in any of the studies. Articles were excluded from the review after abstract screening as they were irrelevant to the topic or did not fit the listed inclusion criteria. B. The Nurses Improving Care to Healthsystem Elders (NICHE) geriatric resource nurse (GRN) model is a proven framework to prepare acute care hospital registered nurses to care for this special population of older adults. In a retrospective analysis by Boltz and colleagues (2013b), 76% of NICHE hospitals reported having a GRN model to provide geriatric assessment and specialized care. Keeping in mind the principles of conducting a scoping review, articles were considered for the study based on a broad array of inclusion criteria (Table 1). Connect with us. GRNs function in all types of units that have older adults, including medical-surgical units, specialty units, and critical care areas. Our findings inform future directions for implementing organizational-level solutions that, for example, could be tailored to meet the Quadruple Aims goals in ways that specifically improve the older adult care delivery (Bodenheimer & Sinsky, 2014). In addition, none of the studies accounted for hospital or individual nursing unit culture that might affect perceptions of geriatric nursing care. The average number of nurses reported national certification in gerontological . Nurses in this role serve as peer mentors, change agents and leaders in person-centered interdisciplinary care planning aimed at ensuring excellent care for older adults.5 The Geriatric Patient Care Associate (GPCA) and Geriatric Certified Nursing Assistant (GCNA) roles empower unlicensed nursing personnel in a similar fashion to the GRN. Get Care Services Geriatrics Aging adults have special healthcare needs. NICHE scoping review PRISMA flow diagram. (, Dillworth, J., Dickson, V. V., Mueller, A., Shuluk, J., Yoon, H. W., & Capezuti, E. (, Fink, R., Gilmartin, H., Richard, A., Capezuti, E., Boltz, M., & Wald, H. (, Fitzpatrick, J. J., Salinas, T. K., OConnor, L. J., Stier, L., Callahan, B., Smith, T., & White, M. T. (, Fox, M. T., Sidani, S., Butler, J. I., & Tregunno, D. (, Fulmer, T., Mezey, M., Bottrell, M., Abraham, I., Sazant, J., Grossman, S., & Grisham, E. (, Gardner, J. K., Thomas-Hawkins, C., Fogg, L., & Latham, C. E. (, Guthrie, P. F., Edinger, G., & Schumacher, S. (, Hu, S. H., Capezuti, E., Foust, J. Opportunities if you pursue a higher degree or certification: Nurses who get an advanced degree have the chance to become a Geriatric Nurse Practitioner or a Geriatric Clinical Nurse Specialist, and may be able to move into leadership or managerial positions easier. NICHE = Nurses Improving Care for Healthsystem Elders. ANCC Gerontological Nursing Certification nursingworld.org; PIH Health 562.698.0811. 2001; 101:62. Many NICHE hospitals have achieved Magnet designation and already have high quality practices in place, potentially enhancing the implementation of the geriatric nurse practice environment. 9719693 Abstract The geriatric resource nurse model of care is an innovative and effective method of integrating high quality, evidence-based geriatric nursing care into a clinical practice setting. The American Nurses Credentialing Center (ANCC) Certification Program will give you the opportunity to advance your nursing career and prove your ability to provide the best patient care. For older adult patients, the NICHE program potentially offers improved quality and experiences of individuals seeking care at facilities participating in the NICHE program, thus meeting the patient-centered goals of the Quadruple Aim. In 2020, she was a Health and Aging Policy Fellow and an American Political Science Association Congressional Fellow, contributing her expertise on care coordination and change management to senior leaders at the Administration for Community Living and the Center for Medicare and Medicaid Innovation. All rights reserved. To date, there are 580 acute care hospitals that are NICHE program members in the United States, Singapore, Canada, Mexico, and Bermuda (Squires, Caceres, Bub, & Negrete Redondo, 2019; Stimpfel & Gilmartin, 2019). The Catholic Health Association of the United States. This review will help determine directions for future research across contexts. Both qualitative and quantitative approaches have contributed to explaining how the NICHE program is implemented, adopted and refined across organizations. Members of the NICHE program gain access to evidence-based resources, tools and education housed in the NICHE Knowledge Center, an online learning management system. Top Girona Traveller Resources: See reviews and photos of traveller resources in Girona, Spain on Tripadvisor. An exploratory assessment of this kind has potential to inform future research seeking to evaluate patient outcomes and impact on participants and organizations of the NICHE program. Research on specialty certificationwhich the GRN model is a form offurther supports the potential impact adopting the model could have on patient outcomes (Aarons et al., 2014; Gardner, Thomas-Hawkins, Fogg, & Latham, 2007; Stalpers, de Brouwer, Kaljouw, & Schuurmans, 2015). American Journal of Nursing. (2011) found that nurses in tertiary hospitals were likely to have higher scores on the geriatric nurse practice environment scales, which highlights the importance of the care setting in addition to the age and experience level of nurses. This study highlighted important factors to consider when health care organizations seek to introduce novel approaches to delivering care, especially related to specialized older adult care. Wallace and colleagues (2006) highlighted that a specialized geriatric nurse education program was useful in improving nursing knowledge about the prevalence of incontinence, sequalae of constipation and causes of sepsis in older adults. (, Tavares, J. P. de A., & da Silva, A. L. (, Tavares, J. P. de A, da Silva, A. L. Sa-Cauto, P., Boltz, M. B., & Capezuti, E. A. The NICHE program has a promising evidence base to meet the goals of initiatives like the Quadruple Aim, though more research within the NICHE network is critical for helping health care organizations to meet goals and improve outcomes. NICHE resources include online educational programs, methodologies, evidence-based tools, and platforms to foster collaboration with NICHE mentors and other NICHE hospitals. A scoping review of the literature was conducted to capture the evidence about the NICHE program. (2016) included an intention to treat analysis. Keywords used were: Nurses Improving Care for Healthsystem Elders (Anywhere) and Nurses Improving Care for Healthsystem Elders (Topic). The Introduction to Gerontology curriculum is part of the NICHE Core Curriculum, which also includes the Geriatric Patient Care Associate (GPCA) curriculum for patient care associates and the Geriatric Resource Nurse (GRN) curriculum for clinical nurses. Institute for Healthcare Improvement, "Age-Friendly Health Systems: Guide to Using the 4Ms in the Care of Older Adults," 2019, Linda Bub et al., "The NICHE Program to Prepare the Workforce to Address the Needs of Older Patients," in. Critical appraisal of each of the articles was conducted by two of the researchers on this review. NICHE is an organizational membership program that aims to improve the care of older adults across the health care continuum. Additionally, defining the dose and duration of NICHE will be another critical component of discerning the broader impact of the program on patient outcomes. To register for the course, emailSusan Lee, PhD, RN, CNP. A benchmarking study by Capezuti et al. Practical nurses rated the quality of care provided and the geriatric nursing practice environment higher than registered nurses, which may be related to differing acuity levels of patients cared for between the two groups. Promote the effectiveness of the interdisciplinary team. There are an estimated 5.3 million Americans with Alzheimer's disease, and as the population ages, that number is expected to reach 7.7 million by the year 2030. Geriatrician. (Geriatr Nurs 2002;23:121-7) The complexities of geriatric care in the hospital setting have been well-documented.1, 2, 3 Estimates suggest that more than 40% of all hospital beds in this country are occupied by people older than 65, with close to 60% of all critical care beds so occupied. Mattia Gilmartin is the Executive Director of the Nurses Improving Care for Healthsystem Elders Program (NICHE) of New York University Rory Meyers College of Nursing, a 500-member organization whose mission is to create age-friendly healthcare services for 48 million older adults in the U.S. Dr. Gilmartins research, published in high-impact journals, spans the boundaries of nursing and management, and advances understanding of leadership competencies for planned organizational change, voluntary turnover, innovation, and entrepreneurship. 7.0 CE credits are available for registered nurses. After implementation of the NICHE program, perceptions of the nursing practice environment, quality of care, and aging-sensitive care delivery scores all significantly improved. Washington, DC 20006 Sharing information on nursing units during huddles and other meetings. Patients age 65 and older often have complex health care needs that need to be addressed with specialized care promoting function, autonomy and dignity. This course is for RNs and LPNs who are enrolled in the MySTEPP program with UPMC Senior Communities or are staff at UPMC McKeesport or UPMC East. Geriatric Resources in acute care hospitals and trauma centers. Copyright 2010 Mosby, Inc. One study examined the testretest reliability of this instrument (Boltz et al., 2009b). She holds a bachelors and masters degree in nursing and an MBA from the University of San Francisco, and a PhD degree from the University of Virginia School of Nursing, which named her its 2018 Distinguished Alumna. As an organizational intervention, cost analysis studies will also contribute to an integral part of future research about NICHE. Overall, authors of the studies evaluating NICHE were positive about the program and its impact. Geriatric resource nurses perform numerous functions, including the following: Rounding on patients to share knowledge with peers and improve patient care. Similarly, Rosenfeld, Kwok, & Glassman (2018) surveyed trained GRNs opinions, attitudes, and perceptions of geriatric care nursing practice and specifics regarding the training they received, overall satisfaction, and support from nurse managers. The validity of the 131-item instrument has not been examined. In 2016, 73% of CVPH's medical/surgical . Articles presented in this section examine how the NICHE program helped member sites improve the care of hospitalized older adults by addressing issues that directly impact this population. The NICHE program gives nurses and other members of the health care team the knowledge and resources needed to help meet the specialized needs of hospitalized older adult patients and their families.
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