NICHE: Nurses Improving Care for Healthsystem Elders

Troy Brown, RN


October 21, 2016

In This Article

NICHE: Nursing Practice Empowerment

Nurses Improving Care for Healthsystem Elders (NICHE; pronounced "nitch") is a program that is helping hospitals and healthcare organizations improve the way in which they care for older adults. The NICHE program emphasizes evidence-based practices, including prevention and management of delirium, falls, pressure ulcers, adverse medication events, and urinary incontinence.

"We bring evidence-based resources to nurses and other providers that they can use to improve their practice. We're significantly focused on care of older adults. We have this principle that nurses should be in charge of their practice, and it's about being leaders of nursing care inside an organizational setting," Mattia J. Gilmartin, PhD, RN, executive director, NICHE Program, New York University (NYU) Meyers College of Nursing, New York City, told Medscape Nurses.

Patient-centered care and the prepared environment figure heavily in the NICHE program's approach to geriatric care. The prepared environment includes senior-friendly lighting, flooring, fixtures, furniture, and beds. Frequent medical review, early rehabilitation, and early discharge planning are also key components of the NICHE program.

"We focus on frontline staff nurses to build their clinical expertise in geriatrics...[and] to empower them with knowledge and tools that they can apply to patient-centered care. We focus on common issues that older adults face when they're in the institutional setting—functional decline, prevention of delirium, identification of poor nutrition or malnutrition," Dr Gilmartin explained. "We are looking at things that tend to go unnoticed oftentimes, but that have a big impact on their outcomes while they're hospitalized. There are specific things that nurses need to be on the lookout for, diagnose, and intervene on. I think that's really the power of the model," she added.

Geriatric Resource Nurse Model

"The core of the NICHE program is a role called the 'geriatric resource nurse (GRN) model.' The model is focused on frontline nurses, so it helps organizations develop a step-wise approach to system-wide improvement," Dr Gilmartin explained. "Nurses start leading improvement in care; it's about not only building the capability of the frontline nursing staff, but also having structures that recognize the care needs of older adults [and] attitudes that are supportive of the age-related changes that older adults have when they come in the care setting."

"Because the GRN is a network model of nurse-to-nurse peer coaching, one thing we recommend are daily rounds led by a GRN, so that there's someone who holds all of the information about the patient, is building care plans, and is looking for early signs of delirium or infection that are common complications," Dr Gilmartin said.

"A successful GRN program needs to address a diverse cohort of patients who are living longer with chronic illnesses, as well as utilize advances in medicine, pharmacotherapies, and technology. Furthermore, patients are often hospitalized for a short time and may be discharged home with complex needs," Marilyn Lopez, MA, RN, GNP-BC, geriatric nurse practitioner, Administrative Nursing Coordinator Geriatric Program, and NICHE coordinator, NYU Langone Medical Center, New York City, told Medscape Nurses. "Similar to other academic medical centers, we do everything required to provide a holistic approach in a concentrated amount of time to ensure that older adults with complex needs transition to posthospitalization safely. This is why these programs are so vital to our older adult population."

"NYU Langone Medical Center is a three-time Magnet recipient institution and also a NICHE exemplar site," Ms Lopez explained. "We have sustained our GRN model to serve as an interdisciplinary team resource to nurses, to ensure patient- and family-centered care. Our model of care is based on the premise that just like physicians, not all nurses have the knowledge base and skill to provide adequate care for the number of seniors that we're seeing in the medical center. Our GRN training advances the knowledge and skills of nurses to ensure that there's an interdisciplinary approach to producing best practice and quality outcomes every day," Ms Lopez explained.

The NICHE program improves the practice environment for nurses as well, because nurses have higher job satisfaction as they develop more confidence in the nursing care they provide for their elderly patients.[5]


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