There are currently 45 geriatric resource nurses across 16 units with a push to eventually have one in every adult unit. The authors would like to acknowledge Mattia Gilmartin, PhD, MBA, RN, FAAN for her mentorship, guidance, and conceptual contributions to this review of the evidence about the NICHE program. The study included 25 units at 20 NICHE hospitals. Third, recognizing the importance of well-coordinated transitions of care, the NICHE program positions nurses to lead patients and families to prepare for transitions. 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. Furthermore, Boltz and colleagues (2013a) examined the relationship between fear of falling and physical function and found that a fear of falling was associated with change in physical function from admission to discharge. The eight-week NICHE Leadership Training Program introduces new members to the NICHE nursing practice model, in which clinical leaders identify opportunities to improve care of older adults by implementing evidence-based nursing interventions into daily clinical practice.6. 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. Copyright 2010 Mosby, Inc. NICHE is an organizational membership program that aims to improve the care of older adults across the health care continuum. As you age, you may develop illnesses that are common to your age group. A secondary analysis by Ansryan and colleagues (2018) sought to examine the important features of the SAFE model by using data from the RCT conducted by Borenstein and colleagues. Geriatrics | JPS Health Network The remaining themes (GRN Model, Geriatric Work Environment, and NICHE Program Adoption and Refinement) address the second objective of this review, which is to provide an overview of implementation of the NICHE program as well as its impact on nursing professionals and the geriatric work environment. In addition, NICHE offers gerontological review courses for both nursing and certified nursing associates. Sharing information on nursing units during huddles and other meetings. Fulmer T. The geriatric resource nurse. Capezuti et al. The Catholic Health Association of the United States. 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. All Rights Reserved. Ansryan and colleagues (2018) found that nurses identified a decline in functional status in half of all study participants. American Journal of Nursing. More information about the NICHE program and how to become a member is at www.nicheprogram.org, or contact us at support@nicheprogram.org. Geriatrician. This study highlighted a significant relationship between ANCC gerontological nursing certification and the time since GRN training was received. The mission of NICHE is to provide principles and tools to stimulate a . (, Abraham, I. L., Bottrell, M. M., Dash, K. R., Fulmer, T. T., Mezey, M. D., ODonnell, L., & Vince-Whitman, C. (, Ansryan, L. Z., Aronow, H. U., Borenstein, J. E., Mena, V., Haus, F., Palmer, K., Bolton, L. B. The GRN model applies a systematic and interprofessional approach to address common conditions and issues among older adults. In the face of a robust increase in the number of older adults globally, which is projected to continue to rise sharply over the next 50 years, organizational stressors will only increase. Intro: 0:25 Spooky Homeownership Mahfood Pink or Teal Sneaker Bevs Like These Headlines 6:36 Salt Lake City Nurse Update Szechuan Sauce Charlottesville Update Harvey Weinstein Spain/Catalonia Politics Round Up 45:39 Jemele Hill Update Trump v. NBC Pence Walks Out Trump v. Birth Control Trump's IQ Trump v. (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 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. B. 617-732-5500, Anesthesiology, Perioperative and Pain Medicine, Trainings are held on the 2nd Wednesday of each month from 4:00-6:00PM through May, 2016, Location: Center for Nursing Excellence, One Brigham Circle 4th Floor Suite 6. After one year of service, nursing staff may be eligible for additional compensation upon successful completion of the Core Geriatric Course. Develop a core group of nurses who serve as a resource to other staff. 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. 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. Pfaff (2002) showed that implementing the GRN model resulted in a significant culture change within in an institution regarding specialized older adult care. The lowest level-designation, RN-Board Certified, requires an RN license and a minimum of two years of experience, 2,000 clinical hours and 30 hours of continuing education in gerontological nursing within the past three years. 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). The GRN/GPCA practices in the role dimensions of: Patient Care, Peer Consultant, Educator, and Change Agent. Since the body of evidence about NICHE grows annually, the volume of studies may reach the point where a specific term is warranted. In 2016, 73% of CVPH's medical/surgical . We opted not to use a conceptual framework to structure the review since the NICHE program is multifaceted, organizations may be in various stages of implementation when disseminating their work, and no single framework would adequately capture programmatic dimensions. (2013) conducted a secondary data analysis of the NICHE database to describe the influence of hospital and nurse characteristics on nurse perceptions of how organizations aligned themselves with NICHE program principles. She favors entrepreneurial approaches and thrives in complex environments that require creative and flexible solutions. Promote the effectiveness of the interdisciplinary team. Nurses Improving Care for Healthsystem Elders (NICHE) imparts principles and tools to stimulate changes in clinical practice to achieve patient-centered nursing care for older adults in healthcare facilities. Provide optimal utilization of hospital services. Nurses are at the forefront of providing care to complex older adults in the United States and many countries globally. Leadership Training Program | NICHE in the U.S. incorporate Geriatric Resource Programs Mostly Level I Trauma Centers 17 of 26 Trauma Centers in PA are Geriatric Resource Program Sites (65%) Extent of incorporation of Geriatric Resource Programs unknown Maxwell, C., Mion, L, & Minnick, A. Both researchers conducted individual appraisal of the articles and then conferred with each other about the quality of evidence. In addition, the NICHE program also emphasizes education and practice development for front-line clinical staff through leadership training, mentorship and educational programming, which promotes the role of the clinician as paramount to implementing high quality care. Identification of frailty risk factors and problems specific to older adults resulted in the interprofessional team referring individuals for appropriate treatment and intervention. With regard to training nurses, about half of NICHE program hospitals provided formal training to those interested in becoming GRNs (Boltz et al., 2013c). One mixed methods study resulted in the creation of a framework for a model of geriatric acute care (Boltz et al., 2010a). TDD: 562.696.9267. We identified relevant articles through a multi-step process of database searches in the following key search engines: CINAHL Plus Full Text and MEDLINE Full Text through Ebsco, Journals@Ovid Full Text, ProQuest Central Full Text, Web of Science, and Embase via Ovid. The GRNs and GCNAs act as peer mentors, coaches, and quality champions to implement evidence-based clinical practices and guidelines into daily care routines. A., Guan, C., Cortes, T., & Galvin, J. E. (, Burhenn, P. S., Ferrell, B., Johnson, S., & Hurria, A. 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. (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. Registration is through HealthStream under BWH Nursing PCA NON CVM ONLY NICHE Class 2015. Days 2 and 3 will be scheduled for early 2016. For questions, contact a NICHE Program Coordinator. Established in 1992, NICHE (Nurses Improving Care for Health System Elders) is an initiative of the Hartford Institute for Geriatric Nursing. Our review illustrates the fruits of a unique retrospective of older adult care scholarship and the organizational and providers influences on care of hospitalized older adults. An RCT by Borenstein and colleagues (2016) studied 1,384 patients in a trial which examined the implementation of the Systems Addressing Frail Elder Care (SAFE) model, which is an interprofessional team-based program for specialized older adult care. Foundational evidence of this kind is useful in developing interventions surrounding prevention of decline in physical functioning. NICHE Scoping Review Inclusion Criteria for Abstract Screening. Final codes and themes were agreed upon by both researchers. 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. This study highlighted a significant relationship between ANCC gerontological nursing certification and the time . Patients age 65 and older often have complex health care needs that need to be addressed with specialized care promoting function, autonomy and dignity. We help you stay independent and improve your quality of life as you age. The Geriatric Institutional Assessment Profile (GIAP), exclusively for NICHE members, is a validated assessment to establish a baseline of nurses' knowledge, attitudes, and perceptions regarding the care . Finally, we were unable to systematically capture unpublished documents about the program, an additional limitation. Published by Oxford University Press on behalf of The Gerontological Society of America. (, Olrich, T., Kalman, M., & Nigolian, C. (, Resnick, B., Galik, E., Boltz, M., Hawkes, W., Shardell, M., Orwig, D., & Magaziner, J. Connect with us. GRN model is the foundation of NICHE Hospitals. St. Louis, MO 63134 The overall interprofessional team identified problems with mobility among the study participants. Stay Informed. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Descriptive and qualitative studies highlighted several important features of older adult care surrounding physical function. Six databases were searched to identify NICHE-related articles between January 1992 and April 2019. Many of the observational studies were unable to account for confounding factors such as patient acuity, nurse staffing ratios, unit culture or hospital characteristics. Suite 550 With regard to refinement of NICHE program-related care, Guthrie et al., 2002 revealed that GIAP survey results can help develop focused staff education, identify target patient outcomes, and support quality improvement initiatives within institutions. McKenzie et al. Finally, 43 original research articles were included in this review. (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. The nursing care of older adults with cancer aims to promote treatment tolerance, manage symptoms, maintain function, improve health, and enhance health-related quality of life (HRQOL), as well as to provide psychosocial support to patients and their family caregivers, many of whom are also older. Future research evaluating NICHE adoption at the organizational level would help determine barriers and facilitators to timely execution of the program. This literature includes older adults receiving cancer treatment, following hip fracture surgery, and those experiencing postoperative delirium and/or signs of dementia. Patient safety in medical-surgical units: Can nurse certification make a difference? 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 Resource Nurses Make a Difference in the Lives of Patients 65 Certification in the nursing course is associated with being a content expert in the field. 7.0 CE credits are available for registered nurses. UVM Health Network - CVPH - NICHE Designation The education consists of online modules that provide20 contact hours for free. 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. Conference schedule, presentations, and photos can be found here. (, 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. Health care systems serving older adults need organizational-level solutions to improve quality of care and patient outcomes. Nonetheless, as cost controls are an inevitable issue in 21st century health care delivery, these analyses are urgently needed to determine long-term viability of the model and its potential costs or savings to the health care system. Our review captures the evidence associated with efforts to provide organizational-level solutions address the unique needs of older adults that has emerged from the NICHE program. Senior Care Center in Jersey City, NJ - RWJBarnabas Health PDF Dolors Selis i Masnou, born in Vidreres (Catalonia) on 15th December 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. 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). Training of non-nursing health care professionals in the care of older adults was also largely missing from NICHE program-related studies. As an organizational intervention, cost analysis studies will also contribute to an integral part of future research about NICHE. The change project culminates with a presentation and summary report and portfolio submitted to the NICHE Member Recognition Program. In fact, there were 52.4 million adults over the age of 65 in 2018, an increase of nearly 14 million individuals in just 10 years. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (, Live Gerontology: Understanding and Representing Aging, Loneliness, and Long-Term Care through Science and Art, A Randomized Clinical Trial of Online Social Intelligence Training with Custodial Grandmothers, Dementia Caregivers Perspectives on Disaster Preparedness: Barriers, Resources, and Recommendations, Managing Complexity: Black Older Adults with Multimorbidity, nurses improving care for health system elders, About The Gerontological Society of America, Institute for Healthcare Improvement (2018), Squires, Caceres, Bub, & Negrete Redondo, 2019, Boltz, Capezuti, Wagner, Rosenberg, & Secic, 2013c, Bilyeu, Gumm, Fitzgerald, Fox, & Selig, 2011, Boltz, Resnick, Capezuti, Shabbat, & Secic (2009b), Boltz, Resnick, Capezuti, & Shuluk, 2013a, Wald, Bandle, Richard, Min, & Capezuti, 2014a, Wald, Bandle, Richard, Min, & Capezuti, 2014b, Wallace, Reiner, Grossman, Lange, & Lippman, 2006, Burhenn, Ferrell, Johnson, & Hurria (2016), McKenzie, Blandford, Menec, Boltz, & Capezuti, 2011, Tavares, da Silva, Sa-Cauto, Boltz, & Capezuti, 2013, Boltz Capezuti, Kim, Fairchild, & Secic, 2009a, Boltz Capezuti, Kim, Fairchild, & Secic, 2009b, Wendel, Durst, Cayer, Abrate, & Tanner, 2010, Gardner, Thomas-Hawkins, Fogg, & Latham, 2007, Stalpers, de Brouwer, Kaljouw, & Schuurmans, 2015, https://www.ncbi.nlm.nih.gov/pubmed/9922290, https://www.ncbi.nlm.nih.gov/pubmed/21191234, https://www.ncbi.nlm.nih.gov/pubmed/23469496, http://www.ncbi.nlm.nih.gov/pubmed/22073502, http://www.casp-uk.net/casp-tools-checklists, https://www.ncbi.nlm.nih.gov/pubmed/15077833, https://www.ncbi.nlm.nih.gov/pubmed/12075275, https://www.ncbi.nlm.nih.gov/pubmed/17644871, https://www.ncbi.nlm.nih.gov/pubmed/12075277, http://www.ihi.org/Topics/TripleAim/Pages/default.aspx, https://www.ncbi.nlm.nih.gov/pubmed/15577667, https://www.ncbi.nlm.nih.gov/pubmed/16396408, http://www.ncbi.nlm.nih.gov/pubmed/22479871, https://www.ncbi.nlm.nih.gov/pubmed/12075278, https://www.ncbi.nlm.nih.gov/pubmed/17672167, https://www.ncbi.nlm.nih.gov/pubmed/17004394, https://www.ncbi.nlm.nih.gov/pubmed/21189740, https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model, Receive exclusive offers and updates from Oxford Academic, DIRECTOR, CENTER FOR SLEEP & CIRCADIAN RHYTHMS, Academic Pulmonary Sleep Medicine Physician Opportunity in Scenic Central Pennsylvania, MEDICAL MICROBIOLOGY AND CLINICAL LABORATORY MEDICINE PHYSICIAN, a)Involved NICHE-related data from a member organization(s), b)Used data from NICHE organizational tools, c)Provided validation of a NICHE organizational tool or service, d)Detailed an account of NICHE program implementation, e)Served as a summation or review of NICHE organizational growth or impact on member organization(s) geriatric care, f)Provided expert opinion on or a description of expanded NICHE services, Copyright 2023 The Gerontological Society of America. A benchmarking study by Capezuti et al. 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). Facilitate safe and effective discharges. The Leadership Training Program is the initial step and introduction to the NICHE program. 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. (, Resnick, B., Galik, E., Enders, H., Sobol, K., Hammersla, M., Dustin, I., Trotman, S. (, Rosenfeld, P., Kwok, G., & Glassman, K. (, Squires, A., Caceres, B., Bub, L., & Negrete Redondo, M. I. Trends Like These: Harvey Weinstein, SLC Nurse Update, Szechuan Sauce The interprofessional team of workers of 10 units were trained in identifying frailty risk among their patients using the SPICES tool. Note: NICHE = Nurses Improving Care for Healthsystem Elders. 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. NICHE is an organizational membership program that aims to improve the care of older adults across the health care continuum.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 population-focused environment of care. Get Care Services Geriatrics Aging adults have special healthcare needs. By linking NICHE survey data with human resources data, researchers could examine the effects of turnover rates on nursing and health care. A secondary analysis of data reflecting 115 NICHE program sites showed that when compared to non-NICHE sites, predictive factors associated with adoption of the NICHE program included having medical home model, being in a network, pain services availability, urban location, and bed size over 100. This segment of the popula-tion is expected to grow to nearly 95 million by 2060.1 The changing population composition, combined with the movement toward value-based care, has resulted in an urgent need for health care providers to implement systems of care that effectively honor the wishes of older adults and their families.2, 3. 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. collected, please refer to our Privacy Policy. The vision of NICHE is that all older adults, age 65 and over, receive age-friendly, exemplary nursing care. The goal of the GRN model is to improve geriatric knowledge and expertise of the nurse, essential to implementing system wide improvement in the care of older adults. While I am an employee of the NYU Rory Meyers College of Nursing and NICHE (Nurses Improving Care to Healthsystem Elders), it is not a conflict of interest for me to participate in the comprehensive review of the research for and about NICHE. Nurses Improving Care for Healthsystem Elders (NICHE) imparts principles and tools to stimulate changes in clinical practice to achieve patient-centered nursing care for older adults in healthcare facilities. Improving upon organizational-level approaches that support delivery of high quality of care and positively impact patient outcomes in the older adult population can be difficult to achieve. 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. In the case of U.S. NICHE participants, comparisons of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data between NICHE and non-NICHE hospitals may be a good way to determine effects on patient satisfaction. . 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. 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. Four thematic categories were identified including specialized older adult care, geriatric resource nurse (GRN) model, work environment, and NICHE program adoption and refinement. The American Nurses Credentialing Center offers three voluntary certification options in gerontological nursing. 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. To ensure that NICHE implementation has achieved multidimensional quality indicators, an organizational leader uses GIAP (Capezuti et al., 2013). In addition to training nurses, the institution provided training to physicians, social workers, pharmacists and the remaining team members. BY ANGELA KALMANASH, MBA* AND JENNIFER PETTIS, MS, RN, America is aging, and older adults comprise a more racially and ethnically diverse group than ever. After critical appraisal, 43 articles were included. NICHE Introduction to Gerontology 2nd Edition Curriculum Released - NYU Other aspects of worker job satisfaction and well-being also merit exploration for the differences between NICHE and non-NICHE facilities. 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. Dr. Aaiza Aamer is board-certified in internal medicine with a specialty in Geriatric Medicine. 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 . She brings 20 years of firsthand experience with organizational and management forces that drive performance improvement. From the content analysis, articles were grouped into categories based on themes including Specialized Older Adult Care, GRN Model, Geriatric Work Environment, and NICHE Program Adoption and Refinement. Consistently, studies showed that older patients cared for within the GRN model received specialized training and education to conduct assessments, dementia evaluations, geriatric primary care, as well as home health and hospice care when appropriate (Boltz et al., 2013b). (6.1) in the hospital. GRNs function in all types of units that have older adults, including medical-surgical units, specialty units, and critical care areas. This article addresses the NICHE/GRN model and its implementation at Palomar Pomerado Health. 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. American Nurses Credentialing Center (ANCC) Certifications | ANA To conduct a scoping review of the evidence associated with the NICHE program to (a) understand how it influences patient outcomes through specialized care of the older adult and (b) provide an overview of implementation of the NICHE program across organizations as well as its impact on nursing professionals and the work environment. Provide excellent bedside nursing to older adult patients. Studies evaluating the GRN model used a variety of methods to assess impact of the model on patient outcomes. Survey respondents also reported high level of support from nurse managers to complete and participate in GRN training. 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. The NICHE program has potential for replication across international health care contexts, based on early translational research. A variety of methodologies were employed across the studies which showed largely positive outcomes of specialized older adult care.
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