Nurses Improving Care to Health System Elders (NICHE): Implementation of best practice models
The John A. Hartford Foundation Institute for Geriatric Nursing, Steinhardt School of Education, Division of Nursing, New York University, 246 Greene Street, New York, NY 10003-6677, USA. JONA The Journal of Nursing Administration
(Impact Factor: 1.27).
11/2004; 34(10):451-7. DOI: 10.1097/00005110-200410000-00005
Nurses Improving Care to Health System Elders (NICHE) is a comprehensive program that hospitals use to foster system-wide improvements in the care of older patients. The authors report on a survey of 103 NICHE hospitals to determine perceptions of the NICHE program, the adoption of NICHE models and protocols, and the educational outcomes, policy changes, and benchmarks related to care of older patients established by the participating NICHE hospitals.
Available from: Karen-Leigh Edward
- "These isues can lead to the need for hospitalisation often resulting in a protracted length of stay and the increased chance of deconditioning which in turn prevents older patients from attending to basic care needs such as oral care. Hospitalization can represent the beginning of functional decline and increased dependency that may lead to an individual requiring longterm care    . The state of a patient's oral health can have a significant impact on their health outcomes, most notably psychosocial well-being, respiratory health, and nutritional status. "
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ABSTRACT: Oral health care is an essential aspect of nursing care. There are many variances in the quality and frequency of the oral care that is delivered to patients by nursing staff, such as oral care being given a low priority when compared to other nursing care elements, oral care being neglected, and oral care delivery being dependent on the nurse's knowledge of oral hygiene. Additionally, there are some particular patient groups known to be at risk of oral health problems or who have existing oral diseases and conditions. As people age their susceptibility increases to chronic and life-threatening diseases, and they can be at increased risk of acute infections increases compromised by ageing immune systems. The aim of this literature review was to ignite the discussion related to the oral care practices of nurses for older acute medical hospitalised patients. The review revealed that nursing staff know that good nursing includes oral health care, but this knowledge does not always mean that oral health care is administered. Oral health care seems to be separated from other nursing activities and is not discussed when nursing care plans are written, only when oral problems are obvious.
Available from: Marie Boltz
- "At the NICHE unit level, the implementation of the GRN model fosters the integration of evidence-based geriatrics within clinical practice. This educational and clinical intervention model prepares staff nurses as clinical resource leaders on geriatric issues to other nursing staff on their unit and supports their active role on the interdisciplinary team (Fulmer 2001, Lee & Fletcher 2002, Lopez et al. 2002, Pfaff 2002, Mezey et al. 2004). The GRN model provides staff nurses, via education and modelling by a geriatric advanced practice nurse, with explicit content to identify and address specific geriatric syndromes, such as falls and confusion, and to implement care strategies that discourage the use of restrictive devices and promote patient mobility (Boltz et al. 2010a,b,c,d,e,f). "
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ABSTRACT: Aims and objectives. To explain the relationship between a positive nurse practice environment (NPE) and implementation of evidence-based practices. To describe the components of NICHE (Nurses Improving Care for Healthsystem Elders) programmes that contribute to a positive geriatric nursing practice environment. Background. The NPE is a system-level intervention for promoting quality and patient safety; however, there are population-specific factors that influence the nurses' perception of their practice and its' relationship with patient outcomes. Favourable perceptions of the geriatric-specific NPE are associated with better perceptions of geriatric care quality. Designs. Discursive paper. Method. In this selective critical analysis of the descriptive and empirical literature, we present the implementation of geriatric models in relation to the NPE and components of the NICHE programme that support hospitals' systemic capacity to effectively integrate and sustain evidence-based geriatric knowledge into practice. Results. Although there are several geriatric models and chronic care models available, NICHE has been the most successful in recruiting hospital membership as well as contributing to the depth of geriatric hospital programming. Conclusions. Although all geriatric care models require significant nursing input, only NICHE focuses on the nursing staff's perception of the care environment for geriatric practice. Studies in NICHE hospitals demonstrate that quality geriatric care requires a NPE in which the structure and processes of hospital services focus on specific patient care needs. Relevance to clinical practice. The implementation of evidence-based models addressing the unique needs of hospitalised older adults requires programmes such as NICHE that serve as technical resources centre and a catalyst for networking among facilities committed to quality geriatric care. Unprecedented international growth in the ageing population compels us to examine how to adapt the successful components of NICHE to the distinctive needs of health systems throughout the world that serve older adults.
Available from: Marie Boltz
- "Research indicates that the organizational and work environment, as well as the organizational supports available , are associated with nursing practice and quality of care (Boltz et al., 2008a; Capuano, Bokovoy, Hitchings, & Houser, 2005; Kim et al., 2009; Mezey et al., 2004, Oelke et al., 2008). In their adaptation of the framework developed by Aiken, Sochalski, & Lake (1997), Boltz and colleagues (2008b) proposed that hospital structural characteristics (e.g., bed size, type of ownership) and nurse characteristics (e.g., demographics, experience in profession ) are linked to the geriatric nursing practice environment , which, in turn, relate to geriatric outcomes. "
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ABSTRACT: To identify and compare perceptions of the geriatric care environment among nurses in three different urban hospital types in one health authority in a Midwestern Canadian province.
The Geriatric Institutional Assessment Profile developed by the Nurses Improving Healthsystem Elders (NICHE) program was administered to staff in eight urban hospitals between 2005 and 2006: two geriatric-chronic care hospitals, four community hospitals, and two tertiary hospitals. The study focused on 1,189 nurses who completed the survey (n= 298 for geriatric-chronic care hospitals; n= 387 for community hospitals, n= 504 for tertiary hospitals).
Analyses focused on items related to the concept of the geriatric nursing practice environment, including a composite measure of overall perceptions and three subscales (institutional values regarding older adults and staff, resource availability, and capacity for collaboration). Nurses' perceptions of the extent to which facilities supported the provision of aging-sensitive or aging-relevant care to older adults and their families was also examined. Univariate analysis of variance was performed to determine significant group differences among nurses in the three hospital types.
Perceptions of the geriatric nurse practice environment (both in terms of the composite scale and the three subscales) were least positive among nurses in community hospitals relative to the other two hospital types. Perceptions in tertiary hospitals were significantly more positive than those in community hospitals in terms of institutional values and resource availability, albeit not capacity for collaboration. Perceptions were most positive in the geriatric-chronic care hospitals. Perceptions of aging-sensitive care delivery were also less positive in community and tertiary hospitals, relative to geriatric-chronic care hospitals; perceptions in community and tertiary hospitals did not differ from each other.
In this Canadian study, nurses' perception of the care environment varied by hospital type, with nurses in community hospitals expressing the most concern and nurses in geriatric-chronic care hospitals being the most positive. This research highlights the importance of the hospital setting in understanding nurses' ability to provide quality geriatric care.
Enhancing the quality of care for older patients requires an understanding of the challenges and obstacles experienced by nurses. Assessing their perceptions of the care environment they work in, therefore, becomes a key issue in targeting policy and programs.
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