Impact of NICHE Preparation on Nursing Knowledge of Geriatric Patient Care

The aging of the United States population has profound implications for nursing practice and health care costs (Capezuti, Bolt, Cline, Dickson, Rosenberg, Wagner, Shuluk, & Nigolian, 2012). Their health care utilization are three to five times more than younger patients, which accounted for $444 billion or 23% of the health care spending in 2008 and 13 % of the U.S federal budget (Wier, Pfuntner, & Steiner, 2010). Research shows units that have implemented the Geriatric Resource Nurse (GRN) model have better patient outcomes in terms of preventing falls and fall related injuries, decreased restraint use, early recognition of confusion or delirium, and decreased hospital acquired infections (Boltz, Capezuti, Bowar-Ferres, Norman, Secic, Kim, Fairchild, Mezey, & Fulmer, 2008; Kim, Capezuti, Boltz, and Fairchild, 2009). 5 Tower, a post-surgical unit, experienced a shift in its patient population in 2015 after the addition of the telemetry monitors to the unit. Since then, there was an in-flux of a geriatric population with both medical and surgical comorbidities. 5Tower served 734 older adults in 2015 ranking the fifth highest unit within the Central Division (CMC-Main and Mercy). Recognizing the special needs of geriatric patients, 5T implemented the GRN model by training staff nurses to better understand the normal signs of aging and contraindications related to caring for the geriatric population to recognize and identify resources available within the community and anticipate risks associated with care of the geriatric patients.

Purpose:The purpose of this project is to increase the number of GRNs on 5T to better serve the geriatric patients.

Clinical Question:Will there be an improvement in nurses’ knowledge related to the geriatric population after the completion of the Nurse Improve Care for Healthcare Elderly (NICHE) Geriatric Nurse modules?

Theoretical Framework: Using the King’s Goal Attainment Theory guided this study. The Goal Attainment Theory is comprised of three major systems: personal systems, interpersonal system, and social systems. In this study, the personal system will be an individual nurse who recognizes the importance of self-growth in pursuing the advanced knowledge of the geriatric population with the desire of becoming a GRN. The unit will have a group of GRNs (interpersonal system) serve as a resource for the unit in order to help improve care for geriatric patients. The hospital administration (social system) provides a supportive environment and tools for staff to practice so they can better care for their patients.

Methods: Using the pre-test and post-test method to assess nurses’ knowledge before and after they completed the NICHE GRN modules. A 25 item survey questionnaires related to geriatric patient care is used to assess nurse’s knowledge about geriatric care before and after completing the modules. The modules cover 14 topics, which take about 20 hours to complete. There is a free 20 contact hours at the end of the 14 modules.

Result:The survey results will be analyzed using descriptive statistic. Aggregate mean of the pre-survey and the post-survey will be analyzed using pair t-test. The final result will be calculated when the project is completed in December 2016.

Conclusion/Implication: Geriatric patients have higher acuity, experience more hospital complications, and have longer lengths of stay; thus, resulting in an increase in health care cost and poor health outcomes. It is important for hospital to support and equip nurses with advanced knowledge to better serve the geriatric patients. This project not only help improve geriatric patient outcomes, but also help the nurses become a geriatric specialist. The next step after forming a team of GRNs, we will be examining geriatric patient outcomes, includes delirium screening, fall prevention, and discharge planning.