Title: Nurses Improving Care to the Hospitalized Elderly (NICHE) Authors: Fulmer, Mezey, Abraham, Bottrell, Fitzpatrick
Objective: To report outcomes from three pilot hospitals that are part of the 60 health systems nationally, using the “Nurses Improving Care to the Hospitalized Elderly” (NICHE) program, now in its eighth year. This presentation reports on data from three pilot hospitals. Baseline data, using the Geriatric Institutional Assessment Profile (GIAP) were collected, using a pre-post design to capture any changes in attitudes, knowledge and perceptions of the environment related to care of the elderly. Based on the success of the pilot effort, NICHE has now evolved as a national program. NICHE targets selected quality indicators in order to monitor nursing knowledge of, and subsequent care for: 1) incontinence, 2) falls, 3) pressure ulcers, and 4) sleep. These 4 clinical topics are used as proxies for overall care of older adults in the hospital setting.
Design: A pre-post field evaluation study, using data from three NICHE sites.
Sample: The sample consisted of Geriatric Institutional Assessment Profiles (GIAPs) from the 3 original NICHE sites. The GIAP is a 68 item self-report survey instrument based on the "Decisions at the End of life" program from Educational Development Center, Inc.
Concepts/Methods : The three key domains of the GIAP are 1) the perceived quality of geriatric practice related to the 4 selected marker conditions noted above, the perceived knowledge about geriatric practice, and 3) the milieu for geriatric practice.
Findings: The aggregated pilot hospital results of the pre-test, post-test GIAP data are summarized and will be presented. These data indicated that perceptions of the experience in caring for the elderly improved significantly (p<.0001) after implementing the NICHE program. There was a reported decrease in both perceived difficulty in caring for, and in perceived burden in working with elderly patients. The perceived reward of working with elderly patients also improved significantly, along with an increase in the feeling of satisfaction with the geriatric care at the institution (p<.02). In terms of knowledge changes in the four marker conditions, three (pressure ulcer, restraint, and incontinence management) improved significantly. When looking at the total knowledge score in all four areas, respondents showed a statistically significant (p<.0001) increase in total knowledge across the geriatric care questions. Nurses’ attitudes towards the same four conditions revealed an increase in positive attitudes in incontinence management (p<.00001) and restraint management (p<.005). In terms of the perceived institutional environment, there was an increase in the valuing of best practice in geriatric nursing (p<.001) as well as a decrease (p<.0001) in the perceived obstacles to best practice in geriatric nursing. Conclusions/Implications: NICHE is an effective educational intervention for the hospital setting, which can improve self-reported attitudes about caring for the hospitalized older adult, and improve knowledge in those nurses who participate in the program. The next phase of NICHE will need to focus on clinical outcomes and cost saving that derive from NICHE.
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