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NICHE conference showcases nurse-driven initiatives

Monday August 22, 2011
Marie Boltz, RN
Marie Boltz, RN
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"On the Front Line of Change," was the theme of this year's NICHE conference in Las Vegas. NICHE, which stands for Nurses Improving Care for Healthsystem Elders, is a nurse-driven program of the Hartford Institute for Geriatric Nursing at the New York University College of Nursing.

The program is the only one in the nation designed to improve the quality of care for hospitalized older adults. In place in nearly 300 hospitals in North America, NICHE seeks to engage, encourage, educate and inspire nurses from bedside to boardroom, to identify gaps and implement solutions to improve geriatric care.

Over the course of the conference and in pre-conference sessions, the 400-plus attendees heard from leading researchers and practitioners in gerontology about current evidence-based practices to identify, prevent, reduce and manage the incidence of common geriatric syndromes and complications such as atypical presentations of disease, dementia, delirium and depression, falls, pressure sores, drug reactions and interactions and functional decline.

"Bettering care for older patients is a complex challenge that demands the combined dedication, determination and resolve of all the stakeholders in a healthcare facility," said Marie Boltz, RN, PhD, GNP-BC, associate director of practice at the Hartford Institute for Geriatric Nursing at NYU College of Nursing. "It's a commitment to changing hospital practices and culture. And getting those pieces in place requires knowledge, leadership skills, tenacity and a healthy dose of creativity."

The impressive impact of NICHE implementation was highlighted in a preconference session presented by NICHE leaders at Hartford (Conn.) Hospital. The 867-bed facility is an inner-city teaching hospital and trauma center, where patients age 65 and older make up about 45% of ED visits and inpatient days.

Along with improving patient care and outcomes, the NICHE program created a more engaged, energized and empowered nursing staff devoted to care of older patients, said Christine M. Waszynski, MSN, APRN, BC, geriatric nurse practitioner and coordinator of the inpatient geriatric consult service, and NICHE coordinator at Hartford Hospital.

For conference highlights, visit www.conference2011.nicheprogram.org/pages/24-conference-highlights/content.

Mary Beth Sammons is a freelance writer and author of "We Carry Each Other: Getting Through Life's Toughest Times." Send letters to editorNY@nurse.com or post a comment below.
Implementation of NICHE protocols at Hartford Hospital

• Geriatric Resource Nurse model implemented. More than 160 GRNs, staff nurses who undergo additional training in geriatrics, now work across 29 inpatient units, acting as resources to help identify older patients who may be at risk for complications or who may need additional intervention.

• NICHE “Try This” tools used to identify and manage age-related medical issues, such as catheter-associated urinary tract infections, falls and delirium. Improved identification of delirium and enhanced falls prevention on one pilot unit resulted in a significant decrease in falls over a four-year period.

• Focus on supportive environment, creative problem solving. As NICHE coordinator at Hartford (Conn.) Hospital, geriatric nurse practitioner Christine M. Waszynski, MSN, APRN, BC, oversees GRNs who have come up with inventive strategies to deal with common geriatric issues. For example, staff GRNs stocked a closet outside the cardiac ICU with “distracter items” such as Fur Real pets, Twiddle Muffs and other tactile items that help redirect cognitively impaired patients who’ve become anxious.

Source: Christine M. Waszynski, MSN, APRN, BC