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Expanding and deepening the mission of elder-friendly care was the message of the annual conference of NICHE (Nurses Improving Care for Health-system Elders) participants held February 17 to 21, 2008, in Philadelphia. The NICHE program was developed by the Hartford Institute for Geriatric Nursing at NYU College of Nursing to help hospitals make systemic changes in the way they care for older adults-their core constituency-largely through improvements in policy and the use of nursing resources. Begun in 1996, NICHE counts among its participants 230 hospitals in more than 40 states, the Netherlands, and parts of Canada.
At the conference, both new and experienced NICHE institutions came together to commit or re-commit to improve care to older adults. In August 2007, NYU College of Nursing received a $5 million grant from Atlantic Philanthropies to expand the widely praised program. The expansion grant will enable NICHE to grow to 500 or more hospitals during the next five years and to increase its ability to reach out and share information about best practices in care for older adults with these institutions.
Neville E. Strumpf, PhD, RN, FAAN, Edith Clemmer Steinbright Professor in Gerontology and director of the Center for Gerontologic Nursing Science at the University of Pennsylvania, gave a preconference keynote address on Sunday, February 17, 2008. Dr. Strumpf challenged the 175 audience members to become even more committed to evidence-based practice-that is, to understand and embrace it, and then to go to the next step and apply it in a way that individualizes care to older patients.
Caption for photo on the right:
Dr. Elizabeth Capezuti, NYU associate professor of nursing and Harford Institute co-director (left) with keynote speaker Dr. Neville Strumpf, Edith Clemmer Steinbright Professor in Gerontology and director of the Center for Gerontologic Nursing Science at the University of Pennsylvania, who also chairs the NYU College of Nursing Board of Advisors
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This approach parallels NICHEs vision for the next five years, says Elizabeth Capezuti, PhD, RN, FAAN, associate professor and co-director of the Hartford Institute. We are expanding NICHEs capacity to be implemented in more sites nationally and to deepen its resources, especially around nursing specialties, so that our programs can be customized to patients with oncologic, orthopedic, critical care and other needs.
The first two days of the conference, February 18 and 19, were attended by more than 200 representatives of 30 new and 18 experienced hospitals, who received an in-depth explanation of the NICHE philosophy and methods of implementation. Speakers focused on the basic NICHE tool-kit, which guides institutions through implementing NICHE and includes extensive resources for developing the Geriatric Resource Nurse model, establishing an ACE (acute care for the elderly) unit, and educating staff on best practices in care for older adults.
The third day of the conference, February 20, brought together additional experienced venues and was attended by 375 people. The day focused on best clinical practices in care of older adults, particularly translating evidence-based practice to the bedside. A keynote presentation, Embedding NICHE Principles in Oncologic and other Specialty Care, was given by Sara Kagan, PhD, RN, professor of Gerontological Nursing in the University of Pennsylvania School of Nursing. Dr. Kagan emphasized new demographics around ever-increasing numbers of older adults in acute care. She also talked about challenges to improving oncologic care for older adults given that their clinical presentation of cancer can be muddied by age-related changes and co-morbidities. Another challenge, she said, is that the image of cancer survivorship is typically youth-focused, even though a large percentage of people with cancer are older.
We need more emphasis on developing aging competencies in cancer, said Dr. Kagan. That will require using protocols and clinical pathways, applying interdisciplinary care, and focusing on communication and coordination not only throughout the patient setting but also across patient settings.
Throughout the day, presentations were provided by panels of researchers, clinicians, and managers. Lorraine Mion, PhD, RN, FAAN, director of nursing research and geriatric nursing services at MetroHealth Medical Center in Cleveland, addressed remaining challenges in the area of physical restraints. She emphasized that practice changes have occurred in response to new regulations regarding restraints-some of which are the result of work that has taken place by nurse researchers including Dr. Elizabeth Capezuti, Dr. Neville Strumpf, and Dr. Mion herself. While there has been an overall reduction in the use of restraints, she explained, more targeted attention is required for patients restrained in critical care. She emphasized the need to examine the practice of restraints in ICU settings and seek alternatives that improve pain management and decrease delirium.
Eleanor McConnell, RN, PhD, APRN, BC, associate professor and director of the gerontological nursing specialty at Duke University School of Nursing, presented national guidelines on fall prevention. Elizabeth Ayello, PhD, RN, APRN,BC, CWOCN, FAPWCA, FAAN, who is internationally known as an expert in pressure-ulcer prevention and treatment, presented with three nurses from the New Jersey Hospital Association Statewide Collaborative to Reduce Pressure Ulcers. Dr. Ayello is the clinical associate editor of Advances in Skin & Wound Care and a faculty member of Excelsior College, School of Nursing. Her co-panelists represented Chilton Memorial Hospital, Robert Wood Johnson University Hospital at Ralway, and Raritan Bay Medical Center, all of which have demonstrated dramatic decreases in the prevalence of facility-acquired pressure ulcers through the development and implementation of a series of skin-care protocols. The statewide collaborative has been recognized widely in the nursing community. Many hospitals are currently preparing to respond to new regulations stipulating that, as of December 2008, Medicare will not reimburse for facility-acquired pressure ulcers and other iatrogenic adverse events.
The final day of the conference, Thursday, February 21, known as the User Conference, brought together more than 250 representatives from 62 mature NICHE sites, who presented their successes and challenges. Lois Evans, PhD, RN, FAAN, the van Ameringen Professor in Nursing Excellence at the University of Pennsylvania, presented a keynote address on improving mental health services for the older adult and meeting the needs of hospitalized older adults with co-existing physical and psychiatric conditions. She discussed the strategies for prevention, early recognition, and specialized care approaches. Other topics included meeting the needs of an aging nurse workforce; including patients and family members on hospital advisory councils; and improving patients transitions between health care settings.
The Hartford Institute for Geriatric Nursing seeks to shape the quality of health care that older Americans receive by promoting the highest level of geriatric competency in all nurses who deliver care. By raising the standards of nursing care, the Hartford Institute aims to ensure that people age in comfort and dignity. Its initiatives include education, practice, research, policy, and consumer education.