Recognizing that older adult patients have a unique set of needs and that the senior population is growing exponentially throughout our nation, ProMedica Toledo Hospital has adopted an innovative program called Nurses Improving Care for Healthsystem Elders, or NICHE.
NICHE, developed by the New York University College of Nursing, “works to ensure that adults age 65 and over receive care that promotes function, autonomy, and dignity.” With over 77 million baby boomers in the United States and 10,000 of them turning 65 each day, the program’s launch in our community could not be more timely.
Christine Weber, a clinical nurse specialist working with the NICHE program at ProMedica Toledo Hospital, explains, “In any given month, 45 to 60-plus percent of the patients here at ProMedica Toledo Hospital are over age 65, and we wanted to be proactive in how we approach their unique needs, so we researched NICHE and decided to join the program.”
Weber further explains that the ongoing surge in the older adult population—commonly referred to as the “Silver Tsunami”—has reinforced awareness throughout the healthcare industry that the treatment of older adults is a specialized area of care similar to any other specialty such as pediatrics, orthopedics or oncology. However, much work still needs to be done to ensure nurses are fully trained in best practices for providing care to this population. “There’s a big push to educate our nurses through special online training so they’re aware of the health problems that commonly affect older adults, such as urinary incontinence, confusion, and malnutrition, as well as how to meet their unique needs,” she says. The program was launched on the orthopaedic floor with the hope to expand to other units in the future.
An important component of this innovative program is the NICHE cart, which contains a wide variety of items and activities that can be given to older adult patients for comfort or diversion. Examples include baby dolls and stuffed animals for the patient to care for; interactive books; aqua paints; music players that play Big Band selections; items to promote relaxation, such as Sleepytime Tea, earplugs to block ambient noise, and aromatherapy; as well as “fidget” items like squiggle wrist bands and foam stars that provide sensory stimulation and distraction so confused or agitated patients, such as those with dementia, are less likely to pull out IVs or catheters.
“We’re also looking into some music therapies, and we provide books and pictures to stimulate conversation so patients stay engaged. For example, we can show an image of fireworks and encourage the patient to reminisce about what he or she used to do and see on the Fourth of July.
Feeling cold is a common complaint among older adult patients, so sometimes all that’s needed to maximize their comfort is a warm blanket or wrap. “It’s up to the nurse to get to know each patient and determine what issues they’re having while they’re here as well as what might potentially work to resolve them,” she says.
Most of the items in the NICHE cart are one-time use, and patients are welcome to keep them when they leave the hospital or transfer to a different unit. Not only is this comforting to the patient, but it’s also helpful from the standpoint of infection control because the items won’t transfer germs from patient to patient.
As Weber notes, caring for older adult patients—particularly those with dementia—presents special challenges because they’re removed from their normal setting and routine and are at higher risk for certain issues such as delirium. The NICHE program provides opportunities to comfort and help these patients without necessarily having to resort to additional medications and their potential side effects.
So far, the response to the NICHE program among older adult patients and their families has been positive. Even in cases where patients have difficult verbalizing due to confusion or dementia, family members often provide very positive feedback, with many stating that the NICHE program really gave their loved one comfort or a sense of purpose.
Weber is grateful to both the ProMedica Toledo Hospital Auxiliary and the ProMedica Toledo Hospital Foundation for providing much of the funds that keep the NICHE cart stocked with items. “They believe in everything we’re doing here and have been a huge support for this program,” she states. ❦