NICHE (Nurses Improving Care for Healthsystem Elders) is the premier designation indicating a hospital’s commitment to excellence in the care of patients 65 years and older. According to the U.S Census Bureau, close to 45 million people in the United States are above the age of 65, a number that is predicted to nearly double by 2060 which furthers the need for specialized geriatric care.
Mercy Health Saint Mary’s has been a NICHE hospital since 2010, and an Exemplar status hospital since 2014. The evaluation for the NICHE hospital benchmarks a hospital’s progress from year-to-year, targets future care initiatives and provides data to use in gaining and sustaining support from institution stakeholders. The Exemplar status further recognizes Mercy Health Saint Mary’s for its ongoing dedication to geriatric care and initiatives that demonstrate organizational commitment to the care of older adults. Nationally, fewer than 100 hospitals currently have earned and maintained this status as of 2016.
“Exemplar status is especially meaningful for our community, our patients and their caregivers,” said Julie Lundvick, BSN, RN-BC, CDE, clinical service director of Senior Care, Mercy Health Saint Mary’s. “We have the tools to serve as advocates for those in need of specialized geriatric care.”
The positive effects of NICHE designation are exemplified in the story of an immigrant couple in their 90s, Johanna and Pieter (not their real names). Johanna had recently been admitted to Mercy Health Saint Mary’s with a urinary tract infection. Her husband, Pieter, was admitted on the same day with dangerously low blood pressure. Prior to their admission, Johanna and Pieter had resided in separate facilities.
Johanna and Pieter had been married for more than 50 years. During their hospitalizations, Pieter was alert, but Johanna was confused. Staff thought that if they could bring the two together, it would reduce the confusion for Johanna. Pieter was too weak to travel within the unit, so the nursing staff brought Johanna to visit Pieter. When she would walk in and see her husband, Johanna would light up. She spoke to him in their native Dutch language and immediately reached out to hold his hand. Staff couldn’t understand a word they were saying, but their love’s language broke through barriers.
Mercy Health Saint Mary’s staff cared for Johanna and Pieter for four days, during which many visits between the two were arranged. Physical and occupational therapy for both patients were coordinated in Pieter’s room. Pieter had a pacemaker implanted to control his heart rate and Johanna’s infection cleared up.
Upon discharge, Mercy Health Saint Mary’s case workers collaborated for the couple to be discharged to the same long-term care facility that provided different levels of care, so Johanna and Pieter would not have to live apart.
The key elements for earning Exemplar status include:
• Implementation of the NICHE Geriatric Resource Nurse (GRN) model;
• Expansion of geriatric care across all applicable units by using evidence-based protocols, such as sleep protocol, avoidance of high-risk drugs for seniors, prevention of functional decline and pain management;
• Physical design of the Senior Adult Unit and the Emergency Department at Mercy Health Saint Mary’s Campus to accommodate for patient population;
• Number of geriatricians who workwithin the health system;
• Involvement and partnership with long-term care facilities.
“The NICHE designation and the Exemplar status signal our resolve to provide patient-centered care for older adults,” said Lundvick. “Through our participation in the NICHE program, we are able to offer evidence-based, interdisciplinary approaches that promote better outcomes, positive experiences, and improved care for the older adults in our care. This leads to greater satisfaction rates for our patients, their families and our staff.”
NICHE guidelines and practices help the staff at Mercy Health Saint Mary’s find what is best for each patient through things such as individualized plans of care and discharge plans that cater to the wants and needs of each patient. NICHE participation has also helped the entire interdisciplinary team work together efficiently; a team that includes health care providers, nurses, physical and speech therapists and case managers.
“There are not enough health providers, nurses included, who either specialize in geriatric care or who possess the necessary competency of geriatrics knowledge in their practice,” said Jennie Chin Hansen, RN, MS, FAAN, CEO of the American Geriatrics Society.
Although there are only 7,300 nurses board-certified as Gerontological Nurses across the nation, Mercy Health Saint Mary’s has 52, demonstrating the organization’s initiative to counter the lack of specialized geriatric care in the United States.