Walk through hospital halls and you mostly will find patients who are older than 65. With the graying of America, some forward-thinking hospitals are dedicating resources to assess and treat the specific needs of geriatric patients.
Studies show elderly people have unique issues that must be considered when healthcare is provided. They often respond to procedures and metabolize medications differently, endure one or more chronic conditions, and may suffer from a litany of ailments, such as malnutrition, incontinence, depression, constipation, and sleep deprivation.
Karen Keaney-Gluckman, RN, MSN, FNP, is part of a group at St. Josephs Regional Medical Center in Paterson, N.J., who helped develop an acute care of the elderly unit at the centers 500-plus bed hospital in 2005. Ocean Medical Center in Brick, N.J., a member of Meridian Health, also has developed an ACE unit for patients older than 65 with acute illness. These facilities have joined Nurses Improving Care for Healthsystem Elders, also known as NICHE, a national nursing initiative developed at the Hartford Institute for Geriatric Nursing, NYU College of Nursing, to assist in development and implementation of the units.
Geriatrics Front and CenterKaren Keaney-Gluckman, RN
The Hartford Institute for Geriatric Nursing was launched in 1996 at New York University to promote the field of geriatrics and concentrate it in nursing, says Elizabeth Capezuti, RN, PhD, FAAN, codirector and NICHE faculty director. The goal is to increase the competence of nurses in America to care for older adults by educating both students and practicing nurses.
According to Capezuti, NICHE encompasses two nursing care models that guide nurses in caring for elders the geriatric resource nurse and the ACE unit. The GRN prepares a staff nurse to become the clinical resource to the nursing staff. She teaches colleagues to identify and address elder-specific syndromes, such as falls and confusion. She also can help to determine whether to use or discontinue restrictive devices, such as catheters and other immobilizing equipment.
We developed the ACE model because many hospitals that became part of NICHE wanted to designate a discrete unit for geriatric patients, Capezuti says, noting the model is adapted from a successful program originated at the University Hospitals-Cleveland in the 1990s.
Customized to Fit
St. Josephs ACE unit includes a communal dining room and an activity space. One special feature is the Snoezelen room, which was developed to help patients who have developed dementia or delirium; multisensory devices of lights, sounds, and aromatherapy are designed to calm and redirect agitated patients. Future plans include a pet visitation program, which underscores the positive effect domestic animals have on treating human anxiety.
The importance of the evolving physical environment is equalled by the increasing interest and dedication of the nursing staff in providing care specifically designed for the elderly, Keaney-Gluckman says. ACE unit protocols, such as the appropriate use of Foley catheters, were adopted throughout the hospital and have resulted in reduced infection incidents, she adds.
When I first heard about NICHE, I thought it sounded great that our med-surg nurses could become specialized, Keaney-Gluckman says. They learn the latest concepts and practices in geriatric nursing and earn their certifications, just as in critical care and other specialized nurse practices. The hospital also initiated ongoing training and enrichment courses for other nurses in elderly care, as well as for therapists and nonprofessional staff in the hospital.
Keaney-Gluckman recently became a full-time certified wound, ostomy, and continence nurse specialist. In her place, the hospital appointed a dedicated geriatric APN and a nurse manager to the ACE unit.
Keaney-Gluckman says she is pleased with the pace and progress of ACE at St. Josephs. Ive told my colleagues, You are the up-and-coming specialty. Geriatric nursing is where its at, she says. Our training teaches us to treat and prevent all kinds of diseases, but you cant prevent growing old. Were all going to get old.
Designed to WorkEllen Barrington, RN
Ellen Barrington, RN, MSN, BC, is nurse manager for Meridian Healths Ocean Medical Centers ACE unit. After I joined the NICHE initiative six years ago, we decided to designate an ACE unit, she says. Because of its success, the hospital opened a new 40-bed unit featuring eight private and 16 semiprivate rooms in December 2006.
The Ocean ACE unit boasts all of the services prescribed for the care of the geriatric patient, Barrington says. This includes oversized patient rooms with flexicare beds and mattresses developed to help reduce pressure points; large bathrooms with easy-access showers; and supportive geriatric recliners by each bed to promote the staffs out of bed initiative that encourages patients to be as mobile as possible. Barrington notes that for each day spent in bed, it may take up to 3.8 days to regain strength and return to mobility.
Throughout the unit, there are small but important features, such as easy-to-read signs, tasteful wall colors and furnishings, lighting to soften glare, and low-shine polish on the floors to prevent trips and falls. Amenities include a multiuse activity room where patients listen to music, watch movies, play a game of cards, read, or complete crossword puzzles. The room doubles as a communal dining room that encourages interaction with others.
In addition to the environmental enhancements, 80% of the units nursing staff have become certified in geriatric nursing by the ANCC.
Barrington says through NICHEs guidance, Ocean Medical Center has implemented protocols to address acute care for elder patients on all units. Because we are a NICHE facility, we receive a great deal of information and can share our knowledge, Barrington says. NICHE offers a comprehensive Web site and resource materials and an excellent list serve that includes ideas from other facilities.
NICHE is continuing its outreach, thanks to a $5 million, five-year grant awarded to the Hartford Institute for Geriatric Nursing by Atlantic Philanthropies, Capezuti says. The grant allows us to develop resources and implement a business plan to market the program, she explains. Because of spending cutbacks, many hospitals have had to limit their funding for conferences. Were changing our formatting in response to that, so we can reach more people through a Web-based program.
NICHEs presence in more than 270 hospitals in 40 states reflects the interest and need for skilled nursing leadership, Capezuti says. By empowering nurses, NICHE addresses the serious shortage of specialists in geriatrics, in nursing, and especially in medicine, Capezuti says. Many hospitals hope that by designing this special ACE unit, they will attract dedicated personnel to it.
Editor’s Note: To read more about NICHE, read the article John Muir Health Helps Elders Find Their Niche at http://include.nurse.com/apps/pbcs.dll/article?AID=2009102090108.