Assessing the perceptions and attitudes among geriatric resource nurses: Evaluating the NICHE program at a large academic medical center

Age-Friendly Healthcare: An Evolutionary Concept Analysis

AIMS

Aging populations require adapting healthcare systems for older adult's specific needs. Numerous initiatives to improve older-patient care have emerged, but the field lacks a unified framework. The current study aims to provide a systematic concept analysis of 'age-friendly healthcare', examining its characteristics, components and structure.

DESIGN

Rodger's evolutionary concept analysis.

DATA SOURCES

Searches were conducted in ProQuest, CINAHL, PubMed and Scopus databases between November 2022 and October 2023, utilising the PRISMA 2020 reporting checklist.

METHODS

A literature search using specific terms relevant to age-friendly healthcare retrieved 1407 articles. After screening for duplicates and relevance, 140 articles were examined for eligibility based on inclusion criteria for age-friendly care, language and full-text availability. Following full-text screening, 65 articles were included for data extraction by multiple researchers to synthesise theoretical, methodological and design elements.

RESULTS

Our findings highlight key attributes of age-friendly healthcare: Respect for older adults' autonomy and needs; leadership and organisational knowledge and support; Proactive policies and processes of care; holistic care environments; and communication and follow-up with awareness of challenges and barriers as well as prioritisation of continuity-of-care.

CONCLUSION

The concept of age-friendly healthcare is still developing, with much research focused on development and implementation rather than evaluation of real-world patient and health-system outcomes. Our analysis of the concept may help unify the field and clarify future research directions through identification of areas requiring further study and enable development of improved practices and policies for implementing age-friendly healthcare in a variety of settings.

NO PATIENT OR PUBLIC CONTRIBUTION

This concept analysis did not include any patient or public involvement.

REPORTING METHOD

This study utilised the PRISMA reporting checklist.

Acute Care for Elders and Nurses Improving Care for Health System Elders Models in Acute Care: Are We Still Using These Geriatric Models of Care?

Care models for older adults have been studied for more than 30 years. Several models of care for older adults were created in the acute care setting to prevent hospital-acquired disability and decline-a phenomenon frequently observed among older patients admitted in the acute care setting. The Acute Care for Elders (ACE) model and the Nurses Improving Care for Health System Elders program were 2 such models that sought to improve the quality of care for older adults and reduce their cost for care. Where are they today? Are we still using these care models in the acute care setting?

"What Matters Most" to Older Adults With Cancer: Advance Care Planning

Approximately 1 in 3 adults have some type of advance directive. Advance care planning (ACP) is associated with greater use of supportive care services and decreased patient and family stress. Despite this, organizations continue to have difficulty in implementing effective programs for increasing ACP. Increasing knowledge and comfort of the health care team with end-of-life discussions and ACP is essential. Educational efforts should focus on decreasing known barriers to ACP discussions such as discomfort, unclear role, lack of experience, and limited education. Role playing and case discussions taught by geriatric resources nurses can help increase staff knowledge and comfort regarding ACP. Role playing allows staff to think about their own mortality and what will happen in various situations if ACP is not complete. Team members find that once they have completed their own ACP, they are more comfortable discussing ACP with patients and caregivers. Nurses should collaborate with social workers and chaplains for ACP education and discussing what matters most to them. Patients are encouraged to make sure that they provide advance directives to their health care providers. This article shares an interprofessional team approach to improving processes for ACP as a component of "what matters most" to older adults with cancer.

A Scoping Review of the Evidence About the Nurses Improving Care for Healthsystem Elders (NICHE) Program

BACKGROUND AND OBJECTIVES

The Nurses Improving Care for Healthsystem Elders (NICHE) is a nurse-led education and consultation program designed to help health care organizations improve the quality of care for older adults. To conduct a scoping review of the evidence associated with the NICHE program to (a) understand how it influences patient outcomes through specialized care of the older adult and (b) provide an overview of implementation of the NICHE program across organizations as well as its impact on nursing professionals and the work environment.

RESEARCH DESIGN AND METHODS

Six databases were searched to identify NICHE-related articles between January 1992 and April 2019. After critical appraisal, 43 articles were included.

RESULTS

Four thematic categories were identified including specialized older adult care, geriatric resource nurse (GRN) model, work environment, and NICHE program adoption and refinement. Specialized older adult care, a key feature of NICHE programs, resulted in improved quality of care, patient safety, lower complications, and decreased length of stay. The GRN model emphasizes specialized geriatric care education and consultation. Improvements in the geriatric nurse work environment as measured by perceptions of the practice environment, quality of care, and aging-sensitive care delivery have been reported. NICHE program adoption and refinement focuses on the methods used to improve care, implementation and adoption of the NICHE program, and measuring its impact.

DISCUSSION AND IMPLICATIONS

The evidence about the NICHE program in caring for older adults is promising but more studies examining patient outcomes and the impact on health care professionals are needed.

Evaluating the NICHE program in an Academic Medical Center: Uncovering the missing link between training and effective practice change in the care of older adults

PURPOSE

This paper recounts the history and experiences of one academic medical center that sought to improve the care of elderly patients by adopting and adapting the Geriatric Resource Nurse (GRN) model recommended by the Nurses Improving the Care of Healthsystem Elderly (NICHE) program. A formal evaluation examined the perceptions, opinions and attitudes of non-GRN nursing peers, Nurse Managers (NMs) and members of the Inter-Professional Advisory Board (IAB) regarding GRN practices and the institution's NICHE program.

DESIGN

A qualitative research design with purposive sampling was utilized.

METHODS

Semi-structured interviews and focus groups conducted in the fall/winter 2017 were analyzed using standard content analysis methods of isolating and grouping contextual themes without a predefined framework.

FINDINGS

The institution's GRN training program, a hybrid of the national NICHE program and organization-developed components, has strong support among NMs, members of the IAB and other RNs. However, there exist many misconceptions, erroneous information and misunderstandings about the program and the roles and expectations of GRNs that have hindered the likelihood of producing desired outcomes.

CONCLUSIONS

Training GRNs was insufficient in disseminating and implementing evidenced-based geriatric practices in this hospital. Future work in this area would benefit from integrating concepts and methods from dissemination and implementation science when developing, launching, and sustaining NICHE programs.

CLINICAL RELEVANCE

Integrating principles and models of dissemination and implementation science can increase consistent use of evidence based practices and the likelihood of improved geriatric patient outcomes in NICHE hospitals.