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Nurses Improving Care of Healthsystem Elders

The modern demographic situation leaves no doubt that caring for older adults is a requirement of time. The aging of the population increases the economic and social burden on society, making it clear that new ways of geriatric care are needed. One of the main features of older adults is polymorbidity, when a patient has several chronic diseases, as a rule, three or four (Dillworth et al., 2016). Patients of older age groups require the attention of specialists who know the characteristics of aging and the course of their diseases. Cardiac issues, urinary infections, end of life decisions, and increased hospitalizations characterize the identified population. This paper proposes the implementation of the Nurses Improving Care of Healthsystem Elders (NICHE) initiative in hospital settings to equip nurses with pertinent tools of geriatric care.

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Problem Identification

The number of older adults grows significantly all over the world, and their care needs grow accordingly. Admi, Shadmi, Baruch, and Zisberg (2015) state that “the global share of older people (aged 60 years or over) increased from 9.2% in 1990 to 11.7% in 2013” (p. 1). Most importantly, it is likely to reach 21.1% by 2050, which shows that more resources, staff, and time should be allocated to provide them with the necessary services. The category of the older adults is the one that often requires hospitalizations: in the US, 40 % of all hospital transfers are made for them (Admi et al., 2015). Functional disability is the major concern that should be taken into account to appropriately meet this growing problem. Even though older adults with acute conditions might not have it previously, they are likely to develop urinary infections, pneumonia, and other issues. Therefore, it is critical to ensure that hospital settings are properly adjusted to geriatric needs, and nurses are well-aware of their responsibilities.

Proposed Quality Improvement Initiative

To facilitate the work of nurses and offer them relevant tools, the NICHE initiative can be suggested as a way to educate and consult them. This program developed by the New York University prioritizes the older adult patients as the key participants of the care process, prescribing to redesign the organizational care culture (Admi et al., 2015). It is expected that the guidelines provided by the program can inform nurses on the specific ways they can apply to make sure that every patient receives what exactly he or she needs for health improvement. As stated by Wald, Bandle, Richard, Min, and Capezuti (2014), the use of the proposed initiative allows accomplishing the systematic change in terms of geriatric care, which promotes better patient outcomes. Also, encouraging the participation of older people in society, it is possible to use their knowledge and experience, providing older people with access to adequate medical care and maintaining their independence and functional activity. The key benefit of the NICHE is that it provides the mechanisms for upgrading geriatric care and evaluating its current status in hospitals.

The available evidence demonstrates that the goal identified in the NICHE guidelines can be achieved in practice. The study by Wald et al. (2014) that was focused on the implementation of the initiative in inpatient settings found that it is useful for catheter use and catheter-associated urinary tract. Namely, the surveillance system introduced in several NICHE hospitals allowed revealing that it is a feasible and viable way to collect and analyze patient data. More to the point, the fact that the standardized incidence ratios (SIRs) were proved below also shows the effectiveness of the proposed project. Another research by Dillworth et al. (2016) found that geriatric nurses need education on end-of-life care services and quality of life provision. Based on the perspectives of the interviewed nurses, the mentioned authors assumed that a focus should be directed towards unrealistic expectations and ineffective physician‐patient‐family communication. In general, the great potential of the NICHE for geriatric palliative care is presented.

The NICHE can be used in hospitals in combination with other quality improvement initiatives. In particular, it was integrated with the Acute Care of Elders Model and the Hospitalized Elder Life Program in one of the health care campuses in a geriatric care unit. The preparation of the proactive decision plan was declared the main strategy to effectively introduce the principles of the mentioned initiatives (Admi et al., 2015). As a result, it was detected that such an approach positively impacts patient outcomes as well as their satisfaction levels. Along with patient benefits, it is also possible to state that the combination of the NICHE with other tools contributes to the continuity of care and quality of life support.

The implementation of the NICHE program can be achieved in several steps, each of which requires the precise attention of nurses. According to the first step, a hospital should identify a number of the Geriatric Resource Nurses (GRN), who are expected to receive education on the key geriatric symptoms and the ways to recognize, treat, and monitor them. In addition, they are to be sent updates regularly in consistency with the changing policies and evidence-based interventions. During the second step, the GRNs share their newly improved knowledge with other nurses in their units, acting as a source of information. The third step implies that the GRNs can work in any geriatric unit of the hospital, collaborating with the advanced practice nurses.

As for the evaluation of the proposed intervention, one may assume that the opinions of nurses and patients should be collected in terms of interviews after six months. Patient outcomes and staff satisfaction will be specified as dependent variables, while the number of critical health conditions and other internal factors existing in the hospital will be the independent variables. The use of SPSS will allow considering the effectiveness of the NICHE in terms of a hypothesis test and other statistical tests. It will also be beneficial to calculate mean, standard deviation, and regression to provide more accurate results. In sum, a mixed-method analysis of the outcomes seems to be important to better understand the potential of the NICHE and reveal its weak points to elaborate on them in the future.

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To conclude, the task of society is to make the life of elderly people full and active, remembering that their experience and knowledge are essential for further generations. Due to the increased level of education and improvement of medical care, older people make an important contribution to the development of society. This paper proposes the use of the NICHE initiatives to improve patients’ clinical outcomes, maintain nurse competence, and achieve community recognition. The reviewed evidence shows that the implementation of the discussed program was successfully performed in many hospitals.


Admi, H., Shadmi, E., Baruch, H., & Zisberg, A. (2015). From research to reality: Minimizing the effects of hospitalization on older adults. Rambam Maimonides Medical Journal, 6(2), 1-14.

Dillworth, J., Dickson, V. V., Mueller, A., Shuluk, J., Yoon, H. W., & Capezuti, E. (2016). Nurses’ perspectives: Hospitalized older patients and end‐of‐life decision‐making. Nursing in Critical Care, 21(2), 1-11.

Wald, H. L., Bandle, B., Richard, A. A., Min, S. J., & Capezuti, E. (2014). Implementation of electronic surveillance of catheter use and catheter-associated urinary tract infection at Nurses Improving Care for Healthsystem Elders (NICHE) hospitals. American Journal of Infection Control, 42(10), 242-249.

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