NICHE designation demonstrates a hospital's organizational commitment and continued progress in improving quality, enhancing the patient and family experience, and supporting the hospital and other healthcare organization's efforts to serve its communities. NICHE is one of the original care models that aims to optimize the nurse practice environment to address the unique needs of older adults. NICHE, based at NYU College of Nursing has over 575 hospitals and healthcare facilities in forty-six states, Canada, Bermuda, and Singapore. As an organizational intervention, the goal of NICHE is to enhance nurses’ knowledge and skills to position nurses as leaders who systematically implement evidence-based practices to improve health outcomes for older adults. NICHE imparts principles and tools to stimulate changes in clinical practice to achieve patient-centered nursing care for older adults in healthcare facilities. The vision of NICHE is that all older adults, age 65 and over, receive age-friendly, exemplary nursing care.
NICHE Guiding Principles
NICHE Guiding Principles are based on gerontologic principles and were validated through research with patients, families and caregivers, clinicians, and administrators.
- Evidence based, geriatric care at the bedside
- NICHE supports the implementation of a variety of best practices, including prevention and management of pain, pressure ulcers, adverse medication events, delirium, urinary incontinence, and falls.
- NICHE helps nurses identify, interpret, and apply evidence-based practice to optimize both care outcomes and the patient/family experience.
- Patient/Family centered environments
- NICHE encourages the creation of physical and social environments that address the special needs of older adult patients and their families and caregivers that serve to maintain and enhance patient function.
- The physical environment is adaptable to age related changes and can include enhanced lighting, flooring, furniture, fixtures, beds, and more. Social aspects involve respectful communication, therapeutic interaction, and individualized activity interventions that can allay anxiety and stress.
- Healthy and productive practice environment
- Nursing care of the older adult patients takes place within a complex healthcare delivery system. External and internal factors in the hospital environment play a significant role in impacting staff practices and the resulting clinical outcomes. NICHE hospitals and other healthcare organizations have found that the following factors influence the quality of care provided to older adults:
- Values related to older adult and staff autonomy – NICHE training, protocols, and models promote leadership and critical decision making among staff and allow patients to have a say in the direction of their care.
- Interdisciplinary collaboration – NICHE promotes the use of interdisciplinary teams that cooperate and coordinate to ensure that care is comprehensive, effective, and continuous access to geriatric specific resources – NICHE offers a host of resources and tools that help bridge the geriatric healthcare knowledge and practice gaps.
- Multidimensional metrics of quality
- The measures of quality include patient outcomes, patient/family/staff satisfaction, cost-avoidance, and compliance with regulations. These and other measures can be employed as part of a continuous quality improvement program.
QCH recognizes that older adult patients have specialized needs, and that patient and family centered care is imperative to creating a positive experience for the older adult patient. QCH is committed to creating a hospital culture where the principal focus is on patients and their families.
The NICHE Program helps hospitals and other healthcare organizations:
- Implement proven strategies and methods to address issues specific to older patients.
- Improve patient outcomes.
- Raise patient and family satisfaction levels.
The Importance of Families and Patient Directed Care
Families provide a vital link between the patient and staff. And nurses are in a unique position to work with families as partners to provide quality care to older adult patients. It is also important to have informed, involved patients who understand and participate in their care. Emphasizing patient directed care is critical to improving safety, efficiency, and quality. The NICHE Program helps nurses and other staff meet the specialized needs of older adult patients with:
- Geriatric Resource Nurse (GRN) model guides in the use of proven practices to foster better outcomes.
- State of the art training, tools, and resources including an interactive 24/7 e-Learning center.
- Shared information, knowledge, and expertise.