Saint Francis Hospital, part of the Saint Francis health system--finding its NICHE.



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We hear it on the news and in the papers that healthcare is not ready for the baby boomers aging needs. Some predict that by 2020, 1 in 6 Oklahomans will be 65 and older with that group doubling by 2030. Only a few hospitals in Oklahoma are prepared for the geriatric tsunami that is about to hit. It is widely known that currently 60% of hospitalized patients are 65 and older with that percentage only increasing in the coming years. We also know that nurses are the ones caring for this large geriatric population. So then the question...how do we prepare the nurses?

At Saint Francis Hospital in Tulsa "NICHE" is the new buzzword. Nursing Improving the Care of Health system Elders is a program of the Hartford Institute for Geriatric Nursing at New York University College of Nursing. The goal of NICHE is to achieve systematic nursing change that will benefit hospitalized older patients. The vision of NICHE is for all patients 65 and over to be given sensitive and exemplary care. The mission of NICHE is to import principles and tools to stimulate a change in the culture of healthcare facilities to achieve patient-centered care for older adults. The focus of NICHE is on programs and protocols that are dominantly under the control of nursing practice; in other words, areas where nursing interventions have a positive impact on patient care.

Saint Francis joined NICHE in 2006 with the first Acute Care Elderly unit (ACE) in the state. This 36 bed unit is dedicated to patients 65 and older with acute medical needs. Saint Francis has improved geriatric outcomes on the ACE unit, largely due to geriatric nursing education, daily patient care rounds, nursing protocols and hourly rounding. Outcomes such as a reduction in falls by 56%, a decrease in restraint rate by 42%, a decrease of 63% for pressure ulcer prevalence and no catheter associated urinary tract infections for a year.

Saint Francis is now infusing NICHE into all adult inpatient nursing units with Geriatric Resource Nurses (another NICHE model), a NICHE page on the Saint Francis nursing website, and taking NICHE based protocols housewide--with the goal of making sure that every nurse has the tools and resources to take care of geriatric patients. The most recent tools are a poster series called the NICHE TOP 10 for dealing with patients with delirium or confusion and a Patient Activity Cart on every adult inpatient unit. These Patient Activity Carts, made from recycled crash carts, are now filled with puzzles, activity aprons, colors, coloring books, stuffed animals, Slinkys and baby dolls to help nurses deal with confused or delirious patients. Saint Francis has been selected twice to present their geriatric best practices at the national NICHE conference, the most recent being for the Patient Activity Carts.

NICHE not only benefits the patients but it also has a large benefit to the hospital. With decreased length of stay and improved nursing satisfaction and a decrease in nursing turnover, NICHE is a win for everyone.

Saint Francis has found its NICHE and is ready for the aging baby boomers. Has your organization found theirs?

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Tyleen Smith, BSN, RN, Clinical Manager

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