Nurses Improving Care for Health System Elders (NICHE)

The Nursing Improving Care for Health Systems Elders (NICHE) project is a national initiative developed to assist hospitals to meet the needs of acutely ill elderly patients and their families. NICHE aims to improve care of the older population by improving approaches to some core geriatric issues, such as falls, restraint use, incontinence, pain, skin breakdown and wounds, use of advance directives, and family involvement in decision making. NICHE is unlike other programs in that it does not prescribe how institutions should modify geriatric care; rather, it provides the materials and services necessary to stimulate and support the planning and implementation process. 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 substantive and positive impact on patient care.

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.

Started in 1992, NICHE has evolved into a national geriatric nursing program comprising 197 active sites in 38 states as well as parts of Canada and The Netherlands. Upon implementation of NICHE, hospitals report:

- Enhanced nursing knowledge and skills regarding treatment of common geriatric syndromes
- Greater patient satisfaction
- Decreased length of stay for elderly patients
- Reductions in readmission rates
- Increases in the length of time between re-admissions
- Reductions in costs associated with hospital care for the elderly