Nurses Improving Care to Health System Elders (NICHE)

Mezey, Mathy; Kobayashi, Mari; Grossman, Sheryl; Firpo, Adolfo; Fulmer, Terry; Mitty, Ethel

doi:10.1097/00005110-200410000-00005

Cited by 72 publications

(54 citation statements)

References 16 publications

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“…[11] Other important elements for developing coordinating role of nurses in improving the continuity of care include nurses' competence, collaboration skills, commitment and resources. [12] Continuity can be seen in informational, management and relational perspectives. [4][5][6] According to Gulliford and coworkers, [13] evaluation of continuity of services calls for consideration of both patients' and professionals' perspectives.…”

Section: Informational Continuitymentioning

confidence: 99%

Continuity of nursing care in Finnish primary health care settings: A 15-year follow-up

Raivio

Paavilainen

Mattila

2018

CNS

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Objective: Continuity is an essential part of high-quality nursing care. This study is the first systematic follow-up of Finnish primary health care patients assessing continuity of health centre nursing staff. The aim was to ascertain how longitudinal interpersonal continuity of care is related to patients' characteristics, their consultation experiences, and how continuity had changed over the 15-year study period.Methods: A questionnaire survey was conducted among patients attending the health centres in the Tampere University Hospital catchment area from 1998 to 2013. A total of 157,549 patients responded out of 363,464 in almost 60 health centres. We analysed the opinions of patients (n = 47,470) who had visited a nurse during the survey weeks. Opinions on the continuity of care were assessed with the question: "When visiting the health centre, do you usually see the same nurse", the alternatives being "yes" or "no". A binary logistic regression model was used.Results: Almost two thirds of the respondents had met the same nurse when visiting their health care centre. Longitudinal interpersonal continuity of care decreased by 15 percentage (67%-52%) during the study years. Continuity was connected to patient-related items such as a visit in the preceding 12 months (OR 1.32, 95% CI 1.17-1.49) and non-urgency of the visit (OR 1.44, 95% CI 1.27-1.63). The most prominent factor contributing to the sense of continuity of care was how attentively nurses had listened to their patients' problems and shown an interest in them and a willingness to answer their questions (OR 1.31, 95% CI 1.120-1.43). Conclusions:In the past 15 years patient-reported longitudinal interpersonal continuity of nursing care has declined. However continuity of care proved to enhance the experienced quality of primary health care. Continuity was best realized in nursing care when nurses had listened to their patients' problems, showed interest toward them and a willingness to answer their questions.

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Section: Informational Continuitymentioning

confidence: 99%

Continuity of nursing care in Finnish primary health care settings: A 15-year follow-up

Raivio

Paavilainen

Mattila

2018

CNS

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“…There is a body of knowledge around the care of older people that, when used by nurses, facilitates recovery and pressure ulcer prevention. It can be packaged in a variety of ways (eg, Acute Care for Elders (ACE) unit, Nursing Improving Care to Healthsystem Elders (NICHE) hospital) [36]. The important thing is to recognize that the care of older persons has a unique body of knowledge and to be effective, it must be applied to the care of older hospitalized adults.…”

Section: Discussionmentioning

confidence: 99%

Hospital Recovery is Facilitated by Prevention of Pressure Ulcers in Older Adults

Stotts

2007

Critical Care Nursing Clinics of North America

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“…Cost reductions have been found related to many outcomes important to policymakers, including decreased hospital costs; decreased hospitalization, emergency department, and intensive care unit rates; reduction in 30-day readmission rates; and decreased hospital mortality. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Most successful models involve some degree of care management. Some are focused on increasing safety and patientcentered care in the inpatient setting, such as Acute Care for the Elderly (ACE) units, the Hospital Elder Life Program (HELP), Nurses Improving Care to Health System Elders (NICHE), and palliative care consult services.…”

Section: Models Of Carementioning

confidence: 99%

“…Some are focused on increasing safety and patientcentered care in the inpatient setting, such as Acute Care for the Elderly (ACE) units, the Hospital Elder Life Program (HELP), Nurses Improving Care to Health System Elders (NICHE), and palliative care consult services. [12][13][14][15][16][17][18][19][20][21][22] Care transitions programs seek to reduce readmissions to the hospital. 23,24 The Hospital at Home program allows some patients with acute illness to entirely avoid a hospitalization.…”

Section: Models Of Carementioning

confidence: 99%

Research Priorities in Geriatric Palliative Care: Policy Initiatives

Unroe

Meier

2013

Journal of Palliative Medicine

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Coordinated palliative care matched to patient needs improves quality of care for vulnerable patients with serious illness and reduces costly use of hospitals and emergency departments. Unfortunately, there is a disconnect in translating geriatric palliative care models and principles into policy and widespread practice. Gaps in policy-relevant research are addressed, including implementation strategies to scale up existing care models, the role of palliative care and geriatrics in health care payment reform efforts, development of quality measures for complex patients, strategies to address workforce shortages, and an approach to hospice reform.''I told the doctor that I never wanted to go back to the hospital again. It's torture-you have no control and can't do anything for yourself. And you get weaker and sicker. Every time I'm in the hospital it feels like I'll never get out.'' This 88-year-old man with mild dementia presents to the emergency department for management of back pain due to spinal stenosis and arthritis. He had been admitted to the hospital four times in the past six months-twice for pain, once for weight loss and falls, and once for altered mental status due to constipation. His overwhelmed 83-year-old wife tells the emergency department physician, ''He hates being in the hospital, but what could I do? The pain was terrible and I couldn't reach the doctor. I couldn't even move him myself, so I called the ambulance. It was the only thing I could do.'' T he fields of palliative care and geriatrics have developed a growing body of evidence in support of customized care models aimed at meeting the needs of frail, vulnerable, and seriously ill patient populations. The problem is not that we don't know what to do-the problem is that we don't do what we know. The business of translating evidence into real-world practice for frail older adults is critically dependent on changes in public and payment policy. As in any aspect of health care, gaps do remain in our understanding of treatments and the optimal approach to delivering services to vulnerable populations. Allocation of research dollars to address these questions is an urgent public health priority. Health care spending in the United States not only fails to deliver quality but quite realistically poses the greatest threat to the American economy and way of life-the 18% of GDP in dollars spent on high cost, low value health care cannot be allocated to other crucial public needs: education, repair of roads and bridges, food and air quality and safety, and protection from the consequences of rising income inequality and poverty. The good news here is that improving quality of care for high risk, vulnerable patients-so that the patient described above does not have to turn to the emergency department for every symptom crisis, but instead receives coordinated palliative care matched to his changing needs at home-leads to much lower need for spending in emergency departments and hospitals. It is critical that federal, state, and local regulat...

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Nurses Improving Care to Health System Elders (NICHE)

Cited by 72 publications

References 16 publications

Continuity of nursing care in Finnish primary health care settings: A 15-year follow-up

Continuity of nursing care in Finnish primary health care settings: A 15-year follow-up

Hospital Recovery is Facilitated by Prevention of Pressure Ulcers in Older Adults

Research Priorities in Geriatric Palliative Care: Policy Initiatives

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