Mattia Gilmartin

Abstract

This month we focus on the role of the NICHE Coordinator, who leads NICHE program activities to advance the use of evidence-based practices that improve the quality and safety of care delivered to older adults in healthcare delivery settings. We present a new leadership development class for NICHE Coordinators to enhance their overall effectiveness with implementing the NICHE practice model in their organizations.

Abstract

Changing practice is complex and multifaceted. I discuss an evidence-based change management model that can be applied to guide clinical practice improvement projects. I use NICHE as a case example. The overall success of any change initiatives relies on creating and following an action plan to address the “what of change” and the “how of change”. The “what of change” focuses on developing tailored interventions aligned with each nursing unit or service line strengths and opportunities to improve nursing care for older adults by implementing the four components of the NICHE practice model. The “how of change” focuses on the activities to prepare the environment to implement the NICHE practice model. Activities to manage the change process include how to effectively communicate a vision for change; mobilize managers, clinical leaders, and front-line staff to support the change in nursing practice; and tracking progress towards meeting clinical improvement goals over time.

Abstract

Nurses Improving Care for Healthsystems Elders (NICHE), one of the original geriatric care models, enhances the overall quality and safety of nursing care provided to older adults in hospital and post-acute care settings. NICHE is a relatively low-cost, high-impact investment in the nursing workforce to improve performance on the nurse-sensitive quality indicators including falls, pressure injuries, medication safety, urinary incontinence, restraint reduction, delirium identification and management, reducing preventable readmissions, among others. NICHE also serves as a foundation to enhance nursing care to achieve national accreditation standards for a number of geriatric and nursing quality programs.

Abstract

Background: Hospitalization can be hazardous for older people, but most hospitals in Europe are not prepared to meet the unique needs of older adult inpatients. Adaptations of the physical environment, care processes, and staff knowledge and skills in geriatric care are essential to improve the quality of care for older people. An assessment of baseline organizational approaches to older adult care is an important first step toward recognizing the challenges organizations face when delivering acute care services to older adults and attempting to improve them. The Geriatric Institutional Assessment Profile could be a promising tool for this endeavor. Objectives: To describe a systematic process implemented across seven countries and languages that sought to develop valid and culturally-appropriate translations of the Geriatric Institutional Assessment Profile. Design: Cross-cultural instrument translation and content validation study. Setting and participants: Expert review panels comprised of 68 practicing nurses from seven European or EU associated countries (Austria (German), Belgium (Dutch), Denmark (Danish), Israel (Hebrew), Poland (Polish), Switzerland (German, French), and Turkey (Turkish)) evaluated cross-cultural relevance, including translation, of the Geriatric Institutional Assessment Profile. Method: A systematic approach to translating and validating a cross-cultural survey instrument, including back-to-back translation, adaptation, and evaluation of content validity using content validity indexing (CVI) techniques for each country and language, assessing translation and relevance content validity separately. The item, subscale and domain content validity index scores were calculated and adjusted for chance agreement among raters for all parts of the Geriatric Institutional Assessment Profile: the four subscales of geriatric care environment, the general knowledge about older adults subscale, and the clinical geriatric knowledge subscale. Consensus discussions among the raters then finalized translations. Results: CVI scores for relevance and translation were all in the “good” to “excellent” range. The geriatric care environment scale's CVI scores were 0.84 to 0.94 for relevance and 0.82 to 0.98 for translation. The clinical geriatric knowledge subscale's CVI scores were 0.83 to 0.97 for relevance and 0.94 to 0.98 for translation. The general knowledge about older adults subscale received high translation agreement (0.93 to 0.99) but slightly lower scores for relevance, ranging from 0.46 to 0.94. Conclusion: Study results provided preliminary evidence of the applicability and validity of a multi-factor measure of age-friendly care in diverse health care systems, in German, Dutch, Danish, Hebrew, Polish, French, and Turkish languages.