A growing geriatric care team finds new ways to understand the needs of older patients
Loved ones should know that when they visit an elderly friend or relative at Jersey City Medical Center (JCMC), they might not find their loved one in their hospital bed, or even in their room.
Thanks to a new and fast-growing geriatric care team at JCMC, the patient might be out and about on the hospital floor. For example, the daily routine for one patient included wheelchair "tours" with a staff member, during which the patient smiled and waved to everyone and would sometimes even sing a song or two. For more mobile patients, daily walks with staff are common.
“We do these kinds of activities with patients to keep them engaged and thinking, and help them become better oriented to where they are," says Janielle Viuya, RN, Geriatric Care Coordinator at JCMC. "In addition, this kind of physical activity improves muscle tone, which helps prevent falls both in the hospital and when they return home."
The special attention also helps patients who are confused and upset. For example, a patient in his 80s with dementia was refusing to take the medicines he needed, or even let staff approach him. His nurse called in a geriatric resource nurse—a colleague trained in best practices for geriatric care—for advice.
"We realized that having a number of people involved at the same time to care for him seemed to agitate him, so we gave him a more comfortable distance," Viuya says. "I then approached him slowly, calling him by the name he had told us he preferred. He began to relax and talk to us—about his home and even the kind of music he likes. Before long, he was ready and willing to receive the medicine and tests he needed."
A new perspective
This approach just took a few extra minutes and a few techniques, which staff members are learning through JCMC’s ongoing process of becoming recognized by the national NICHE (Nurses Improving Care for Healthsystem Elders) program. The effort is part of a system-wide senior care initiative at RWJBarnabas Health facilities.
Research has shown that older patients have different issues during hospitalization than younger patients do. "They are more likely to develop delirium, confusion or lower cognitive function-how well they think and understand," Viuya says. "And it can happen quickly." These unexpected symptoms are disturbing to the patient and to their loved ones
Through the NICHE process, JCMC staff who have a passion for geriatric care can take a course to become a trained member of the Geriatric Care Team. They learn how to identify the specific risks of hospitalized older patients—from confusion to loss of muscle tone-and how to avoid them.
Proven benefits
In the absence of activity and engagement, a hospital stay due to one medical issue can lead to other problems for an older patient’s overall mental and physical condition. Steps like the ones the JCMC team is taking to deal with delirium can significantly reduce the length of a hospital stay as well as the overall cost of care, research shows.
One study showed that older patients who underwent major abdominal surgery and received an intervention that included nutritional assistance and early mobilization were less likely to experience delirium.
"When we understand what’s really going on with these patients, it’s easier to provide them what they want and need," says Nicole Cabrera, Geriatric Registered Nurse and a member of the NICHE leadership team. "NICHE training gives us ways to talk to our patients to make sure they understand. It allows us to become advocates for patients who aren’t always able to speak up for themselves."
At JCMC, staff who have NICHE training include patient sitters, transporters and patient care technicians across many areas of the hospital, including medical/ surgical, telemetry, step-down and orthopedic units. Two trained geriatric resource nurses are available at all times.
In just six months, the new team has grown from one person to more than 50. As a bonus, many say that it also helps them care for their own family members.
"I’m getting calls every day from more staff members who want the training," Viuya says. "It’s exciting to see this program grow so quickly."
Patients who need additional support can ask for a geriatric resource nurse. To learn more about our Geriatric Care Team, visit www.rwjbh.org/seniorhealth.