The We Improve Senior Health (WISH) Program at Christiana Care Health System, Newark, DE, is a collaborative effort among nurses, physicians, pharmacists, rehabilitative therapists, social workers, dietitians and other disciplines to improve the care Christiana Care delivers to senior patients in all settings.
WISH is derived from a national initiative called Nurses Improving Care for Healthsystem Elders (NICHE). NICHE is the leading organization designed to help healthcare professionals improve their clinical skills and competencies in elder care. NICHE was developed by New York University College of Nursing and the Education Development Center for Health Care Practice, and is funded by The Atlantic Philanthropies. We have been a NICHE site for more than 10 years.
Time for Training
A 2-day geriatric training for all healthcare providers within our healthcare system is offered by the WISH program. The goal is to make a difference in the care of senior patients. This initial training program focuses on preventing and managing common geriatric syndromes.
The training program is offered 6 times per year. The 16-hour curriculum is based on the NICHE curriculum, and the training is divided into two 8-hour days with one week between training days. It is taught by interdisciplinary faculty including geriatric clinical nurse specialists, a geriatrician, a pain nurse practitioner, a wound and ostomy nurse, and a physical therapist.
The participants receive a certificate at the completion of the training, designating them as Senior Health Resource Team (SHRT) members. The SHRT members serve as unit-based resources to address the diverse problems of seniors to ensure everyone is working together to provide best practice geriatric care. The SHRT members are empowered to make suggestions to avoid complications associated with hazards of hospitalization for older adults, including adverse drug reactions, delirium, depression, falls and malnutrition/dehydration.
In the past 10 years, more than 1,500 healthcare providers have attended the WISH program training and become SHRT members. In April 2012, we celebrated our 50th class.
The program also prepares SHRT members to successfully pass the gerontological nursing certification exam offered by the American Nurses Credentialing Center. We have more than 150 nurses certified in geriatrics throughout our system.
Additionally, ongoing geriatric education is provided by quarterly 1-hour lunch sessions on a topic picked by SHRT members. These lectures are evidence-based and clinically relevant. Geriatric tips of the month are also shared via email. The annual Update and Retreat provides an additional 4-hour education-based workshop for SHRT members.
Based on November 2011 survey results (27 percent response rate), 98 percent of the participants reported they put into practice what they learned from the WISH program. Even more participants reported that the WISH program was valuable in that it helped them provide best practice care to their geriatric patients. At least 91 percent reported that, since they attended the WISH program, they are better at:
• making sure patients have sensory aids such as eye glasses and hearing aids;
• encouraging family involvement;
• identifying delirium using the Confusion Assessment Method;
• avoiding restraints;
• attempting diversional activities for patients who are agitated, confused, or delirious;
• attempting least-restrictive alternatives;
• toileting patients on schedule;
• preventing falls;
• monitoring bowel movements;
• removing Foley catheters;
• ambulating patients;
• getting patients out of bed for meals;
• preventing skin breakdown;
• assessing pain in the nonverbal patient; and
• avoiding Benadryl for sleep.
The WISH champion role was initiated in May 2005, and one champion has been identified per unit. WISH champions act as facilitators for the WISH program, keeping geriatrics in the forefront on their unit. They also coordinate a unit-specific project related to a geriatric issue. WISH champions are also encouraged to be certified in geriatrics. More than 75 percent of the WISH champions actively facilitate unit-specific projects related to a geriatric issue, such as:
• delirium prevention;
• identification of depression;
• fall prevention;
• maintaining hydration;
• improving mobility;
• initiating music therapy; and
• improving nutrition.
Three WISH champion projects are past winners of Christiana Care Health System Focus on Excellence awards. Over the past 4 years, several WISH champions have presented at our annual WISH retreat and one WISH champion presented her project at a national conference. More than 50 percent of WISH Champions are certified in gerontology.
The WISH program at Christiana Care Health System demonstrates that this health system is educating all healthcare providers to care for the diverse problems of our elderly patients and is committed to providing the best possible care for our senior patients.
Denise L. Lyons is clinical specialist in gerontological nursing and the WISH/NICHE program coordinator at Christiana Care Health System, Newark, DE.