The United States Census Bureau predicts that by 2030, when the remaining members of the baby boomer generation pass the age of 65, one out of every five Americans will be of retirement age. Medical facilities are preparing to treat a growing elderly population by focusing on reducing the length of hospital stays and increasing the quality of care and recovery rates.
In January 2018, five undergraduates from the Department of Allied Health Sciences (AHS) began internship positions with Nurses Improving Care for Healthsystem Elders (NICHE), a program delivered in partnership with UConn Health. NICHE promotes better care and outcomes for older adult patients through evidence-based nursing practice, resources, protocols and procedures in collaboration with multidisciplinary teams at hospitals.
NICHE was established 26 years ago by Terry Fulmer, PhD, RN, FAAN, and is now led by nursing faculty at New York University’s Rory Meyers College for Nursing. NICHE has since grown to include over 700 member organizations. UConn Health joined in 2017 and invited undergraduates from the College of Agriculture, Health and Natural Resources to participate in a pilot internship program.
Susan Gregoire, PhD, RRT, director of AHS academic programs and the department’s advising center, helped develop the internship program after she received a call from Heather Spear, APRN-BC and Lead APRN for UConn’s NICHE program.
“Heather reached out and was looking for partners for this great initiative,” says Gregoire. “The NICHE program benefits everyone and we were excited to become involved. The patients receive better care, students gain valuable experience and it makes hospital caregivers even more attentive to the unique challenges facing older adults.”
Students work at UConn John Dempsey Hospital in Farmington, where over 40 percent of patients admitted to the hospital are over the age of 65. Hospitalized older adults are at an elevated risk for a number of medical issues that can adversely affect their length of stay and recovery, including confusion, falls and infections. A major part of UConn’s NICHE program focuses on reducing delirium, a common complication afflicting hospitalized older adults.
Delirium is an acute confusional state that older adult patients and those with dementia are at higher risk for developing. This condition is usually temporary, but can be very serious and lead to increased morbidity and mortality. Patients are often admitted with delirium or may develop it in the hospital setting. Factors such as infection, metabolic abnormalities, respiratory failure, dehydration, polypharmacy, previous episodes of delirium and change in environment predispose older adult patients to delirium. However, in addition to medical treatment, one method to reduce the duration or prevent delirium is through purposeful visits. The AHS students meet with older adults to reduce hospital isolation and offer interactions that can help reorient at-risk patients.
Students make visits where they read to patients, watch television with them and engage in conversation. They often use items such as dolls, coloring books and puzzles from the hospital’s Therapeutic Activity Cart to enhance the visit. The type of activity is completely up to the patient, but the interaction and attention from a visit improves cognition and has other benefits. It has been shown to reduce length of stay, may reduce the likelihood of readmission and raises the satisfaction of patients and their families. For a population that can lack a strong social system and typically receives less company from family and friends, these interns make a meaningful impact on patient morale that translates to improved recovery.
“NICHE training resources guide students’ interactions with research-based best practices. Students read and practice geriatric care. That time spent promotes recuperation. Interns also serve as another set of eyes and ears on these patients. While their visits are social and not case-focused, they are in a position to report warning signs. These interactions further promote interprofessional communications with hospital staff,” says Gregoire.
RNs and other members of the treatment team identify patients that would most benefit from intern visits. Students document their visits and share concerns and observations with Spear, their on-site host advisor. The number of patients interns see, and the length of a meeting, varies by patient and from week to week.
“I thought this was a very unique opportunity, especially as a healthcare student,” says Joanne Puzio, who graduated from AHS in May 2018. “Many internships within healthcare don’t allow you to directly or independently interact with patients for legal reasons. That’s what made this internship so valuable. I plan to work with the geriatric population as an occupational therapist, so this experience was helpful for me in cultivating my interpersonal skills with the elderly.”
Students establish a schedule and generally commit six to nine hours a week for the duration of their internship. Approximately half of those hours are spent visiting patients. When they are not meeting with patients, students dedicate time to completing tutorials, reading and consuming other materials devoted to understanding elderly patients and families made available through the NICHE program’s extensive educational resources. Students come away with an increased awareness and appreciation of clinical care and of best practices when interacting with elder patients and healthcare providers. Building upon this experience, students also complete a research project related to elderly care and deliver a presentation at the hospital when they conclude their internship.
“The presentation adds the element of public speaking to the internship and helps students contribute to raising awareness of best practices for elder care and encouraging further research into hospitalized older adults. Students participating this past spring examined the connections between music and decreased agitation, hip fractures and delirium, aromatherapy and sleep patterns and also explored post-stroke depression and the impacts of readmission,” says Gregoire.
Upon completing the internship, students also produce a three to four page report detailing their experience. Finally, students and the hospital site assess each other through an evaluation. Spear also completes an evaluation of the interns. Students receive an overall grade of satisfactory or unsatisfactory. The number of credits they receive is based upon the hours per week they commit.
“We received great feedback all around and it gave us a few ideas for how to improve the next round of internships beginning this fall,” says Gregoire.
Two students are returning to the program, joined by four new students this semester. Gregoire says the internship will now require a commitment of one year, allowing new and seasoned students to work alongside one another. Gregoire also changed the project component by further embedding students in research at the John Dempsey Hospital.
“We’re going to match students with researchers at the hospital for their projects. This will turn their projects into applied research. They’ll learn more about a topic and be able to actually put their ideas into practice,” says Gregoire.
The internship prepares AHS students on their way to graduate and professional schools and into the healthcare profession. Their research projects and documented healthcare experience hours are valuable factors for admission to academic and professional programs.
“I love being in the hospital setting and interacting with the nurses there,” says Jillian Kopcik, a senior in AHS. “I am set on becoming a physician assistant and the internship gave me greater exposure to my future goals.”
Gregoire says, “The internship helps students better understand where they fit, in terms of the big picture. They get comfortable working in a hospital environment, gain interprofessional experience by being part of a team, and learn how to communicate and relate to patients and families. Even if they don’t end up working with geriatric patients, they are learning transferable skills.”
“This partnership between UConn Health, NICHE and AHS is a win for everyone. The hospital is achieving improved health outcomes for its older patients utilizing students eager to help and gain experience. We feel like this has been a great start and we’re excited to see where it goes,” says Gregoire.