NICHE Carts improve care for patients with cognitive impairment

Elderly patients with cognitive impairments, such as dementia, Alzheimer’s disease or delirium, present unique challenges for hospital staff. Some patients may become resistant and attempt to remove IVs or other medical equipment. And, staff didn’t feel they had the proper tools to address this issue.

With funds from generous donors, a multidisciplinary team of staff created activity diversion carts for senior patients. Stocked with purposeful activities meant to stimulate the senses, these carts have greatly improved care for patients with cognitive impairments. The carts were introduced in 2015 and there are now seven carts throughout the hospital.

The carts are part of the NICHE (Nurses Improving Care for Healthsystem Elders) initiative at Swedish Covenant Hospital. The hospital was recently redesignated “Senior-Friendly” by NICHE, which indicates the hospital’s commitment to caring for the special needs of patients over 65. Swedish Covenant Hospital has been a NICHE hospital since 2004.

Linda Beagley, MS, RN, CPAN, who chairs the NICHE committee, shared one story of how the carts have made a difference. When the initiative was first launched, staff was having difficulties communicating with a patient who was hospitalized as a result of a stroke and had limited English proficiency. A caregiver offered her a doll from the cart, which helped soothe and provide purpose for the patient. The patient carried the doll with her throughout the unit and took care of the doll by tucking it into bed.

“It is gratifying that the cart was so purposeful for that one patient,” Linda said.

The activity carts expand the choice of activities for confused or bored patients. Nurses and CNAs determine which activity from the cart is most appropriate for each patient, and will offer an activity based on each patient’s needs. The NICHE committee is continuously testing new activities to add the cart. Some of the more popular items include playing cards, puzzles, and markers and colored pencils for coloring.

Since the implementation of the carts, staff has noticed an improvement for patients and staff.

“It has made caring for patients with cognitive impairments easier,” Maryanne Graf, nurse on 4N and NICHE committee member said. “It’s also nice to be able to offer patients and families something.”

To learn more about supporting initiatives like NICHE carts, contact the Foundation at or 773.293.5121.

About Swedish Covenant Hospital Foundation

Swedish Covenant Hospital Foundation works to inspire charitable giving through philanthropic partnerships with those in our community who want to make a real difference. We fulfill our health care mission through the generosity of our friends, neighbors and business leaders who care about the community and the health of those who live here.

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