Boltz and colleagues31 used the GIAP in a pre- and post-test cross-sectional survey of registered nurses in 8 acute-care hospitals in urban areas. The geriatric nursing practice environment, including institutional values regarding older adults and resource availability, was significantly improved after NICHE implementation. Institutional values regarding respect for the rights of older adults, inclusion of older adults in decision-making regarding care was significantly improved. The actual quality of geriatric care according to nurses in the survey was also significantly improved (see Appendix A). Quality of care was defined as “geriatric-specific, evidence-specific, individualized care that promotes informed decision making and is continuous across settings.”31 Boltz and colleagues found that geriatric care, nursing environment, and values regarding geriatric care were improved.