innovations in nursing

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Panna Dhai Maa Subharti Nursing College

• Innovations In Nursing
• Amritanshu Chanchal
• M.Sc Nursing 2nd year

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Introduction

• Nursing innovation is a fundamental source of prog
  ress for health care systems around  the world. 
  Nurses work in all settings with all types of pati
  ents, family, communities,  health  care 
  personnel  and  personnel  in  other  sectors. 
  As  such,  we  are  critically 
  positioned to provide creative and innovative solu
  tions that make a real difference to the 
  daytoday lives of our patients, organisation, co
  mmunities and our profession. 
• The need for innovative solutions has never been 
  greater as health care environments globally stru
  ggle to provide equitable, safe and 
  effective health services while, at the same time,
   containing costs. 

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Definition

• Innovation is the process of developing new approa
  ches, technologies and way. It can apply to tools
   and technologies  and  processes, or to the wa
  yan  organisation or an individual behaves, works 
  or acts.
• Innovations may be technical, involving the develo
  pment of a new or improved product 
  or process, or administrative, which involves orga
  nisational structures and administrative 
  processes  (Afuah  1998).

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Need of innovations

• Innovation is central to maintaining and improving
   quality of care.  And nurses Innovate 
  to find new information and better ways of promoti
  ng health,  preventing disease and 
  better  ways  of  care  and  cure.  One  of  the 
  earliest  examples  of  innovations  is 
  Nightingales  landmark  study  of  maternal 
  morbidity  from  puerperal  fever  following 
  childbirth.  She observed the high number of death
  s in maternity wards and asked the 
  question, Do more women die after giving birth in
   a hospital rather than at home? And if 
  so, why?  Her  study proved that the death rate w
  as higher for women who gave birth in 
  hospitals her innovation resulted in changes to t
  he services that resulted in the  saving of 
  womens lives. (McDonald 2005). 

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• The health care system operates in an environment 
  of constant change and  challenge. 
  Changes in demographics and the burden of disease 
  continue to  present new demands 
  on the health system, placed as is on the front li
  ne of  addressing the global challenges 
  of disease and delivering on the Millennium 
  Development Goals (Affara 2007).  These 
  increasing demands do not occur in 
  isolation.  Growing demands on health services in 
  turn create increasing 
  pressures to do more with fewer resources.

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• Innovations often arise out of necessity in order 
  to address a need or a gap in  service or 
  technology.  For example, nurses know that caring 
  for preterm  infants in incubators is 
  expensive, and unsafe if not properly done. 
  Incubators are also not readily available in a 
  number of countries.  Kangaroo care was 
  developed in Colombia by an American nurse 
  as an easy, economical, safe and socially acceptab
  le alternative.  It involves placing 
  healthy, preterm infants  skintoskin betwee
  n their mothers breasts.  Its application in 
  Zimbabwe showed Kangaroo care reduces neonatal mor
  tality in developing countries. 
  This new idea developed by nurses in one country, 
  eventually benefited babies on the 
  other side of the world (Kambarami et. al. 1999). 
  

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Innovations in health promotion and disease
prevention

• The realm of disease prevention and health promoti
  on  provides  a  range  of  examples 
  of  the  influence  of  nursing in improving popul
  ation health status.  Nurses 
  are uniquely positioned to identify risk factors, 
  provide  information  about  how  to 
  manage  these  risks,  and  promote the benefits o
  f healthier  lifestyles, diets  and 
  avoid risky behaviours (ICN 2008a  2008c). 
• In Denver, Colorado (USA), the NurseFamily 
  Partnership (NFP) programme was developed  to 
  support  low  income,  first  time  mothers 
  during pregnancy and in  the first two years of 
  the childs life.  Three separate randomised 
  controlled  trials  have  found  lasting 
  improvements in child health and other  social 
  indicator for  programme  participants  as  a 
  result of this initiative.  These include bette
  r  pregnancy  outcomes,  increased  intervals 
  between first  and second births as well as reduct
  ions in child injuries and child abuse.  The 
  programme has  also  been  associated  with 
  enduring  gains  for  both  mothers  and 
  children,  and  cost  savings  to  government 
  (AHRQ 2008a). 

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• The private sector has implemented different
  types of delivery models that generally aim to
  provide high-quality, affordable care to those at
  the bottom of the pyramid. For example, the
  non-profitcare rural health mission, which
  operates in Andhra Pradesh and Maharashtra, is
  one of many leveraging telemedicine to link
  trained community health workers with remote
  physicians at primary care clinics and hospitals.
  This approach helps to circumvent Indias acue
  shortage of trained doctor and nurses. In Mumbai,
  the for-profit swasth india medical center(SIMC)
  runs a chain of health centers in the citys
  slums. Its clinics provide much needed access to
  drugs, prevention, primary care, dental and
  diagnostic services, and facilitate referrals to
  hospitals and specialist as needed. Through smart
  procurement and efficiency gains from digitized
  patient records as well as use of standard
  protocols and referrals, SIMC reportedly offers
  affordable prices and achieves high patient
  satisfaction. There are numerous other examples
  of similar small-scale efforts with potential for
  scale-up.

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Innovations in primary and community and health
care

• Similarly Ghanaian trained nurses, who were moved 
  from fixedlocation clinics to  village 
  residences  built  by  the  community,  provide 
  doortodoor  servicedelivery  inthe 
  community.  They provide ambulatory care and visit
  s to all houses in the community for health educat
  ion, followup and diagnosis.  The project provide
  s them with a  motorbike 
  for community liaison work and they are responsibl
  e for immunisations and outreach  services. 
  Evaluation in the first five years of project impl
  ementation showed the nurses  operating in the com
  munity outreach site achieved reductions in child 
  mortality rates  through improved treatment of
   acute respiratory infections, malaria and 
  diarrhoea and through improved childhood vaccinati
  on.
• In the USA, nurse specialists use telephones to pr
  ovide followup for infants with lung 
  disease in rural areas.  The programme targets fam
  ilies living in rural areas who often 
  find it difficult to repeatedly travel to a distan
  t medical centre for necessary followup 
  care.  A randomised control trial found that the p
  rogramme, believed to be the first 
  application  of  telephone  followup  care  for 
  an  infant  population,  delivers  similar 
  developmental and health outcomes as traditional m
  odels of care, suggesting that the 
  programme successfully enhanced access without imp
  acting on quality (AHRQ 2008b).

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• The Ministry of Health Family Welfare,
  Government of India holds National Summit on
  Good, Replicable Practices and Innovations in
  Public Healthcare Systems in India since 2013 to
  recognize, showcase and document various best
  practices and innovations adopted by States and
  UTs for addressing their public health challenges
  and to improving their health outcomes though
  better implementation of programmes under
  National Health Mission.
• Through these summits, the MoHFW endeavours to
  foster cross learning amongst the State
  Governments, NGOs, Healthcare organizations and
  other academic institutions so that these work in
  concordance to achieve the overarching Public
  health goals.
• Summit has participation from all States and
  Union Territories with Principal Secretaries
  (Public Health), Secretaries Health, Mission
  Directors (National Health Mission) and Director
  (Health FW) from States along with programme
  officers, officials from Government of India
  along-with heads of programme divisions, MoHFW,
  Development Partners, Civil Society
  representatives and other healthcare
  organizations as key participants.

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• The National Healthcare Innovation Portal
  (NHiNP), was launched in 2015 where States/UTs
  can upload their good practices and innovations
  which is reviewed and scientifically assessed
  prior to shortlisting it for presentation at the
  national summit. It represents the Ministry of
  Health and Family Welfares unstinting effort
  towards identifying and nurturing good practices
  and innovations.

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Innovations in management

• The availability of  health  care workers is a wor
  ldwide  issue.  Skill shortages  are 
  evident across the world, and  the distribution of
   available workers is  uneven. 
• One response to these pressures has been to change
    the way that nurses work toensure that the best 
  use is  made of the available skills. 
  New nursing roles, in  which 
  nurses develop new approaches to care to take on r
  oles  formerly the domain of 
  other health professionals, have 
  proliferated and have been cited as 
  numbering at least  3000 (Read et al.1999 cited in
   Spilsbury  Meyer 2001). 
• For example, advanced practice nurses including nu
  rse  practitioners,  have  come  to 
  play  an  important  role  in  health care deliver
  y since their inception  in  the 1960s, 
  driven  by  a  number  of  factors  including 
  shortages  of  health professionals in rural and r
  emote areas and efforts  to contain costs. 
  While  research is so  far inconclusive in 
  regard to longterm cost effectiveness, there is 
  evidence  to  demonstrate  that  these 
  models  can  provide  an  effective  means to 
  provide  good  quality  patient  care 
  (Buchan  Calman 2005). 

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• Nursing roles have developed into many areas of pr
  actice and roles in the  United  Kingdom. 
  For example, advanced nurse practitioners (ANPs) h
  ave taken the role of senior house officers in obs
  tetrics and gynaecology. 
• A study of the impact of this innovation found las
  ting benefits in terms of 
  better communication  and multidisciplinary workin
  g, and the development of  an informal referral 
  system  that allows patients to be seen more quick
  ly and  appropriately, without any ill 
  effects on patient care (Easton et al. 2004). 

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• For example, the American Nurses Association
  (ANA) and the Healthcare Information and
  Management Systems Society (HIMSS) have developed
  a collaborative partnership that aims to drive
  nurse-led innovation through cobranded
  initiatives, such as NursePitch, Nurse Jam, and
  other events. At the inaugural NursePitch event
  held in March during HIMSS19 in Orlando,
  contestants were given 5 minutes to present their
  innovative products to expert judges and answer
  questions, such as what problem the product
  solves, its cost to produce, the target market,
  and related challenges. During the Nurse Pitch
  event held in April at the ANA Quality and
  Innovation Conference, the top three winning
  nurse innovators presented products they
  developed to enhance clinical competence for
  assessing skin lesions assessing heart, lung,
  and abdominal sounds via a virtual
  stethoscope-otoscope and monitoring patients
  using computer vision and artificial intelligence 

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Innovative approaches to education and
development

• Approaches  to  education  have  also  undergone 
  significant changes in recent decades, moving from
   a  focus on  the  transfer  of  knowledge  and 
  skills  to  acompetencies based approach with a 
  greater focus on  transferable capabilities and de
  cisionmaking. 
• Advances in imaging and communication technologies
    have  also  resulted  in  new  models for  the 
  delivery  of  education, particularly in relation 
  to ongoing professional  development.  Some 
  examples  of  the  way  these  new 
  technologies can be used for nurse education are
  
• A Second Life for nurse training.  In the United
    Kingdom, the virtual world programme Second 
  Life is being developed to help enhance student 
  nurses  clinical  skills.  Glasgow  Caledonian 
  University  has  created  a  Second 
  Lifeisland  where the Universitys clinical skill
  s laboratory is  recreated.  Here, 
  student nurses can test their  knowledge and skill
  s in a virtual world (Tweedle  2008).

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• Another example of an educational innovation is th
  e LeaRN CRNE Readiness  Test  supported by the Can
  adian Nurses Association.  The online test simulat
  es 
• the Canadian  Registered Nurse Examination (
  CRNE).  The tool assists internationally educated 
  nurses  to meet registration requirements and to 
  integrate into the Canadian health care
   system.  The test includes 100 questions from pre
  vious  CRNEs.  Benefits of the LeaRN CRNE 
  Readiness Test include
• Worldwide accessibility
• It allows nurses to assess their readiness to take
   the CRNE even before coming  to Canada and
• It provides test takers with experience with real 
  CRNE questions that have been matched  for 
  level  of  difficulty  with  the  CRNE 

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Innovations adopted by nursing personnels

• Simulation, using actors posing as patients,
  complex high-fidelity mannequins, or virtual
  reality. The brief notes that simulation allows
  students to work through their responsesand make
  mistakesbefore encountering high-risk scenarios
  with actual patients. In the real clinical
  world, when the student is a novice and something
  potentially life-threatening occurs, somebody
  will take over, says Pamela Jeffries, PhD, RN,
  ANEF, vice provost for digital initiatives at
  Johns Hopkins University School of Nursing and
  current president of the Society for Simulation
  in Healthcare. In the sim lab, its the student
  who has to make a decision. A newly released and
  eagerly awaited study by the National Council of
  State Boards of Nursing (NCSBN) offers powerful
  support for the trend toward simulation. It found
  no differences in licensure pass rates or other
  measures of overall readiness for practice
  between new graduates who had traditional
  clinical experiences and those who spent up to 50
  percent of their clinical hours in simulation.

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• Interprofessional education with the goal of
  overcoming learning silos that divide clinicians,
  thus encouraging the habits of collaboration. At
  Emory University, about 20 nursing students in
  the schools community health class work each
  semester with physical therapy, pharmacy, and
  dental hygiene students in a family health
  program at a migrant labor camp in Moultrie, Ga.
  They are literally working side by side with
  different professions, says Elizabeth Downes,
  DNP, MPH, FAANP, an assistant clinical nursing
  professor who helps run the program. Its a very
  rich two-week immersion.

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• Dedicated Education Units (DEUs) that assign a
  group of nursing students to an entire unit of a
  care facility and engage staff nurses along with
  clinical faculty in instructing students over an
  extended period. Hospitals tell us it makes them
  better nurses, says Joane Moceri, RN, PhD,
  associate dean for the undergraduate nursing
  program at the University of Portland. When they
  are teaching students what they know, it keeps
  them on their toes, and it keeps them up with
  the latest evidence-based nursing. Facilities
  also gain access to a tested group of student
  nurses they can later hire. Meanwhile, students
  can experience a richer clinical learning
  environment and develop a greater sense of
  belonging to a health care team.

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Adopting innovations

• The process by which innovations go from creation 
  or development to  becoming part of 
  everyday practice involves both dissemination an
  d  diffusion. Dissemination refers 
  to  the planned, formal communication of 
  information about the innovation, usually through 
  formal  channels  such  as  organisational 
  hierarchies.  Diffusion  is  a  more  informal 
  process, by which  ideas become adopted through m
  ore informal, decentralized means. 
  It refers to the more organic process of a good id
  ea catching on.  Both processes play 
  an important  role.

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Robotics in nursing

• Today, across the country, robots (powered by
  artificial intelligence) are being deployed and
  tested in inpatient care environments, so the
  proverbial genie is already out of the
  bottle. While we cant go back in time to before
  robots existed, we can ensure that nurses have
  input into how robots are designed, developed,
  tested, and utilized in the patient care setting.
  Robots assisting nurses in providing patient care
  is something with which technology can help us,
  not as a replacement, but rather as a force
  multiplier. It is important to understand both
  the functionality and limitations that service
  robots will bring to the patient care ecosystem.
  This paper is a deep dive into the impact of
  service robots and the benefits they bring to the
  care team. This paper does not evaluate the
  design and development of the technology,
  artificial intelligence, or robotics that can
  potentially supplement nurses in the care setting.

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Virtual reality

• Newly used in healthcare and nursing practice
  settings, Virtual Reality (VR) is a technology
  that immerses and transports a patient into a
  virtual world. (Ficarra, 2020). VR is a
  multi-sensory experience enabling a user to
  perceive being present in a simulated environment
  (Chirico et al., 2018). VR is an entirely
  imaginary digital experience, providing a
  realistic recreation of a threedimensional
  environment experienced and controlled by the
  movement of the body (Ficarra, 2020). VR excludes
  the external (real-world) environment, and it
  resembles real-life interactions (Chirico et
  al., 2018 Chan et al., 2018). The
  computer-simulated environment is accessed
  through a head-mounted display (HMD) (Li et al.,
  2011) allowing patients to have a fully immersed,
  nonclinical, more comforting experience.

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Forensic nursing

• A forensic nurse is a Registered or Advanced
  Practice nurse who has received specific
  education and training. Forensic nurses provide
  specialized care for patients who are
  experiencing acute and long-term health
  consequences associated with victimization or
  violence, and/or have unmet evidentiary needs
  relative to having been victimized or accused of
  victimization. In addition, forensic nurses
  provide consultation and testimony for civil and
  criminal proceedings relative to nursing
  practice, care given, and opinions rendered
  regarding findings. Forensic nursing care is not
  separate and distinct from other forms of medical
  care, but rather integrated into the overall care
  needs of individual patients.

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conclusion

• Here we understand innovation to be about
  purposeful change change to realise clearly
  defined benefit(s). It doesn't have to be "brand
  new", but it is new within a specific context. It
  can be about the design and development of a new
  product or service but it can also be about the
  modification of an existing product or the
  redesign of an existing service. 

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