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Title: innovations in nursing

1
Panna Dhai Maa Subharti Nursing College

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

2
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.

3
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).

4
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).

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.

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).

7
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).

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.

9
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).

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.

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.

12
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).

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).

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

15
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).

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

17
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.

24
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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