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Title: innovations in nursing

Panna Dhai Maa Subharti Nursing College
  • Innovations In Nursing
  • Amritanshu Chanchal
  • M.Sc Nursing 2nd year

  • 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. 

  • 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).

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). 

Innovations in health promotion and disease
  • 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

Innovations in primary and community and health
  • 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
  • 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.

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 

Innovative approaches to education and
  • 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
  • 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
  • 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 

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.

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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  • 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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