SEMINAR

ON

INNOVATIONS IN NURSING

PRESENTED TO : Mr. Gopal Singh

Lecturer, Child Health Nursing

PRESENTED ON : SEPT 29, 2011

PRESENTER:

Gundeep Kaur

M.Sc. (N) 2nd year

Roll No. 8
 INNOVATIONS IN NURSING

INTRODUCTION: - innovation is an important topic in the study of economics, business, design, technology,
sociology, engineering and nursing. The word “Innovation” is often synonymous with the output of the process.
Innovation typically involves acting on the creative ideas to make some specific and tangible different in the
domain in which the innovation occur.

DEFINITIONS:-

An innovation is a new way of doing something.

OR

"Innovation is using knowledge to create ways and services that are new (or perceived as new) in order
to transform systems. It requires deconstructing (i.e., challenging) long-held assumptions and values. The
outcome of innovation in nursing education is excellence in nursing practice and the development of a culture
that supports risk-taking, creativity, and excellence. (Nursing Department, International University of
Health and Welfare, Japan, The Task Group on Innovation in Nursing Education )

OR

“Innovation….is generally understood as the successful introduction of a new thing or

method…..Innovation is the embodiment, combination or synthesis of knowledge in origin, relevant, valued
new products, processes or services.” (Luecke and Katz 2003)

OR

“All innovations begins with creative ideas….we define innovation as the successful implementation of
creative ideas with in an origin. In this view, creativity by individuals and teams is a starting point for
innovation; the first is necessary but not sufficient condition for the second.” (Amabile et al 1996)

SOURCES OF INNOVATION:-

1. Manufacturer innovation.
2. End- user innovation.
NEED FOR INNOVATIONS IN NURSING: -
 As innovation is the generation of new ideas or the application of existing ideas to a new situation,
resulting in the improvements to a service, programme, structure, product or system.
 The health care system operates in the environment of constant change and challenge. Changes in the
demographics and the burden of the disease continue to present new demands on the health care system.
 Growing demands on the health services in turn create increasing pressures to do more with the fewer
resources. These pressures are likely to be exacerbated by the current economic downturn, as
governments balance competing demands for the available funds and continue to seek the best value for
a limited supply of money. Global workplace shortages also provide another driver for innovation.
 While innovation is thought of in terms of high cost, high tech solutions, the need for innovations is
even more pressing in developing world.
 One of the earliest examples of innovations in nursing is Nightingale’s landmark study of maternal
morbidity from the puerperal fever following childbirth. She observed the high number of deaths in the
maternity wards and asked the question, “Do more women die after giving birth in a hospital rather than
 in home? And if so, why?” her study proved that the death rate was highest for women who gave birth in
hospitals; her innovation resulted in changes to the services that resulted in saving of women’s lives.
HISTORY :-

 In a session entitled "Nursing at the Forefront of Innovation," Frances Hughes, Professor in the School
of Nursing and Director of the Centre for Mental Health Research, Policy and Service Development at
the University of Auckland, New Zealand, highlighted significant innovations of nursing throughout
history.
 Dr. Hughes gave examples of nursing innovation in research, practice, technology, and policy. She
began by discussing the Native Health Nursing Scheme of 1911 that was a response to a population
need.
 The scheme raised the profile of nurses and gave them increased autonomy and accountability to care
for indigenous populations. Dr Hughes offered news clips from 1946 to visualize the district health
nurse who arrived to care for the Maori by grey car and horseback. The district health nurse was the
healthcare link to the community. She was caring, autonomous, and offered access to care for remote
populations.
 In the area of research, the work of Linda H. Aiken, PhD, RN, University of Pennsylvania, was
highlighted. Dr. Aiken was a pioneer in interhospital outcome studies and applied objective performance
measures to establish evidence-based practice and the development of the magnet hospital movement.
 Nurses have been leaders in using technology and health informatics. In New Zealand, in conjunction
with Microsoft NZ, 145,000 people benefit by the use of smart phones that assist in integrating health
information.
 Sometimes described as a "disruptive" innovation in healthcare, nurse practitioners (NPs) provide
quality care and devote more time to the patients. Dr. Hughes believes that innovation is an integral part
of all strategies. Leadership clears the way for creativity, and technology is an enabler.
GOALS OF INNOVATIONS IN NURSING:-

1. To maintain the quality of care.

2. To improve the quality of care.
3. To find new information.
4. To find new ways of promoting health.
5. To find new ways for preventing illness.
6. To find better ways of care and cure.
7. To conform to the regulations.
8. To reduce the energy consumption.
INNOVATIONS IN NURSING:- We can broadly classify these into the following:-

1. Innovations in nursing practice.

2. Innovations in nursing education.
3. Innovations in nursing care.
4. Innovations in nursing management.
1.INNOVATION IN NURSING CARE DELIVERY:

The nursing has had an opportunity to make significant Contributions to health care through out history. The
21st century will be no different health care reform is giving nurses the opportunity to expand their roles.
CARE MANAGEMENT:

a) An innovation approach that has met with success is care management structuring accountability for
clients outcome at the care delivery level with in a unit or area of care.
b) Care management typically one care giver co- ordinate care form admission through discharge with in
an ...acute care setting. A single multi disciplinary plan is implemented so that all care givers work with
one plan to achieve the same client outcomes.
c) A Critical Pathway is a multi disciplinary treatment plan that sequence clinical intervention over a
projected length of stay (e.g. hone health visits)
d) A care map is unique in that it incorportates day to day expected outcome as those outcome anticipated
at discharge or at the end of treatment phase.
e) Each day a care map out line clinical assessment treatment & procedures, intervention activity &
exercise therapies pathenis education & other discharge. Planning activities necessary to ensure a
smooth un-eventual course of recovery.
f) The care map tells the care giver what care needs to be given & when so that a client is discharge on
time and in a healthy condition as possible.

2. CASE MANAGEMENT.

Case management is defined by zander as the co- ordination of client care across a continum.

Eg. A client with chronic disease such as congestive heart future may be assigned a nurse as a case manager in a
medicine Outpatient clinic whenever the client is hospitalized the same case manager co- ordination care so that
all providers understand the client unique needs.

The case manager must have skill & knowledge in negotiating obtaining & coordinating services & resources,
intervening at key points for client & analyzing the trends in care that create negative clinical outcome.

3. PATIENT FOCUSED CARE.

1. Many hospitals have begin at re- designing the work of care provider so that staff work smarter rather
that harder many different types of profession & non professional are involved.
2. The assumption of patient focused care is that in the tasks that are normally provided by a personnel, for
example phlebotomy, physical therapy, respiratory therapy ECG testing etc, the number of staff
involved & number of steps to get the work done are reduced.

4. ASSISTIVE PERSONNEL

1. The addition of alternate care providers can be done in an innovative way that successfully reduces RN
work load.
2. The organization that have successfully added assistive personal without compromising quality of care
have recognized the importance of having RNS & assistive personal in doing the right work & engaging
in team building.
3. For example activities like bathing, assisting in feeding, specimen collection measuring height & weight
to assistive personal which do not require nursing judgement.
5.ADVANCE PRACTICE NURSING

1. An advanced practice nurse is not an innovation however the roles that advanced practice nurses are
beginning to assume with health care reform are innovation and challenge.
2. Advanced practice nurses consists of
 Clinical nurse specialists
 Nurse practitioners
 Nurse midwifes
 Nurse anaesthetist
1.INNOVATIONS IN NURSING PRACTICE: - innovations in the clinical practice occur across the
continuum of care. Advances in medical equipment and technology have formed a significant driver in changes
in clinical practice, demanding new skills and techniques as well as the new ways of working. Similarly
changes in the availability and effectiveness of drug based treatments have also brought about significant shifts
in the clinical practice. Just as important, however are innovations to way we approach care through new
collaborative partnerships with other organizations and health care providers, communities and community
groups and with consumers of health services, their families and caregivers.

Once innovation has been developed, the process of introducing it into practice begins. There are a
number of complex factors which influence whether an innovation translates in to a change in practice; factors
which influence personal characteristics and motivations of those involved and the cultural and organizational
environment into which the innovation will be introduced.

Rogers identified that there are number of stages in the diffusion process: knowledge,
persuasion, decision, implementation and confirmation. These stages describe the process which begins with the
involved parties becoming aware of the innovation and then forming a view about it. This leads to the next stage
in which a decision is made about whether it should be pursued. Next, the innovation is implemented and
experimented with. Finally, in the confirmation stage the new method becomes part daily activity or practice,
replacing the former approach.

Not all innovations will proceed to implementation, however. There are a number of factors to be
considered in making the decision about whether to proceed from innovations to implementation or not.

3.INNOVATION IN NURSING EDUCATION:

1.Development of computer-assisted thinking: In order to enhance students' active thinking, faculty members
at International University of Health and Welfare developed the CAT (Computer Assisted Thinking) program.
The CAT program is different from CAI (Computer Assisted Instruction), which mainly asks users to choose
correct answers. Instead, the CAT program asks users to type in short sentences. There are two functions in the
CAT program:
 one is to keep the students' action log each time they use the program and
 The other is to serve as medical dictionary.
An analysis of the action log revealed that the students demonstrated little skill in inferential thinking. Their
observations were very concrete. In order to help the students to develop their abstract thinking skills, we
need to review our curriculum.

2,Substantive innovation in nursing education: shifting the emphasis from content coverage to student
learning:- To help advance the idea of substantive innovation in nursing education, NEAC formed the Task
Group on Innovation in Nursing Education, Task Group developed four strategies. Three of these strategies are
as follows:

a) Distribute an online survey that asks faculty to share their perceptions about the current state of
innovation in nursing education.
b) Formulate specific questions, shared with deans, directors, and chairpersons of nursing programs, that
are designed to stimulate thoughtful dialogue at any forum where faculty engage in conversations about
thinking and learning, such as faculty meetings and retreats.
c) Develop an electronic community where educators can share innovative practices and engage in ongoing
dialogue.
These strategies, which might be embedded in individual courses or used as an organizing framework for the
entire academic program, included ideas such as the following:

a. Incorporate creative use of technology, including CD-ROMs, personal digital assistants (PDAs),
computer-assisted instruction, and human patient simulators.
b. Use concept mapping as a method to promote higher level thinking skills.
c. Integrate educational theories, including learning styles.
d. Use gaming in classroom and clinical settings.
e. Employ integrative exercises and tests as teaching tools.
f. All ideas offered were recorded, and the information was later analyzed. This analysis revealed several
themes related to barriers to and stimuli for innovation and change.
g. Risk taking is essential for innovation.
h. Partnering with colleagues facilitates innovative practices. Do pilot projects hold promise for promoting
innovation, fostering collegial support, and creating climates that are conducive to innovation? How can
faculty work together most effectively to support strategic restructuring of courses...
3. INNOVATIONS IN THE NURSING CARE ;-

 This literature review focuses on substitution-related innovations in the nursing care of chronic patients
in six western industrialized countries.
 Differences between primary and secondary care-orientated countries in the kind of innovations
implemented are discussed.
 Health care systems are increasingly being confronted with chronic patients who need complex
interventions tailored to their individual needs.
 However, it seems that today's health care professionals, organizations and budgets are not sufficiently
prepared to provide this kind of care. As a result, health care policy in many countries targets
innovations which reduce health care costs and, at the same time, improve the quality of care.
 Frequently, these innovations are related directly to the 'substitution of care' phenomenon, in which
care is provided by the most appropriate professional at the lowest cost level, and encompass advanced
nursing practice, hospital-at-home care and integrated care.
 The main conclusion of this is that integrated care innovations are implemented in both primary care as
well as in secondary care-orientated countries.
 However, innovations in hospital-at-home care and advanced nursing practice are primarily
implemented in primary care-orientated countries. Whether these innovations positively influence
the quality of care, costs of care or patients' use of health care facilities remains rather unclear.
 Practical innovation leads to an immediate improvement in patient care.
4. INNOVATIONS IN NURSING MANAGEMENT:-

There are many changes occurring in the National Health Service (NHS) at this time, not just to economic and
funding policies, but also at the very heart of nursing care delivery. The introduction of 'managerialism' into the
senior clinical grades of nursing, midwifery and other professional staff has characterized the past few years.
Against this backdrop is the increasing belief that NHS organizations must find improved ways of delivering
patient care and other services. This has inexorably led to the consideration of diffusing innovation into practice
as a way to improve performance and competitiveness. While there have been a number of clinical attempts at
understanding this process, there has been very little written about innovation from the perspective of the nurse
(or midwifery) clinical manager.

INNOVATIONS IN HEALTH PROMOTION AND DISEASE PREVENTION:- the realm of health

promotion and disease prevention provides a range of examples of the influence of nursing in the improving
population health status. Nurses are uniquely positioned to identify risk factors, provide information about how
to manage these risks and promote the benefits of healthier lifestyles, diets and avoid risky behaviours.

THE ROLE OF NATIONAL NURSING ASSOCIATIONS: - NATIONAL NURSING ASSOCIATION

(NNAs) represents a key force in fostering and supporting innovation. The NNAs provide the leadership by:-

Promoting nursing as a profession with a long standing and respected tradition of creating, driving and
supporting innovative approaches to health care and celebrating nurses’ innovative achievements.
 Supporting innovative cultures in the workplace, collaboration with other key players to promote
positive practice environments which have a high readiness for change and where innovative ideas can
be openly discussed.
 Providing input to health care organizations, researchers and policy makers on the implications of the
proposed innovations for the nurses and contribution to discussions about how these implications can be
effectively managed.
 Advocating for key innovations in the broader external environment among key opinion leaders and
communities and within the field of political and industrial debate.
 Providing a space/ forum for exchange and discussion of innovations.
 Recognising/ acknowledging nurse innovators.
 Disseminating nursing innovations to nurses and others.
NURSES IN THE WORKPLACE AS INNOVATORS:-

 Every nurse can play a role in ensuring that innovations are effectively implemented and
adopted, by providing feedback on their usefulness and applicability, contributing suggestions as
to how innovations can be altered to make a better ‘fit’ with local circumstances and needs.
 Through their professional conduct and relationship with colleagues, nurses can play in creating
a working environment which is receptive and ready for positive changes to practice.
 In their leadership positions nurses are well placed to disseminate information about innovations
and innovative practices that are occurring within an organisation or other organisation.
 In leadership roles they can make a significant role toward creating an environment in which
innovation is encouraged and supported among peers and more junior staff.
 Every day nurses are developing new and innovative approaches to improving health care
services and health care outcomes for local people.
NURSES AS INNOVATORS:- FLORENCE NIGHTINGALE

 Florence Nightingale’s work provides a great example of leadership in innovation.

 Among her many innovations was the introduction of systematic handwritten records for the
medical profession.
 She was also an innovator in the collection, tabulation, interpretation and graphical display of
descriptive statistics. She developed the polararea diagram as a means to present evidence to
support her augments for reform, in an era when the measurements and mathematical analysis of
social phenomenon was in its infancy.
 In 1860, in acknowledgement of these efforts, Florence Nightingale became the first woman
elected a fellow of the statistical society.
 The Florence Nightingale International Foundation, established in her honour, continues to
promote and strengthen nursing worldwide through a range of activities, including its support for
the International Council of Nurses.

INNOVATION PROCESS:

Internal pressure External pressure Characteristics of

Characteristics of for change for change community:
personnel:

Training

Sociodemographic consumer Groups

Values regulatory agencies

Performance Gap

Recognition

Identification

Implementation

Institutionalization

Fig: Innovation Process

REASONS FOR FAILURE OF INNOVATIONS:-

 Poor leadership.
 Poor organisation.
 Poor communication.
 Poor empowerment.
 Poor knowledge management.
 Poor goal definition.
  Poor participation in teams.
 Poor monitoring of results.
 Poor access to information.

SELF ASSESSMENT: HOW RECEPTIVE TO CHANGE AND INNOVATION ARE YOU?

Read the following items. Write the answer that most closely matches your attitude toward creating and
accepting new or different ways, out of Yes, No, Depends

1. I enjoy learning about new ideas and approaches.

2. Once I learn about a new idea or approach, I begin to try it right away.
3. I like to discuss different ways of accomplishing a goal or end result.
4. I continually seek better ways to improve what I do.
5. I commonly recognize improved ways of doing things.
6. I talk over my ideas for change with peers.
7. I communicate my ideas for change with my manager.
8. I discuss my ideas for change with family.
9. I volunteer to be at meetings when changes are being discussed.
10. I encouraged others to try new ideas and approaches.

SCORING:

 If you answered “yes” to 8 to 10 of the items, you are probably receptive to creating new and different
ways of doing things.
 If you answered “depends” to 5 to 10 of the items, you are probably receptive to change conditionally
based on the fit of change with your preferred way of doing things.
 If you answered “no” to 4 to 10 questions, you are probably not receptive, at least initially, to new ways
of doing things.
 If you answered “yes”,”no”,”depends” an approximately equal number of times, you are probably mixed
in your receptivity to change based on individual situations.

BIBLIOGRAPHY:-

1. Nightingale Nursing Times. Vol 5. no. 2. May 2009.

2. http:// ppn.sagepob.com/cgi/content/abstract/7/1/45.
3. http:// gerontologist. Gerontology journals. Org/cgi/content/full/ 45/1/68.
4. http:// www.WCnursing.org/ master plan for nursing education/ curriculum%20. innovation %20 in
nursing. Pdf.