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 Nightingales 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 womens lives. HISTORY :1

 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:y 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.
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y y y

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 Nightingales 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 for change External pressure for change Characteristics of community:

Characteristics of personnel: Training Sociodemographic Values

consumer Groups regulatory agencies Performance Gap Recognition Identification Implementation Institutionalization

Fig: Innovation Process REASONS FOR FAILURE OF INNOVATIONS:y y y y y y y y y 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.

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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.