COLLEGE OF NURSING

AIIMS RAIPUR
SUBJECT-ADVANCED NURSING
PRACTICE

TOPIC- INNOVATION IN
NURSING

SUBMITTED TO- SUBMITTED BY-

MR . SHARUN N.V. MS SHALINI SAHU

NURSING TUTOR MSC NURSING 1ST YEAR
COLLEGE OF NURSING COLLEGE OF NURSING
AIIMS RAIPUR AIIMS RAIPUR
INTRODUCTION
• The only constant feature in this world is change.

• While all the change may not lead to progress, there can be no progress without change.

• This is true for the individual, institution, organization or the country.

• Civilization owes its existence to change.

• The success or even survival of an institution or organization on depends on making necessary

changes.

DEFINITION

Innovation is the act of

• constructive thinking

• grouping knowledge

• skills

• attitude into new

• original & rational ideas.

Critical thinking Imagination Plan Action Achieve objectives

DEFINITIONS:

• Innovation is defined as the generation of new ideas or application of existing ideas to a new
situation resulting in improvement in organization.

• Innovation is the action of introducing a new method, idea or product

NEED OF INNOVATION:

1. INOVATION TO CENTRAL TO MAINTAINING AND IMPROVING QUALITY OF CARE

2. GROWING DEMANDS IN HEALTH SERVICES

3. GLOBAL WORKFORCE SHORTAGE

CHARACTERISTICS OF INNOVATION

• RELATIVE ADVANTAGE: It is the degree to which the new idea is considered superior to the old one

• COMPATIBILITY: It refers to the degree of congruence between the innovation and existing
values,habits,past experience and need of the participant

COMPLEXITY: It describes the amount of difficulty that participants have in understanding and
subsequently using the innovation

TRIALABILITY: it is the degree to which the new idea can be pretested or tried on a limited basis
OBSERVABILITY: It refers to how visible the innovation is to participants and onlookers

PRICIPLES
• Innovation is to analyze the opportunities or sources

• Innovation is both conceptual and perceptual

• It should be simple and focused

• Effective innovation start small and they aim to do one specific thing

• Successful innovation aim at being the best from the very beginning

INNOVATION IN NURSING EDUCATION

1. HANDHELD COMPUTERS IN NURSING EDUCATION

• First personal digital assistant in 1996
• According to ANA (2001) all nurses need to use nursing informatics

2.  VIDEOCONFERENCING AND WEB BASED CONFERENCING

• Connects students and educators across distance
• Connects diverse student groups

3.  E-LEARNING
• Adaptation of different distance learning technologies
• Self directed, active learning
• Refocusing from educator to the subject

4.  SERVICE-LEARNING
 • Structured learning experience that combines community service with preparation and
reflection
• Achieves a balance between service and learning objective

 HIGH FIDELITY PATIENT SIMULATOR

• Help student practice decision making and problem solving skill and to develop human
interaction
• Simulation is the third leg in the stool of education and science

5.  TELE TEACHING
• Online model of education-learner directly interacts with tutor
• Learner oriented learning
• Promotes discovery learning

6.  MICRO TEACHING
• Miniature classroom teaching
• Small duration
• Paying full attention to a particular unit and skill
• Content reduced to one unit with a single concept

7.  NURSING INFORMATICS
• Integrates nursing science, computer science and information science in identifying,
collecting, processing and managing data and information to support nursing practice,
administration, education, research

8.  URSING CERTIFICATION NURSING CERTICATION NURSING CERTIFICATION

Certification
•Advanced cardiac life support example
•Basic life support
•Certified emergency nurse
•Critical care registered nurse
•Neonatal resuscitation program
•Pediatric advanced life support
•Cardio thoracic nursing
•Emergency and trauma care nursing
•Oncology nursing
 •Renal nursing
•Fellowship in family nurse practice
•Fellowship in Hematology Nursing
•Fellowship in Respiratory Nursing
•OT technique and management
•Psychiatric nursing

9.  NURSING MOBILE LIBRARY

• Access to health care information for nurses working in remote area
• To reduce the gap between the desperate need for nursing information and its availability

10 STAFF AND STUDENT RECRUITMENT

• New methods like OSCE &OSPE
• Objective because examiner use a checklist for evaluating the trainee
• Structured, because every trainee sees the same problem and performs the same task in
same time frame
• Clinical, because the task are representative of those faced in real clinical situation

10.  INNOVATION IN CLINICAL PRACTICE AREA

. COMPUTER ASSISTANCE
• Maintenance of health records
• Health security card
• Use of ROBOTS
• Reduce error and give certitude to the clinical planning process

11.  WIRELESS TECHNOLOGY

• Nurse have immediate telephone contact with employees and with patient
• Direct and accurate communication between Nurse and Physician
• E.g.. In south Africa nurses uses their mobile phone to support people living with
HIV/AIDS

12. . EVIDENCE BASED PRACTICE

• It is combination of professional expertise with available evidence to produce practice that
lead a positive outcome for client
• Steps:
1. Identify a knowledge need and formulate an answerable clinical question
2. Locate the best available evidence
3. Critically evaluate the evidence
4. Integrate the evidence with patient’s unique biology, preferences and values
5. evaluate

13.  PATIENT CLASSIFICATION BY ACTIVITY & ACUITY OF ILLNESS

• This will provide more nurses for each shift.
• INC says 1 : 9 / shift.
• In areas where they are unable to use that ratio, an activity study is done & they come to a
conclusion about the number of needed staff nurses.

14.  INFECTION CONTROL

• To meet the annual JCAH educational requirement.
• To identify available resources which in the Hospital while maintaining good patient care.
• Infection control has become Paramount importance.
• Segregation of waste has become mandatory in all the hospitals.
• Every hospital need to have Hospital infection control committee & policy.
 15.  MANAGEMENT & LEADERSHIP
Nursing leaders and managers are exposed to different management principles relevant to
nursing practice. They are as follows:

 Management theory & leadership principles

 Time management
 Decision making & problem solving
 Teaching & performance strategies
 Identifying and achieving patient goals
 Documentation as an instrument
 Performance evaluation
 Quality assurance

16.  OUTCOME ;-

By exposing them to all the aforesaid concepts o the nurses have developed personal plans
for using time more effectively. o There is an increase in written agendas for staff meetings.
o Routine tasks are delegated more effectively. o A calendar system for planning & setting
appointments is used. o Are able to identify and achieve patient goals. o Documentation on
the nursing care has improved in measurable terms

. JOB DESCRIPTION
• These are written according to specific practice area and level of responsibility.
• Nurses are also given format of the standards for performance.

17. . PROCEDURE MANUALS

• Procedure manual has become mandatory
.
18. . EMERGENCY MEDICAL SERVICES
• To disseminate information about emergency medical services, pre hospital care &
emergency department care, as well as to share ideas, problem solving & develop
relationships among many emergency departments within the country. • By doing this kind
of networking will enhance pre hospital and emergency care in our country.

19. TRIAGE
• Triage has become mandatory in the accident and emergency and thereby they are able to
prioritize the patients those who come to causality and are able to treat the sick and
vulnerable one as early as possible.
 
20. ETHICS
• This is to increase more awareness among nurses that they will be able to apply ethics
principles while caring for patients.
• It significantly increase their knowledge about ethics and improves patient satisfaction and
the litigation rates.
• Many hospitals encourages nurses to attend such conferences and workshops.
. 
21. MAGNET HOSPITAL STATUS

• In 1980, the concept of magnet hospital came into being.

• In 1994, the American Nurses Association through the American Nurses, credentiality
centres (ANCC), established a ‘new magnet’ hospital designation process that would allow
hospitals to self – nominate under the “Magnet Nursing Services recognition program” for
excellence in Nursing Services.
• Becoming a magnet hospital is not easy. First the hospital must create and promote a
professional practice culture in all aspects of nursing care.

 
22. MAGNET HOSPITAL STATUS CONTD….
• Then, they must apply to ANCC, submit comprehensive documentation that demonstrates
its compliance with standards in the ANA’s scope & standards for nurse administrators and
undergo a multi day onsite evaluation to verify the information in the documentation
submitted and to assess the presence of the “forces of magnetism within the organization
(Joint commission For the Accreditation of Hospitals, 2003)
•Magnet status is awarded for a 4year period after which the organization must reapply
.•As of October 15, 2003, there were 88 magnet – designated organization.
•The first ANCC magnet hospital, university of Washington, was designated in 1994 &
international certification began in 1999.

.
23.  FORCES OF MAGNETISM FOR MAGNET HOSPITAL STATUS
• Quality of nursing leadership
• Organizational structure
• Management style
• Personnel policies & programs
• Professional model of care
• Quality of care
• Quality improvement
. 
24. FORCES OF MAGNETISM FOR MAGNET HOSPITAL STATUS CONTD…
• Consultation & resources
• Autonomy
• Community and the Hospital
• Nurses as Teachers
• Image of Nursing
• Interdisciplinary relationships
• Professional development
. 
25. FORENSIC NURSING SPECIALIST
• Forensic psychiatric nurse work with mentally ill offenders and with victims of crime
• It is the management of crime victims from trauma to trial
• SANE-Sexual Assault Nurse Examiner

26.  COMMUNITY BASED NURSING ROLE

• People in communities in partnership with health care professionals will define the health
needs to be met and maintain control of strategies for meeting those needs

27. . NURSE RESEARCHER

• Nurse researcher is pivotal to the profession and discipline because it directs the future
path of nursing

28. . NURSE EDUCATOR

• They are the leaders and developers of nursing program of the future
• Diabetic nurse educator
• Asthma educator

29. . ASTHMA EDUCATION COPD EDUCATION

  Home Peak Flow Smoking Cessation Monitoring

30. . NURSE ANESTHETIST

Nurse anesthetist is a registered nurse who got specialization in anesthesia and is
responsible for monitoring , administering anesthesia, to detect equipment fault

31. . NURSE MIDWIFE LED ANTENATAL CLINIC

32. TELE NURSING
• Tele nursing is nursing practice that occurs through the utilization of telecommunication
and includes the use of nursing knowledge, skills and abilities; the application of critical
thinking and nursing judgement;and provision of nursing direction or care in specific client
situation

33.  VARIATIONS IN TRADITIONAL ROLE

• HOSPICE NURSE The nurse works holistically with clients and family.
• INFORMATICS NURSE SPECIALIST Nursing specialty whose activities center or
management and processing of health care information
34.  • OCCUPATIONAL HEALTH OPPORTUNITIES Nurse designs and implement a
program of health promotion and disease prevention for employees • QUALITY
MANAGER Quality management nurses research and describe findings and look for
opportunities to improve care
35.  • CASE MANAGER:
36. case manager co-ordinate resources to achieve health care outcomes based on quality,
access and cost.
37. FLIGHT NURSE: military and civilian flight nurse
38.  TELEPHONE TRIAGE NURSE The practice nurse interacts with clients on telephone
to assess needs, intervene and evaluate
39. TRAVEL NURSE Assignment usually for a minimum time. Extra allowance will be
provided
40.   PARISH NURSE The role focuses on health promotion within the beliefs, values and
practices of various faith communities
41.   NURSE PRACTITIONER Nurse serves as a primary care provider and consultant for
individuals, families or communities • CERTIFIED NURSE MIDWIFE Independent
42. management of women’s health care. should pass the national certification examination
conducted by ACNM

43.  • CLINICAL NURSE SPECIALIST

Clinical expertise in a defined area of nursing practice for a selected client population or
clinical setting
• NURSE ADMINISTRATOR Nurse administrator unites the leadership perspective of
professional nursing with various aspects of business and health administration

INNOVATION IN ADMINISTRATION AND MANAGEMENT

44.   USE OF COMPUTER
Computerized physician order entry (CPOE)
Clinical decision support system (CDSS)

 ELECTRONIC MEDICAL RECORDS

• Affordable & integrated.
• For improving patient care.
• Powerful practice management system for practices of any size.
• Fast, flexible, Easy to use schedule for increasing productivity.
• Clinical desktop for improving enterprise work flow.
• Integrated, Internet – based solution that securely connects clinics and patients.
• Electronic document management system for eliminating paper charts.

45. LEADERSHIP FOR CHANGE

It is an action learning programme to develop nurses as effective leaders and managers •
46. OUTSOURCING  outsourcing is subcontracting a process to a third party company 
it helps to provide core job-care giving  transcription  electronic medical record 
medical billing and coding services  entry level recruitment, security, house keeping,
nursing assistance

47.  Source: HR Magazine (April 1995)

48.  • STAFFING STRUCTURE
Benchmarking: organization has varying levels of support in place at the unit level for the
nurse.eg. Nursing unit that has dietary aides JCAHO: surveys hospitals for the quality of care
provided. sees for the right number of competent staff to meet the need of patient Skill mix: it
is the percentage of RN staff to other direct care staff, LPNs and unlicensed assistive
personnel •

PERSONAL MANAGEMENT
Use of computer in recording staff files,biodata,accounts
 49.  INNOVATION IN RESEARCH
 • TYPES OF RESEARCH
QUALITATIVE RESEARCH
QUANTITATIVE RESEARCH •

USING NURSING RESEARCH TO PROMOTE EBP

EBP requires integration of best research evidence with clinical expertise and patient value and
needs in the delivery of quality, cost effective care

INCREASED FOCUS ON OUTCOME RESEARCH

Outcome research is research designed to assess and document the effectiveness of health
care services •
PROMOTION OR RESEARCH UTILIZATION
Translate research findings into practice and nurses at all levels are encouraged to
evidence in evidence based patient care
  EXPANDED DISSEMINATION 
CINAHL (Cumulative Index to Nursing and Allied Heath Literature) 
MEDLINE (Medical Literature on line) 
psyc –INFO( Psychology Information) 
AIDSLINE(AIDS information on- line) 
Cancerlit (Cancer literature) 
HEALTH STAR(Health services Technology, Administration and Research) 
CHID (Combined Heath Information Database)

50.   ELECTRONIC PUBLICATION

Information of all type is disseminated in computer and in internet
Many journals that publish in hard copy format now also have online capabilities
Some researches or research team develop their own web page with information about their
studies
Electronic research reports are accessible to worldwide audience of potential consumers,
typically without page limitations, thus enabling researchers to describe and discuss complex
studies more fully
 

. INNOVATION IN PRIMARY AND COMMUNITY HEALTH CARE

• INNOVATION IN HEALTH PROMOTION AND DISEASE PREVENTION Nurses are

uniquely positioned to identify risk factors, provide information about how to manage these
risks and promote the benefits of healthier lifestyles , diet and avoid risky behavior
• APPLICATION OF TELENURSING IN HOME CARE
 The programme targets families living in rural areas who often find it difficult to repeatedly
travel to a distance medical center for necessary follow up.

POPULATION BASED HEALTH CARE

Acts on three levels: the community system within the community, and individuals,
families and groups. Population based individual focused practice changes the
knowledge, attitude, beliefs, practices and behavior of individuals , families and groups

51. . INNOVATION IMPLEMENTATION

• DISSEMINATION Planned, formal communication of information about the innovation,
through formal channels
• DIFFUSION ideas become adopted through more informal, decentralized means. It occurs
through a series of communication channels over a period of time among the member of
similar social system
 
52. STAGES OF DIFFUSION

KNOWLEDGE
DECISION
CONFIRMATION
P P PERSUASION
IMPLEMENTATION
ACCEPT
REJECT

READINESS TO CHANGE
• Some individuals and organizations are more ready to affect changes than others.
• This depends often on the degree of felt security.
• In turn, it depends on the knowledge
• skill
• attitude
• self confidence
• tolerance to stress
• motivation of the individuals It also depends on the security to change. If there is optimal
feeling of security , then the acceptance of change will be possible. Change is crucial.
Change is a must for progress.

 ADOPTABILITY Qualities of innovation

INNOVATION
SUSTAINABILITY PROCESS OF Involvement
IMPLEMENTATION commitment

CAUSES FOR NOT ATTEMPTING INNOVATION

• Afraid of failures; of opposition; of the unknown.
• Lacking adequate and correct information.
• Reluctant to experiment.
• Bound by custom & tradition.
• Unaware of our strengths for achievement.

Nursing innovation are key to improvement and progress in health systems worldwide
REFRENCES

• Taber’s; Cyclopedic Medical Dictionary; copyright in 1997by F. A. Davis Company; published by JAYPEE
Brothers; 18th edition; page no.1771.

• Fundamental of nursing; standard and practice; 2nd edition; Syc. Delaune; patricia K. Ladner; page
no.942- 950.

• A concise text book of Advanced Nursing practice; Shebeer. P. Basheer; S. Yaseen Khan; published by
EMMESS medical publishers; 1st edition 2012; page no. 273-284.