INNOVATIONS IN NURSING

INTRODUCTION Those who never walk, except in others tracks, will make no discoveries - Author unknown Brookfield describes change as a societal constant evident in relationships in all settings. Lutjens describes changes as an inherent, natural and continuous. Civilizations owe its existence to change. The success or even survival of an institution or organization depends on making necessary changes. To innovate means to introduce something new; to be creative. An administrator must be innovative: an agent of change. Innovations are a social value of immense proportions. There is an active role of nurses as initiators or participants in changes that affect nursing. There is currently ongoing evidence of some reevaluation of the changes in health care delievery that took place during the 1990s. As a result, nursing is gaining greater autonomy in the way it is practiced within the health care system. CREATIVITY AND INNOVATION Creativity is defined in Websters New Twentieth Century Dictionary, Unabridged (2 nd edition) as artistic or intellectual inventiveness. With the definition of innovation and creativity, it is seen that the terms are interchangeable. Creativity is the mental work or action involved in bringing something new into existence, whereas innovation is the result of that effort. To differentiate between the two, one might say that a

nurse can create or invent a new nursing product, process or procedure (creativity) and then can effect change by putting a new product, process or procedure into use (innovation). Creativity is a way of using the mind. Creativity is a special talent and an important tool for survival in the 21 st century. Research indicates that creativity is separate from intelligence. NEED FOR CREATIVITY A constant flow of new ideas is needed to feed the mandate for change in every aspect of our lives. According to J.Gilmartin, Creativity is the fuel of innovation. Innovation is key to the survival and growth of both health care and nursing. Entrepreneurs create the new and different; entrepreneurial nurses create new businesses with new products and services, from which both the nurse and the organization benefits. The nurse gains personal satisfaction, rewards, and recognition while the organization survives, thrives and prospers. Creative people have the mental skills of curiousity, openness, sensitivity to problems, flexibility, ability to think in images, and capability of analysis and synthesis. Creative individuals value the work and association of other creative individuals; they stimulate each other to think and perhaps even to be competitively creative.

INNOVATION Innovations are brought about by a series of processes. It starts with thought. Imagination is the workshop of the mind. It is the act of constructive thinking, grouping knowledge, skills and attitude into new, original and national ideas. Old ideas and established facts are reassembled into new combinations and put to new uses. Imagination is

both interpretative and creative. It can receive impressions and form new combinations and build them into ideas. These ideas are then translated into plans and then into activities. Creative thinking requires that we keep our minds open and in a state of expectancy to achieve our objectives. Resistance in innovation We often do not attempt innovation because we are: 1. Afraid: of failures; of opposition; of the unknown, 2. Lacking adequate and correct information, 3. Reluctant to experiment, 4. Bound by custom and tradition, and 5. Unaware of our strengths for achievement. Characteristics of an innovator A successful innovator or change agent: 1. Identifies opportunities for improvement or overcoming major problems; 2. Has a readiness to accept change; 3. Creates a climate for innovation; 4. Supports and sustains the change effort; 5. Evaluates, reviews and modifies activities appropriately for

effective change; and 6. Continues the effort till the desired goal is achieved. Requirement for innovation To bring about innovation, there is need for:

 A definite purpose: if you wish to succeed, you must have a definite aim and purpose. Anticipate the needs of the future. Work out the general and specific objectives. Initiative: It is the pass key that opens the door to opportunity. Knowledge of fact: Get as much information as possible. Self confidence: Most often, the only limitation to ones trying out the new is lack of confidence in one self and in the organization. Persistent effort: one does not succeed because one gives up at the least difficulty or resistance. He has to put up even greater efforts when faced with resistance. INNOVATIVE INTERVENTIONS IN NURSING Innovation is central to maintaining and improving quality of care. Nurses innovate to find new information and better ways of care and cure. One of the earliest examples of innovation is Nightingales Landmark study of maternal morbidity from puerperal fever following child birth. Observing the high number of deaths in maternity wards, her query was, Do more women die after giving birth in a hospital rather than in a home? And if so, why? Her study proved that the death rate was higher for women who gave birth in hospitals; her innovation resulted in the saving of womens lives. Innovations often arise out of necessity in order to address a need or gap in service or technology. E.g. 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 by an American nurse as an easy, economical, safe and socially acceptable alternative. It involves placing healthy, preterm mothers breasts. infants skin-to-skin between their

Manpower shortages at global level also provide another drives for innovation. While innovation is often considered in terms of high costs, high tech solutions, the need for innovation is even more pressing in the developing world. In South Africa, nurses use mobile phones to support people living with HIV/AIDS and to improve adherence to antiretroviral therapy (ART). Similarly, nurses in Iceland provided telephonic nursing intervention and reduced fatigue and distress for mothers who received up to five telephone calls over two months from a skilled nurse counselor. Thus innovation provides a way to meet local challenges. Areas of Nursing Innovations Innovations in nursing can be in any area of nursing like nursing service, community care or primary care, nursing education and administration or in any related areas. For e.g. use of simulation in teaching clinical procedures, use of virtual reality and web based learning are innovations in nursing education. Utilization of ICN Innovations Database The ICN Innovation Database can be utilized by a wide range of nurses, other health care professionals, employers, government, industry, and the general public. It is a long term initiative with the objective nurses to foster to nursing health innovation, systems and promote provide the an dissemination of nursing innovation to a wider audience, recognize the contribution make environment for knowledge sharing. Even proposed innovations can be included in addition to implemented or successful ones. To read more about this database search or add an innovation, go to http://www.icn.ch/innovations/about.htm. Health promotion and Disease Prevention

Nurses are uniquely positioned to identify risk factors, provide information to manage these risks, and promote the benefits of healthier lifestyles, diets and avoid risky behaviors. As an instance, a survey of 1000 nurses in Northern Ireland revealed a total of 392 nursing interventions addressing issues such as breast and cervical screening, adolescent childhood suicide, accident prevention, and smoking lay cessation, worker AIDS/HIV awareness health

programmes. Innovations in Primary and Community Health Care A key component of PHC is the concept of community development. Nurses continue to innovate in PHC. For e.g. the Tirawhiti Innovative Nursing Team (TINT) project, which is an entirely nurse-led project in a deprived area of New Zealand, provides health assessment, follow up, teen-parent counseling, case management and outreach services to deprived communities. Similarly Ghanaian trained nurses, who were moved from fixed location clinics to village residencies built by the community, provide ambulatory care and visits to all houses in the community for health education, follow up and diagnosis. Five-year evaluation showed the nurses achieved reductions in child mortality rates through improved treatment of acute respiratory infections, malaria and diarrhea and through improved childhood vaccination. Innovations in Management, Policy and Education Workforce Innovation Shortages of skilled nurses and their uneven distribution are twin challenges in health care scenario across the world. Besides, advanced practice nurses including nurse practitioners, have come to play an important role in health care delivery. Workforce innovations play an important part in health care policy and development. The Wellness Centers offer a range of services, including

testing, counseling and treatment for HIV and TB; antenatal services, including Prevention of Mother to Child Transmission (PMCT); stress management; post exposure prophylaxis; screening for chronic conditions and a training and resource/knowledge centre for continuous professional development. Innovative approaches to education Advances in diagnostics, imaging and communication technologies have also resulted in new models for the delivery of education. In this context, the new courses for all levels of learners are already in the pipeline. Leadership in Innovation Leadership for Change (LFC) is an action learning programme to develop nurses as effective leaders and managers in constantly changing health environment- it involves developing the attitudes, skills and behaviors that differentiate effective leaders and managers. This learning by doing programme is implemented over enough time to allow for leadership development through hands on experience. LFC is particularly effective in preparing future nursing managers and developing quality cost effective nursing services. From Innovation to Practice Once innovation has been conceived or developed, the process of introducing it into practice begins. The two do not follow an automatic course. Perhaps the most influential text on this subject is Rogers Diffusion of Innovations, which provides a comprehensive overview of the introduction into practice and is widely quoted by subsequent authors. Rogers identified that there are a 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 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 of daily activity or practice, replacing the former approach (Rogers 2003; Van der Weide and Smits 2004). The adoption of an innovation will be influenced by the character and personality of the individuals involved, and the roles they play in their social groups, the norms and values they share and the way in which they communicate with each other. Nurses as Innovators Nurses work in varied settings with all types of patients, families, communities and health care personnel. As such, they are critically positioned to provide creative and innovative solutions that make a real difference to the day-to-day lives of patients. Florence Nightingale provides a great example of leadership in innovation. Among many of her innovations were: a. The introduction of systematic handwritten records for the medical profession. b. System for collection, tabulation, interpretation and graphical display of descriptive statistics, and c. Polar area diagram in an era when the measurements and mathematical analysis of social phenomenon was in its infancy. The role of Nursing National Associations National Nursing Associations (NNAs) represent a key force in fostering and supporting innovation, and can provide 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, collaborating 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 proposed innovations for nurses. 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. Recognizing/acknowledging nurse innovations. Disseminating nursing innovations to nurses and others.

What nurses can do? 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. Also, through their professional conduct and relationships with colleagues, nurses can play a role in creating a working environment which is receptive and ready for positive changes to practice.