INTRODUCTION

Innovation is an important topic in the study of economics,

business, design, technology, sociology, engineering and nursing.
The wurd "innovation" is often synonymous with the output of the
process. Innovation typically involves acting on the creative ideas
to make some specific and tangible differences in the domain in
which the innovation occurs.

DEFINITION

An innovation is a new way of doing something.

Nursing Department, International University of Health and

Welfare, Japan, The Task Group on Innovation in Nursing
Education conducted a thorough review of the literature in
nursing, higher education, business, and other fields and engaged
in extended discussion before formulating the following definition:
"Innovation is using knowledge to create ways and services that
are new (or perceived as new) in order to transform systems. It
requires deconstructing (Le.. 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.

By Luecke and Katz (2003): "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."

According to Amabile et al. (1996): "All innovations begin with

creative ideas.... we define innovation as the successful
implementation of creative ideas within 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."

SOURCES OF INNOVATION
Research and evidence-based practice: New findings from
academic research and clinical trials

Technology: Advances like telehealth, electronic health records,

and wearable devices

Interdisciplinary collaboration: Working with other healthcare

professionals and industry partners

Patient and family feedback : Insights and suggestions from those

receiving care Professional organizations: Initiatives from groups
like the ANA and ICN

Educational institutions: New teaching methods and simulation

labs in nursing schools

Healthcare policy: Changes in regulations and funding

opportunities Personal initiatives: Innovations from nurse
entrepreneurs and frontline practitioners

Global health trends: Responses to global health challenges and

international collaboration.
Manufacturer innovation End-user innovation

INNOVATIONS IN NURSING

Innovation is the generation of new ideas or the application of

existing ideas to a new situation, resulting in the improvements to
a service, program, structure, product or system. The healthcare
system operates in an environment of constant change and
challenge. Changes in the demographics and the burden of the
disease continue to present new demands on the healthcare
system. Growing demands on the health services in turn create
increasing pressures to do more with 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 the 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 of Innovations in Nursing

In a session entitled "Nursing at the Forefront of Innovation."

Frances Hughes, Professor in the School of Nursing and Director of
the Center for Mental Health Research, Policy and Service
Development at the University of Auckland, New Zealand,
highlighted significant nursing innovations 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, which 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 cat and horseback. The district health nurse was
the

healthcare link to the community. She was caring and

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 pioneered
interhospital outcome studies and applied objective performance
measures to establish evidence-based practice and the
development of the magnet hospital movement.

The Tongan Health Society's Diabetes Clinic in Auckland, New

Zealand, was presented as an innovative practice model. The
clinic offers holistic care and consultations in Tongan language in
a cultural setting with native music in the background. Exercise
classes and podiatric services are offered. Patients are
encouraged to come to the center for coffee or lunch. Another
innovation is a mobile surgical service consisting of a bus that
travels to remote areas and offers surgical procedures to those
who cannot access traditional healthcare services.

Nurses have been leaders in using technology and health

informatics. In New Zealand, in conjunction with Microsoft NZ,
145,000 people benefit by using smartphones that assist in
integrating health information.

Two policy examples were given. The first example was the
Kenyan Nursing Workforce Project, designed to measure workflow
data, such as the outmigration of Kenyan nurses. The data can be
used to facilitate planning for an effective workforce and assess
the impact of HIV/AIDS on nursing.

The second was the UK Community Matrons, established in 2001.

The project aimed at securing and assuring high standards
through leadership, ensuring support systems, and providing a
visible and accessible presence for nursing in healthcare.

Sometimes described as a "disruptive" innovation, 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

To maintain the quality of care

To improve the quality of care To find new information

To find new ways of promoting health

To find new ways to prevent illness.

UNIT V. Biopsychosocial Pathology

To find better ways of care and cure

To conform to the regulations

To reduce energy consumption

CLASSIFICATION OF INNOVATION IN NURSING

We can broadly classify these into the following

Innovations in nursing practice

Innovations in nursing education

Innovations in nursing care

Innovations in nursing management

Innovations in Nursing Practice

Innovations in 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 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 the way we approach care through new
collaborative partnerships with other organizations and healthcare
providers, communities and community groups and with
consumers of health services, their families and carers.

Once an innovation has been developed, introducing it into

practice begins. A number of complex factors influence whether
an innovation translates into a change in practice, including the
personal characteristics and motivations of those involved and
the cultural and organizational environment into which the
innovation will be introduced.

Rogers identified 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 of 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 of daily
activity or practice, replacing the former approach.

However, not all innovations will proceed to implementation.

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

Research Input 7

Planning and evaluating innovations in nursing practice by

measuring the ward atmosphere

Derek Miline BSc MSc Dip Clin Psych PhD ABPS Senior Clinical
Psychologist

Stanley Royd Day Hospital, Wakefield WF1 4DQ

A controlled evaluation of nurses and patients' perceptions of the

hospital ward atmosphere served to both define

problems and evaluate the corrective changes that were

implemented in a psychiatric day hospital. The results indicated
that nurses and patients held similarly unfavorable views of the
ward at a baseline assessment, including low levels of support,
involvement, spontaneity and program clarity. This finding then
served as the basis for systematic changes, including staff
training, the regrouping of patients, and revising the therapeutic
program. A repeat evaluation then indicated that these changes
had significantly improved the ward atmosphere from the
perspective of both nurses and patients. It is concluded that this
approach holds considerable promise for implementing changes
in nursing practice.

Innovation in Nursing Education

Development of computer-assisted thinking: In order to enhance

students' active thinking, faculty members at the 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: 1. One is to keep the students'
action log each time they use the program and

2. The other is to serve as a medical dictionary.

An analysis of the action log revealed that the students

demonstrated little skill in inferential thinking. Their observations
were very concrete. We need to review our curriculum to help the
students develop their abstract thinking skills.
Pathology

The main conclusion of this is that integrated care innovations are

implemented in both primary care as well as in secondary care-
orientated countries.

Howevet 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
healthcare facilities remains rather uncleat

Practical innovation leads to an immediate improvement in

patient care.

Example

The Fox Chase nursing team on hospital floor 3 South had a

problem and created a solution. They need to track which patients
walk and how many times a day. This is an important part of
postoperative healing and complication prevention after chest
surgery.

Aber a brainstorming session, the nurses devised an innovative,

simple, and inexpensive way to monitor this. Less than 24 hours
later, the system was in place.
They used adhesive towel hooks and covered rubber bands to
mark the daily progress of each patient in the hallways.

This information was documented in their chart for future

reference.

Joanne Hambleton, VF of Nursing, shared her thoughts:

"Teamwork is about listening and involving others. The staff of 3
South demonstrated their teamwork and innovation by the rapid
deployment of a simple but highly effective tool to visually
document patient ambulation and daily weights-important
interventions in the postoperative care of thoracic oncology
patients"

"This is an example of the wonderful care this team provides to

our patients and each other," Joanne continued. "They are truly
an innovative team striving to improve patient care," said
Abraham Lebenthal, MD, a thoracic surgeon

at Fox Chase

Research Input

To what extent do children with cerebral palsy participate in

everyday life situations?

Parkes J, McCullough N. Madden A

Nursing: Midwifery Research Unit, School of Nursing & Midwifery,

Queen's University Belfast, Belfast, UK.

Abstract

The aims of the study are to describe the participation of children

with cerebral palsy in everyday life situations, to investigate the
relationship between participation (primary outcome variable)
with child and parent characteristics (independent variables) and
to compare the frequency of participation (secondary outcome
variable) of children with cerebral palsy with children without
disabilities. A cross-sectional survey of parents of children with
cerebral palsy in Northern Ireland was undertaken in families'
homes using standard questionnaires. A total of 102 parents
opted in (51% response rate). Questionnaires included the life
habits questionnaire (Life-H) to measure difficulties in
participation and the frequency of participation questionnaire
(FPQ) to measure the frequency of participation with comparative
data for children without disability. Overall, children with cerebral
palsy participated less often than their nondisabled peers actoss a
number of lifestyle and cultural pursuits. Among the 102 children
with cerebral palsy, participation in 'relationships' was the least
disrupted area of everyday life and aspects of 'school, 'personal
care' and 'mobility' were the most disrupted. Children with
cerebral palsy and severe co-impairments were significantly less
likely to experience higher levels of participation in most areas of
everyday life when compared to children with cerebral palsy and
no severe co-impairments. A child's physical and psychological
well-being did not influence participation, although higher
parenting stress was significantly related to lower child
participation in 'community activities. Participation is an important
health outcome for children with cerebral palsy and should be
incorporated into routine clinical practice. Professionals have a
role to play in addressing individual child and family needs and
influencing legislation and policy to ensure improved access to
services and local communities.

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 considering diffusing innovation into
practice 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 nursing's influence on Improving population
health status. Nurses are uniquely positioned to identify risk
factors, provide information about [Link] manage these risks, and
promote the benefits of healthier lifestyles and diets and avoid
risky behaviors.

THE ROLE OF NATIONAL NURSING ASSOCIATIONS

The 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 healthcare 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
healthcare 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.

Recognizing/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 create 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 organization or other
organizations.

In leadership roles, they can play a significant role in creating an

environment in which innovation is encouraged and supported
among peers and more junior staff.

547

Every day, nurses are developing new and innovative approaches

to improve healthcare services and healthcare 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 polar
area diagram as a means to present evidence to support her
argument for reform in an era

when the measurements and mathematical analysis of social

phenomena were in their infancy. In 1860, in acknowledgment of
these efforts, Florence Nightingale became the first woman to be
elected as a fellow

of the Statistical Society. The Florence Nightingale International

Foundation, established in her honor, continues to promote and
strengthen nursing worldwide through various activities, including
its support for the International Council of Nurses.

REASONS FOR FAILURE OF INNOVATIONS

Poor leadership

Poor communication

Poor knowledge management

Poor participation in teams.

Poor access to information

Poor organization

Poor goal definition

Poor empowerment

Poor monitoring of results

SUMMARY/CONCLUSION

Innovations in nursing, including technological advancements,

expanded roles, evidence-based practices, and improved
communication, are transforming patient care. These innovations
enhance efficiency, improve outcomes, and support a more
personalized and sustainable approach to healthcare.

Technology integration:

Electronic health records (EHRs): Streamline patient data

management, improve accuracy, and enhance communication
among healthcare providers.

Telehealth: Allows remote consultations and monitoring,

expanding access to care and supporting patient management
from a distance.

Wearable devices: Monitor vital signs and health metrics in real-

time, enabling early detection of issues and

personalized care.

Nurse practitioners (NPs): Provide comprehensive care, including

diagnosing and treating conditions, prescribing

medications, and managing chronic diseases.

Advanced practice roles:

Clinical nurse specialists (CNSs): Focus on improving patient

outcomes through specialized knowledge and direct

care interventions.

Research implementation: Using the latest research to guide

clinical decisions and improve patient outcomes.

Evidence-based practice:

Quality improvement projects: Develop and implement strategies

to enhance care quality and safety based on

evidence.

Simulation and training:

High-fidelity simulations: Provide realistic clinical scenarios for

training, allowing nurses to practice skills and decision-making in
a controlled environment.

Virtual reality (VR): Offers immersive training experiences and

aids in skill development.

Patient-centered care models:

Care coordination: Integrate services across different care

settings to ensure continuity and comprehensiveness of care

Personalized care plans: Tailor interventions to individual patient

needs and preferences, improving engagement
and outcomes. Innovations in communication:

Mobile health applications: Facilitate patient education, self-

management, and communication with healthcare providers.

Patient portals: Allow patients to access their health information,

schedule appointments, and communicate with their care team.

Sustainable practices:

Green initiatives: Implement eco-friendly practices in healthcare

settings to reduce environmental impact

Resource management: Optimize the use of resources and reduce

waste to enhance sustainability.

SUGGESTED READING

1. [Link] Gerontology journals.

Org/cgi/content/full/45/1/68.

2. [Link]

3. [Link] master plan for nursing

education/curriculum%20, innovation %20 in nursing. Pdf. 4.
Nightingale Nursing Times. Vol 5. no. 2. May 2009.