TNAI JOURNAL

International Nurses Day (IND) falls on 12th May each year. The theme this year is: Delivering Quality, Serving Communities:Nurses Leading Care Innovations. Besides the message its President (see Box in this page below), the international body promoting the intersts of nurses observed the day, interalia, by releasing a kit.

The IND kit contains elaborate discussion on important issues relevant to nursing community. An overview of these items has been summed up in following paragraphs.

Innovation : Innovation refers to developing and adopting new approaches, technologies, products and ways of functioning. In nursing, it means finding new information and better ways of promoting health, preventing disease and better patient care. One of the earliest examples of innovations is Nightingale’s landmark study of maternal morbidity from puerperal fever following childbirth. Observing the high number of deaths in maternity wards, her query was , “Do more women die after giving birth in a hospital rather than at 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 changes to the services that resulted in the saving of women’s lives.

Innovations often arise out of necessity in order to address a need or a gap in service or technology. As an example, 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 infants skin-to-skin between their mothers’ breasts

Manpower shortages at global level also provide another driver for innovation. While innovation is often considered in terms of high cost, 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. Similarly, nurses in

Worldwide, nurses are engaged in innovative activities on a daily basis to improve patient care outcomes and to reduce costs to the health system. Many of these initiatives have resulted in significant improvements in the health of patients, populations and health systems. Fast becoming the first and primary point of contact for health services, nurses are heading up specialised clinics in such areas as diabetes, mental health and rheumatology. However, the nursing contribution to health care innovation is seldom recognised.

Expert knowledge and the nursing research are at the heart of many of our new roles, as well as the basis for traditional nursing care. But it is the combination of innovation and vitality that allows nurses’ work to take flight. Novel solutions by nurses represent a vital element in efforts to address current and future global health challenges – such as aging populations, HIV/AIDS, TB, malaria, an increase in non-communicable diseases, poverty, inadequate resources and workforce shortages. The need for innovative solutions has never been greater as health care environments globally struggle to provide equitable, safe and effective health services, while at the same time containing costs.

Within today’s context of scarce resources, continuous change and expanding knowledge, innovation is a legitimate expectation. The business sector and governments are among those investing heavily in this area. We must invest too “ to advance our practice, and improve care and outcomes.
Best wishes for success and enjoyment on International Nurses Day 2009!

(Abridged message of Hiroko Minami and David C. Benton
President and CEO, ICN, 1201 Geneva Switzerland)

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 counsellor. Thus innovation provides a way to meet local challenges.

Utilisation of ICN Innovations Database: The ICN Innovations Database can be utilised 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 to foster nursing innovation, promote the dissemination of nursing innovations to a wider audience, recognise the contribution nurses make to health systems and provide an environment for knowledge sharing.

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 behaviours. The ICN document describes different interventions by nurses, which help patient manage chronic health conditions and live longer and healthier lives. 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, childhood accident prevention, smoking cessation, adolescent suicide, AIDS/HIV awareness and lay health worker programmes. Nurses support young people to consider a wide range of issues such as the impact of teenage pregnancy, divorce, single parenthood and abortion.

Innovations in Primary and Community Health Care : A key component of PHC is the concept of community development. Providing 80% of primary health care, nurses work closely with communities. Nurses continue to innovate in PHC. For example 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, teenparent counselling, case management and outreach services to deprived communities. Similarly Ghanaian trained nurses, who were moved from fixed location clinics to village residences 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 diarrhoea 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 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 Centres offer a range of services, including testing, counselling 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 behaviours 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.

ICN Mobile Library: Mobile Books for Nursing and Health : Nurses deliver more than 80% of health care in developing countries. These nurses are often working in remote clinics, with poor or no access to current health care information. Yet everyday these nurses are called upon to care for people with new diseases. The ICN/MSD Nursing Mobile Library, housed in a transportable trunk is dedicated to closing the gap between the desperate need for nursing information and its availability.

Communication and Influence :
People communicate and learn in different ways. Interpersonal approaches through professional or personal social networks have a powerful and last influence in persuading people to actually adopt an innovation. New ideas can be big or small, and can come from all parts of the organisation. A small change to the way appointment bookings are made in a small rural health service, for example, can create large improvements in patient and staff satisfaction at minimal cost. An effective organisation is one that is able to capture this idea, recognise its value, and support the innovators and the rest of the organisation to translate the innovation into practice. Innovation requires involvement and commitment of staff at all levels.

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 (i) the introduction of systematic handwritten records for the medical profession (ii) system for collection, tabulation, interpretation and graphical display of descriptive statistics and (iii) polar area diagram in an era when the measurements and mathematical analysis of social phenomenon was in its infancy.

The Role of National Nursing Associations : National Nursing Associations (NNAs) represent a key force in fostering and supporting innovation, and can provide leadership by: promoting nursing, creating, driving and supporting innovative approaches to health care, and celebrating nurses’ innovative achievements; supporting innovative practices in the workplace; providing valuable inputs to health care organisations, researchers and policy makers; advocating for innovations in the external environment, among opinion leaders; providing a forum for exchange of ideas for innovations; honouring nurse innovators; and Disseminating nursing innovations to nurses and others.

Every day nurses are developing new and innovative approaches to improving health care services and health care outcomes for local people. This is occurring in a variety of ways, and across an enormous number of settings, ranging from major acute health providers in large cities to the smallest villages in rural and remote areas. Given the courage, determination and creativity, with which nurses have been discharging their role across the globe, they will continue to play a critical role in the task of ongoing health care innovation.