CREATIVITY IS THINKING UP NEW THINGSINNOVATION IS DOING NEW THINGS                    - THEODORE LEVITT                   ...
INTRODUCTION• The only constant feature in this world is change.• While all the change may not lead to progress, there  ca...
DEFINITIONInnovation is the act of• constructive thinking• grouping knowledge• skills• attitude into new• original & ratio...
DEFINITIONS:• Innovation is defined as the  generation of new ideas or  application of existing ideas to a  new    situati...
• 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 CARE2. GROWING DEMANDS IN HEALTH SE...
CHARACTERISTICS OF       INNOVATION• RELATIVE ADVANTAGE:       It is the degree to which the new  idea is considered super...
COMPLEXITY:          It describes the amount of difficulty thatparticipants    have    in   understanding      andsubseque...
PRICIPLES• Innovation is to analyze the  opportunities or sources• Innovation is both conceptual and  perceptual• It shoul...
INNOVATION IN NURSING EDUCATION
HANDHELD COMPUTERS IN  NURSING EDUCATION• First personal digital assistant in 1996• According to ANA (2001) all nurses  ne...
VIDEOCONFERENCING AND      WEB BASED    CONFERENCING• Connects students and educators  across distance• Connects diverse s...
E-LEARNING• Adaptation     of   different  distance  learning technologies• Self directed, active learning• Refocusing fro...
SERVICE-LEARNING• Structured learning experience that  combines community service with  preparation and reflection• Achiev...
HIGH FIDELITY PATIENT       SIMULATOR• Help student practice decision making  and problem solving skill and to  develop hu...
TELE TEACHING• Online model of education-learner  directly interacts with tutor• Learner oriented learning• Promotes disco...
MICRO TEACHING• Miniature classroom teaching• Small duration• Paying full attention to a particular  unit and skill• Conte...
NURSING INFORMATICS• Integrates nursing science, computer  science and information science in  identifying, collecting, pr...
URSING CERTIFICATION   NURSING CERTICATION                        NURSING CERTIFICATION    Certification      •Advanced ca...
•Renal nursing•Fellowship in family nursepractice•Fellowship in HematologyNursing•Fellowship in RespiratoryNursing•OT     ...
NURSING MOBILE         LIBRARY• Access to health care information for  nurses working in remote area• To reduce the gap be...
STAFF AND STUDENT        RECRUITMENT• New methods like OSCE &OSPE• Objective because examiner use a  checklist for evaluat...
INNOVATION IN     CLINICALPRACTICE AREA
COMPUTER ASSISTANCE•   Maintenance of health records•   Health security card•   Use of ROBOTS•   Reduce error and give cer...
WIRELESS TECHNOLOGY• Nurse have immediate telephone contact with  employees and with patient• Direct and accurate communic...
EVIDENCE BASED PRACTICE•    It is combination of professional expertise with     available evidence to produce practice th...
PATIENT CLASSIFICATION BY ACTIVITY &         ACUITY OF ILLNESS• This will provide more nurses for each  shift.• INC says 1...
INFECTION CONTROL• To meet the annual JCAH educational  requirement.• To identify available resources which in the  Hospit...
MANAGEMENT &              LEADERSHIP    Nursing leaders and managers are exposed to    different management principles rel...
OUTCOMEBy exposing them to all the aforesaid conceptso the nurses have developed personal plans for using time  more effec...
JOB DESCRIPTION• These are written according to specific  practice area and level of responsibility.• Nurses are also give...
PROCEDURE MANUALS• Procedure manual has become  mandatory.
EMERGENCY MEDICAL          SERVICES• To disseminate information about emergency  medical services, pre hospital care & eme...
TRIAGE• Triage has become mandatory in the  accident and emergency and thereby  they are able to prioritize the patients  ...
ETHICS• This is to increase more awareness among  nurses that they will be able to apply ethics  principles while caring f...
MAGNET HOSPITAL STATUS• In 1980, the concept of magnet hospital came into being.• In 1994, the American Nurses Association...
MAGNET HOSPITAL STATUS      CONTD….• Then, they must apply to ANCC, submit  comprehensive       documentation      that  d...
•Magnet status is awarded for a 4year period afterwhich the organization must reapply.•As of October 15, 2003, there were ...
FORCES OF MAGNETISM FOR     MAGNET HOSPITAL STATUS•   Quality of nursing leadership•   Organizational structure•   Managem...
FORCES OF MAGNETISM FOR      MAGNET HOSPITAL STATUS             CONTD…•   Consultation & resources•   Autonomy•   Communit...
FORENSIC NURSING        SPECIALIST• Forensic psychiatric nurse work with  mentally ill offenders and with victims  of crim...
COMMUNITY BASED       NURSING ROLE• People in communities in partnership  with health care professionals will  define the ...
NURSE RESEARCHER• Nurse researcher is pivotal to the  profession and discipline because it  directs the future path of nur...
NURSE EDUCATOR• They are the leaders and developers  of nursing program of the future• Diabetic nurse educator• Asthma edu...
ASTHMA EDUCATION   COPD EDUCATION
Home Peak Flow   Smoking Cessation  Monitoring
NURSE ANESTHETISTNurse anesthetist is a registered nurse who got specialization in anesthesia and is responsible for monit...
NURSE MIDWIFE LED ANTENATALCLINIC
TELE NURSING• Tele nursing is nursing practice that  occurs through the utilization of  telecommunication and includes the...
VARIATIONS IN     TRADITIONAL ROLE• HOSPICE NURSE            The nurse works holistically  with clients and family.• INFOR...
• OCCUPATIONAL HEALTH  OPPORTUNITIES        Nurse designs and implement a  program of health promotion and  disease preven...
• CASE MANAGER:            case manager co-ordinate  resources to achieve health care  outcomes based on quality, access  ...
• TELEPHONE TRIAGE NURSE            The practice nurse interacts  with clients on telephone to assess  needs, intervene an...
• PARISH NURSE           The role focuses on health  promotion within the beliefs, values  and practices of various faith ...
• NURSE PRACTITIONER             Nurse serves as a primary  care provider and consultant for  individuals, families or com...
• CLINICAL NURSE SPECIALIST          Clinical expertise in a defined  area of nursing practice for a  selected client popu...
INNOVATION INADMINISTRATIONAND MANAGEMENT
• 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 sy...
• LEADERSHIP FOR CHANGE        It is an action learning programme to develop nurses as effective leaders and managers• OUT...
Source: HR Magazine (April 1995)
• STAFFING STRUCTURE  Benchmarking: organization has varying levels of support in place at the unit level for the nurse.eg...
INNOVATION IN  RESEARCH
• TYPES OF RESEARCH       QUALITATIVE RESEARCH       QUANTITATIVE RESEARCH• USING NURSING RESEARCH TO  PROMOTE EBP      ...
• INCREASED FOCUS ON OUTCOME  RESEARCH           Outcome research is research designed to assess and document the effectiv...
• EXPANDED DISSEMINATION     CINAHL (Cumulative Index to Nursing      and Allied Heath Literature)     MEDLINE (Medical ...
• ELECTRONIC PUBLICATION     Information of all type is disseminated in      computer and in internet     Many journals ...
PATHOPHYSI                   PATHOPHYSI      RETROSPECT                                   RETROSPECT                     O...
INNOVATION IN PRIMARYAND COMMUNITY HEALTH        CARE
• INNOVATION IN HEALTH PROMOTION AND  DISEASE PREVENTION       Nurses are uniquely positioned to identify risk factors, pr...
• POPULATION BASED HEALTH CARE                    Acts on three levels: the community system      within the community, an...
INNOVATION IMPLEMENTATION• DISSEMINATION           Planned, formal communication of information about the innovation, thro...
• STAGES OF DIFFUSIONKNOWLEDGE                    DECISION             CONFIRMATION                   P                   ...
READINESS TO CHANGE• Some individuals and organizations are more ready to affect  changes than others.• This depends often...
ADOPTABILITY                  Qualities of                   innovation                 INNOVATION                        ...
CAUSES FOR NOT ATTEMPTING        INNOVATION• Afraid of failures; of opposition; of the  unknown.• Lacking adequate and cor...
Nursing innovation are key toimprovement and progress in  health systems worldwide
Innovation in Nursing
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Innovation in Nursing

  1. 1. CREATIVITY IS THINKING UP NEW THINGSINNOVATION IS DOING NEW THINGS - THEODORE LEVITT J.SANGEETHA M.SC (N)
  2. 2. 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.
  3. 3. DEFINITIONInnovation is the act of• constructive thinking• grouping knowledge• skills• attitude into new• original & rational ideas.Critical thinking Imagination PlanAction Achieve objectives
  4. 4. DEFINITIONS:• Innovation is defined as the generation of new ideas or application of existing ideas to a new situation resulting in improvement in organization
  5. 5. • Innovation is the action of introducing a new method, idea or product
  6. 6. NEED OF INNOVATION:1. INOVATION TO CENTRAL TO MAINTAINING AND IMPROVING QUALITY OF CARE2. GROWING DEMANDS IN HEALTH SERVICES3. GLOBAL WORKFORCE SHORTAGE
  7. 7. 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
  8. 8. COMPLEXITY: It describes the amount of difficulty thatparticipants have in understanding andsubsequently using the innovationTRIALABILITY: it is the degree to which the new idea can bepretested or tried on a limited basisOBSERVABILITY: It refers to how visible the innovation is toparticipants and onlookers
  9. 9. 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
  10. 10. INNOVATION IN NURSING EDUCATION
  11. 11. HANDHELD COMPUTERS IN NURSING EDUCATION• First personal digital assistant in 1996• According to ANA (2001) all nurses need to use nursing informatics
  12. 12. VIDEOCONFERENCING AND WEB BASED CONFERENCING• Connects students and educators across distance• Connects diverse student groups
  13. 13. E-LEARNING• Adaptation of different distance learning technologies• Self directed, active learning• Refocusing from educator to the subject
  14. 14. SERVICE-LEARNING• Structured learning experience that combines community service with preparation and reflection• Achieves a balance between service and learning objective
  15. 15. 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
  16. 16. TELE TEACHING• Online model of education-learner directly interacts with tutor• Learner oriented learning• Promotes discovery learning
  17. 17. 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
  18. 18. 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
  19. 19. 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
  20. 20. •Renal nursing•Fellowship in family nursepractice•Fellowship in HematologyNursing•Fellowship in RespiratoryNursing•OT technique andmanagement•Psychiatric nursing
  21. 21. 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
  22. 22. 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
  23. 23. INNOVATION IN CLINICALPRACTICE AREA
  24. 24. COMPUTER ASSISTANCE• Maintenance of health records• Health security card• Use of ROBOTS• Reduce error and give certitude to the clinical planning process
  25. 25. 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
  26. 26. 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
  27. 27. 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.
  28. 28. 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.
  29. 29. 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
  30. 30. OUTCOMEBy exposing them to all the aforesaid conceptso 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
  31. 31. JOB DESCRIPTION• These are written according to specific practice area and level of responsibility.• Nurses are also given format of the standards for performance.
  32. 32. PROCEDURE MANUALS• Procedure manual has become mandatory.
  33. 33. 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.
  34. 34. 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.
  35. 35. 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.
  36. 36. 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.
  37. 37. 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)
  38. 38. •Magnet status is awarded for a 4year period afterwhich the organization must reapply.•As of October 15, 2003, there were 88 magnet –designated organization.•The first ANCC magnet hospital, university ofWashington, was designated in 1994 & internationalcertification began in 1999.
  39. 39. 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
  40. 40. 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
  41. 41. 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
  42. 42. 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
  43. 43. NURSE RESEARCHER• Nurse researcher is pivotal to the profession and discipline because it directs the future path of nursing
  44. 44. NURSE EDUCATOR• They are the leaders and developers of nursing program of the future• Diabetic nurse educator• Asthma educator
  45. 45. ASTHMA EDUCATION COPD EDUCATION
  46. 46. Home Peak Flow Smoking Cessation Monitoring
  47. 47. NURSE ANESTHETISTNurse anesthetist is a registered nurse who got specialization in anesthesia and is responsible for monitoring , administering anesthesia, to detect equipment fault
  48. 48. NURSE MIDWIFE LED ANTENATALCLINIC
  49. 49. 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
  50. 50. 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
  51. 51. • 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
  52. 52. • CASE MANAGER: case manager co-ordinate resources to achieve health care outcomes based on quality, access and cost.• FLIGHT NURSE: military and civilian flight nurse
  53. 53. • TELEPHONE TRIAGE NURSE The practice nurse interacts with clients on telephone to assess needs, intervene and evaluate• TRAVEL NURSE Assignment usually for a minimum time. Extra allowance will be provided
  54. 54. • PARISH NURSE The role focuses on health promotion within the beliefs, values and practices of various faith communities
  55. 55. • NURSE PRACTITIONER Nurse serves as a primary care provider and consultant for individuals, families or communities• CERTIFIED NURSE MIDWIFE Independent management of women’s health care. should pass the national certification examination conducted by ACNM
  56. 56. • 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
  57. 57. INNOVATION INADMINISTRATIONAND MANAGEMENT
  58. 58. • USE OF COMPUTER Computerized physician order entry (CPOE) Clinical decision support system (CDSS)
  59. 59. 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.
  60. 60. • LEADERSHIP FOR CHANGE It is an action learning programme to develop nurses as effective leaders and managers• 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
  61. 61. Source: HR Magazine (April 1995)
  62. 62. • 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
  63. 63. INNOVATION IN RESEARCH
  64. 64. • 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
  65. 65. • 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
  66. 66. • 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)
  67. 67. • 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
  68. 68. PATHOPHYSI PATHOPHYSI RETROSPECT RETROSPECT OLOGY OLOGY IVE OR IVE OR COST COST CONCURREN CONCURRENEFFECTIVE EFFECTIVE T CHART T CHARTANALYSIS ANALYSIS REVIEW REVIEW QUALITY QUALITY IMPROVEMEN IMPROVEMEN T AND RISK T AND RISK BENCHMARKING DATA DATA DATA VALID & CURRENT RESEARCH INRERNATION INRERNATION AL,NATIONAL AL,NATIONAL &LOCAL &LOCAL CLINICAL CLINICAL STANDARDS STANDARDS EXPERTISE EXPERTISE PATIENT PATIENT INFECTION INFECTION PREFERENCE PREFERENCE CONTROL CONTROL SS DATA DATA
  69. 69. INNOVATION IN PRIMARYAND COMMUNITY HEALTH CARE
  70. 70. • 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.
  71. 71. • 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
  72. 72. 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
  73. 73. • STAGES OF DIFFUSIONKNOWLEDGE DECISION CONFIRMATION P P PERSUASION IMPLEMENTATION ACCEPT REJECT
  74. 74. 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.
  75. 75. ADOPTABILITY Qualities of innovation INNOVATION SUSTAINABILITY PROCESS OF InvolvementIMPLEMENTATION commitment
  76. 76. 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.
  77. 77. Nursing innovation are key toimprovement and progress in health systems worldwide
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