ADVANCEMENT IN NURSING SERVICE, NURSING EDUCATION, NURSING ADMINISTRATION AND NURSING RESEARCH

1. ADVANCEMENT IN
NURSING
SUBMITTED BY
MRS.SARASWATHY.S,M.SC(N)
ASSOCIATE PROFESSOR IN NURSING
HIND COLLEGE OF NURSING

2. PROFESSIONAL
ADVANCEMENT

3. Advanced Practice Registered
Nurse
• APRN defines a level of nursing practice that utilizes extended
and expanded skills. experience and knowledge in assessment,
planning, implementation, diagnosis and evaluation of the
care required.

4. Space Nurses
• Space nurses provide organisation a on ground monitoring & a
full range of health services to astronauts. Space Nursing
Society is an international space advocacy devoted to space
nursing & the contribution to space exploration by registered
nurses.

5. Clinical Nurse Specialist
• CNSs are clinical experts in the diagnosis and treatments of
illness, and the delivery of evidence-based nursing
interventions
• Adult nurse practitioner (A.N.P.)
• Family Nurse Practitioner (F.N.P)
• Paediatric Nurse Practitioner (P.N.P.)
• Women’s Health Nurse Practitioner (W.H.N.P.)
• Geriatric Nurse Practitioner (G.N.P.)
• Acute Care Nurse Practitioner (A.C.N.P)

6. Flight Nurse
• A Flight Nurse is a Registered Nurse who provides
comprehensive pre-hospital and emergency or critical nursing
care to all types of patients during aeromedical evacuation or
rescue operations aboard helicopter and propeller aircraft or
jet aircraft.

7. Legal Nurse Consultant
• A legal Nurse consultant (LNC) is a registered nurse who uses
expertise as a health care provider and specialized training to
consult on medical – related legal cases.

8. Certified Hyperbaric Registered
Nurse
The CHRN program is a subspecialty for registered nurses.
• Hyperbaric medicine, also known as hyperbaric oxygen
therapy (HBOT), is the medical use of oxygen at a level higher
than atmospheric pressure.

9. Parish Nursing
• Faith Community Nursing/Parish nursing is a practice specialty
that focuses on the intentional care of the spirit, promotion of
an integrative model of health and prevention and
minimization of illness within the context of a community of
faith

10. Travel Nursing
• Travel nursing developed as to overcome the nursing shortage
in which nurses’ travel to work temporary short-term nursing
positions.

11. ADVANCEMENT IN NURSING
SERVICE

12. Patient remote monitoring
what remote monitoring
does is, it keeps the patient
more in touch with the
physician over a period of
time outside of the acute-
care setting, such that you
don’t have to wait for
disasters to happen” to bring
the deteriorating condition
to a provider’s attention .

13. Smart Beds
• Smart beds can monitor a patient’s blood pressure, body
temperature, heartbeat, oxygen levels, and more, and deliver
it to a central node which can be accessed remotely. Smart
beds can even turn a patient every few hours to reduce the
risk of bedsores.

14. Genetics and Genomics
• Geno-typing and genetic sequencing will continue to
significantly improve diagnostic and Interventional medicine.
Gene therapy is expected to make significant inroads in curing
cancer and preventing birth defects.

15. 3-Dimensional (3D) Printing
• Bio-printers, using a "bio-ink"
made of living cell mixtures can
build a 3D structure of cells, layer
by layer, to form human tissue
and eventually human organs for
replacement . Healthcare is just
beginning to explore the limits of
this technology. There are limits to
the materials which can be used
for printing and materials science
is a laggard in 3D printing .

16. Robotics
• Robotics can provide
improved diagnostic abilities;
a less invasive and more
comfortable experience for
the patient; and the ability to
do smaller and more precise
interventions. In addition,
robots can be used as adjunct
care providers for some
physical and mental health
care provision.

17. Less Invasive and More Accurate
Tools for Diagnosis
There are several different types
of less invasive meters being
developed for monitoring blood
glucose. One of these includes a
sort of nano-tattoo, and
Symphony® CGM System. It was
developed by a medical device
company with expertise in
advanced skin permeation
technology.

18. Newer Equipments
• Wireless patient monitoring
• Non- invasive glucose monitoring
• Handly portable ultrasound monitor
• Handly portable pulse oximetry
• Electronic IV monitors
• The Electronic Sphygmomanometer
• The portable defibrillator
• Local wireless telephone networks
• Hands-free communication devices (wearable “badges” and server-
based software)

19. Schematic representation of eyeglasses biosensor system
which integrate a wireless circuit board

20. Glucotrack Device
Glucose Sensor integrated in to
a wearable wristband
Google and Novartis smart
Contact lens
Glucose sensing patch on the forearm
The systems use a glucose sensor. The sensor wirelessly transmits results to
a small recording device (about the size of a cell phone).(David K, 2018)

21. NEWER DRUGS
• Bezlotoxumab- Neutralizing the effects of C. difficile toxin B
• Sofosbuvir/velpatasvir/voxilaprevir-Anti viral drugs for HCV.
• Glecaprevir/pibrentasvir- An 8-week course of treatment for
all HCV genotypes.
• Betrixaban-First anticoagulant approved for in-hospital and
extended-duration Venous Thrombo Embolism prophylaxis in
acutely ill patients.
• Plecanatide-Indicated for chronic idiopathic constipation
• Naldemedine tosylate-Indicated to treat Opioid Induced
Constipation in adults taking opioids for chronic non cancer
pain
• Edaravone-Second treatment approved for this devastating
neurodegenerative disease( Amyotrophic lateral sclerosis)

22. Advancement in cancer
treatment
TARGETED THERAPY:
• Examples of targeted drugs include:
• Trastuzumab (Herceptin) treats breast cancers that have the
HER-2 gene mutation.
• Afatinib (Gilotrif) and cetuximab (Erbitux) block a substance
called EGFR that helps colorectal and lung cancers grow.
• Dabrafenib (Tafinlar) and vemurafenib (Zelboraf) treat
melanomas that have a mutated BRAF gene.
• Targeted therapy has promise, but doctors can only treat a
few kinds of cancer with it right now. As researchers learn
more about cancer cells, they’ll find more targets.

23. IMMUNOTHERAPY
• Monoclonal antibodies: Your immune system creates proteins
called antibodies that seek out cancer and other foreign cells.
They attach to substances called antigens on those cells. Once
attached, the antibodies send out a signal that tells other
immune cells to launch an attack.
• Checkpoint inhibitors: Your body's cells have substances
called checkpoints on their surface that tell your immune
system they're friendly. Cancer cells sometimes hide behind
these checkpoints so your immune system can’t find them.
Inhibitors remove these checkpoints so your immune system
can find and attack cancer cells.

24. CONT…
• Cytokines: These proteins control the growth and activity of
immune cells. They can help boost your immune system's
response against cancer. They include:
• Interferons, which jump-start cancer-fighting immune cells
• Interleukins, which help immune cells talk to each other

25. CAR T-cell therapy:
• Your immune system has an army of fighter cells called T cells,
which defend your body against viruses and other invaders.
CAR T-cell therapy is a treatment that helps T cells attack
cancer more effectively.
• Doctors first remove T cells from your blood. Then they
change genes in the cells to help them find and destroy cancer
cells. Finally, they put the T cells back in your body.
• The FDA approved tisagenlecleucel (Kymriah) for children and
some young adults with B-cell acute lymphoblastic leukemia
who haven’t gotten better with other treatments.
Tisagenlecleucel and axicabtagene (Yescarta) both treat
certain types of B-cell lymphoma in adults that have not
improved with other treatments.

26. CANCER VACCINES
• Cancer vaccines: Regular vaccines teach your immune system
to fight off diseases like mumps or measles. Cancer vaccines
show it how to fight off cancer. There are two main types:
• Preventive (or prophylactic) vaccines, which aim to prevent
cancer.
• Treatment (or therapeutic) vaccines, which strengthen your
immune system to fight a cancer you already have.
• In the U.S., you can get two types of cancer preventive
vaccines: human papillomavirus (HPV) and hepatitis B virus. A
treatment vaccine for metastatic prostate cancer is also
available.

27. Newer chemo therapy drugs
• Balversa (erdafitinib) is the first targeted therapy approved for
bladder cancer.
• Combination of Tecentriq (atezolizumab) and Abraxane (nab-
paclitaxel) for people with advanced triple negative breast
cancer. The targeted therapy Piqray (alpelisib) for a type of
breast cancer caused by a certain inherited genetic mutation.
• Immunotherapy drug Keytruda (pembrolizumab) was
approved in the treatment for people with advanced head and
neck cancer and other cancer types.

28. Cont…
• Tecentriq (atezolizumab) - immunotherapy drug for people
with advanced small cell lung cancer.
• The new drug, Polivy (polatuzumab vedotin-piiq), is approved
to be used along with the chemotherapy drug bendamustine
and a rituximab product for the treatment of non-Hodgkin
lymphoma
• Rozlytrek (entrectinib), treatment for multiple cancer types-
tumors that test positive for Neurotrophic Tropomysin
Receptor Kinase gene changes, which can help cancerous
tumors grow.

29. NEWER RADIATION THERAPY
• This treatment kills cancer cells with intense beams of energy.
Newer forms of radiation include:
• Intensity modulated radiotherapy (IMRT): A machine aims
the radiation beam precisely at the affected area. This gets the
highest dose of radiation to the cancer, but does the least
damage to healthy tissue nearby.
• Image-guided radiation therapy (IGRT): Your doctor uses
imaging scans like an MRI or CT to focus the laser on the area
to be treated. IGRT works well for areas of your body that
move, like the lungs or liver.

30. CONT…
• Stereotactic radiosurgery (SRS): This treatment also delivers a
high dose of radiation to a small area. It’s a good option for
tumors in your brain and spine.
• Proton therapy: This type of radiation treatment uses protons
-- positively charged particles of energy
-- to kill cancer cells.
• It sends an intense burst of energy to a highly focused area.
This means the treatment can destroy cancer cells without
damaging healthy tissues nearby.
• Proton therapy is being used to treat tumors in the Brain,
Prostate, Lung, Liver, Breast, Esophagus, Colon, Eye, Head and
neck

31. Robot-Assisted Surgery
• In robotic surgery, your doctor inserts tools and cameras into
small cuts in your body. They sit at a console and look into a
viewfinder while working the robotic arms with hand and foot
controls.
• The robotic arm is more precise than the surgeon's hands, and
it can reach hard-to-get-to body parts. This type of surgery can
reduce blood loss during the procedure and pain afterward. It
can also shorten hospital stays.
• Robotic surgery is used to treat several cancers in the Bladder,
Kidneys, Ovaries, Prostate, Throat and Uterus.

32. Ayurvedic practices:
- Examples of Ayurvedic practices are oil and coffee
enema which produce anti-oxidative effects and
considered a significant part of alternative practices.
-Health problems commonly treated by enema
Constipation, lower backache ,Rheumatoid,
osteoarthritis, headache, liver cancer, edema, loss of
appetite, gout,…….etc. (NCCAM,2012:WHO,2012)
-For healthy person oil enema should be administered twice a year
(Center Disease Control and Prevention,2016).

33. ADVANCEMENT IN NURSING
ADMINISTRATION

34. Nursing
Administration
Specialty
Authentic
leadership
Polarities
management
Magnet-
recognized
organization
Talent
management
Nursing
informatics
( Technology)
Artificial
Intelligence
Telenursing Barcode
technology
Fingerprint reader
Education Smartphone
as
educational
tool
Mind
Mapping
Research Evidence-based practice
New trends in nursing
administration

35. The concept of authenticity :is know, accept, and remain true to oneself.
Authentic leadership defined as: a pattern of leader behavior that draws
upon and promotes both positive psychological capacities and a positive
ethical climate between leaders working with followers that fostering
positive self-development.
Authentic leadership
1. New trends in Nursing
Administration Specialty

36.  Empirical evidence has emerged linking authentic leadership
with positive patient and nurse outcome .
Build trust and positive relationships.
 Role models a high standard of ethical and moral.
Creating health work environment.
Advantages ofAuthentic Leadership

37. Authentic Leadership Components

38. Bill George ModernAuthentic
Leadership Model

39. Polarity Management
• Polarities: are free energy-interdependent pairs of values or
points of view that need each other over time to reach a higher
purpose.
• Polarity management: are model and set of principles providing
a set of resources to deal with all polarities in life .
New trends in Nursing Administration
Specialty

40. 1) Identify the situation / polarity (the two poles or opposites
you tend to move between )
2) Build the polarity management map(advantages and
disadvantages of each of the poles)
3) Understand the dynamics of polarities.
4) Create action plans for both poles.
5) Identify early warning signs.
6) Monitor the polarity.
Steps of Managing Polarities in
Health Care

41. 1- Head OF department identify centralization and
decentralization are polarities to manage.
2- Head OF department build the polarity management map
(There are 4 quarters contain 8 pieces to the “map)
Application of Polarity Management in Nursing
Administration Department

42. 3- How polarities work (dynamic): Head OF department manage
(centralization and decentralization) by;
a- Getting both upsides (identify the positive results of
centralization
and decentralization ;
Example:
Centralization (Be clear about which decision system integration)
 Decentralization ( Many decision possible , which can delegated to
those
who work directly with customer
Cont.Application of Polarity Management in Nursing
Administration Department

43. b- Head OF department must be sensitive to the downsides of
centralization as they are experienced
c- Head OF department be willing to switch from centralization to
decentralization to meet staff’ job satisfaction.
d- They manage the opposite pole and mediate between centralization
and decentralization in the nursing administration department.
Cont.Application of Polarity Management in nursing
administration department

44. Magnetism
• Concept of Magnetism:
A framework for facilitating the professional nursing practice that
demonstrate effectiveness in attracting nurses and contributing to
optimal patient outcomes
• Concept of Magnet hospital:
A hospital where nursing delivers excellent patient outcomes, where n
urses have a high level of job satisfaction, and low staff nurse turnover
rate.
Cont. New trends in Nursing
Administration Specialty

45. For nurses
• High level of nurses’ job satisfaction
• Professional nurses consider Magnet designation as the Gold
Standard
• Low nurse staff’ turnover rate
For patients
• patient outcomes are more favorable in Magnet hospitals ( fewer
complications, lower mortality rates & higher patient satisfaction
scores)
• high quality patient care
45
Benefits of Magnet Designation

46. 46
ANew Magnet Model component
Empirical
Outcomes
Structural
Empowerment
Transformatio
nal
Leadership
Exemplary
Professional
Practice
New
Knowledge
Innovations &
Improvement
© American Nurses Credentialing Center

47. Talent management defined as the process of attracting, developing
and retaining high-potential individuals.
Benefits of Talent Management:
Right person in the right job at the right time
Retaining the top talent
Better hiring
Understanding employees better
Better professional development decisions
Cont. New trends In Nursing
Administration Specialty
Talent Management

48. Talent Management process

49. New Trends in Nursing
Informatics (Technology)
Nursing informatics is an new and exciting specialty that
combines nursing skills with computer expertise Examples may
include:
• Nurse programmers.
• Nurses communicators.
• Informatics nurse managers.
• Nurse vendor representatives

50. e-Health services
• The use of information and communication technologies (ICTs)
for health, referred to as eHealth represents a means to
support health care delivery. These technologies change how
nurses plan, deliver, document, and review clinical care; this
will only continue as technology advances. The process
whereby nurses receive and review diagnostic information,
make clinical decisions, communicate and socialize with
patients and their relatives, and implement clinical
interventions will be fundamentally modified with further
integration of ICTs into nursing practice

51. Telehealth and Telenursing
• Telehealth is the method of delivering long-distance care
through tablets, computers, electronic charts, and
smartphones. As communication technology evolves, so do
the applications in care delivery.
• Telenursing puts cutting-edge technology in the hands of
nurses, allowing them to monitor patients with chronic
conditions through video chat or to provide critical care to
patients in remote areas.

52. CONT…
REGISTER ONLINE AT www.telephone-triage.com (Events)
Name: _________________________________________
License: RN ___ LPN/LVN ___ Other __________
Position: ____________________________
PRACTICE SETTING: Office/Clinic ___ Call Center ___
HH/Hospice ___ Other ____________
Employer: ___________________________________
Work Address: _______________________________
City/State/Zip: _______________________________
Home Address: ___________________________
City/State/Zip: ______________________
Work Phone: ____________ Home Phone: ______
Email: _______________________________________
(REQUIRED - CONFIRMATION LETTER WILL BE EMAILED)
Address______________________________________

53. Computerized Physician/Provider Order;
Entry (CPOE) and Clinical Decision Support
• CPOE and clinical decision support fundamentally change
the ordering process resulting in lower costs, reduced
medical errors, and more interventions based on
evidence and best practices.

54. Barcode technology
A barcode reader is a machine for graphical
representation of a number or character string
and transmits the data to the computer system.
Types Bar Code Readers
- Fixed readers
Connected to PC
- Portable
Recommend for Isolation rooms
Cont…

55. Biometrics
• Biometrics is the automated recognition of individuals
based on their behavioral and biological characteristics.
It is a tool for establishing confidence that one is dealing
with individuals who are already known (or not known)
and consequently that they belong to a group with
certain rights (or to a group to be denied certain
privileges)

56. Electronic Healthcare Records
(EHR)
• Healthcare providers have access to critical patient
information from multiple providers, literally 24 hours a
day, 7 days a week, allowing for better coordinated care.

57. Electronic Nursing Record
System
• The benefits of electronic nursing record (ENR) systems
include reduced errors, improved quality of care, and lowered
cost. These benefits can be maximized by using a standard
nursing terminology, which improves data quality, data
sharing, and decision support

58. Patient Identification Technology
• Compared to simple barcoded patient wristbands, which have
been an industry standard for decades, newer methods of
identification, such as radio-frequency identification (RFID)
tags, are reusable, easier to scan, more secure, and able to
carry more information. Similarly, palm vein scanning utilizes
biometric identification in a way that is both reliable and
minimally intrusive.

59. ADVANCEMENT IN NURSING
EDUCATION

60. Technology in nursing
education
• Working with trajectories: The role of digital technology in
higher education teaching and learning over the near term.
Working with trajectories is an admission that we cannot
predict the unexpected factors and developments that might
affect the trajectory, quickening it or maybe derailing the
trajectory entirely. Digital technology is the very fabric of
nearly everything associated with teaching and learning. A
core trajectory of digital technology in higher education is the
shift away from thinking of it as Information Technology (IT)
infrastructure and toward conceiving it as a digital learning
engagement environment.

61. Learning technologies-Video
conferencing

62. Mobile Technology
Mobile technology use for continuing professional
development in nursing profession
• The rapid growth of health technology and informatics, mobile
learning platforms and software applications in healthcare has
enabled an increased and diverse range of additional
opportunities for learning and teaching in the workplace than
previously available, with implications at the individual and
systems levels in the planning and delivery of care and for
supporting lifelong learning in healthcare settings

63. Mind Mapping is a visual form represent and organized information
about topic in creative way.
• Uses of Mind Maps are useful for:
 Brainstorming – individually, and as a group.
 Summarizing information, and note taking.
 Thinking through complex problems.
 Presenting information in a format
 Studying and memorizing information.
Cont. New Trends in Education
Mind Mapping

64. Example for application mind maps

65. Competency based education
• The competency-based education (CBE)
approach allows students to advance
based on their ability to master a skill or
competency at their own pace regardless
of environment. This method is tailored to
meet different learning abilities and can
lead to more efficient student outcomes.

66.  Evidence-based practice defined as the integration of the best
research evidence with clinical expertise and patient values in
decision making for patient care.
VI. New Trends in Research

67. 1. Steps of evidence-based
practice process:

68. 1) Ask question: formulate clinical question
•
Apply PICO elements:
P (Problem) hospital acquired infection
I (intervention) hand washing
C (comparison) hand washing; and other solution; masks..etc.
O (outcome) reduced infection
Example for formulation clinical question
•Does hand washing among healthcare
workers reduce hospital acquired
infections?

69. Example for evidence-based practices in nursing administration
• Collaboration is a critical organizational attribute ensuring that
evidence-based practices are incorporated into nursing care.
Collaboration within the organization should involve the
interdisciplinary healthcare team. For example, the adoption of
hemodialysis guidelines should include healthcare team involved in
hemodialysis including nurses, nephrologists, and nutrition therapists.

70. Photovoice
• Photovoice is a qualitative method of community-based
research that uses photographs to encourage knowledge and
transformative change, especially among marginalized groups.
• In the context of nursing, patient-participants are asked to
capture and share photographs that relate to a particular
condition, as well as their sentiments regarding it. These
photographs can reveal dimensions of a patient’s condition
that had previously gone unnoticed, thus leading to more
interesting discussions between patient and provider, as well
as within patient groups, and better health outcomes.

71. THANK YOU