**3. Describe aspects of nursing innovation throughout history**

Innovation looks into the future while history reflects on the past. These two may seem to be on opposite ends of the spectrum. However, they are interrelated disciplines. Reflecting on the past allows for us to influence the future. We can look back and see how innovations came to be, the problems they were solving, and the new problems that were introduced in need of newer solutions. Innovations are built on the past that is no longer meeting the needs of others.

For nursing, this is no different. Innovation is not new to nursing. From the very beginning of the profession and even leading up to it, nurses have innovated to meet the needs of others. However, the term innovation has not been as prominently used. Yet, the actions led to innovative developments to foster improved care, systems, tools and more for those who are in need. Those in need include patients, families, communities, and populations. One does not need to be a patient to need the care of nurses.

Innovations emerge through the minds, creativity, and resourcefulness of others. There was a time when nursing was not a profession. There was a time when we did not have resources that we depend on today to provide quality nursing care. Examples of such resources include nursing as a profession, public health nursing, the crash cart, nurse practitioners, simulation education tools, the American Red Cross, the stretcher, pediatric pain scale, neonatal phototherapy, and even the emergence of electronic health records has roots from a nurse. Each of the innovations mentioned above are briefly described below. The descriptions are organized according to either nursing roles or nursing resources for care.

### **3.1 Nursing professional roles**

The science of caring is a foundation of the nursing profession [20]. The profession today consists of over 27 million nurses across the globe [21]. Yet, there was a time when a nurse emerged as a new professional role and educational career path. There are many nurses in history who have had a profound impact by innovating within the nursing profession. Florence Nightingale and Mary Seacole are two of those nurses. Florence Nightingale and Mary Seacole were both instrumental in supporting soldiers during the Crimean War [22]. Florence Nightingale's innovative efforts focused on is often referred to as the founder of modern-day nursing [23]. Nightingale had many contributions during the Crimean War however her efforts to connect sanitation, nutrition, and overall cleanliness on the health status of wounded soldiers were new contributions to nursing [24]. Mary Seacole also provided significant contributions during the Crimean War. Seacole, who was known by many as "Mother Seacole" identified many ways to support and positively impact the British troops. Seacole used her Jamaican herbal remedies to provide nursing care to the ill and wounded. Additionally, she created the British Hotel that served as a storehouse where British soldiers were able to get necessary food, medicine, and supplies. The contributions of Nightingale and Seacole during the Crimean War led to their acknowledgements as Crimean Heroines [25]. Innovation was inherent in their abilities as nurses. Throughout the profession's history, nurses have continued to exhibit innovativeness in their nursing contributions. The examples shared in this section are just a few of the many nurses who have created necessary innovations that are staples today.

### *3.1.1 Public health nursing*

In March 2020, the whole world became very aware of the need for public health nurses and public health expertise. Public health nursing is defined by the American Public Health Association [26] as "the practice of promoting and protecting the health of populations using knowledge from nursing, social and public health sciences". With 8 billion people in the world [27] and the World Health Organization defining health as "the state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity" [9] there absolutely is a need for public health nurses. The origins of public health nursing date back to 1893 and the innovativeness of Lillian Wald [28]. Lillian Wald was a nurse who advanced the nursing profession to establish the term public health nurse. Today, there are nearly 16,000 public health nurses in the United States.

### *3.1.2 Nurse practitioners*

In 1965, the United States established Medicare and Medicaid. Medicare and Medicaid provided greater access to healthcare services for more people. With more access to care, there was a need for many more primary care providers. Loretta Ford, a nurse, and Henry Silver, a physician, got together and innovated to create a new provider role: the Nurse Practitioner [29]. At the time, there was a shortage of available pediatric primary care providers. The new provider role and educational experience led to the Pediatric Nurse Practitioner role. From that first Nurse Practitioner role, others began to emerge (e.g., Adult Primary Care, Family) for nurses to pursue. Today there are over 355,000 Nurse Practitioners in the United States [30].

### **3.2 Nursing innovations for care**

As nurses are in a profession of caring. The actions of their efforts are directed toward others (either directly or indirectly). Those who are recipients of care experience the greatest health outcomes when care is of high quality (more on that in Section 4). To provide high quality care, nurses need appropriate resources and tools to address care needs. Anything that does not exist naturally in nature was created by an individual or a group of individuals. The impetus for creating new innovations, as mentioned in Section 2, stems from an unmet need affecting a target group of people. As nurses are the healthcare professional group who spend the most time with patients, they are also able to recognize gaps, or unmet needs, in available resources (or solutions) that could enhance their caregiving. A nurse is attributed to many nursing resources depended upon today that are staples of caregiving for nurses and the healthcare team at large. Those resources include, but are not limited to, the American Red Cross, simulation mannequins for education, the crash cart, the stretcher, electronic health records, and one of the most prominently used pediatric pain scale tools. Each mentioned innovation is briefly described below.

### *3.2.1 American red Cross*

The American Red Cross was founded in 1881 in the United States. Clara Barton advocated for the United States to establish a Red Cross for some time before its inception. She led the organization for 23 years. Barton provided nursing care during

### *Advancing the Nursing Profession through Innovation DOI: http://dx.doi.org/10.5772/intechopen.110704*

the Civil War and earned herself the nickname of Angel of the Battlefield. In 1869, Barton went to Switzerland and learned of the Red Cross while there. She saw that America could benefit from an organization that provided resources to those injured and brought the idea to the U.S. Twelve years later, the American Red Cross was established in the U.S. Barton saw that America did not have a comparable resource to support people who were hurt or in need of aid because of the war. The American Red Cross recognizes Barton's innovative efforts that has sustains over 140 years, "because of one woman, Clara Barton, the American Red Cross brings help and hope across the nation and around the world." [31].

### *3.2.2 Simulation mannequin for nursing education*

Nursing education today has advanced to include the use of simulation mannequins that can present clinical scenarios to students that they may not see while in their clinical rotations. The evolution of simulation in nursing education can be traced back to nurse A. Lauder Sutherland in 1910. Sutherland invented the first simulation mannequin that became known as Mrs. Chase at Hartford Hospital in Connecticut [32, 33]. Mrs. Chase is now on display at Hartford Hospital's Innovation Center. Today, simulation is a core learning experience of nursing education.

### *3.2.3 Crash cart*

The modern-day crash cart was invented by Anita Dorr. In 1967, Anita Dorr was working in an Emergency Department. Dorr recognized the lack of efficiency and organization to gathering necessary supplies when patient emergency situations would occur. Dorr decided to work with her husband to develop the first crisis cart that was made out of wood. She painted it red and added wheels to the bottom for ease of transport to and from areas within the emergency department. The crisis cart supported more effective patient care. Her innovativeness and invention led to the staple nurses and healthcare professionals depend upon today, the modern-day crash cart. Every care area has a crash cart in the event of a patient emergency [4].

### *3.2.4 Stretcher*

Stretchers are a common form of transporting a patient within a hospital or healthcare facility. The origins of the stretcher date back to 1926. The inventor and innovator, Elizabeth Kenney, was caring for patients during World War I. Kenney saw the need for a more comfortable and easy way to transport patients to minimize their suffering in transport. Today, stretchers are a necessary piece of equipment within hospitals and healthcare facilities [32, 34].

### *3.2.5 Wong-baker faces pain scale*

Prior to 1983, there was not a systematic way for pediatric patients' pain to be communicated and measured to the nurse. Donna Wong, a registered nurse, and Connie Baker, a child life specialist, both saw the need for a better way to help these children and their pain. Through their collective innovative research, the Wong-Baker Faces Pain Scale was developed and put into practice. Today, the Wong-Baker Faces Pain Scale is used around the world with people over the age of 3 [35].

### *3.2.6 Electronic health records*

Electronic health records (EHRs) date back to the 1950's. Harriet Werley was one of the first (if not the first) nurse to examine the possibility of using computer technology to support the use and management of healthcare data and information [35]. Despite the conceptualization and initial versions that emerged in the 1960's, EHRs did not reach near full adoption until the last few years [36, 37]. While EHRs continue to have areas for enhancement and refinement, digitizing healthcare data creates new opportunities for improving quality care [38].

The nursing profession has a rich history of nurses who exhibit innovative behaviors to create necessary innovations. The innovations shared in this section are just a few of the many innovations that nurses have created to contribute to the unmet needs of groups, communities, and populations for higher care quality.
