Australian College of Nursing Innovation article

Reality exists in the human mind, and nowhere else. ~George Orwell, 1984

As technology advances, so does health care. Web or cloud-based software has helped develop medical records and continues to integrate into our daily practice. The question we need to ask is: Is this innovation or are we just catching up?
The first hospital to develop electronic medical records (EMR) was in the mid-1960s and in the early 1970s, the first full EMR system was implemented (Evans, 2016). This was 40 years ago. So, to discuss an EMR as innovative perhaps seems confusing. What then is innovation and what does it mean for nursing?
Plainly, Wikipedia tells us that innovation is a new method, idea or product (Wikipedia, 2019). Have you or a team member had a new idea at work that could help workflow, or help patients? Think then, how easy is it for that idea to evolve and become real change? Generally, I am sure that pathway is long, it is hard and at times, it is defeating.
I have spent much of my time in the past three years preparing, developing and building an idea, an innovation. I have spent 90% of that time not knowing if that idea would even be possible. Two strange things happened when I started to act on that idea. One colleague said, ‘Wow, that’s innovative’ and another commented, ‘You’re such an entrepreneur’ – two concepts that did not resonate with me at all, probably because in nursing, we hear or learn little about these two facets of the industry.
If you haven’t yet, you will soon get the opportunity to use augmented reality (AR) or virtual reality (VR). These immersive technologies are entering health care and they are doing it at pace. AR provides the opportunity to put digital information into the real world and virtual reality, it literally places you inside a whole new world. This is where innovation starts to get extremely exciting. Learning traditionally takes place with the teacher at the front of the room speaking to the class, sitting and listening, whereas these technologies immediately change the landscape of the classroom by placing the learner inside the content rather than sitting, falling asleep to it. Learning standing up is an entirely new realm.
It is important to start by stating that currently no VR therapy-based application is approved by the Food and Drug Administration (FDA). It is not currently a form of therapy but that doesn’t mean there are not hundreds, if not thousands of start-up companies globally deep in research looking to build applications, to help patients and save organisations significant time and money.
To collectively understand the potential and significance of this emerging field, the European Union’s Horizon 2020 programme is allocating nearly $91.51 billion USD of funding towards VR and AR projects over seven years for research and innovation. This market is growing so quickly as the research thus far looks extremely positive. Complex rehabilitation, pain therapy, building empathy, patient education regarding diagnosis and prognosis and autism behavioural management are just a few examples of where these technologies may stamp their presence. The area where AR and VR has really hit the ground running is training and education.
Surgical skills, anatomy and physiology, simulation-based scenarios are all examples that are being applied and utilised in current clinical settings. So, what do these technologies offer that traditional teaching methods do not? Immersion is the key. Imagine learning about diffusion from respiration and being able to stand in the alveoli and watch the air flow in and out right in front of your eyes or learning about sinus rhythm and be able to hold the right atrium in your hand. This is captured in full 360 degrees, 3-dimensional vision and allows a significant “wow” factor. Exposure isn’t learning but immersion brings a memorable moment and that you will not forget. The key features to immersive learning that are being integrated into industry are an ability to learn faster, learn more and retain knowledge longer all the while engaging learners to get excited about learning.
I started my business Bundle of Rays 12 months ago and since inception we have been working hard to try to understand how these technologies can have an integral place within nursing education. We teach clinical skills i.e ECG and chest xray analysis and we utilise the technology, much like a teacher would have utilised an overhead projector back in the 19990’s. We use it as a teaching tool, not a magic bullet. We booked one workshop with the Australian College of Critical Care Nurses (ACCCN) at their annual conference and due to demand ended up delivery 3! We have won International awards for excellence and innovation from the International Nursing Association of Clinical Learning and Simulation (INACLS), We have spoken at various International conferences in Italy and London and we have been delivering our courses across Australia with a strong focus on rural and remote regions. 3 months ago, we changed our business model to allow distribution, everything we use during our training, we can now sell. This allows us to enable any healthcare providers i.e. hospitals and clinics and health-based training organisations i.e. universities and colleges to choose and implement VR for their own internal training purposes. This has been an extremely positive feature to our business model, and we have already had significant interest from medical, nursing and paramedicine academics and differing health services and simulation centres. In 2020 keep a sharp eye out for what Bundle of Rays is up to because we are about to embark on an adventure in nursing education that none has yet succeed in and none have yet even imagined. We will be providing “LIVE” VR streaming training sessions that can allow up to 300 people globally to log in to a virtual space and watch and participate in clinical training. We have a plan to not stop innovating. Nurses deserve it.
Murray (2018) clearly outlines that the continued emergence of new interactive and engaging technologies has created an inflection point in nursing education, demanding a change in the usual conducting of the business of nursing education. To grasp and understand these dynamic changes across industry, nurses on the ground will be required to take control of this change with measured engagement of innovation. This is a new wave of process learning but not encapsulated just to VR and AR, also emerging are blockchain, machine learning and AI, robotics, drones and 5G Wi-fi capabilities for current IT infrastructure.
Integration and adoption are the key determinants for successful uptake of innovation. Inspiration, cultivation and collaboration add to produce the momentum for change but essentially the integration of innovation is a cultural issue, not a technological limitation. To talk about change and to lead it are two entirely different entities. Do you have an idea that can change the world? If you do, chase it.

Evans, R. S. (2016) Electronic Health Records: Then, Now, and in the Future. Year Med Inform. 2016;Suppl 1(Suppl 1):S48–S61.
Murray, T (2018) Nursing Education. Our Iceberg is melting. J Nurs Educ 57(10), 575-579.
Wikipedia 2019, Innovation. Viewed 23 Aug 2019,


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