EXTENDED AND EXPANDED ROLES OF NURSING

INTRODUCTION
Nursing is an art and a science involving many activities, concepts and skills related to
basic social sciences, physical sciences, ethics, contemporary issues and other areas. Nursing
is a unique profession because it addresses the response of individuals and families to health
promotion, health maintenance and health problems. Nursing practice is undergoing changes
that are both exciting and controversial. Published evidence shows that nurses can be as
effective as doctors with in their expanded roles.
The roles of doctors and nurses should complement each other and all practitioners
should work for the benefit of patients in their care, rather than defending traditional roles and
hierarchy.

EXTENDED ROLE: - MEANING

Nurses role in extended care facilities is one that a nurse assumes by virtue of
education, type of institution in which she is employed and experienced.
The concept of extended role is to reach out. The role of nurse cannot remain static. The
knowledge and skills of the nurse need to be broadened.

EXPANDED ROLE: - MEANING

Expanded roles on the other hand are specific roles in employment positions. An
expanded role is one that a nurse assumes by virtue of education and experience.
An expanded role in nursing is one in which a nurse assumes expanded or increased
responsibilities in a practice area and in most cases practice with greater autonomy.
Expanded role denotes functioning in specially area with advance education and skills.

EXTENDED ROLE
1. CAREGIVER:
The caregiver role has traditionally included those activities that assist the client
physically and psychologically while preserving the clients dignity. The required nursing
actions may involve full care for the partially dependent client and supportive education care
to assist clients in attaining their highest possible level of health and wellness. Care-giving
encompasses the physical, psychological, development and spiritual levels. The nursing
process provides nurse with a framework for providing care. A nurse many provide care
directly or delegate it to other caregivers.
As intimate level of contact is required in the caregiver role, the nurse must
communicate to the patient that she cares for him as a person.
2. HEALTHCARE COORDINATOR:
As the healthcare provider is responsible for patients care 24 hours a day, the nurse
serves as the primary coordinator of all other professional services committed to the care of
the patients. In this role, the nurse arranges for the necessary diagnostic testing, therapies,
counseling and patient teaching sessions, and treatments. Throughout the patients
hospitalization the nurse must carryout the coordinator role in such a way that the patients
health is not compromised.
3. ADVOCATE:
As medical knowledge and technology have advanced, the healthcare system has
become more complex. In this environment of tubes, alarms and caregivers clad in gowns,
masks and gloves, the advocacy role of the nurse is more critical than ever.

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 The nurse is responsible for defining defending and promoting the rights of patients. As
an advocate, the nurse is compelled to work on behalf of the patient.
4. EDUCATOR:
As an educator the nurse explains to clients concepts and facts about health,
demonstrates procedures such as self-care activities, determines that the client fully
understands, reinforces learning or client progress in learning. The nurse must also be aware of
the influence of culture when she instructs the patient in aspects of care such as dietary and
management and grieving.
Some client teaching may be unplanned and informal. Some may be formal and
planned such as when the nurse teaches a client with diabetes to self-administer insulin
injections. The nurse uses teaching methods and incorporates other resources such as family in
teaching plans.
5. COMMUNICATOR:
The role of communicator is central to all nursing roles and activities. Nurses
communicate with the client, support persons other health professionals, and people in the
community.
Nurses identity client problems and then communicate these verbally and / or in writing
to other members of the health team. The nurses must be able to communicate clearly and
accurately in order for a clients healthcare needs to be met.
6. MANAGER:
Delivering quality care in todays complex healthcare system required managerial
knowledge and skill. The nurse manager must know how to assess the overall patient care
needs, organize patient assignments, delegate work appropriately, and evaluate the
effectiveness. When managing patients care assignments the nurse manager must consider
both the efficiency and effectiveness of outcomes and must be knowledgeable about the
budget process.
The nurse manager must know how to assess the strengths and weakness of staff and
facilitate their ongoing professional development. Acquisition of new skills, as well as
refinement of basic skills can do much to increase staff efficiency and effectiveness. As a
clinical decision-make, the nurse uses critical thinking skills throughout the nursing process to
provide effective care.
7. COUNSELLOR:
Counseling is the process of helping a client to recognize and cope with stressful
psychological and social problems, to develop improved interpersonal relationships, and to
promote personal growth. It involves providing emotional, intellectual and psychological
support. In contrast to the psychotherapist who counsels primary healthy individuals with
normal adjustment difficulties the nurse focuses on helping the personal develop new attitudes
feelings and behaviors rather than on promoting intellectual growth. The nurse encourages the
client to look at alternative behaviors, recognize the choices, and develop a sense of control.
8. CHANGE AGENT:
The nurse acts as a change agent when assisting others, , to make modification in their
own behavior. Nurses also a often act to make changes in a system, such as clinical care, if it is
not helping a client return to health. Nurses are continually dealing with change in the health
care system.
9. LEADER:
his role can be employed at different levels: individual client, Family groups of clients,
colleagues, or the community Effective leadership is a learned process requiring an
understanding of the needs and goals that motivate people, the knowledge to apply the
leadership skills, and the interpersonal skills to influence others.
10. RESEARCH CONSUMER:
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 Every profession is built on a body of descriptive knowledge. Nursing recognizes the
need to identity, verify and increase the body of scientific knowledge on which practice is
based. Although the researcher role is viewed primarily as the responsibility of doctor ally
prepared nurses, all nurses can participate in the research process. It is appropriate for nurses
practicing primarily as caregivers to help identity researchable problems and collect data.
The primary responsibility of the nurses in the care giving roles is to apply research
findings in practice. Nursing research provides a theoretical foundation for practice, promoting
its advancement and the welfare of those receiving care.
11. COLLABORATOR:
According to styles, collaboration involves 4 elements.
Individual who share a common interest
Purpose for the collaborate effort.
Principles or ground rules for the effort
Structure with in which effort takes place.
Using this framework, nurses can effectively work with other members of the health
care team to deal with patient care problems.
Patients becomes more complex and life expectancy lengthens while healthcare resources
decline..
EXPANDED ROLE
Nurse Clinician

Meaning:
The tem Nurse clinician was first carried by Reiter (1943). She described the nurse
clinician as one who was competent in care and knowledge about care and knowledge about
care.

Minimum educations
The first clinical masters programme was developed in 1954 by Hildegard Peplum at
Rulegers university.
At the 1993 National convention of the national league for nursing a resolution was
passes that the graduate degree be the minimal educational preparation for advanced practice
in nursing clinician had always been prepared at the masters level.

Definition
Institution of medicine defines nurse clinician as an individual who uses a recognized
scientific knowledge base and the authority to direct delivery of personal health services to the
patients.

Concept
A nurse clinician is most likely to care directly for a patient whose diagnosis or care in
complex unique or problematic.
1. The clinician is concerned about cure and care unlike the traditional nurse who allowed
care functions to recede to the background of her daily work schedule with high priority
accorded to care function.
2. It was initiated to increase the involvement of senior nurses in patient care responsibilities
and to great opportunities for advancement of nurse within the clinical nursing care.
3. The nurse clinicians role was proposes when there was need for senior nurses with
experience to retain their clinical role as they moved up the career ladder into supervisory
and administrative positions.
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4. Provide direct care of patients and also includes administration, teaching and for good
patient care.
Types of appointment of nurse clinician
1. Assistant clinical directors: a clinician may have a primary appointment in the university
hospital and a clinical faculty appointment in the school of nursing.
2. A joint appointment: she has the responsibility for teaching and guiding a group of
students and influences the quality of nursing care for a group of students.
Functions or roles of a nurse clinician
The nurse clinician role is evolved to reinforce the role of caring supporting and helping
patient in needing then basic needs she would provide a wide ranges of services located to co-
ordination collaboration and continuity of care.
Basic functions of nurse clinician

Care function Cure function counseling function

- Palliative care - data collection
- Physical care - Assessment - psychological care
- Protective care - implementing care - teaching patient & families
- Mental healthcare - evaluating the result - guidance
Care function
1. Palliative care: alleviating pain and providing comfort as for as possible.
2. Physical care: meeting the hygienic needs, nutrition and exercise.
3. Protective care: protecting the client by providing safe environment and preventing
possible complications.
4. Metal health care: these include basic and technical care based on the needs of the patient.
2). Cure function: these are directly related to medical care therapeutic regimen and overall
clinical management are function mainly include:
- Data collection
- Assessment
- Planning care
- Implementing care
- Evaluating the result
3). Counseling Function:
- Psychological care
- Teaching patient and families
- Providing guidance in matters related to health
- Working with families for restoration and maintenance of health
Broad functions for a nurse clinician 3cs
Co-ordination of patient care therapeutic and professional services
Collaboration with other members of the medical team
Continuing of care
Sub roles of nurse clinician
1. Clinician: as a clinician expert she would be directly responsible for patient care ensure
basic and technical care of high quality is provided to patient accordance to their needs.
2. Teacher: teaching of clinical staff and student in her area e.g. In services education.
3. Researcher: she should be concerned with advancement of knowledge in her clinical area
and conduct study for improvement of nursing practice.

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4. Leader: she would direct supervise and organize the clinical nursing and participate as a
care provider.
5. Co-ordinator: co-ordinate the work of clinical nursing team and in addition carry out the
role of co-ordinator of patient care therapeutic regimen and professional service.
6. Role model: clinical nurse must be role model of staff and students by demonstrating
nursing care of high quality so that can require skills and competencies from her.

Nurse Practitioner
The advance practice nurse has a masters degree in nursing. Advanced education
in pharmacology and physical assessment and certification and expertise in a specialized area
of practice (ANA 1995).
Origin of Nurse Practitioner
Increased cost of physical services and non availability of the physicians to all sectors
of population has forced the health planners and policy makers to prepare other types of health
personnel to meet the needs of people.
During 1990s there was great special change and political emphasis on healthcare as a
right of citizens. Access to health care service was a problem and therefore practitioners role
was developed to meet the demand for primary care services.
The first formal education programme for nurse practitioner was established in 1965 at the
university of Colorado school of nursing. In 1995 nurse practitioner education was leading to
masters degree in nursing.
Definition
The nurse practitioner according to the ANA is a skilled health care provides who
utilizes critical judgment in the performance of comprehensive health assessment differential
diagnosis. And the prescribing of pharmacologic treatment in the direct management of Acute
and chromic illness and desease. Indira Gandhi nation Open University defines nurse
practitioner as a primary health care provides who assumes responsibilities of the expanded
role to meet the health care needs of the groups in the country.
Concept of Nurse practitioner
1. Nurse practitioner should have educational preparation
2. Nurse practitioner is meant to provide first contact primary care to the clients or care load
of patients. All registered nurses are authorized to practice nursing practitioner in a term
used for those assuming responsibilities of the expanded role whose work reflects the kind
of nursing practice. Which encompasses additional function and activities beyond the scale
of traditional nursing practice.
3. Nurse practitioner works with clients of all ages and health care needs.
4. Nurse practitioner provides health care to clients usually in an out patient or ambulatory
care or community bases selling.
5. A nurse practitioner provides care for all clients with complex problems and attends more
to symptoms.
6. The approach of nurse practitioners in holistic the comphasis is on the interrelated parts
and wholes. The patient is treated as a fragments desease entity but is ministered to as part
of family and community.
7. They render primary health care within divisions like internal machine, paediatric family
practice obstetrics and geriatric hence more practitioners tend to perform as generalist
rather than specialists in a clinical practice.
8. Nurse practitioner work in group practice with physician in the neighborhood and
community health care agencies in the clinic in hospitals with outpatients in extended care
facilities in industry school parish etc.

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9. Nurse practitioner are caring or the well the worried the acutely ill persons chromically ill
persons terminally ill patients the child elderly adult and the poor.
10. The areas are womens health occupational health mental health emergency care and acute
care.

Educational Qualifications
The nurse who has an advanced education and is a graduate of a nurse practitioner
programme there are two types of course for nurse practitioner short-term programme award a
certificate and long term programme leading of a masters degree.
Certifications
Certification is advanced via written exam requirements very from licens are as a registered
nurse to master degree up to 3yeras. Experience in clinical speciality.
Placement of Nurse Practitioner
With intense preparation they are places in a variety of settings like community clinic.
- Community health nurse practitioner
- Community health specialist
- Family nurse practitioner
- Rural health specialist
- School health nurse
- Occupational health nurse in industry
- Womens health practitioner
- Acute care nurse practitioner
- Pediatric nurse practitioner
- Gerontological nurse practitioner
The function is an autonomous manner with the authority of an independent practitioner who
does not require close supervision.
Clinical areas where nurse practitioner perform:
1. Adult nurse practitioner: Provides primary ambulatory care to adult with a non-
emergency acute or chronic illness and work in collaboration with a primary physician.
2. Family nurse practitioner: primary care for families usually in collaboration with a
family care physician the practitioner meets the familys general health care needs,
manages some illness by providing direct care and guides or counsels the family needed.
3. Pediatric nurse practitioner: Providing health care to infant and child.
4. Obstetrics and gynarcology nurse practitioner: gynarcology nurse practitioner provides
primary ambulatory care to women seeking obstetrical or gynarcological health care the
nurse practitioner who is also a certified nurse midwife may independently deliver infants.
5. Geriatric nurse practitioner: provides ambulatory or implement care to older adults. The
GNPs activities include interventions for health maintenance illness prevention or health
restoration.
6. Medical nurse practitioner
7. Surgical nurse practitioner
8. Ophthalmic nurse practitioner
Functions of nurse practitioner
1. Nurse practitioners are educated to perform a broad spectrum of function:
2. History taking it is based on the interpersonal relationship and communications skills.
3. Health assessment
4. Risk appraisal diagnosis
5. Management of acute minor ailments
6. Management of chromic condition
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 7. Order laboratory tests
8. Prescribe medication (which may have to be authorized within a frame work of
standing order approves by the health authorities on essential drugs).
9. Initiate continue or discontinue treatment
10. Refer clients to secondary level of health care
11. Maintain appropriate records
12. Health education and counseling
13. Provide preventive curative and rehabilitative for promote maintenance and restoration
of health of clients.
14. Parish health areas
15. In agencies which take care of women and children
16. Psychiatric clinics
17. Dispensaries
18. Rehabilitation centre, daycare centers)
19. Orphanage or geriatric health care
20. Emergency and acute care
Characteristics of the nurse practitioner role
1. Nurse practitioner is meant to provide first contact primary care.
2. Nurse practitioner role is to extend the delivery of health care service to the neglected
remote or under several areas.
3. Under expanded role the nurse practitioner assumes delegated medical responsibilities
such diagnosis and treatment of minor aliments through standing orders.
4. To provide a package of services in preventive curative and rehabilitative services for
promotion maintenance and restoration of health of clients.
5. To acquire additional skills and professional settings that requires study to seek assumers.
6. Role model of students inspiring of the higher level of nursing practice.
7. Contribute the development maintenance and revision guidelines for quality care.
8. Contribute to the formation of professional policy.
9. Evaluate the plan of care.

Nurse Counselor
Nurse can act as a counselor to her patient by a careful listening to his question cancers
demands and complaints of the client and family. Nurse as a counselor can do counseling in
different form like short term counseling long term counseling and motivational counseling
guidance counseling is a valuable tool in the hands of a nurse. Having a through knowledge of
guidance and counseling she must be able to guide her client.
Tele Nursing
Introduction:
Tele health nursing practice is defined as nursing practice using the nursing process to
provide care for individual patients or defined patient populations through telecommunications
media criteria \for telehealth nursing practice include the following:
- Using protocols algorithms or guidelines to assess and address client needs systematically.
- Prioritizing the urgency of client needs
- Developing a collaborative plan of care with clients and their support system the plans of
care may include wellness promotion prevention education care Counseling desease state
management and care co-ordination.
- Evaluating outcomes of practice and care.

Telemedicine
Definition:
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 Telemedicine has been defined by the W.H.O as the delivery of health care services
where distance in critical factors by the health care professional using information and
communication technologies for the exchange of valid information for diagnosis, treatment
and prevention of desease and injuries research and evaluation and for the continuing
education of health care provides all in the interest of advancing the health of the individuals
and their communities.

Application in Health Care

1. General: the every country there is need of fast exchange of information for prevention
and control of the epidemics in addition to that the telemedicine is required as support
system for the health care professionals deputed in remote areas and also for the members
of the community.
2. Tele communication: it can be carried out either on telephone or with the help of video
conferencing.
- Consultation between medical professionals
- Consultation between clinician and patients
- Investigations and treatment of patient
- Rehabilitative care and investigation during emergency situation.
3. Diagnosis and reporting: cases can be diagnosis and report can be transmittes via fax or
E-mail to the referral centre and expert opinion and advice can be blamed at a faster rate. It
saves money time also improve quality of care rendered to the community.
4. Accessing health information: the information is reality available through interest and the
health care professionals can be empowered by providing them a telephone connection
personal computer and a broad internet connection.
5. Continuing medical education: with the help of video conferencing the people need not
to go to a different place for attending medical education the purpose can very wall be
served with the help of video conferencing.
6. Advice on self-care: good quality advice can be provided to the people on telephone for
aliments of routine nature.
7. Health promotion and prevention of the diseases: mass media has great role to play in
educating the people particularly in disease like HIV/AIDS.
8. Medical records maintenance: patient records can be maintained stored and retrieve
through the system of electronic maintenance of medical record.
9. Health and hospital administration: this is useful from the point a view of material
management financial management human resources management and hospital information
systems of the hospital and health care organization.

Certified nurse midwife:

The CNM is an RN who is also educated in midwifery. The practice of nurse-midwifery
involves providing independent care for women during normal pregnancy, labor and delivery,
as well as care for the new born. It may include some gynecological services such as routine
papanicolan (pap) smear, family planning, and treatment for minor vaginal infections. A CNM
practices with a health care agency that provides medical consultation, collaboration
management and referral.
iv. Certified registered nurse anesthetist:
She is a nurse who has completed advance education in an accredited programme in
anesthesiology. The nurse anesthetist carries out pre-operative visits and assessments, and
administers general anesthetics for surgery under the supervision of a physician prepared in
anesthesiology. The nurse anesthetist also assesses the post-operative status of he clients.
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. Nurse Educator:
A nurse educator works primarily in schools of nursing, Staff development departments
of health care agencies, and client education departments. Nursing educators need experience
in clinical practice to provide them with practice skill and theoretical knowledge. A faculty
member in a school of nursing educators in nursing schools are usually required to have
graduate degrees in nursing and additional education in the educational process. Many hold
doctorate or advanced degrees in nursing, education or administration. Generally they have
specific clinical, Administration or research specialty and advanced clinical experience.

Nurse educators in staff development departments of healthcare institutions provide

educational programs for nurses within their institutions. The programs include orientation of
new personnel, critical skill competency, safety training, and instruction about new equipment
or procedures. These nursing education educators after participate in the development of
nursing policies and procedures.
The primary focus of the nurse educators in an agencys department of client education
is to teach ill and disabled clients and their families how to provide care in the home. These
nurse educators may be specialized and certified educator or an ostomy care nurse and see
only a discrete population of clients.
Nursing researcher:
The nurse researcher investigates problems to improve nursing care and to further
define and expand the scope of nursing practice. He may be employed in an academic setting
hospital pr independent professional or community services agency. The minimum educational
requirement is a doctoral degree, with al least a Masters degree in nursing.
Nurse Administrator:
A nurse administrator manages client care and the delivery of specific nursing services
within a healthcare agency. Nursing administration begins with positions such as the change
nurse or assistance nurse manager. Experience and additional education may lead to a middle
arrangement positions, such as nurse manager of a specific patient care area or house
supervisor, or to an upper management position such as assistance or associate director or
director of nursing services.
Nurse managers position usually requires at least baccalaureate degree in nursing , and
director and nurse execution positions require masters degree . Chief nurse executive and vice
president positions in large health care organizations often require preparation at the doctorate
level. Nurses may have advanced degrees such as masters degree in business administration
(MBA) hospital administration(MHA) or public health (MPH).
Responsibility of directors may include a particular service at product line, such as
medicine or cardiology, and include supportive functions and personnel such as those working
in medicine clinics, cardiac diagnostics or outpatient services such as cardiac cauterization .
The director also may be responsible for auxiliary personnel such as cardiology technicians,
respiratory therapist, social workers, and dietitians.
Vice President of nursery or chief nurse executives may include all auxiliary personnel
who provide and support patient care services. The nursing administration needs to be skilled
in business and management as well as understand all the aspects of nursing and client care.
Functions of administrators include budgeting, staffing, strategic planning of programs and
services, employee evaluation development.
Nursing entrepreneur:
A nurse usually has an advanced degree and managers a health related business. The
nurse may be involved in education, consultation or research.
Operating room nurse:
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 When patients are admitted before and/or after surgery the ORN monitors patients
progress from the time he or she enters the operating room until he or she is dismissed to the
attending staff.

Rehabilitation nurse:
The clinical nurse specialist serves on the rehabilitation teams as educators, consultants
and liaisons within their organization and communities. They conduct research and help apply
findings.
Travel nurse:
Traveling nurse are recruited for assignment that involves at least 13-20 hrs per week,
after the nurse has the opportunity to join the organization as a permanent employee.
Nurse psychiatrist:
They are moving into domain of primary care and working with other nurses and
physicians to treat and diagnose the illness in patients with somatic complaints.
Critical care nurse:
It offers challenges and excitement to the role of the nurse. The functions of a critical
care nurse are:
a. Perform basic patient care.
b. Administration and maintaining medications and IV fluids.
c. Identifying cardiac arrhythmias.
d. Performing CPR and defibrillation.
e. Complementary physical assessment with clinical history.
f. Interpreting and ordering diagnostic tests.
g. Health teaching.
h. Identifying community resources.
i. Collaborating with physician regarding treatment.
j. Monitoring haemodynamics.
Nurse author:
Nurses are encouraged to submit material for publications in professional journals nurse
education both in school/college level and clinical nurses.
Palliative care nursing:
Palliative means alleviate the symptoms without curing. Nurses practice holistic and
family centered care. For this a registered nurse needs the skills with kindness, empathy and
understanding who is able to handle stress.
Nurse oncologist:
Advanced oncology nursing practice is defined as expert competency and leadership in
the provisions of case to individuals with an actual and potential diagnosis of cancer.
Enterostomal therapist:
Providing emotional support.. Selecting appropriate alliances...Teaching the patients
how to irrigate stoma and care of the skin, discussing diet and making referrals to health and
welfare agencies.
Nurse endoscopist:
One who works in the endoscopy room infection control nurse. to monitor hospital
environment for existing and potential infection and to plan and teach isolation or aseptic
technique.
Trauma care specialist:
She is the team member of the emergency room.
In flight nursing:
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 These nurses are trained to work in the air, the main aim is to continue care rather than
suspend it for the duration of flight. The nurse required to have the knowledge of aircraft
safety and other medical conditions.
Community health nurse/public health nurse:
A community health nurse functions within the communal framework. She serves the
health needs of his/her assigned portion of the public. The goal of the community health nurse
is to improve community health nurse is to improve community health by identifying people
who are at high risk of illness disability or death.
a. Occupational health nurse:
It has become more diversified and complex. The nurse can develop surveillance
programmers, counsel employees, co-ordinate health promotion activities, set up
comprehensive referral network, treatment individuals for emergency and primary health care
problems, consult with business partners, and manage the overall occupational health services.
b. Hospital nurse:
The role of the hospital nurse is to provide support and instruction to the terminally ill
and to keep them at home as long as possible.
c. Home health case nurse/visiting nurse:
Although community/public health nursing is based on a wellness model. Home
healthcare has evolved as a medical model. The term itself describes a system in which health
care and social services are provided to home bound or disabled people in their home rather
than the medical facilities.
d. School nurse:
The goal of school nursing is to support the educational process by helping students
keep healthy, and teaching students and teachers preventive practices. She may be responsible
for one or two schools. Responsibilities may include first aid, screening, follow up, control of
communicable diseases, teaching health classes, conducting health studies, and responding to
calls from other schools
Nursing informatics
American nursing association defines nursing informatics as a specialty that integrate
nursing sciences, computer science and information science to manage and communicate data,
information and knowledge in nursing practice nursing informatics facilitates the integration
of data information and knowledge support patient nurses and other care provides in their
decision making in all roles and settings in January 1992 the (ANA) congress of nursing
practice designated informatics as a nursing specialty.
Position of nurses in nursing informatics system
Many nurses working in this field have created then own position and titles some of the
positions are:
- System analyst
- System nurse
- Projector manager
- System analyst
- Nursing information specialist
Characteristic of nurse informatics
- Flexibility
- Humor
- High tolerance for meticulous work
- Interest in computer literacy
- Good verbal written and communication skills
- Intelligent diplomatic and Eager to learn
- Ability to balance technology with human needs
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- Should be energetic creative and self starters
Responsibilities of the nurse informatics
- System analysis and designing
- Development of data dictionaries
- Evaluation and testing off applications for patient care
- Configuration of hardware and software
- Translating the language of nursing to engineers and system designers and vice versa.
- Using application software and computer networks
- Installing and maintaining hardware and software
- Programming in one or more computer systems
- Coordinating projects of various sizes involving diverse team members.
- Analyze and evaluate information requirements
- Design and implement applications to solve patient care problems.
- Analyze ethical issues concerned with safety and privacy

EXPANDED AND EXTENDED ROLE OF NURSE IN COMMUNITY

Nursing roles are ever changing the roles or set of expectations associated with given
position of all health care professionals are continuously redefined in response to changing
knowledge technology cost and consumer need. As health care delivery systems change the
practice of nursing continues to shift from acute care to institution based settings to
community settings .The new community health nurse must recognize the broader scope of
practice. The community health nurse must be capable of performing role functions regardless
of the setting of employment these role functions include:
- Clinician
- Advocate
- Collaborator
- Consultant
- Counselor
- Educator
- Researcher
- Care manager
Role of the community health Nurse
Advocate

Clinician Collaborator

CH
Care manager Consultant
N

Researcher Counselor

Educator

Clinician
Community health nursing differs from most traditional nursing roles in it focus on the
community as client personal health services focus on individuals any include services to help
individuals maintain health recover most from others or adopt to long term disabilities. Most
nurses with a background in acute care do not have experience with a board community based
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practice perspective associate degree and diploma program in nursing generally do not provide
a theoretical background for community health nursing practice there are community health
nurse generalist and community health nurse specialist.

NURSE PRACTITIONER

Primary health care nurse practitioners are registered nurses, who are specialists in
primary health care who provide accessible comprehensive and effective care to client of all
ages. They are experienced nurse with additional nursing education which enables them to
provide individuals, family groups and communitys health services in health promotion
disease and injury, prevention and rehabilitation. The nurse practitioner is an advanced
practice nurse functioning within full scope of nursing practice and as such is not a second
level physician

Definition:
A nurse practitioner is a registered nurse who has completed specific advanced nursing
education (generally a masters degree or doctoral degree) and training in the diagnosis and
management of common as well as complex medical conditions. Nurse practitioner provides a
broad range of health care services.

History of nurse practitioner

In the late 1950s and early 1960s physician began to collaborate with nurses who had
clinical experience. In addition increasing specialization in medicine led a large number of
physicians to be out of primary care thus creating a shortage of primary care physician.
In 1965, the Medicare provided health care coverage to lower group like women,
children, the elderly and people with disabilities. The sudden availability of coverage
increased the demand for expanded primary care services. Because physicians were unable to
meet their demand. In 1965, Loretta ford, a nurse and a physician created the first training
programme for nurse, practitioner, the curriculum focused on health promotion, disease
prevention and the health of children and families.

The nurse practitioner job may include the following:

- Diagnosing, treating, evaluating and managing acute and chromic illness and disease
- Obtaining medical histories and conducting physical examination.
- Ordering, performing and interpreting diagnostic studies (E.g. routine lab tests, bone X-ray,
ECG)
- Prescribing physical therapy and other rehabilitation treatment.
- Prescribing pharmacologic treatment and therapeutic for acute and chronic illness (extent
of prescriptive authority varies by state regulation)
- Providing child care, including screening and immunization.
- Providing primary and specialty care services health maintenance care for adults including
annual physical check up.
- Providing care for patients in acute and critical care settings.
- Performing minor surgeries
- Counseling and educating patients on health behavior self-care skill and treatment.

Practice settings
- Community health centre, clinic
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- Health Department
- Health maintenance organization
- Home health care agencies
- Hospitals as hospital clinics
- Hospice centre
- Nurse practitioner office
- Nursing homes
- Private and public schools, universities and college
- Mental health centre
- Research centre
- Employee health clinics

Nurses practitioner specialities

- Adult nurse practitioner
Attends to health needs from adolescent through advanced age.
- Certified Nurse midwife
Provides health care to women during pregnancy, birth and after birth and manages
newborn health needs.
- College health nurse practitioner
Provide health care to college students.
- Family nurse practitioner
Provides health care to individuals ranging in age from new born to elderly adults
- Geriatric nurse practitioner
Specialize in health needs of persons 65 years of age or older
- Pediatric Nurse practitioner
Provides health care to children from birth to 14 years of age
- Psychiatric mental health nurse practitioner
Assess and treats problem of individuals and families that relate to emotional and
mental health.
- Womens health care nurse practitioners
Provides management of health problem in obstetric and gynecology.

Community health nurse generalist

The community health nurse generalist function is the broadest practice role. This roles
combines nursing epidemiology care management, and resource coordinates the generalist
provides care in a wide variety of settings to individuals families and groups while maintaining
an understanding of the values and concepts of population based practice. The community
health nurse generalists participate with the specialist in community wide assessment and in
the planning implementation and evaluation of programme.
Community health nurse specialist
The community health nurse specialist may perform all of the function of the generalist
in addition the nurse specialist brings expertise in working with families and group in
formulating health policy and increasing communities and in carrying out all phase of
population focused program the specialist has skills in epidemiology including health disease
births and deaths. The community health nurse specialist engages in research theory
development and testing and health policy development the roles are teaching and counseling
individuals families and groups are major responsibilities for both groups. The present trend
in community health nursing is to bring about the need for more graduate prepared clinical

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specialist. Community health nurses are being employed through out the community health
department, schools industries home health hospice and multiple other settings.
Advocate
The community health nurse act as advocate for the individual group or community
client Advocacy in the act of speaking or acting for an individual or group of individuals who
may be unable to speak for themselves. In the health care system or larger social system.
Clients may be unable to speak for themselves for multiple resources. These resources include
lack of knowledge difficulty or inability to articulate needs or ideas perceived lack of power
fear and physical or mental disability. Because of close and frequent contact with the client the
nurse is often the best health professional to promote the needs and desires of the within the
realm of the complicated. To advocate for the client to care for that individual to care for the
individual in to help the client develop full potential the nurse as advocate in dedicated to
supporting this process. As an advocate the nurse support the clients right to make decision
freely. Nursing action include supporting the client so that the client can make possible
decision regarding health.
Collaborator
To collaborate means to work with others toward a common goal. It is a process of joint
decision making is an atmosphere of mutual respect and co-operation collaborator should
always be the mode of inter action between the community health nurse and the client and is
an equally important nursing role when the nurse function as part of a team. Effective
collaborator requires skills in communication and problem solving the nurse must be able
communicate effectively with the client family group or team with other team members the
nurse shares client needs and possible interventions to bring about the resolution of problems.
Consultant
Every community heath nurse is a consultant. Each time a nurse gives information or assists a
client in choosing between alternative actions the nurse is using consulting skills. The nurse
also acts as consultant when helping a client improve specific skills or make more effective
helps .A consultant must be trained teacher and an expert in a particular specialty. The
successful consultant must be able to motivate others and be able to get things done even when
not is direct charge of the people concerned. The nurse consultant brings knowledge and
assistance in the wise use of resource. The nurse provides information about resources so the
client can make informed choices from a variety of alternative.

COUNSELOR:
Counseling at its most basic level is the process of helping clients choose appropriate
solution to their problem counseling is not telling people what to do instead it is the process of
assisting them to use problem- solving process to decide on the course factors most
appropriate for them. The counselors role is to listen objectively clarity, provide feedback and
information and guide the client through a problem solving process.
The consultant is not necessarily concerned with subjective understanding on the part of
the client. The nurse works with the client to achieve present goals in an efficient way so that
the tasks at hand can be accomplished.
Counseling remains an important component of community health nursing.

EDUCATOR:
Community health nursing has embraced the responsibility of educating individuals.
Families and communities, Health teaching is considered one of the major functions of the
community nurse and deemed an essential nursing responsibility regardless of the setting
where the nurse is employed. Teaching is a necessary role function for the promotion of health
and welfare of individuals and societies. Health education focuses on health promotion, health
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maintenance and disease prevention. The role of nurse educator is challenging get offers
significant rewards. The goal of the nurse as educator is to ensure of optimal learning by the
client is order to encourage improved health behaviors.

RESEARCHER:
The community health nurse participates in the research process at multiple levels the
nurse may be involved in activities such as identifying problem areas collecting analyzing and
interpreting data applying findings and evaluating, designing, and conducting research. The
community health nurse is expected to read current research and apply the findings to practice
as a consistent part of professional actions. As researcher, the nurse seeks to discover,
investigates, understand, explain and predict phenomena the research process comprise
specific actions to collect data and synthesize information. To manage future health concerns,
the researcher will be challenged to answer research questions on issues related to HIV/AIDS
infections disease chromic physical and emotional conditions and injury prevention.

CASE MANAGER:
Coordination of care is different in a health care system with many differing public and
private programs, services agencies and institutions. Case management is the application of
strategies the health care system. Case management so comprises major functions that must be
present in all case management models these functions are case finding, assessment, care
planning, implementation, monitoring and reassessment and evaluation.

Case finding:
Case finding in the identification of those individuals from a population who will benefit from
case management service, appropriate case were identified through the screaming of applicant,
information and referral net work or brief assessments of key dimensions that showed need
eligibility.
Assessment:
Assessment use as a full scale, multidimensional standardized functional assessment of the
clients needs and resources.
Care planning:
Care planning is the core function of the care function of the case management process. The
use of computer to track and samples the data collected from these tools in helpful to the nurse
in providing high quality case.
Implementation::Implementation is when the service plan is enacted.
Monitoring: the service received are evaluator reassessment and evaluation this function
providers for the assessment and evaluation of the total service plan.

Health promotion activities

It can be broadly classified into passive or active with strategies of health promotions
are the fluoridation of municipal drinking water the fortification homogenized milk with
vitamin dare two examples of passive health promotion.
With active strategic of health promotion individuals are motivated to adopt specific
health programs weight reduction and smoking isolation programs require clients to be
actively involved in measures to improves their present and future levels of wellness while
diseasing the risk of desease.

Interventions
1. Health education: Large number of desease could be prevented with little or no medical
intervention of people care adequately informed the prevention.
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2. Environment modification
- Provision of safe water
- Installation of sanitary and rodents
- Improvement of honoring
- Minimizing the use of in insecticide and pesticides on food crops.
3. Nutritional interventions: This intervention compromise food distribution and nutrition
improvement of vulnerable group child feeding programmes food fortication nutrition
education etc. nutritional deficits in nutrition intake can result in student growth.
Nutrition excess: can cause obesity alcoholism constipations hypertension causes
Balances nutrition: eat fresh food. Fruits, vegetable
4. Exercise: Exercise like nutrition should be balance and dense on a regular basis. A
physical exercise program couple to actualize physical health promotion.
5. Life style and behavioural changes: Life style and behavioural changes like lack of sleep,
pollution such as noise, air and environment, smoking substance abuse and obesity etc. can
affect the health and cause desease and illness in man. The modifications of these factors
are very important for health promotion provision of adequate rest and sleep practice of
healthy habits balance diet adequate exercise.
6. Stress management:
- Developing coping skills
- Evoke the relaxation response
- Yoga, meditation, guided guided imagery

Health promoting life style profile

1. Self actualization
- Find life has purpose and goal
- Find satisfying environment
- Looks forward to future
- Aware of strengths and weakness
- Feel happy and content
2. Health responsibility
- Periodic health check up
- Reports symptoms to physician
- Reads books about health
- Observe body for changes
3. Exercise
- Participate in stretching exercise
- Vigorously exercise 3 times a weak
- Engages n recreational activities
4. Nutrition
- Take in essential nutrients
- Select from basic food groups
- Eat three meals daily
- Eat breakfast
5. Interpersonal support
- Discuss the problems
- Praises other easily
- Maintain meaningful interpersonal relationship
- Spends time with close friends
- Express concerns and love
6. Stress management
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 - Daily relaxation
- Aware of stress sources
- Use meditation and relaxation exercises
- Use pleasant bed time thoughts
- Expresses feelings
- Use stress control methods

The Nurses role in health promotion

- Model healthy life style behaviour and attitudes
- Facilitate client involvement in the assessment implemental and evaluation of health goals.
- Teach clients self-care strategies to enhance fitness .
- Assist clients families and communities to increase their levels of health
- Educate clients to be effective health care consumers
- Assist clients families and communities to develop and choose health promoting options.
- Guide clients development in effective problem solving and decision making.
- Reinforce clients personal and family health promoting behaviour.
Levels of prevention
There are 4 levels of prevention
1. Primordial prevention:
It is concept is receiving special attention in the prevention of chromic diseases this is
primary prevention of the emergence or development of risk factors in contribute or
population groups. For e.g. many adult health problems (e.g. obesity hypertension) have their
early origins in childhood because this is when the life styles are formed (e.g. smoking eating
pattern physical exercise) in promotional preventions efforts are directed towards discouraging
children from adopting harmful life styles. The main intervention is primordial prevention in
through individuals and mass education.

2. Primary prevention
Primary prevention can be defined as action taken prior to the onset of desease which
removes the possibility that a desease will ever occur. It is concerned health promotions of
health activities that prevent the actual occurrence of a specific illness or desease primary
prevention includes health education program immunization physical and nutritional fitness
activities.
3. Secondary prevention
The specific intervention is early diagnosis (e.g. screening tests care finding programme)
and adequate treatment it helps to arrest the desease process and restore health by seeking out
unrecognized desease and treating it.
4. Tertiary prevention
Can be defined as all measures available to reduce or limit impairment and disability
minimize suffering caused by existing desease tertiary is direct toward rehabilitation after a
deseases or condition has developed modern rehabilitation include physiological, vocational
and medial components based ob team work from a variety of professions.
Restoration of health
To heal in to restore to health or sound some of the interventions
1. Physiological intervention
Patients who receive selected drugs under go procedure and receive direct nursing skills are
being help to heal. Assist the patient in the healing process providing adequate nutrition
exercise rest and sleep periods and reducing exposure to micro organics by providing aseptic
environment are nursing tasks that promote healing.
2. Psychological intervention
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Physician and nurses who have built a strong trust relationship with there patients can
influence healing e.g. of psychological intervention are communication listening and touch are
all important to healing.
3. Self care Self help or self care refers to the patients active involvement in bringing about
healing. Self care is to allow the patient to take control of his or her own health.
4. Holistic healing
Holistic healing implies that all possible avenues of healing must be used and that no single
healing be used to the exhaustion of others.
E.g. meditation and relaxation have long been used to promote healing of the mind and body.
.
5. Rehabilitation
Rehabilitation is a dynamic process that restores an individual to the highest possible level of
function of level of function it is restoration of health.

Conclusion
In India nurses are for behind with the nursing specialist. This is a challenge for Indian nurses
who are working in settings which do not have facilities of newer technology. Health care
delivery is largely dependant on information for effective decision making.
Bliography
1. Potter,perry,fundamentals of nursing.6thed.New york;Mosby.2006p.16-23
2. kozier.erb.Fundamentals of nursing.6th ed.Singpur;pearson education Pvt. Ltd 2003 p.10-13
3. Bearce p c;Judith l. m principles and practice of adult heath nursing. P. 74-82.
4. Basvanthappa B.T.Community heath nursing. 1st ed. Toronto;c.v. mosby,1984.p.27-29.
5. Barbara kozier,GlenoraErb;Fundamental of nursing.17th ed. New Delhi. Dorling
Kindersley.2007.p.129-130.
Journals
1. 1.Nursing service administrator,Nursing Journal of India,1998,89 p.56-57.
2. 2.Indian jornal of holistic nursing, sept.2006.p.17
3. 3The nursing journal of India march 2000.p.56-57.
4. 4.Thenursing journal of India march 1998 p.60
5. 5.Trends in nursing administration and education volume-1 january july-2008 p.54-56.

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