EXTENDED AND EXPENDED ROLE OF NURSE

INTRODUCTION
During the first five decades the nursing profession made significant progress
towards developing a body of scientific knowledge, nursing practice change a
response to consumer demand and involvement of new technology changes in health
care delivery system and policy.

A. Resent debate about nursing is weather the nurses role should be expanded or
extended health care delivery system an policy.

EXTENDED ROLE OF NURSE

INTRODUCTION

 Extended care facilities assists client with their daily activities ,provide care
when necessary and co-ordinate rehabilitation service.

 Extended care facilities are becoming the nurse popular means managing the
health care needs of the client who require additional care .

DEFINITION:-

Extended role of nurse is a activities concerned with the patient either in

hospital or community that are appropriate for delegation by doctors to nurses.

EXTENDED ROLE OF NURSE:-

1.Care giver
2.Manager
3.Advocator &protector
4.Counselor
5.Nurse educator
6.Communicator
7.Rehabilitator
8.Collaborator
9.School health nurse
10.Occupational health nurse
11.Parish nurse
12.Public health nurse
13.Home care nurse
14.Rehabilitation nurse
15.Office nurse
 16.Nurse epidemiologist
17.critical nurse
18.Nurse administrator
19. Nurse practitioner
20. Nurse midwife
21. Community health nurse
22. Occupational health nurse
23. Psychiatric nurse
24. Medical surgical nurse

1. CARE GIVER-
- Care giving role is primary role of nurse.
- The nurse add the holistic care needs of the client, including measures to restore
emotional, spiritual & social well being.

2. MANAGER-
- Co-ordinate activities with other health team .
- Manage there own time and resources.
- use critical thinking skill.
- Make decision and consult to professionals.

3. PROTECTOR AND ADVOCATOR –

- As protector,nurse helps to maintain a safe environment for the client and take steps
to prevent injury and protect client from possible adverse effects of diagnostic or
treatment measures.
- Conforming that a client does not have an allergy to a medication and providing
immunization.

4 .COUNCELLOR-
- The role of a counselor, nurse helps to explore feelings and attitude about wellness
&illness with patients and their families.
- It involve providing emotional, intellectual and psychological support.
- Counseling requires therapeutic communication skills.

5. COMMUNICATOR-
- The role of communicator is central to all nursing roles and activities.
- Nursing involves communication with client, families, other nurses and health care
professional and he community.
- Quality of communication is critical factor in meeting the needs of individual, families
and communities.
- The nursing interventions planned and implemented for each client and should
document them on client record this type of communication need to be clear and
relevant.

6. EDUCATOR-
- Explain the concept and factors of health.
- Demonstrate the procedure.

- USE FOUR COMPONENT OF TEACHING :

- Assessment
- Planning
- Implementation
- Evaluation

7. REHABILITATOR-
- Rehabilitation is the process by which individual returns to maximum level of
functioning after illness ,accidents or other disability events.
- Usually client experiences physical or emotional impairment that changes their lives
and nurse helps them to adapt as fully as possible by using her knowledge and skills.

- Functions-
- Move towards independence
- Work as part of multidisciplinary team
- Coordinate patient care prevent complication
- Patient education and counseling

8. COLLABORATOR-
- Many professions make up the team involved in the care of each client.
- Besides nurse ,their also can be physical therapist ,occupational therapist, social
workers and nutrionists.
- The nurse collaborates with other team members when providing care to client.

9. SCHOOL HEALTH NURSE-

- School nursing is a specialized practice of professional nursing that facilitates the
well being, academic success and life long achievement of students.

Functions :
 Health educator-
The nurse provides health education regarding proper nutrition or safety
information ,personal hygiene to children and also to their parents.

 Consultant-
Provide professional information about changes in school environment
and their impact on the health of children.

 Case manager-
Help to coordinate the health care for children, with any health problem.

 Case finder-
 The school health nurse identifies as early as possible children at risk for
physical, behavioral, social or academic problems.

 Direct care giver-

The school nurse is expected to give immediate nursing care to the ill or
injured child or the school staff members.

10 .OCCUPATIONAL HEALTH SERVICES-

- Occupational and environmental health nursing is the specially practice that
provides for the delivery health and safety programmes and service to the workers and
community group.

Practices focus on:-

- Promotion of health
- Restoration of health
- Prevention of illness
- Injury and protection from environmental hazards.

FUNCTIONS:-

 Direct nursing care-

This care involved primary, secondary and tertiary prevention with nursing
intervention from assessment. - eg. Physical assessment, screening

 Counseling-
Occupational nurse counsel for issues such as substance abuse and emotional
or family problems .

 Health promotion-
Occupational health teaching skills and developing health education
programmes especially on smoking cessation exercise, nutrition wait control
and chronic illnesses family problems.

11.PARISH NURSE-
- Parish nurse is the most commonly used term for the
professional advanced nurse practice role for the gathering in churches,tempels or
mosques
- A parish nurse specialist who encourages physical and spiritual health .
- A parish nurse is a registered nurse with specialized knowledge who is called to
ministry and affirmed by a faith community to promote health, healing and
wholeness
 FUNCTIONS–

-Provide a spiritual care :-

spiritual care is the core of parish nurse practice and central to the healing
process.

- Health counselor :-
Health counselor explain health risk apprisal,plan for health their life style,
provide support and guidance related acute and chronic, actual and potential
health problems.

- Health advocate :-
As an advocate, parish nurse guides persons successfully for problem solving
and care options.

- Health educator :-
As an educator ,serves to gain knowledge in order to make best choices for
maintaining health, lowering health risk, preventing illness and managing
diseases' already present.

12 .PUBLIC HEALTH NURSE-

Public health nurses work within the communities and focus on different areas to
improve the overall health of the people within that community.
- It is a registered nurse specially trained in community health .

FUNCTION :-

 Health advocate-
As an advocate, public health nurse collects, monitors & analyze data and
discuss with the client which services are needed.

 Care manager-
Public health nurses uses the nursing process of assessing, planning,
implementing & evaluating outcome to meet clients needs .

 Health educator-
As an educator the public health nurse identifies community needs &
implement activities aimed at changing behavior.

 Communicable disease control-

 public health nursing skills are necessary for education, prevention,
survivelence &investigation of communicable diseases on community.

14. REHABILITATION NURSE-

- Rehabilitation nurse as a nurse who specializes in assisting with disabilities and
chronic illness to attain optimal function, health, and to adapt to an altered life style.

Functions –
-They work as a part of multidisciplinary team and often coordinate patient care
and team activities.
- Rehabilitation nurse provides care that helps to restore and maintain function
and prevent complication.
- Provide patient and family education,counselling and case management.

15 OFFICE NURSE-
- Office nurse is called as clinic nurse.
-Office nurse provide patient care along with physician in setting such as physician
office ,medical office.
- The main focus is on diagnosis and treatment of specific illness rather than health
promotion.

Functions –
-Identifies trends in the type of problems client present and treating them.
- provides health promotion activities by health education and health counseling.
- Acts as problem solver who helps with referral questions .

16 NURSE EPIDEMIOLOGIST
- Nurse epidemiologist searches for new diseases and its reporting and taking part in
health programs.

Function-
- Survey for outbreak of disease.
- Education on control of communicable disease.
- Provide ongoing in-service training on infection control.
- Consultation to staff on various incidens.
- Conduct research to determine risk factors leading to infections.

17 CRITICAL CARE NURSE-

- Qualification of critical care nurses are basic b sc ,degree or diploma in nursing and
advanced preparation in critical care nursing .

Functions-
 Performs defibrillation.
 Manages patients total care.
  Monitoring balloon angioplasty, pacemaker, hemodynamic ,bedside
hemodialysis and surgical procedures.

18 NURSE ADMINISTRATOR-
- The nurse administrator manages client care, including delivery of nursing service.
- The function of nursing administrator include budgeting, staffing and planning
programes.

19. NURSE PRACTITIONER-

A nurse who is qualified to treat certain medical condition without the direct
supervision of doctors.
- Nurse practitioner who are educated and trained to provide health promotion and
maintenance through the diagnosis and treatment of acute illness and chronic
condition.

20. NURSE MIDWIFE-

- The nurse midwifes gives perinatal care for the mothers.
- They also conduct pap smear, family planning and routine breast examination.

21 COMMUNITY HEALTH NURSE-

- The goal of community health nurse is to improve health of community as a whole.
- Community health nurse function within the community framework and serves the
health needs of public and deliver care to the community. .

Functions of community health nurse-

 Health education
 Conduct school health services
 Collection of information and data collecting
 Assisting in ANC and PNC
 Home visiting

22 OCCUPATIONAL HEALTH NURSE-

- It is a branch of public health nursing.
- The occupational health nurse work in traditional manufacturing, industry services,
construction sites and government setting.
- The role includes: assessment, primary health care ,case management counseling,
health promoting and protection, research, administration and management.

23 PSYCHIATRIC NURSE-
 - it is a branch of nursing that deals with mentally challenged and mentally disturbed
clients and their needs.
- The role includes educator, surrogate, councelling,psychotherapist and advocate.

24 MEDICAL SURGICAL NURSE-

- It is a branch of medicine that deals with the overall medical and surgical
needs of the client and the functions include assessment of problem help in
diagnosis, treatment, administration of medication etc.

EXPANDED ROLE OF NURSE

INTRODUCTION
- Expanded role of nurse is the responsibility assumed by the nurse within the field of
practice.
- Increasing educational opportunities for nurses, the growth of nursing as a
profession and a greater concern for job .
- The nursing profession offers expanded role and different kind of career opportunity.

DEFINITION:-

-Expanded role of nurse means enlargement of nursing within the boundaries of

nursing.

The expanded role of nurse includes the following

1. Advanced nurse practitioner
2. Clinical nurse specialist
3. Nurse anesthetist
4. Nurse researcher
5. Nurse educator
6. Acute care nurse practitioner
7. Nurse entrepreneur
8. Operating home nurse
9. Travel nurse
10. Nurse oncologist
11. Nurse informatics
12. Sport nurse
13. hospice nurse
14 space nurse
15 Tele nurse
16 Cruise nurse
17 Disaster nurse
18 Nurse as author
19 Epidemiological nurse
 20 Ethicist

1 ADVANCED NURSE PRACTITIONER-

a nurse who has an advanced education and is a graduate of nurse practitioner
program is employed in health care agencies.

Job responsibility includes-

- taking client history
- Conducting physical examination
- ordering performing diagnostic test
- providing primary care
- consultant for individual, families and communities

2 NURSE CLINICIAN/CLINICAL NURSE SPECIALIST-

The clinical nurse specialist has
a master degree in nursing and expertise in a specialized area of practice

Functions-
- the main function as client care provider, educator, and consultant researcher,
manager and improve the quality of care provided to the client and family members

3 NURSE ANESHETIST-
- A nurse anesthetist is an registered nurse who received advanced training in an
accelerated program of anesthesiology.

Functions-
- carries visit and assessment
- Administration of general anesthetic agent for surgery .
- Assessment of post operative status of client.

4 NURSE RESEARCHER-
- Nurse researcher may be employed in an academic setting, hospital, or community
service agencies

Functions –
The nurse researcher investigates problems to improve nursing care and to further
define and expand the scope of nursing.

5 ADVANCED NURSE EDUCATOR-

- The nurse educator is usually degree holder or more advanced or more advanced
and frequently an expert in particular area of practice

6. ACUTE CARE NURSE PRACTITIONER-

- An acute acre nurse practitioner function in setting where critically ill patient reside
this type of nurse provide special expertise.

7 NURSE ENTERPRENEUR-
- An entrepreneur is an individual who organize operates and assumes business. Such
as independent nursing practice, consultants service etc. the nurse may be involved in
education consultation research etc

8 OPERATING ROOM NURSE-

- When patient are admitted before and after surgery, the operating room nurse
monitors the patients progress.
- She also performs preoperative assessment, prepare the patient for surgery, assist
the surgeon during procedure and manage patient recovery.

9 TRAVEL NURSING-
- Travel nursing and the travel nursing industry developed in response to the nursing
shortage in which nurses are relocated for short term nursing positions

10 NURSE ONCOLOGIST-
- Advance oncology nursing practice it means practice of expert and leadership in the
provisional care to individual with an acute and potential diagnosis of cancer.

11. NURSE INFORMATICS/NURSE ANALYST-

- The nursing analyst work within the management team to ensure high quality of
performance and technical support to both the management and the nursing staff .
- A nursing analyst must have a strong statistical background and be able to interpret
data in a logical manner.
- The nursing analyst must be able to work on multiple project at one time, focus on
details.

12 SPORT NURSE-
- The nursing profession has yet to officially develop a specialty in fitness nursing or
sport nursing on either the professional or academic level, a growing numbers of
nurses become involved in these areas.
- The connection between physical fitness, wellness and disease prevention is well
documented.
- Some nurses are involved in sport medicine on a full time basis while others work on
a full time, contract basis for sport time.

13 HOSPICE NURSE-
- The focus of hospice care is a comprehensive physical, psychosocial, emotional, and
spiritual care to terminally ill person and their families.
- Hosp[ice and palliative care includes 2 hours nursing availability, management of
pain and other symptoms and family support.
- Hospice providers promote quality of life by protecting patient from burden some
intervention and providing care at home.

14 SPACE NURSE-
- Space nurse provides a on the ground monitoring and a full range of health services
to astronauts, who are screened to determine if they meet the NASA health
requirement
. -Flight medicine nurse also coordinate dietary and fitness services ; clinical nurse
staff a sick call service for astronauts to use before and after flight.

15 TELE NURSE -
- Among its many benefits telenursing may help solve increasing shortage of nurses, to
reduce distances and save travel time, and to keep patient out of hospital.
-It carries out telephonic communication with patients thus providing response to
medical care/treatment

16 .CRUISE NURSE-
- These nurses work on ships or resort to provide emergency and general care to
passengers /vacationers, should it be required.
- Responsibility includes providing patient care in the health centre and dealing with
onsite emergencies.
- The requirements are registration with a minimum 2 years of experience in a recent
Shospital required. experience with cardiac care,trauma,and internal medicine etc.
- They must have excellent interpersonal skills, strong health assessment skill.

17 DISASTER NURSE / BIOTERRORISM NURSE-

- these nurses works in disaster areas that are the result of bioterrorist attack or a
situation caused by natural disaster,war,or poverty, red cross nurse are often part of
wing of nurses.
- The skills include: emergency room and critical care experience, management skill,
ability to meet the needs of the people in high crisis situation.

18. NURSE AS AUTHOR-

- An registered nurse who works in area of writing this written materials may be used
in research education,training,sales and marketing, and other mediums and
communication forums.
- The quality of journals which publish to nursing practice, material concerning nursing
issues depend on quality of material submitted.

19. EPIDEMILOGY NURSE-

- A nurse epidemiologist investigates trends in groups or aggregates and studies the
occurrence of diseases and injuries.
- The information is gathered from census data and statistics and reportable disease
records.
- They identify population at risk monitor the progress of disease, specify areas of
health care needs.
- They don’t provide direct nursing care, but they do research and publish the latest
trends in health care.

 Functions-
- Health education
- Identification and treatment of certain specific diseases
- Participation in early diagnosis and treatment
- Administration of general and specific health surveys

20. ETHICIST-
- A nurse who knows about legal/moral/ethical issues and provides services for patient
and families is called nurse ethicist.
- The nurse may work with an ethicist team to develop a detailed investigative plan .
- The criteria is a master degrees in bioethics or related field along with a registered
nurse certificate.

SUMMARY
1.Extended role of nurse is a activities concerned with the patient either in hospital or
community that are appropriate for delegation by doctors to nurses.
-Expanded role of nurse means enlargement of nursing within the boundaries of
nursing.

BIBLIOGRAPHY

1. Shebeer.P.Basheer.S.Yasmeen khan Advanced nursing practice 2 nd Edition

2017 Page no.681-686.

2. Sr.nacy Fundamental of nursing 7th Edition Page no. 94-96

 GOVT. COLLEGE OF NURSING
SPMC&AGH, BIKANER (RAJ.)

SUBJECT- ADVANCE NURSING

PRACTICE
TOPIC - EXTENDED AND EXPENDED
ROLE OF NURSE

SUBMITTED TO: submitted by:

Mrs. Sudipta Paul Ms. Ankita Jain
Assistant Professor M.Sc. (N) 1 st year
GOVT. College of nursing
Bikaner