CLASS PRESENTATION ON

ALTERNATIVE MODALITIES OF CARE,

COMPLIMENTARY THERAPIES,
EXPANDED ROLE OF NURSE, HOME
AND FAMILY NURSING

SUBMITTED TO, SUBMITTED BY,

MRS. APARNA KUNDU PALLABI MAJUMDAR
SR. LECTURER M.Sc. NURSING 1ST YEAR
W.B.G.C.O.N. W.B.G.C.O.N.
INTRODUCTION
Complementary and alternative medicine (CAM) includes various healing approaches and therapies that
originate from around the world and that are not based on conventional Western medicine. These therapies
are called alternative medicine when they are used alone and complementary medicine when they are used
with conventional medicine.
Alternative medicine includes therapies and health care practices not widely taught in most medical schools;
however, many such practices are popular. and some are used in hospital. Although the distinction between
conventional and alternative medicine is not always easy to determine, a basic philosophic difference exists.
Alternative medicine often defines health as a balance of body systems physical. emotional, and
spiritual involving the whole patient; i.e., the approach is holistic.
Conventional medicine generally defines health as the absence of disease; disease is usually thought to result
from isolated factors (e.g., pathogens, biochemical imbalances), and treatment often involves drugs or
surgery.
Disease is thought to result from disharmony and imbalances between body systems. Treatment
often involves strengthening the body's own defences and restoring these balances and energy flows.
Patients are most likely to seek alternative medicine for conditions such as chronic low back
pain, stress, migraine headaches, menopausal symptoms, cancer, and arthritis. Some patients seek alternative
medicine when conventional medicine offers little hope, especially at the end of life.

Basic Concepts of CAM:

Several concepts are common to most alternative practices. These are holism, humanism, balance, energy &
healing environments.
Holism: The idea that the whole of the sick person, including their body, mind and way of life, should be
considered when treating them, and not just the symptom of the disease.
Humanism: A system of thought that considers the solving of human problems with the help of religious
beliefs. It emphasizes the fact that the basic nature of humans is good.
Balance: A situation in which different things exist inequal, correct or good amount.
Energy: The ability to put effort and enthusiasm into an activity, work etc.
Healing: The process of returning to normal function after a period of disease or injury.

Definition of Complementary & Alternative Therapy

Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems,
practices, and products that are not generally considered part of conventional medicine.

Types of Complementary and Alternative Medicine

1. Alternative medical systems.
2. Biologically based treatments.
3. Mind-body techniques.
4. Manipulative and body-based methods and
5. Energy therapies.
6. Other therapies
 ALTERNATIVE MEDICINES
1. Ayurveda: Ayurveda is a System of healing based on an extensive use of herbs. It is a system of
traditional medicine native to the Indian Subcontinent, originated more than 5000 years ago and practiced in
other parts of the world as a form of alternative medicine. In Sanskrit, the word Ayurveda consists of the
words ayus, meaning ‘life’, and veda, meaning 'related to knowledge' or 'science'. The Sushruta Samhita and
the Charaka Samhita were influential works on traditional medicine during this era.

The famous treaties of Ayurveda are:

 Charaka Samhita by Sage Charaka, which details the prevention and treatment of disease.
 Sushruta Samhita of Sage Sushruta, which deals with Ayurvedic surgical procedures.
In the Ayurvedic system, the prevention of all
types of disease has a prominent place in
treatment, including restructuring a patient's
lifestyle to align with the course of nature.

The aims of Ayurveda:

 To remove the cause of disorders, prevent illness and harmonize body, mind and consciousness.
 Ayurveda aids in maintaining good health, increasing longevity and overall quality of life.
Alternative Ayurvedic treatments and self-help regimens include: nutrition, herbal remedies, aromatherapy,
lifestyle recommendations, massage treatments, color or sound therapy, meditation, Panchakarma
(detoxification), Yoga, meditation and rejuvenation therapies. Ayurveda empowers the individual to take
control of their own health and wellbeing.
A few examples are:
1. Terminalia arjuna is useful in eviating the pain of angina pectoris and in treating heart failure and
coronary artery disease. Terminalia may also be useful in treating hyperlipidemia.
2. Black pepper and long pepper are combined with ginger to form the traditional trikatu mixture in
Ayurveda. This mixture increases appetite, promotes the secretion of digestive juices, and cures certain
gastric disorders particularly Achlorhydria and Hypo chlorhydria.

2. Siddha: The Siddha medicine is a form of south Indian Tamil traditional medicine and part of the trio
Indian medicines -ayurveda, siddha and unani. However Lord Sri Akshunna, a master of northern siddha
tradition, says there is use of siddha medicine in the north Indian part or rather in Himalayan region as
jharphuk and siddha buti (medicine) tantra. This system of medicine was popular in ancient India due to the
antiquity of this medical system, the siddha system of medicine is believed to be the oldest medical system
in the known universe. The system is believed to be developed by the 9 nath and 84 siddhas in the north and
18 siddhas in the south called siddhar.

Siddhars were of the concept that a healthy soul can only be developed through a healthy body. So they
developed methods and medication that are believed to strengthen their physical body and there by their
souls. They practiced intense yogic practices, including years of fasting and meditation and
believed to have achieved super natural powers and gained the supreme wisdom and overall
immortality.

It is assumed that when the normal equilibrium of three humors—vata (wind), pitta (fire) and kapha (water)
is disturbed, disease is caused. The factors, which assumed to affect this equilibrium are environment,
climatic conditions, diet, physical activities, and stress. According to the siddha medicine system, diet and
life style play a major role not only in health but also in curing diseases.
The treatment in siddha medicine is aimed at keeping the three humors in equilibrium and maintenance of
the elements. So proper diet, medicine and a disciplined regimen of life are advised for a healthy living and
to restore equilibrium of humors in diseased condition. Saint Thiruvalluvar explains four requisites of
successful treatment. These are the patient, the attendant, physician and medicine. When the physician is
well qualified and the other agents possess the necessary qualities, even severe diseases can be cured easily.
The treatment should be commenced as early as possible after assessing the course and cause of the disease.
Treatment is classified into three categories: devamaruthuvum (Divine method); manudamaruthuvum
(rational method); and asuramaruthuvum (surgical method).

3. Unani & Tibbi: As an alternative form of medicine, Unani has found favour in Asia, especially
India. In India, these Unani practitioners can practice as qualified doctors, as the Indian government
approves their practice. Unani medicine is very close to Ayurveda. Both are based on theory of the presence
of the elements in the human body. In Unani, they are considered to be fire
water, earth and air.
According to followers of Unani medicine, these
elements are present in different fluids and their
balance leads to health and their imbalance leads
to illness. All these elaborations were built on the
basic Hippocratic theory of the Four Humors; blood,
phlegm, yellow bile and black bile.

Each person's unique mixture of these substances

determines his temperament: a predominance of
blood gives a sanguine temperament; phlegm makes
one phlegmatic; yellow makes choleric; and black bile makes melancholic. As long as these humors are in
balance, the human system is healthy, it's imbalance can result in disease.

4. Homeopathy: Homeopathy is developed in Germany in the late 1700s by Samuel Hahnemann,

based on the principle that like cures like. It is a system of therapy based on the concept that a substance that
causes the symptoms of a disease in healthy people would cure similar symptoms in sick people. The
preparations are manufactured using a process called homeopathic dilution, in which a substance is
repeatedly diluted in alcohol or distilled water. Remedies used in homeopathy are derived from naturally
occurring substances, such as plant extracts and minerals. Extremely low concentrations are prepared in a
specific way. The more dilute the homeopathic medicine, the stronger it is considered to be effective.
Traditional scientists can find no scientific explanation for how the diluted remedies used in homeopathy
could cure disease. Some solutions are so dilute that they contain no molecules of the active ingredient.
Homeopathy has least side effects.
Homeopathic remedy Rhus toxicodendron, derived from poison ivy substance prepared with a particular
procedure and intended for treating patients. Examples include Arsenicum album (arsenic oxide), Natrum
muriaticum (sodium chloride or table salt) and Thyroidinum (thyroid hormone).
5. Naturopathy: It is a system of therapy based on preventative care by the use of heat, water, light,
and the body's natural healing abilities. This system also focuses on finding the cause of a disease rather than
merely treating symptoms. Some of this system's principles are similar to those of modern Western
medicine.
Naturopathy is based on the belief that the body is self-healing. The body will repair itself and recover from
illness spontaneously if it is in a healthy environment. Naturopaths have many remedies and
recommendations for creating a healthy environment so the body can spontaneously heal itself. The
following therapies are considered to be of primary importance in the naturopathic treatment of disease:
Nutrition and Dietetic: This includes the prescription of a balanced wholesome, natural diet, based on the
principles advocated by naturopathic practitioners.
Fasting: The controlled abstinence from food has been used therapeutically for over 2,000 years. It was
advocated by Hippocrates as a treatment for many diseases, because it allowed the body to concentrate its
resources on dealing with the disease rather than the processes of digestion.
Structural Adjustment: By such methods as osteopathy, chiropractic, neuromuscular technique, postural
education and remedial exercises, the naturopathic practitioner seeks to balance and integrate the spine,
muscles, ligaments and joints of the whole body.
Hydrotherapy: It is a form of physical medicine using the therapeutic application of water in a variety of
ways, both internally and externally, on the body. Topical applications of cold or hot water packs,
compresses, baths, pools, steams, sweats, showers, enemas, and colonics are all forms of hydrotherapy.
Healthy Lifestyle: This includes the general care of one's body, the use of moderate physical exercise, the
cultivation of a positive approach to life and health, relaxation techniques, etc.
Education: In naturopathic philosophy it is very important to explain to the patient why disease occurs and
what the patient can do for him or herself to maintain the health and wellbeing. In this way the patient is
given responsibility for his or her health.

 BIOLOGICALLY BASED TREATMENTS

1. Herbal Medicine: Herbal medicine has always attracted some scientific interest and many well-
known drugs are plant-derived, for example digoxin from Digitalis Lanata and morphine from poppies. The
following are some of the herbs commonly thought to be effective:
 Ginger– many studies have shown ginger to be useful in treating nausea, including motion
sickness and morning sickness. It is used to reduce the risk of heart disease by lowering levels of blood
cholesterol.
 Ginseng – generally used to treat fatigue during recovery from illness.
 Ginkgo Biloba may be effective in relieving the symptoms of dementia and it may also support memory
in all older people.
 Horse chestnut seed extract can alleviate the symptoms of varicose veins.
 Tea tree oil may be effective against fungal infections such as athlete's foot.
 Green tea is used to combat fatigue, prevent arteriosclerosis and certain cancers, lower cholesterol, and
aid in weight loss.
 Vegetables from the allium family (onions and garlic) may protect against certain cancers if eaten
regularly, especially cancers of the digestive tract.

2. Nutritional therapy: Nutritional therapy is a system of healing based on the belief that food
provides the medicine we need to obtain and maintain a state of health. Although some health problems
require specific medication, many conditions can be relieved effectively with nutritional therapy. These
include disorders ranging from chronic fatigue, energy loss, insomnia and depression, to backache, skin
complaints, asthma, and headaches. Nutritional therapy will also benefit you if you have no specific illness,
but want to maintain a state of optimum health.
Nutrition as the key to good health is the fundamental principle used to help people of all ages to stay at
their personal peak of energy and vitality. Today, new insights of food scientists play a significant role in the
practice of nutritional therapy as preventative medicine.

 MIND-BODY TECHNIQUES
Mind-body techniques are based on the theory that mental and emotional factors can influence physical
health. Behavioral, psychologic, social, and spiritual methods are used to preserve health and prevent or cure
disease. Because of the abundance of scientific evidence backing the benefits of mind-body techniques,
many of the approaches are now considered mainstream.
Benefits: Mind-body techniques can be used to treat anxiety and panic disorders, chronic pain, coronary
artery disease, depression, headaches, difficulty sleeping (insomnia), and loss of urinary control
(incontinence) Mind-body methods also are used as an aid in childbirth, in coping with the disease-related
and treatment-related symptoms of cancer, and in preparing people before surgery.

1. Meditation: In meditation, people regulate their attention or systematically focus on particular

aspects. Meditation usually involves sitting or resting quietly, often with the eyes closed. Sometimes it
involves the repetitive chanting of mantra meant to help the person focus. Meditation has shown favourable
effects on cardiovascular function, immunity and brain activity. As a health care intervention, however,
meditation may be effective regardless of people's cultural or religious background.

2. Relaxation Techniques: Relaxation techniques are practices specifically designed to relieve

tension and strain. The specific technique may be aimed at reducing activity of the nerves that control the
stress response (sympathetic nervous system), lowering blood pressure, easing muscle tension, slowing
metabolic processes, or altering brain wave activity. Relaxation techniques may be used in combination with
other techniques, such as meditation, guided imagery, or hypnotherapy.

3. Guided Imagery: Guided imagery involves the use of mental images to promote relaxation and
wellness, reduce grief, pain, or facilitate healing of a particular ailment, such as cancer or psychological
trauma. The images can involve any of the senses and may be self-directed or guided by a practitioner,
sometimes in a group setting. For example, a person with cancer might be told to imagine an army of white
blood cells fighting against the cancer cells. Guided imagery has not been thoroughly scientifically studied,
but many people claim to have had success with it.
4. Hypnotherapy: This alternative therapy is derived from Western practice. In hypnotherapy, people
are guided into an advanced state of relaxation and heightened attention. Hypnotized people become
absorbed in the images suggested by the hypnotherapist. Because their attention is more focused and they
are more open to suggestion, hypnotherapy can be used to help people change their behaviour and thus
improve their health. Hypnotherapy can be used to treat or help treat purely psychological symptoms,
treating many symptoms in which psychological factors can influence physical symptoms:
 Phobias
 Certain pain syndromes
 Smoking cessation
 Headaches
 Asthma
 Irritable bowel syndrome
 Conversion disorders (in which apparent physical illness
actually is caused mainly by psychological stress and conflict)
 Nausea and vomiting caused by chemotherapy, particularly
the nausea some people get before chemotherapy (anticipatory nausea)
 Anxiety and diminished quality of life in people who have cancer.

5. Biofeedback: Biofeedback is a method

of bringing unconscious biologic processes
under conscious control. It involves the use
of electronic devices to measure and report
back to the conscious mind information such
as heart rate, blood pressure, muscle tension,
and brain surface electrical activity. With the
help of a therapist or with training people
then can understand why these functions
change and can learn how to regulate them.
Biofeedback typically is used to treat pain
including headache and chronic abdominal
pain, stress, insomnia, fecal or urinary incontinence. attention deficit disorder and mild cognitive
impairment, and tinnitus.

 MANIPULATIVE AND BODY BASED METHODS

1. Yoga: The fundamental idea behind the practice of Yoga is to unite the individual
self, Jiva with the supreme or pure consciousness, Brahma.
The factual connotation of Yoga is unification. As
Yogic philosophy says, the human body and mind are
parts of the deceptive world of matter, with a limited
period, whereas the spirit is endless and passes onto
a new world when this body dies. In the present view,
Yoga is one of the most helpful and healthy forms of
experience to manage the influence of thinking by
turning psychological and physical force into spiritual
energy. Its daily practice is often seen as a way of
gaining control over your health. The main aim of yoga
therapy is the mind/body integration, which strike into
the normal healing properties of the body and helps to restore functions of your body and health.

Yoga therapy consists of three basic parts of your body which work together.
 Physical posture: It helps to stretch and strengthen your muscles. It also improves your mobility,
flexibility and balance. The proper posture enhances your body's natural functions of circulation,
elimination, respiration, and digestion.
 Breathing technique: It mainly focuses on awareness of breath and helps promote calm, focus the mind
and relieve stress and fatigue.
 Relaxation technique: It mainly helps you to recharge and ease tension.

Benefits of yoga therapy

 Yoga therapy shows positive results in treating stress, depression.
 Deep breathing associated with yoga is beneficial in controlling premature ventricular complexes.
 Yoga therapy is beneficial in post-treatment strategy, breast cancer and other survivors.
 It helps in diminishing tension, improving mood disturbances, cognitive function and gastrointestinal
disturbances.
 Increases your body's ability in using antioxidants which is beneficial in the prevention of cancer.
 Yoga therapy improves nerve function and regulates blood sugar.
 Yoga increases your motor functions.
 Yoga helps in weight reduction.

Criticisms of Yoga Therapy: The practice of yoga therapy is difficult in person having limited mobility and
flexibility. While attempting some of the postures of yoga without any pre-exercise preparation then there is
a possibility of getting injured.

2. Chiropractic: In chiropractic, the relationship

between the structure of the spine and function of
the nervous system is thought to be the key in
maintaining or restoring health. The main method
for achieving balance is spinal manipulation.
Chiropractic is useful in treating low back pain,
headaches, and nerve impingement.

3. Tai Chi & Qigong: Tai chi and qi gong are martial arts that can help your circulation, balance, and
alignment. They can also help restore your energy, the Qi. It has recently been considered as an alternative
method for lowering the blood pressure levels This discovery has big implications for patients who are
suffering from chronic hypertension. When we are stressed our pituitary gland releases ACTH
(adrenocorticotropic hormone) which is triggering other glands, including adrenal glands, to produce
enormous amounts of adrenaline.
Tai Chi therapy, leads to a relaxation response. This can result in vasodilation, thus the blood supply to the
brain is increasing. Apart from reducing the high blood pressure, it positively affects metabolic rate, heart
rate and breathing, and other life supporting processes. People practicing Tai Chi have documented less
frequent headaches, diarrhea, and are less prone to anger, anxiety, and frustration. It boosts their energy level
and adds to their daily activities.

 ENERGY THERAPIES
1. Massage Therapy: Body tissues are manipulated to promote wellness and reduce pain
and stress. The therapeutic value of massage for many musculoskeletal symptoms and stress is widely
accepted. Massage has been shown to help relieve muscle soreness, pain due to back injuries, and
fibromyalgia and to help relieve anxiety in cancer patients. Massage therapy is also effective in treating low
birth weight infants, preventing injury to the mother's genitals during childbirth, relieving chronic
constipation, and controlling asthma.
2. Acupuncture: A therapy within traditional Chinese medicine, is one of the most widely accepted
alternative therapies in the Western world. Specific points on the body are stimulated, usually by inserting
thin needles into the skin and underlying tissues. Sometimes additional stimulation is added
by using a very low voltage electrical current, by
twisting the needle, or by warming the needle.
Stimulating these specific points is believed to
unblock the flow of Qi (the vital energy flowing
through our body) along energy pathways
(meridians) and thus restore harmony between
yin and yang. The procedure is not painful but
may cause a tingling sensation.
A variation of acupuncture, called
acupressure, uses localized massage instead of
needles to stimulate points. Acupuncturists are
licensed to practice after receiving training and qualifying examination. Research has shown that
acupuncture releases various neurotransmitters that act as natural painkillers.

3.Reflexology: A variant of massage therapy relies on manual pressure applied to specific

areas of the foot; these areas are believed to correspond
to different organs or body systems via meridians.
Stimulation of these areas is believed to eliminate the
blockage of energy responsible for pain or disease in
the corresponding body part.

3. Hand Mediated Bio-field Therapies: Therapeutic touch (TT) is a mostly secular variant of
faith healing, started by Dolores Krieger in the early 1970s. The TT practitioner moves his hands over
the patient's body, specifically the affected area, without actually touching the patient. TT adherents
claim that this directs the flow of Qi so that the patient can heal. The practice is based on the belief that
living beings have an energy field or aura which extends beyond the surface of the body that can be
manipulated by the therapist. Though no evidence of effectiveness has been found.

 OTHER THERAPIES
1. Traditional Chinese Medicine: Originating more than 2000 years ago, traditional Chinese
medicine is based on the theory that disease results from improper flow of the life force (Qi). Qi is restored
by balancing the opposing forces of yin and yang, which manifest in the body as heat and cold, external and
internal, and deficiency and excess.
Yin and yang is a concept originated in ancient Chinese philosophy that describes how obviously opposite or
contrary forces may create each other by their comparison and how they may give rise to each other as they
interrelate to one another.
Various practices like acupuncture, acupressure, herbal remedies, massage, meditation are used to preserve
and restore health.

2. Curanderismo: It is a cultural healing tradition

found in Latin America and Mexico. Although it is
a traditional healing system, it utilizes western
biomedical belief, treatment and practices.
Curanderismo blends religious beliefs, faith, and
prayer with the use of herbal medicine, massage,
body cleansing, music therapies and other healing
techniques.
3. Aroma Therapy: Aromatherapy is based on the healing power of plant oils which may be
massaged into the skin, inhaled or used in the bath. Anecdotally it is said to induce a feeling of well-being.
Aromatherapy massage relieves tension and improves circulation and can reduce anxiety in short-term
settings such as intensive care. A trial of 'melissa' (lemon balm) aromatherapy shows highly significant
effects in reducing agitation and increasing social interaction in dementia patients.

4. Spiritual Therapy: Spiritual therapy is a regimen designed to heal one’s spirit and psyche as well
as the body. In many traditions it is believed if one's spirit is ailing, one's whole being suffers. This is where
spiritual therapy comes in. It treats the whole being, especially the spirit to promote a healthy whole person.
a. Faith: Faith is the confident belief or trust in the truth or trustworthiness of a person, idea, or thing. Faith
is often used in a religious context, as in theology, where it almost universally refers to a trusting belief in a
transcendent reality, or in a Supreme Being. Faith is the persuasion of the mind that a certain statement is
true. It is the belief and the assent of the mind to the truth of what is declared by another, based on his or her
authority and truthfulness.
b. Baha'i Faith: In the Baha'i Faith is ultimately the acceptance of the divine authority of the Manifestations
of God. In the religion's view, faith and knowledge are both required for spiritual growth. Bahá'í faith
believes that there is only one God, Who is the Creator and absolute ruler of the universe.
c. Prayer: Prayer is the act of addressing a god or spirit for the purpose of worship or petition. Specific
forms of this may include praise, requesting guidance or assistance, confessing sins, as an act of reparation
or an expression of one's thoughts and emotions. The words used in prayer may take the form of
intercession, a hymn, incantation, words of gratitude, or a spontaneous utterance in the person's praying
words. Praying can be done in public, as a group, or in private.
Scientific studies regarding the use of prayer have mostly concentrated on its effect on the healing of sick or
injured people.

5. Music therapy: It is an interpersonal process in which a trained music therapist uses music and all
of its facets physical, mental, social, aesthetic, and spiritual to help clients to improve or maintain their
health.
Music therapy is used with individuals of all ages and with a variety of conditions, including: psychiatric
disorders, medical problems, physical handicaps, sensory impairments, developmental disabilities, substance
abuse, communication disorders, interpersonal problems, and aging.
It is also used to: improve learning, build self-esteem, reduce stress, support physical exercise, and facilitate
a host of other health-related activities.

6. Humour and Laughter: Laughing is found to lower blood pressure, reduce stress hormones,
increase muscle flexion, and boost immune function. Laughter also triggers the release of endorphins, the
body's natural painkillers, and produces a general sense of well-being. Hospitals around the country are
incorporating formal and informal laughter therapy programs into their therapeutic regimens. In countries
such as India, laughing clubs in which participants gather in the early morning for the sole purpose of
laughing.
Humour is the tendency of particular cognitive experiences to provoke laughter and provide amusement. A
sense of humour is the ability to experience humour, although the extent to which an individual will find
something humorous depends on variables, including geographical location, culture, maturity, level, etc.
Benefits of laughter
 Laughter Activates the Immune System, by raising levels of T-cells, interferon and B-cells.
 It Decreases "Stress" Hormones.
 It brings in positive emotions that can enhance wellbeing but cannot replace conventional treatments.
Hence it is another tool available to help fight the disease.

7. Bioelectromagnetic Therapy: Bioelectromagnetic therapy (BT) is the application of

electromagnetic fields to treat and prevent disease and promote health and wellness. Whenever current
passes through a wire, it induces a magnetic field. The electricity remains confined within the wire,
the magnetic field induced moves outside. When
a varying electromagnetic field is placed close to
a conductive medium such as the human body, it
will induce electrical currents. It is standard
practice in Eastern Europe, where it has been
studied systematically for many years.
The effects of electromagnetic fields include
accelerated healing. Greater cellular energy
(increased ATP), vasodilatation/increased blood
flow, reduced inflammation and edema, muscle relaxation, cell membrane changes, enhanced movement of
calcium, sodium and other ions, bone formation, improved oxygenation, better sleep, lysis of clots, reduction
in platelet adhesion, increased fertility. enhanced cognitive ability, improved central and peripheral nerve
function, reduced stress and better mood.

8. Photo Energy Therapy: Photo Energy Therapy devices emit near infrared light (NIR Therapy)
typically at a wavelength of 880 nm. This wavelength is believed to stimulate the release of Nitric Oxide, an
Endothelium- derived relaxing factor into the bloodstream, thus vasodilating the capillaries. This increase in
circulation has been shown effective in various clinical studies to decrease pain. Photo Energy Therapy
devices seem to address the underlying problem of neuropathies, poor microcirculation, which leads to pain
and numbness in the extremities

9. Detoxification Therapy: Detoxification Therapy involves the removal of toxic substances. Our
body naturally eliminates or neutralizes toxins. But due to industrial revolution the accumulation of toxins
(food additives, chemicals, anesthetics and residue of pharma drugs, pesticides and heavy metals) surpasses
its elimination.
Detoxification Therapy Treatment: There are a number of methods of detoxification.
 Brief physical checkup is made, X-Ray is taken, urine and blood samples are sent for analysis sometimes
sweat and hair maybe analyzed.
 Colonic irrigation, fasting, special diets, hyperthermia, other hydrotherapy treatments, lymphatic
stimulation and nutritional supplements are some methods of detoxification.
 Nutritional Supplements - Intake of massive quantities of Vitamin C are recommended for people
undergoing detoxification treatment. Vitamin A, Vitamin B and Vitamin E and minerals like Magnesium,
Potassium, Selenium and Zinc are also suggested. Herbs such as cayenne, Echinacea and garlic are also
included.

Contraindications of Detoxification Therapy:

 Old age
 Weak or underweight
 pregnant and nursing mothers
 Ulcerative colitis, crohn's disease, any other type of bowel inflammation or hemorrhoids, diverticulitis,
tumor of the large intestine or rectum
 liver or kidney problems
 high or low B.P., cardiac disease, epilepsy, multiple sclerosis
 lung problems like asthma, tuberculosis
 advanced cancer
 diabetes
 history of blood dyscrasias

10. Animal-Assisted Therapy: AAT is a type of therapy that involves an animal with specific
characteristics becoming a fundamental part of a person's treatment. Animal- assisted therapy is designed to
improve the physical, social, emotional, and/or cognitive functioning of the patient, as well as provide
educational and motivational effectiveness for participants. It can be provided on an individual or group
basis. During AAT, therapists document records and evaluate the participant's progress. Many kinds of
animals are used in therapy, including dogs, cats, horses, elephants, dolphins, rabbits, and other small
animals, birds and insects like bees, butterflies, etc.

Benefits: People who have pets benefit in various ways as follows

Physical:
 Improve fine motor skills
 Improve wheelchair skills.
 Improve standing equilibrioception (balance).
 May lower blood pressure, risk for stroke or
heart attack, and decrease depression.
Mental:
 Increase attention skills
 Develop leisure/recreation skills.
 Increase self-esteem.
 Reduce anxiety.
 Reduce loneliness.
 Sense of responsibility.
 Though the practice of capturing dolphins can leave more injured or even dead.

11. Horticultural therapy: It is the practice of horticulture as therapy to improve human well-
being. According to the American Horticultural Therapy Association it is defined as "a process utilizing
plants and horticultural activities to improve social, educational, psychological and physical adjustment of
persons thus improving their body, mind, and spirit." Horticultural therapists are specially educated and
trained members of rehabilitation teams who involve the client in all phases of gardening - from propagation
to selling products - as a means of bringing about improvement in their life.

CONCLUSION
A lot of research is being done in this field and new drugs for treating more illness, are being explore the
side effect and the resistance to allopathy, drug is becoming a human concern, so people are turning to
alternative approaches. So the prospects of alternative approach in the future are bright.

EXTENDED AND EXPANDED ROLE OF NURSES

During the past five decades the nursing profession made significant progress towards developing a body of
scientific knowledge and establishing the credibility of nursing science. Nursing practice changes in
response to consumer demands and accessibility and involvement in decision making, new technology
changes in health care delivery systems and policy. Nursing Role is a set of expected behaviors associated
with a person's status or position and it includes behavior, rights and responsibility.

Predominant Nursing Roles

Nurses assume a number of roles when they provide care to the client. Contemporary nursing requires that
the nurse possess knowledge and skills in a variety of areas. In the past the principle role of a nurse was to
provide care and comfort. But changes in nursing have expanded the role to include increased emphasis on
health promotion and illness prevention as well as a holistic approach.
The roles are:-
1. Health promoter and care giver.
2. Counsellor.
3. Learner and teacher.
4. Protector and client advocate.
5. Resource person.
6. Communicator.
7. Leader and manager.
8. Case manager.
9. Resource consumer.
10. Rehabilitator.
11. Clinical decision maker.
12. Political advocate.
13. Colleague and collaborator.

Expanded Role of Nurses

Because of increasing educational opportunities for nurses, the growth of nursing as a profession and a
greater concern for job enrichment, the nursing profession offers expanded role and different kinds of career
opportunities.
The expanded roles include the following.
1. Advanced Nurse Practitioner.
2. Clinical nurse specialist.
3. Nurse anesthetist.
4. Nurse researcher.
5. Nurse educator.
6. Nurse entrepreneur.
7. Acute care nurse practitioner.
8. Operating home nurse.
9. Professional nurse care manager.
10. Rehabilitation nurse.
11. Nurse analyst.
12. Travel nurse.
13. Nurse oncologist.
14. Sport nursing.
15. Nurse as authors.
16. Nurse liaison.
17. Space nursing.
18. Hospice nurse.
19. School health nurse.
20. Tele nursing.
21. Cruise ship/ resort nurse
22. Attorney.
23. Disaster/ bioterrorism nurse.
24. Epidemiology nurse.
25. Ethicist.

1. Advanced Nurse Practitioner: Nurses who have an advanced education and is a graduate of a
nurse practitioner program is employed in health care agencies or in community settings and deals with non-
emergency acute or chronic illness and provide primary ambulatory care.
Job responsibility include: -
 Taking client history.
 Conducting physical examinations.
 Ordering performing and interpreting diagnostic tests,
 Prescribing pharmacologic agents.
 Treatment and therapies for the management of client's condition
 Providing primary care.
 Consultant for individuals, families and communities.

The major nurse practitioner categories are: -

 Adult nurse practitioners are those who provide primary ambulatory care to adults with a non-
emergency, acute or chronic illness and some setting tertiary care.
 Family nurse practitioners provide primary ambulatory care for families usually in collaboration with
family care physician.
 Pediatric nurse practitioner provides care to infants and children.
 An obstetrics and gynecology nurse practitioner provides care to women seeking obstetrical and
gynecological health care and conducts delivery independently.
 Geriatric nurse practitioner provides ambulatory or in patient care to older adults. Their activities include
interventions for health maintenance, illness prevention or health restoration.

2. Nurse Clinician or Clinical Nurse Specialist: The clinical nurse specialist has a master's
degree in nursing and expertise in a specialized area of practice. The CNS may work in primary care, acute
care, restorative care and community-based settings. The CNS function as client care provider, educator, and
consultant, and researcher, manager, to plan and improve the quality of care provided to the client and
family.

3. Nurse Anesthetist: A nurse anesthetist is an RN who received advanced training in an accelerated

program of anesthesiology.
Functions:
 Carries preoperative visits and assessments.
 Administration of general anesthetic agent for surgery under supervision of anesthetist.
 Assessment of post operative status of client.

4. Nurse Researcher: The nurse researcher investigates problems to improve nursing care and to
further define and expand the scope of nursing. They may be employed in an academic setting, hospital or
independent professional or community service agencies.

5. Advanced Nurse Educator: The nurse educator is usually holder a baccalaureate degree holder
or more advanced degree and an expert in a particular area of practice.

6. Acute Care Nurse Practitioner: An acute care nurse practitioner functions in settings where
critically ill patients reside, this type of nurses provide special expertise. The certification includes
physiology, advanced assessment, advanced pathophysiology, pharmacology and advanced therapeutics.
7. Nurse Entrepreneur: An entrepreneur is an individual who organize operates and assumes the risk
for business ventures. Such business includes independent nursing practice, consultant services etc. the nurse
may be involved in education consultation research etc.

8. Operating Room Nurse: When patients are admitted before and after surgery, the operating room
nurse monitors the patient's progress from the time he/she enters the operating room until he/she is
dismissed to the attending staff nurse. She also performs preoperative assessment, prepares the patient for
surgery, set up for surgery, assists the surgeon during the procedure and manages patient recovery.

9. Professional Nurse Case Manager: The nurse case manager assesses the patient and develops
care according to expected out comes in terms of cost and quality.

10. Rehabilitation Nurse: The most important role of rehabilitation nurse is education. She teaches
the client to perform self-assessment, make decisions about beginning continuing self care measures.
Perform every day activities and evaluate the progress and recovery.

11. Travel Nursing: a skilled and qualified healthcare professional who accepts a temporary
assignment at a hospital in a different geographical location than where they live. This concept was
developed as a response to the nursing shortage seen globally. Most nurses enjoy travel nursing for 3
reasons: -
 Visiting many different locations.
 Free benefits.
 Higher salary with bonuses.
12. Nurse Oncologist: Advance oncology nursing practice is defined as the practice of expert
competency and leadership in the provisional care to individuals with an actual or potential diagnosis to
cancer.

13. Nurse Informatics/Nursing Analyst: The nursing analyst works within the management
team to ensure high quality of performance, compliance and technical support to both the management and
the nursing staff. The nursing analyst is involved in data analysis and interpretation with regards to
effectiveness and efficiency of data collection, entry and use within the various areas of the hospital or
healthcare facility.
Qualities of a Nurse Analyst:
 A nursing analyst must have a strong statistical background and be able to interpret data in a logical and
organized manner.
 The nursing analyst must be able to work on multiple projects at one time, focus on details as well as the
overall project.
 The nursing analyst may be required to actually present the material orally or in written form or to create
Power Point or other presentations to display the required information.
 Excellent computer skills and a good working knowledge of data analysis and display are critical.
 The nursing analyst should be able to conduct public speaking activities as required.
 An ability to analyze data is critical to effectively make recommendations for standards and policy and
procedural changes.

14. Sport Nursing: Helping humans stay healthy and prevent disease is one of the main thrusts behind
an emerging trend that combines nursing with some aspect of fitness or sports. Although the nursing
profession has yet to officially develop a specialty in 'fitness nursing" or 'sports nursing' on either the
professional or academic level, a growing number of nurses are becoming involved in these areas. The
connection between physical fitness, wellness and disease prevention is well documented. As a result,
hospitals around the country have begun opening fitness centers and offering wellness programs with
information on nutrition, stress management and exercise.
15. Hospice Nurse or Palliative Nurse: The focus of hospice care is a comprehensive physical,
psychosocial, emotional, and spiritual care to terminally ill persons and their families. Hospice providers
promote quality of life by protecting patients from burdensome interventions and providing care at home,
whenever possible, instead of the hospital.
Hospice and palliative care nurses work in collaboration with other health providers within the context of an
interdisciplinary team. Hospice and palliative nurses distinguish themselves from their colleagues in other
nursing specialty practices by their unwavering focus on end-of-life care.
Hospice and palliative care include 24-hour nursing availability, management of pain and other symptoms,
and family support promoting the highest quality of life for the patient and family. Nurses collaborate in a
cultural assessment of the patient and family and provide culturally sensitive care. Hospice and palliative
nursing is not only practiced at the bedside.
Education: Hospice and palliative nurses are registered nurses prepared at the associate- degree,
baccalaureate degree, and/or master's-degree level.

16. Nurse liaison: The Nurse Liaison's role is multifaceted. They are the vital link between the
potential patient and the rehabilitation facility. In this capacity, the transition between an acute
hospitalization and rehabilitation is made as smooth as possible for the patient. The Nurse Liaison explains
to the potential patient and his/her family members what to expect during the rehabilitation stay. This
explanation is usually given during the assessment of the potential patient. The Nurse Liaison performs the
assessment at the request of the attending physician. This information, once obtained, is then submitted to
the physician and the admissions staff for review. The major role in liaison nursing is enhancement of
delivery of psychological nursing care and effective management. Also serves as a catalyst in negotiations
with staff and clients. The Nurse Liaison is an RN/LPN currently licensed in the state of Tennessee. He/she
has three or more years of diverse clinical experience, sound clinical judgment, and excellent assessment
skills.

17. Space Nursing: Space nurses provide on the ground monitoring and a full range of health services
to astronauts, who are screened to determine if they meet the NASA health requirements and, in some cases,
military stipulations. It is very crucial for mission safety and service eligibility. Flight medicine nurses also
coordinate dietary and fitness services; clinic nurse staff coordinates service for astronauts to use before and
after flight. Space nurse society members now meet yearly at conferences to exchange ideas share research
findings, and discuss application of research findings, and application of nursing methods used on earth in
space settings. The members are with a basic nursing degree and a doctorate or masters in any discipline of
nursing. The skills needed are excellent communication skills; interest and knowledge of aerospace industry
and challenges, mental health skills, innovation and creativity, knowledge of physics and engineering

18. Tele Nursing: This refers to the use of telecommunications and information technology for
providing nursing services in health care whenever a large physical distance exists between patient and
nurse, or between any numbers of nurses. As a field it is part of telehealth, and has many points of contacts
with other medical and non-medical applications, such as tele-diagnosis, tele-consultation, tele- monitoring,
etc.

19. School Health Nurse: The role of the nurse is to support the educational process by helping
students keep healthy and by teaching both the students and the teachers about the healthy and preventive
practices. The responsibilities include first aid, screening, follow up, control of communicable discases,
immunization, teaching health classes, transmitting knowledge regarding healthy behaviors, conducting
health related studies, referral services.

20. Cruise Ship or Resort Nurse: These nurses work on ships or resorts to provide emergency and
general care to passengers or vacationers, as required. These nurses also serve as part of the occupational
health team of the crew who live in the ship for 6 to 8 months of time, or the staff at resorts.
Responsibilities include providing patient care and dealing with onsite emergencies. They must have
interpersonal skills, enjoy travelling and be very flexible with time, strong health assessment skills, possess a
valid passport and able to tackle minor illnesses.
The requirements are-
 Registration with a minimum of 2 years of experience in recent hospital required.
 Experience with cardiac care, trauma, and internal medicine is desirable.

21. Nurse Attorney: A nurse attorney represents medical professionals in court, or works to change
policies within the healthcare system." Nurse attorneys take on the important role of defending nurses and
other healthcare professionals in malpractice cases, but they also fulfil many other responsibilities. These
professionals hold degrees and licensure in both nursing and law. Nurse attorneys engage in a range of legal
activities including providing legal consult, prosecution, engage in legal research, define standards of care.

22. Disaster or Bioterrorism Nurse: These nurses' work in disaster areas that are the result of
bioterrorist attack or in situations caused by natural disaster, war or poverty, Red Cross nurses are often part
of this wing of nurses. A basic degree in nursing is needed and should be the member of a society like Red
Cross. The skills include: emergency room and critical care experience, experience with local disaster action
teams, management skills, ability to meet the needs of the people in high crisis situations, knowledge of
disaster preparedness and basic first aid.

23. Nurse as Authors: An RN who works in any area of writing, this written material may be used in
research education, training, sales and marketing, and other mediums and communication forums. Nursing
knowledge must be disseminated as widely as possible to nursing practice and keep pace with the health
needs of the community. The quality of journals which publish, materials concerning nursing issues depends
on quality of material submitted. It's the responsibility of nurses to attempt to publish any new knowledge
they gain.

24. Epidemiology 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 need, determine priorities and size and scope of programs and evaluate their impact.
They don't provide direct nursing care, but they do research and publish the latest trends in health care.

25. Ethicist: A nurse who knows about legal/moral/ethical issues and provides services for patients and
families is called nurse ethicist. The nurse may work with an ethicist team to develop a detailed investigative
plan to answer question raised by an ethics violation allegation or resolve clinical dilemmas. The criteria is a
master's degree in bioethics or related field along with a registered nurse certificate.

Conclusion
There are more roles of nurses and nursing avenues, some explored and some unexplored. To achieve
positive patient outcomes, institutions are standing to provide care in a timely cost-effective manner. The
future of nursing is brighter than ever. Because of the never-ending changes and the broadening of new
avenues more health care jobs will result. Professional nursing has to be viewed as a cost-effective way to
provide care to the clients. So according to the advancement of technologies and increased health problems
nurses has to be prepared to deal with all these technologies and health problems.

FAMILY NURSING
Nursing care directed to improving the potential health of a family or any of its members by assessing
individual and family health needs and strengths, by identifying problems influencing the health care of the
family as a whole and those influencing the individual members, by using family resources, by teaching and
counselling, and by evaluating progress towards stated goals.

Definitions
 Family: A group that engages in socially sanctioned, enduring and exclusive relationships that are based
on marriage, descent, adoption or mutual definition, as in common- law of marriage. -Yorburg

 Health: Health is a state of complete physical, mental and social wellbeing and not merely an absence of
disease or infirmity. -WHO

 Family Health: It is a dynamic changing relative state of wellbeing which includes the biological,
psychological, spiritual, sociological and cultural factors of the family system.

 Family Nursing: It is the provision of care involving the nursing process, to families and family
members in health and illness situations.

Types of Family: The family may take one of several following forms-
1. Nuclear family: It consists of the husband, wife and perhaps one or more children. For children, this
family is often referred to as family of origin. For the parents it is the family of procreation.

2. Joint extended family: It includes members of the nuclear family and other relatives, aunts, uncles,
grandparents and cousins are all parts of the extended joint family.

3. Blended families: Are formed when parents bring unrelated children. from prior marriages into a new
joint living situation because of remarriage or co-habilitation.

4. Single Parent Families: Are formed when one parent leaves the nuclear family because of divorce,
dissertations or death. The circumstances of the separation influence its impact on the family.

Characteristics of Family: The family is a primary reference group having following five
universal characteristics: -
1. Every family is a small social system.
2. Has its own cultural values and roles.
3. Has its own structure.
4. Performs certain basic function
5. Moves through stages of the life cycle.

Roles of the Family

 Child socialization.
 Child care.
 Provider role.
 House keeper role.
 Sexual role.
 Therapeutic role.
 Recreational role.

Functions of the Family

 Generating affection.
 Providing personal security and acceptance.
 Giving satisfaction and sense of purpose.
 Ensuring continuity of companionship.
 Providing social placement and socialization.
 Imposing control and sense of what is right.

Approaches to Family Nursing: The approaches that nurses use are determined by
many factors, including the issues for which the individuals or families as a whole are
seeking help. The environment in which they coexist with other family members and the
community.

1. Family as the Context

The family has a traditional focus that places the individual first and the family second. The family as a
context serves as either a strength or a stressor to individual health and illness issues.

2. Family as the Client

The family is primary and individuals are secondary. The family is seen as the sum of individual family
members. The focus is concentrated on each individual as they affect the family as a whole.

3. Family as a system
The system approach to families implies that when something happens to one family member, the other
members of the family system are affected and vice versa. The focus is on the family as client, and the
family is viewed as an interactional system in which the whole is more than the sum of its parts. This
approach focuses on individual members and the family as a whole at the same time. The interaction among
family members becomes the target for nursing intervention.

4. Family as a component of society

The family is seen as one of many institutions in society, along with health, education, religious and
financial institutions. The family is a basic or primary unit of society, as are all the other units and they are
all a part of the larger system of society. The family as a whole interacts with other institutions to receive
exchange or give services.

5. Family as a unit of health services

The emergence of family health has been hailed as a rediscovery of the human social and cultural
aspects of health and disease and the recognition of family as a focal point of health care and the right place
for integrating preventive, promotive and curative services. The family system is a basic unit within which,
health behaviour including health values, health habits and health risk perceptions are developed organized
and performed. The interrelationship between health, health behaviour and the family are a highly dynamic
one in which each may have a dramatic effect on the others.

Theoretical Frameworks
1. Family Nursing Theory: It is an evolving synthesis of theory from three different traditions; family
social science, family therapy and nursing. Of these three categories of theory, the family social science
theories are the best developed and informative with respect to how families function, the environment-
family interchange, interactions within the family, how the family changes over time, and the family's
reaction to health and illness.

2. Structure Function Theory: The structure function framework from a social science perspective
defines families as social systems. This approach describes the family as open to outside influences, yet the
same time the family maintains its boundaries.
Assumptions of this theory include: -
 A family is a social system with functional requirements.
 A family is a small group that has basic features common to all small groups.
 Families accomplish functions that serve the individuals and also serve the society.
 Individuals act within a set of internal norms and values that are learned primarily in the family
socializing process.

3. System Theory: The system approach to understanding families was influenced by theory derived
from physics and biology. A system is composed of a set of interacting elements; each system can be
identified and is different from the environment in which it exists.
Assumptions of this theory include: -
 Family systems are greater than and different from the sum of their parts.
 There are many hierarchies within family systems and logical relationships between subsystems,
 Boundaries in the family system can be open, closed or random.
 Family system change constantly in response to stresses and strains from within and from outside
environments. There are structural similarities in different family systems
 Change in one part of the family system affects the total system.
 The family system theory encourages nurses to view clients as participating members of the family.
Nurses using this theory determine the effects of illness or injury on the entire family system.

4. Interactionist Theory: It views families as units of interacting personalities and examines the
symbolic communications by which family members relate to one another. Within the family, each member
occupies positions to which a number of roles are assigned. Members decide their role expectations in each
situation through their perceptions of the role demands. Assessment of families using the interactionist
theory emphasizes interaction. between and among family members and family communication patterns
about health and illness behaviours appropriate for different roles.
Principles of Family Health Nursing
 Establishing good professional relationship with the family.
 Proper health education and guidance should be provided to family to take care of themselves according
to their needs, intelligently.
 Gather all relevant information about family to identify problems and set priorities.
 Provide need-based support and services to the family to improve their health status.
 Health care services should be provided to the family irrespective of sex age, income, religion, etc.
 Duplication of health services should be avoided, and there is need to co-ordinate services with other
disciplines providing health service.
 Proper health messages to be communicated to family in every contact.

Family nursing process: Family nursing process is the same, whether the focus of the family is as
patient or as environment. The nursing process is used in the same way as with individuals. The goal of the
family health nurse is to help the family reach and maintain its maximum health in any given situation.

 Assessing the Needs of the Family: Family assessment is essential for providing adequate family care
and support. The nurse begins assessment by determining the client's definition of and attitude towards
family and the extent to which the family can be incorporated into nursing care.
Here the nurse collects the data by using the methods of interviewing, observation,
subjective appraisal, communication, reviewing records and reports. Family health assessment will be
done by collecting relevant information of the housing condition, and surroundings, family composition,
socio economic status, educational status, means of communication, dietary pattern, health status of each
individual in the family including mother and child, vital statistics, immunization status, family planning
status and any information related to health of the family and community.

 Nursing Diagnosis: Nursing assessment results in clustering pertinent data that support the nursing
diagnosis and identifies inadequate or deficient functioning and interventions needed. The diagnostic
label may include family's health needs, current, and potential health problems, level of wellness, or
combination of the above.
 Planning: Planning of family health care includes setting goals, identifying potential internal and
external resources, choosing effective approaches and setting priorities. The goals must be
concrete and realistic, compatible with the developmental stage and acceptable to family members.
The nurses care plan should include following goals: -
I. The patient will use appropriate resources within the family.
II. The family will accomplish appropriate development tasks.
III. Family members will understand the patient's health problems.
IV. The patient will return to a functional state within the family environment .
 Implementation: After goals and actions have been defined, implementation begins. Interventions are
strategies that help families adjust goals or are the process by which the family attains them. Family
interventions include nursing actions that increase members abilities in a certain area, remove barriers to
health care and do things that family cannot do for itself.
 Evaluation: When the patient's family functions as an environment, evaluation is patient-centred,
although nursing measures may have involved assisting the patient to adapt to the environment. The
response of the patient is compared with predetermined outcomes.

Barriers to Practicing Family Nursing: Many barriers exist that affect the practice of family
nursing in a community setting.
 Most practicing nurses had little exposure to family concepts during their under graduate education and
have continued to practice using the individual focus.
 There has been a lack of good comprehensive family assessment models, instruments and strategies in
nursing.
 Nursing has strong historical ties with the medical model, which views families as structure not central
to individual health care.
 The traditional charting system in health care has been oriented to the individual.
 The medical and nursing diagnosis system used in health care are disease centred, and diseases are
focused on individuals.
 The hours during which health care systems provide service to families are at times of day when family
members cannot accompany one another.

Conclusion
Family Nursing examines a systemic approach to care which can be applied both in hospital and community
settings. Working collaboratively with the family, the nurse is able to strengthen the level of care available to
the patient and promote the health and well-being of the whole family.
HOME NURSING
Visiting the sick people at their home and giving them nursing care has been a tradition since early times. At
present, in the field of community health nursing, the importance of home nursing is increasing day by day,
especially due to unavailability of health services. their uneven distribution, and the lack of resources. These
has made home nursing an essential feature for achieving the objectives of home nursing practice. Home
health care nursing is defined as the delivery of specialized nursing care services in the home health care
setting.

Objectives
 Protection against diseases.
 Providing essential treatment.
 Providing comfort and relief from pain to the patient.
 Giving a support and empathy to the patient and his family.
 Using domestic equipment for the nursing.
 Providing health education.
 Giving as much respect as possible to the faiths and beliefs of the family during the procedure.

Role of Community Health Nurse in Home Nursing

 Recording the history of family to ascertain the cause and duration of illness.
 Providing treatment and related care.
 Demonstrating the nursing procedure to educate the family members.
 Giving medicines as per the standing orders and providing essential nursing care in the grave situations.
 Supervising the nursing procedures provided by family members.
 Including the patient himself in taking care of chronic illness (heart, arthritis, cancer, diabetic patients,
etc.) and giving them mental support.
 Preparing plans to carry the patient to the hospital or clinic and then bringing him back to his home.

General Instructions for Home Nursing: While nursing the patient at home, one should remember
what Florence Nightingale said: first objective of home nursing is to provide nursing, second is to keep the
patient and his room in the nursing order and the third is to remove all those shortcomings of cleanliness,
which can cause the illness or death.

 Try to include the aspects of general nursing in the home nursing.

 It is essential to make family independent in taking care of their health, so their activities should be
carefully monitored.
 As far as possible, home nursing should not affect the daily life and normal activities of the family and
their mental strength should be enhanced.
 In home nursing it is necessary to take care of the patient's age, his hierarchy to the family, financial
condition, educational background etc.
 In case of chronic and fatal diseases diversional or recreational and occupational therapy should be used.
 In home nursing there should be maximum utilization of family resources and items available in home.
 To increase the participation of family in home nursing, the class sessions should be pre planned. These
sessions should be separately organized for the women, men and children.
 For home nursing the nurse should have a thorough knowledge of the diagnosis, etiology, sources of
infection, course of disease, treatment, complications arising from the disease, surgery and aseptic
techniques.
 In the home nursing, it is necessary to pay attention to social psychological and emotional aspects,
because they influence the isolation treatment and the process of nursing.
 In home nursing the nurse should follow her professional standard and code of conduct (ethics).
 It should be remembered that 5-6 times actual nursing care given is more effective and benefiting than
10-15 times normal meetings.
 All principles of home visit should be followed in home nursing.

Principles of Home Visit: Home visit is the process of providing nursing care to patients at their
doorsteps. The goal of home visit is to provide appropriate nursing care leading to wellness of the patients.
When carrying out home visits, the community health nurse should follow certain basic principles given
below.

1. Home visits should be planned with purpose and should be beneficial to patients.
2. The purpose of home visits should be clear and must meet the needs of the patients. It should include
surveys and statistics, MCH services, home nursing in cases of illness, including health teaching.
3. Home visits should be regular and flexible according to the needs of the patients.
4. Home visit should be educative, i.e., it gives excellent opportunities for health and education.
5. Home visits should give excellent opportunities for nurses to demonstrate hygienic principles.
6. Home visit should be convenient, acceptable and educative to the patients.
7. The nurse should make an attempt to include cach family member while using nursing process.
8. The nurse and the family must develop positive interpersonal relationship in their work to achieve the
goal.
9. The nurse must be flexible and must respect the patient's rights to accept or reject care and to participate
in goal-setting and goal-achievement.
10. Home visits should be recorded in the diary and family folder.

Advantage of the Home Visits

1. Home visit provides an excellent opportunity to implement the nursing process.

2. Home visits provide an opportunity to study the home and family situation.
3. Home visits provide an opportunity to render services to the family members at their own surroundings.
4. Prompt and proper home visits create a good understanding between nurse and family and builds good
image of nurse.
5. Home visits clarify the doubts raised by the family members.
6. Home visits help to observe family practices and progress of care given by nurse and others.
7. Home visits help to prevent and handling the problems.
8. Home visits help the nurse and family members to modify the ways of their care.
9. Home visits are convenient for the patients.

10. Home visit facilitate patient control of the setting.

11. Home visits are the best option for patients unwilling or unable to travel. Home visits provide natural
environment for the discussion of concerns and needs.

Components of Home Visit: It has already been stated that home visit provides an opportunity to
implement nursing process in the community. The home visit itself can be viewed in a process in which the
nursing activity may be initiation phase, pre-visit phase, activities during home visit phase, phase, post-visit
phase of visit or transfer phase of visit. The activities of a nurse in each phase are discussed here briefly: -

1. Initiation Phase:
In this phase the community health nurse clarifies the source of referral for visit and purpose of visit and
also share information on reason and purposes for home visits with family.

2. Pre-Visit Activities:
When the nurses are assigned to home visit, they must know certain prior information regarding the home
and the family which includes location of the house and its distance, and address and some information on
need for visit. Pre-visit is the part of assessment phase in which the nurses gather information about the
patient, investigates community resources, assembles supplies and plans for the first patient contact. The
information may be obtained from family-folders care agencies regarding age, sex, family culture and
values. problems, care given and appropriate steps during the visit to meet the needs of the patient and also
help to make initial planning.

3. Activities during Home Visit:

The community health nurse has to develop trust and rapport, which are the basis for positive inter- personal
relationship. The nurse-patient relation is the basis for providing possible health services to the community.
Here, the nurse introduces herself to family, shows professional identity, and establishes nurse-client
relationship.
Nurse-client relationship is defined as a professional relationship that occurs when the nurse and the client
have entered into an agreement to interact and to achieve some mutually determined health-oriented goals
that are consistent with nursing professional obligation.

The inter-personal relationship starts when nurse enters into the house. The nurse has to introduce her or
himself with the family members prior to entry into home or knocking the door of the house. The initial
introduction tells the patient who you are and the purpose of visit. The nurse makes an attempt to gain the
acceptance of the patient by showing certain behaviours such the greeting the family members, shaking
hands (in doing so) smiles, and takes a seat in a relaxed manner. And the nurse has to accept the culture of
the family. Then the nurse should acknowledge each family member and seek cooperation from them for
their end. Then the nurse should use effective communication skills to implement the nursing process.
During visit, nurse assesses the family needs and plans the nursing care. During home visits, nurse practice a
variety of roles when intervening in patient care. The community health nurse has to take a role as
collaborator, consultant, coordinators, preventer of disease, promoter of health, health educator and an
epidemiologist and takes steps to implement nursing process.

4. Termination Phase of visit: Termination of visits occurs when: -

i. Nurse-patient goals are reached, health is restored and the patient can function without nursing actions.
ii. A patient changes his residence or leaves the home to go to another home.
iii. The nurse transfers the patients care to another nurse or other members to provide health care.
In addition, the nurse has to review visit with family and plan for future visits.

5. Post-Visit Activities:

Post-visit activities include recording and reporting. The nurse records the important events in the family
and reports the necessary materials to the higher authorities and discusses the problems of the family with
the colleagues and other members of health teams and make plans accurately to meet the needs of the
family. The records are kept. The nurse conducts the activities such as analyzing community resources and
preparing for the next visit. In brief in this stage, nurse records the visit and plans for next.

Conclusion
Home nursing is a growing emphasis on providing nursing and care to chronically ill peoples in their homes
to enable them to live as long as possible in their own homes. Implementing sound, rational infection control
practices in home care has been challenging since guidelines, standards, and most references have been
developed for the acute care setting. Such practices include hand washing, home infusion therapy,
respiratory care, wound care, urinary tract care, and isolation precautions. Assessment of the home care
environment, cleaning and reprocessing of equipment, surveillance, implications for occupational health.

Bibliography
1. Basheer PS. A Concise Textbook of Advanced Nursing Practice. Emmes publishers; 3rd edition,2022. p
661-675, 683-688, 704-714.
2. Brar KR. Textbook of Advanced Nursing Practice. Jaypee publishers; 2023. p 933-945.
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