EXTENDED AND EXPANDED ROLES OF NURSING

INTRODUCTION Nursing is an art and a science involving many activities, concepts and skills related to basic social sciences, physical sciences, ethics, contemporary issues and other areas. Nursing is a unique profession because it addresses the response of individuals and families to health promotion, health maintenance and health problems. Nursing practice is undergoing changes that are both exciting and controversial. Published evidence shows that nurses can be as effective as doctors with in their expanded roles. The roles of doctors and nurses should complement each other and all practitioners should work for the benefit of patients in their care, rather than defending traditional roles and hierarchy. EXTENDED ROLE: - MEANING Nurses role in extended care facilities is one that a nurse assumes by virtue of education, type of institution in which she is employed and experienced. The concept of extended role is to reach out. The role of nurse cannot remain static. The knowledge and skills of the nurse need to be broadened. EXPANDED ROLE: - MEANING Expanded roles on the other hand are specific roles in employment positions. An expanded role is one that a nurse assumes by virtue of education and experience. An expanded role in nursing is one in which a nurse assumes expanded or increased responsibilities in a practice area and in most cases practice with greater autonomy. Expanded role denotes functioning in specially area with advance education and skills. EXTENDED ROLE 1. CAREGIVER: The caregiver role has traditionally included those activities that assist the client physically and psychologically while preserving the clients dignity. The required nursing actions may involve full care for the partially dependent client and supportive education care to assist clients in attaining their highest possible level of health and wellness. Care-giving encompasses the physical, psychological, development and spiritual levels. The nursing process provides nurse with a framework for providing care. A nurse many provide care directly or delegate it to other caregivers. As intimate level of contact is required in the caregiver role, the nurse must communicate to the patient that she cares for him as a person. 2. HEALTHCARE COORDINATOR: As the healthcare provider is responsible for patients care 24 hours a day, the nurse serves as the primary coordinator of all other professional services committed to the care of the patients. In this role, the nurse arranges for the necessary diagnostic testing, therapies, counseling and patient teaching sessions, and treatments. Throughout the patients hospitalization the nurse must carryout the coordinator role in such a way that the patients health is not compromised. 3. ADVOCATE: As medical knowledge and technology have advanced, the healthcare system has become more complex. In this environment of tubes, alarms and caregivers clad in gowns, masks and gloves, the advocacy role of the nurse is more critical than ever.
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The nurse is responsible for defining defending and promoting the rights of patients. As an advocate, the nurse is compelled to work on behalf of the patient. 4. EDUCATOR: As an educator the nurse explains to clients concepts and facts about health, demonstrates procedures such as self-care activities, determines that the client fully understands, reinforces learning or client progress in learning. The nurse must also be aware of the influence of culture when she instructs the patient in aspects of care such as dietary and management and grieving. Some client teaching may be unplanned and informal. Some may be formal and planned such as when the nurse teaches a client with diabetes to self-administer insulin injections. The nurse uses teaching methods and incorporates other resources such as family in teaching plans. 5. COMMUNICATOR: The role of communicator is central to all nursing roles and activities. Nurses communicate with the client, support persons other health professionals, and people in the community. Nurses identity client problems and then communicate these verbally and / or in writing to other members of the health team. The nurses must be able to communicate clearly and accurately in order for a clients healthcare needs to be met. 6. MANAGER: Delivering quality care in todays complex healthcare system required managerial knowledge and skill. The nurse manager must know how to assess the overall patient care needs, organize patient assignments, delegate work appropriately, and evaluate the effectiveness. When managing patients care assignments the nurse manager must consider both the efficiency and effectiveness of outcomes and must be knowledgeable about the budget process. The nurse manager must know how to assess the strengths and weakness of staff and facilitate their ongoing professional development. Acquisition of new skills, as well as refinement of basic skills can do much to increase staff efficiency and effectiveness. As a clinical decision-make, the nurse uses critical thinking skills throughout the nursing process to provide effective care. 7. COUNSELLOR: Counseling is the process of helping a client to recognize and cope with stressful psychological and social problems, to develop improved interpersonal relationships, and to promote personal growth. It involves providing emotional, intellectual and psychological support. In contrast to the psychotherapist who counsels primary healthy individuals with normal adjustment difficulties the nurse focuses on helping the personal develop new attitudes feelings and behaviors rather than on promoting intellectual growth. The nurse encourages the client to look at alternative behaviors, recognize the choices, and develop a sense of control. 8. CHANGE AGENT: The nurse acts as a change agent when assisting others, , to make modification in their own behavior. Nurses also a often act to make changes in a system, such as clinical care, if it is not helping a client return to health. Nurses are continually dealing with change in the health care system. 9. LEADER: his role can be employed at different levels: individual client, Family groups of clients, colleagues, or the community Effective leadership is a learned process requiring an understanding of the needs and goals that motivate people, the knowledge to apply the leadership skills, and the interpersonal skills to influence others. 10. RESEARCH CONSUMER:
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Every profession is built on a body of descriptive knowledge. Nursing recognizes the need to identity, verify and increase the body of scientific knowledge on which practice is based. Although the researcher role is viewed primarily as the responsibility of doctor ally prepared nurses, all nurses can participate in the research process. It is appropriate for nurses practicing primarily as caregivers to help identity researchable problems and collect data. The primary responsibility of the nurses in the care giving roles is to apply research findings in practice. Nursing research provides a theoretical foundation for practice, promoting its advancement and the welfare of those receiving care. 11. COLLABORATOR: According to styles, collaboration involves 4 elements. Individual who share a common interest Purpose for the collaborate effort. Principles or ground rules for the effort Structure with in which effort takes place. Using this framework, nurses can effectively work with other members of the health care team to deal with patient care problems. Patients becomes more complex and life expectancy lengthens while healthcare resources decline..

EXPANDED ROLE
Nurse Clinician
Meaning: The tem Nurse clinician was first carried by Reiter (1943). She described the nurse clinician as one who was competent in care and knowledge about care and knowledge about care. Minimum educations The first clinical masters programme was developed in 1954 by Hildegard Peplum at Rulegers university. At the 1993 National convention of the national league for nursing a resolution was passes that the graduate degree be the minimal educational preparation for advanced practice in nursing clinician had always been prepared at the masters level. Definition Institution of medicine defines nurse clinician as an individual who uses a recognized scientific knowledge base and the authority to direct delivery of personal health services to the patients. Concept A nurse clinician is most likely to care directly for a patient whose diagnosis or care in complex unique or problematic. 1. The clinician is concerned about cure and care unlike the traditional nurse who allowed care functions to recede to the background of her daily work schedule with high priority accorded to care function. 2. It was initiated to increase the involvement of senior nurses in patient care responsibilities and to great opportunities for advancement of nurse within the clinical nursing care. 3. The nurse clinicians role was proposes when there was need for senior nurses with experience to retain their clinical role as they moved up the career ladder into supervisory and administrative positions.
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4. Provide direct care of patients and also includes administration, teaching and for good patient care. Types of appointment of nurse clinician 1. Assistant clinical directors: a clinician may have a primary appointment in the university hospital and a clinical faculty appointment in the school of nursing. 2. A joint appointment: she has the responsibility for teaching and guiding a group of students and influences the quality of nursing care for a group of students. Functions or roles of a nurse clinician The nurse clinician role is evolved to reinforce the role of caring supporting and helping patient in needing then basic needs she would provide a wide ranges of services located to coordination collaboration and continuity of care. Basic functions of nurse clinician

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

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

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

persons terminally ill patients the child elderly adult and the poor. 10. The areas are womens health occupational health mental health emergency care and acute care. Educational Qualifications The nurse who has an advanced education and is a graduate of a nurse practitioner programme there are two types of course for nurse practitioner short-term programme award a certificate and long term programme leading of a masters degree. Certifications Certification is advanced via written exam requirements very from licens are as a registered nurse to master degree up to 3yeras. Experience in clinical speciality. Placement of Nurse Practitioner With intense preparation they are places in a variety of settings like community clinic. - Community health nurse practitioner - Community health specialist - Family nurse practitioner - Rural health specialist - School health nurse - Occupational health nurse in industry - Womens health practitioner - Acute care nurse practitioner - Pediatric nurse practitioner - Gerontological nurse practitioner The function is an autonomous manner with the authority of an independent practitioner who does not require close supervision. Clinical areas where nurse practitioner perform: 1. Adult nurse practitioner: Provides primary ambulatory care to adult with a nonemergency acute or chronic illness and work in collaboration with a primary physician. 2. Family nurse practitioner: primary care for families usually in collaboration with a family care physician the practitioner meets the familys general health care needs, manages some illness by providing direct care and guides or counsels the family needed. 3. Pediatric nurse practitioner: Providing health care to infant and child. 4. Obstetrics and gynarcology nurse practitioner: gynarcology nurse practitioner provides primary ambulatory care to women seeking obstetrical or gynarcological health care the nurse practitioner who is also a certified nurse midwife may independently deliver infants. 5. Geriatric nurse practitioner: provides ambulatory or implement care to older adults. The GNPs activities include interventions for health maintenance illness prevention or health restoration. 6. Medical nurse practitioner 7. Surgical nurse practitioner 8. Ophthalmic nurse practitioner Functions of nurse practitioner 1. Nurse practitioners are educated to perform a broad spectrum of function: 2. History taking it is based on the interpersonal relationship and communications skills. 3. Health assessment 4. Risk appraisal diagnosis 5. Management of acute minor ailments 6. Management of chromic condition
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7. Order laboratory tests 8. Prescribe medication (which may have to be authorized within a frame work of standing order approves by the health authorities on essential drugs). 9. Initiate continue or discontinue treatment 10. Refer clients to secondary level of health care 11. Maintain appropriate records 12. Health education and counseling 13. Provide preventive curative and rehabilitative for promote maintenance and restoration of health of clients. 14. Parish health areas 15. In agencies which take care of women and children 16. Psychiatric clinics 17. Dispensaries 18. Rehabilitation centre, daycare centers) 19. Orphanage or geriatric health care 20. Emergency and acute care Characteristics of the nurse practitioner role 1. Nurse practitioner is meant to provide first contact primary care. 2. Nurse practitioner role is to extend the delivery of health care service to the neglected remote or under several areas. 3. Under expanded role the nurse practitioner assumes delegated medical responsibilities such diagnosis and treatment of minor aliments through standing orders. 4. To provide a package of services in preventive curative and rehabilitative services for promotion maintenance and restoration of health of clients. 5. To acquire additional skills and professional settings that requires study to seek assumers. 6. Role model of students inspiring of the higher level of nursing practice. 7. Contribute the development maintenance and revision guidelines for quality care. 8. Contribute to the formation of professional policy. 9. Evaluate the plan of care. Nurse Counselor Nurse can act as a counselor to her patient by a careful listening to his question cancers demands and complaints of the client and family. Nurse as a counselor can do counseling in different form like short term counseling long term counseling and motivational counseling guidance counseling is a valuable tool in the hands of a nurse. Having a through knowledge of guidance and counseling she must be able to guide her client. Tele Nursing Introduction: Tele health nursing practice is defined as nursing practice using the nursing process to provide care for individual patients or defined patient populations through telecommunications media criteria \for telehealth nursing practice include the following: - Using protocols algorithms or guidelines to assess and address client needs systematically. - Prioritizing the urgency of client needs - Developing a collaborative plan of care with clients and their support system the plans of care may include wellness promotion prevention education care Counseling desease state management and care co-ordination. - Evaluating outcomes of practice and care. Telemedicine Definition:
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Telemedicine has been defined by the W.H.O as the delivery of health care services where distance in critical factors by the health care professional using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of desease and injuries research and evaluation and for the continuing education of health care provides all in the interest of advancing the health of the individuals and their communities. Application in Health Care 1. General: the every country there is need of fast exchange of information for prevention and control of the epidemics in addition to that the telemedicine is required as support system for the health care professionals deputed in remote areas and also for the members of the community. 2. Tele communication: it can be carried out either on telephone or with the help of video conferencing. - Consultation between medical professionals - Consultation between clinician and patients - Investigations and treatment of patient - Rehabilitative care and investigation during emergency situation. 3. Diagnosis and reporting: cases can be diagnosis and report can be transmittes via fax or E-mail to the referral centre and expert opinion and advice can be blamed at a faster rate. It saves money time also improve quality of care rendered to the community. 4. Accessing health information: the information is reality available through interest and the health care professionals can be empowered by providing them a telephone connection personal computer and a broad internet connection. 5. Continuing medical education: with the help of video conferencing the people need not to go to a different place for attending medical education the purpose can very wall be served with the help of video conferencing. 6. Advice on self-care: good quality advice can be provided to the people on telephone for aliments of routine nature. 7. Health promotion and prevention of the diseases: mass media has great role to play in educating the people particularly in disease like HIV/AIDS. 8. Medical records maintenance: patient records can be maintained stored and retrieve through the system of electronic maintenance of medical record. 9. Health and hospital administration: this is useful from the point a view of material management financial management human resources management and hospital information systems of the hospital and health care organization. Certified nurse midwife: The CNM is an RN who is also educated in midwifery. The practice of nursemidwifery involves providing independent care for women during normal pregnancy, labor and delivery, as well as care for the new born. It may include some gynecological services such as routine papanicolan (pap) smear, family planning, and treatment for minor vaginal infections. A CNM practices with a health care agency that provides medical consultation, collaboration management and referral. iv. Certified registered nurse anesthetist: She is a nurse who has completed advance education in an accredited programme in anesthesiology. The nurse anesthetist carries out pre-operative visits and assessments, and administers general anesthetics for surgery under the supervision of a physician prepared in anesthesiology. The nurse anesthetist also assesses the post-operative status of he clients.
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. Nurse Educator: A nurse educator works primarily in schools of nursing, Staff development departments of health care agencies, and client education departments. Nursing educators need experience in clinical practice to provide them with practice skill and theoretical knowledge. A faculty member in a school of nursing educators in nursing schools are usually required to have graduate degrees in nursing and additional education in the educational process. Many hold doctorate or advanced degrees in nursing, education or administration. Generally they have specific clinical, Administration or research specialty and advanced clinical experience. Nurse educators in staff development departments of healthcare institutions provide educational programs for nurses within their institutions. The programs include orientation of new personnel, critical skill competency, safety training, and instruction about new equipment or procedures. These nursing education educators after participate in the development of nursing policies and procedures. The primary focus of the nurse educators in an agencys department of client education is to teach ill and disabled clients and their families how to provide care in the home. These nurse educators may be specialized and certified educator or an ostomy care nurse and see only a discrete population of clients. Nursing researcher: The nurse researcher investigates problems to improve nursing care and to further define and expand the scope of nursing practice. He may be employed in an academic setting hospital pr independent professional or community services agency. The minimum educational requirement is a doctoral degree, with al least a Masters degree in nursing. Nurse Administrator: A nurse administrator manages client care and the delivery of specific nursing services within a healthcare agency. Nursing administration begins with positions such as the change nurse or assistance nurse manager. Experience and additional education may lead to a middle arrangement positions, such as nurse manager of a specific patient care area or house supervisor, or to an upper management position such as assistance or associate director or director of nursing services. Nurse managers position usually requires at least baccalaureate degree in nursing , and director and nurse execution positions require masters degree . Chief nurse executive and vice president positions in large health care organizations often require preparation at the doctorate level. Nurses may have advanced degrees such as masters degree in business administration (MBA) hospital administration(MHA) or public health (MPH). Responsibility of directors may include a particular service at product line, such as medicine or cardiology, and include supportive functions and personnel such as those working in medicine clinics, cardiac diagnostics or outpatient services such as cardiac cauterization . The director also may be responsible for auxiliary personnel such as cardiology technicians, respiratory therapist, social workers, and dietitians. Vice President of nursery or chief nurse executives may include all auxiliary personnel who provide and support patient care services. The nursing administration needs to be skilled in business and management as well as understand all the aspects of nursing and client care. Functions of administrators include budgeting, staffing, strategic planning of programs and services, employee evaluation development. Nursing entrepreneur: A nurse usually has an advanced degree and managers a health related business. The nurse may be involved in education, consultation or research. Operating room nurse:
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When patients are admitted before and/or after surgery the ORN monitors patients progress from the time he or she enters the operating room until he or she is dismissed to the attending staff.

Rehabilitation nurse: The clinical nurse specialist serves on the rehabilitation teams as educators, consultants and liaisons within their organization and communities. They conduct research and help apply findings. Travel nurse: Traveling nurse are recruited for assignment that involves at least 13-20 hrs per week, after the nurse has the opportunity to join the organization as a permanent employee. Nurse psychiatrist: They are moving into domain of primary care and working with other nurses and physicians to treat and diagnose the illness in patients with somatic complaints. Critical care nurse: It offers challenges and excitement to the role of the nurse. The functions of a critical care nurse are: a. Perform basic patient care. b. Administration and maintaining medications and IV fluids. c. Identifying cardiac arrhythmias. d. Performing CPR and defibrillation. e. Complementary physical assessment with clinical history. f. Interpreting and ordering diagnostic tests. g. Health teaching. h. Identifying community resources. i. Collaborating with physician regarding treatment. j. Monitoring haemodynamics. Nurse author: Nurses are encouraged to submit material for publications in professional journals nurse education both in school/college level and clinical nurses. Palliative care nursing: Palliative means alleviate the symptoms without curing. Nurses practice holistic and family centered care. For this a registered nurse needs the skills with kindness, empathy and understanding who is able to handle stress. Nurse oncologist: Advanced oncology nursing practice is defined as expert competency and leadership in the provisions of case to individuals with an actual and potential diagnosis of cancer. Enterostomal therapist: Providing emotional support.. Selecting appropriate alliances...Teaching the patients how to irrigate stoma and care of the skin, discussing diet and making referrals to health and welfare agencies. Nurse endoscopist: One who works in the endoscopy room infection control nurse. to monitor hospital environment for existing and potential infection and to plan and teach isolation or aseptic technique. Trauma care specialist: She is the team member of the emergency room. In flight nursing:
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These nurses are trained to work in the air, the main aim is to continue care rather than suspend it for the duration of flight. The nurse required to have the knowledge of aircraft safety and other medical conditions. Community health nurse/public health nurse: A community health nurse functions within the communal framework. She serves the health needs of his/her assigned portion of the public. The goal of the community health nurse is to improve community health nurse is to improve community health by identifying people who are at high risk of illness disability or death. a. Occupational health nurse: It has become more diversified and complex. The nurse can develop surveillance programmers, counsel employees, co-ordinate health promotion activities, set up comprehensive referral network, treatment individuals for emergency and primary health care problems, consult with business partners, and manage the overall occupational health services. b. Hospital nurse: The role of the hospital nurse is to provide support and instruction to the terminally ill and to keep them at home as long as possible. c. Home health case nurse/visiting nurse: Although community/public health nursing is based on a wellness model. Home healthcare has evolved as a medical model. The term itself describes a system in which health care and social services are provided to home bound or disabled people in their home rather than the medical facilities. d. School nurse: The goal of school nursing is to support the educational process by helping students keep healthy, and teaching students and teachers preventive practices. She may be responsible for one or two schools. Responsibilities may include first aid, screening, follow up, control of communicable diseases, teaching health classes, conducting health studies, and responding to calls from other schools Nursing informatics American nursing association defines nursing informatics as a specialty that integrate nursing sciences, computer science and information science to manage and communicate data, information and knowledge in nursing practice nursing informatics facilitates the integration of data information and knowledge support patient nurses and other care provides in their decision making in all roles and settings in January 1992 the (ANA) congress of nursing practice designated informatics as a nursing specialty. Position of nurses in nursing informatics system Many nurses working in this field have created then own position and titles some of the positions are: - System analyst - System nurse - Projector manager - System analyst - Nursing information specialist Characteristic of nurse informatics - Flexibility - Humor - High tolerance for meticulous work - Interest in computer literacy - Good verbal written and communication skills - Intelligent diplomatic and Eager to learn - Ability to balance technology with human needs
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- Should be energetic creative and self starters Responsibilities of the nurse informatics - System analysis and designing - Development of data dictionaries - Evaluation and testing off applications for patient care - Configuration of hardware and software - Translating the language of nursing to engineers and system designers and vice versa. - Using application software and computer networks - Installing and maintaining hardware and software - Programming in one or more computer systems - Coordinating projects of various sizes involving diverse team members. - Analyze and evaluate information requirements - Design and implement applications to solve patient care problems. - Analyze ethical issues concerned with safety and privacy EXPANDED AND EXTENDED ROLE OF NURSE IN COMMUNITY Nursing roles are ever changing the roles or set of expectations associated with given position of all health care professionals are continuously redefined in response to changing knowledge technology cost and consumer need. As health care delivery systems change the practice of nursing continues to shift from acute care to institution based settings to community settings .The new community health nurse must recognize the broader scope of practice. The community health nurse must be capable of performing role functions regardless of the setting of employment these role functions include: - Clinician - Advocate - Collaborator - Consultant - Counselor - Educator - Researcher - Care manager Role of the community health Nurse Advocate Clinician Care manager Researcher Educator Clinician Community health nursing differs from most traditional nursing roles in it focus on the community as client personal health services focus on individuals any include services to help individuals maintain health recover most from others or adopt to long term disabilities. Most nurses with a background in acute care do not have experience with a board community based
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Collaborator

CH N

Consultant Counselor

practice perspective associate degree and diploma program in nursing generally do not provide a theoretical background for community health nursing practice there are community health nurse generalist and community health nurse specialist.

NURSE PRACTITIONER
Primary health care nurse practitioners are registered nurses, who are specialists in primary health care who provide accessible comprehensive and effective care to client of all ages. They are experienced nurse with additional nursing education which enables them to provide individuals, family groups and communitys health services in health promotion disease and injury, prevention and rehabilitation. The nurse practitioner is an advanced practice nurse functioning within full scope of nursing practice and as such is not a second level physician Definition: A nurse practitioner is a registered nurse who has completed specific advanced nursing education (generally a masters degree or doctoral degree) and training in the diagnosis and management of common as well as complex medical conditions. Nurse practitioner provides a broad range of health care services. History of nurse practitioner In the late 1950s and early 1960s physician began to collaborate with nurses who had clinical experience. In addition increasing specialization in medicine led a large number of physicians to be out of primary care thus creating a shortage of primary care physician. In 1965, the Medicare provided health care coverage to lower group like women, children, the elderly and people with disabilities. The sudden availability of coverage increased the demand for expanded primary care services. Because physicians were unable to meet their demand. In 1965, Loretta ford, a nurse and a physician created the first training programme for nurse, practitioner, the curriculum focused on health promotion, disease prevention and the health of children and families. The nurse practitioner job may include the following: - Diagnosing, treating, evaluating and managing acute and chromic illness and disease - Obtaining medical histories and conducting physical examination. - Ordering, performing and interpreting diagnostic studies (E.g. routine lab tests, bone X-ray, ECG) - Prescribing physical therapy and other rehabilitation treatment. - Prescribing pharmacologic treatment and therapeutic for acute and chronic illness (extent of prescriptive authority varies by state regulation) - Providing child care, including screening and immunization. - Providing primary and specialty care services health maintenance care for adults including annual physical check up. - Providing care for patients in acute and critical care settings. - Performing minor surgeries - Counseling and educating patients on health behavior self-care skill and treatment. Practice settings - Community health centre, clinic
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Health Department Health maintenance organization Home health care agencies Hospitals as hospital clinics Hospice centre Nurse practitioner office Nursing homes Private and public schools, universities and college Mental health centre Research centre Employee health clinics

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

The community health nurse generalist function is the broadest practice role. This roles combines nursing epidemiology care management, and resource coordinates the generalist provides care in a wide variety of settings to individuals families and groups while maintaining an understanding of the values and concepts of population based practice. The community health nurse generalists participate with the specialist in community wide assessment and in the planning implementation and evaluation of programme.
Community health nurse specialist

The community health nurse specialist may perform all of the function of the generalist in addition the nurse specialist brings expertise in working with families and group in formulating health policy and increasing communities and in carrying out all phase of population focused program the specialist has skills in epidemiology including health disease births and deaths. The community health nurse specialist engages in research theory development and testing and health policy development the roles are teaching and counseling individuals families and groups are major responsibilities for both groups. The present trend in community health nursing is to bring about the need for more graduate prepared clinical
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specialist. Community health nurses are being employed through out the community health department, schools industries home health hospice and multiple other settings. Advocate The community health nurse act as advocate for the individual group or community client Advocacy in the act of speaking or acting for an individual or group of individuals who may be unable to speak for themselves. In the health care system or larger social system. Clients may be unable to speak for themselves for multiple resources. These resources include lack of knowledge difficulty or inability to articulate needs or ideas perceived lack of power fear and physical or mental disability. Because of close and frequent contact with the client the nurse is often the best health professional to promote the needs and desires of the within the realm of the complicated. To advocate for the client to care for that individual to care for the individual in to help the client develop full potential the nurse as advocate in dedicated to supporting this process. As an advocate the nurse support the clients right to make decision freely. Nursing action include supporting the client so that the client can make possible decision regarding health. Collaborator To collaborate means to work with others toward a common goal. It is a process of joint decision making is an atmosphere of mutual respect and co-operation collaborator should always be the mode of inter action between the community health nurse and the client and is an equally important nursing role when the nurse function as part of a team. Effective collaborator requires skills in communication and problem solving the nurse must be able communicate effectively with the client family group or team with other team members the nurse shares client needs and possible interventions to bring about the resolution of problems.

Consultant
Every community heath nurse is a consultant. Each time a nurse gives information or assists a client in choosing between alternative actions the nurse is using consulting skills. The nurse also acts as consultant when helping a client improve specific skills or make more effective helps .A consultant must be trained teacher and an expert in a particular specialty. The successful consultant must be able to motivate others and be able to get things done even when not is direct charge of the people concerned. The nurse consultant brings knowledge and assistance in the wise use of resource. The nurse provides information about resources so the client can make informed choices from a variety of alternative. COUNSELOR: Counseling at its most basic level is the process of helping clients choose appropriate solution to their problem counseling is not telling people what to do instead it is the process of assisting them to use problem- solving process to decide on the course factors most appropriate for them. The counselors role is to listen objectively clarity, provide feedback and information and guide the client through a problem solving process. The consultant is not necessarily concerned with subjective understanding on the part of the client. The nurse works with the client to achieve present goals in an efficient way so that the tasks at hand can be accomplished. Counseling remains an important component of community health nursing. EDUCATOR: Community health nursing has embraced the responsibility of educating individuals. Families and communities, Health teaching is considered one of the major functions of the community nurse and deemed an essential nursing responsibility regardless of the setting where the nurse is employed. Teaching is a necessary role function for the promotion of health and welfare of individuals and societies. Health education focuses on health promotion, health
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maintenance and disease prevention. The role of nurse educator is challenging get offers significant rewards. The goal of the nurse as educator is to ensure of optimal learning by the client is order to encourage improved health behaviors. RESEARCHER: The community health nurse participates in the research process at multiple levels the nurse may be involved in activities such as identifying problem areas collecting analyzing and interpreting data applying findings and evaluating, designing, and conducting research. The community health nurse is expected to read current research and apply the findings to practice as a consistent part of professional actions. As researcher, the nurse seeks to discover, investigates, understand, explain and predict phenomena the research process comprise specific actions to collect data and synthesize information. To manage future health concerns, the researcher will be challenged to answer research questions on issues related to HIV/AIDS infections disease chromic physical and emotional conditions and injury prevention. CASE MANAGER: Coordination of care is different in a health care system with many differing public and private programs, services agencies and institutions. Case management is the application of strategies the health care system. Case management so comprises major functions that must be present in all case management models these functions are case finding, assessment, care planning, implementation, monitoring and reassessment and evaluation. Case finding: Case finding in the identification of those individuals from a population who will benefit from case management service, appropriate case were identified through the screaming of applicant, information and referral net work or brief assessments of key dimensions that showed need eligibility. Assessment: Assessment use as a full scale, multidimensional standardized functional assessment of the clients needs and resources. Care planning: Care planning is the core function of the care function of the case management process. The use of computer to track and samples the data collected from these tools in helpful to the nurse in providing high quality case. Implementation::Implementation is when the service plan is enacted. Monitoring: the service received are evaluator reassessment and evaluation this function providers for the assessment and evaluation of the total service plan. Health promotion activities It can be broadly classified into passive or active with strategies of health promotions are the fluoridation of municipal drinking water the fortification homogenized milk with vitamin dare two examples of passive health promotion. With active strategic of health promotion individuals are motivated to adopt specific health programs weight reduction and smoking isolation programs require clients to be actively involved in measures to improves their present and future levels of wellness while diseasing the risk of desease. Interventions 1. Health education: Large number of desease could be prevented with little or no medical intervention of people care adequately informed the prevention.
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2. Environment modification - Provision of safe water - Installation of sanitary and rodents - Improvement of honoring - Minimizing the use of in insecticide and pesticides on food crops. 3. Nutritional interventions: This intervention compromise food distribution and nutrition improvement of vulnerable group child feeding programmes food fortication nutrition education etc. nutritional deficits in nutrition intake can result in student growth. Nutrition excess: can cause obesity alcoholism constipations hypertension causes Balances nutrition: eat fresh food. Fruits, vegetable 4. Exercise: Exercise like nutrition should be balance and dense on a regular basis. A physical exercise program couple to actualize physical health promotion. 5. Life style and behavioural changes: Life style and behavioural changes like lack of sleep, pollution such as noise, air and environment, smoking substance abuse and obesity etc. can affect the health and cause desease and illness in man. The modifications of these factors are very important for health promotion provision of adequate rest and sleep practice of healthy habits balance diet adequate exercise. 6. Stress management: - Developing coping skills - Evoke the relaxation response - Yoga, meditation, guided guided imagery Health promoting life style profile 1. Self actualization - Find life has purpose and goal - Find satisfying environment - Looks forward to future - Aware of strengths and weakness - Feel happy and content 2. Health responsibility - Periodic health check up - Reports symptoms to physician - Reads books about health - Observe body for changes 3. Exercise - Participate in stretching exercise - Vigorously exercise 3 times a weak - Engages n recreational activities 4. Nutrition - Take in essential nutrients - Select from basic food groups - Eat three meals daily - Eat breakfast 5. Interpersonal support - Discuss the problems - Praises other easily - Maintain meaningful interpersonal relationship - Spends time with close friends - Express concerns and love 6. Stress management
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- Daily relaxation - Aware of stress sources - Use meditation and relaxation exercises - Use pleasant bed time thoughts - Expresses feelings - Use stress control methods The Nurses role in health promotion - Model healthy life style behaviour and attitudes - Facilitate client involvement in the assessment implemental and evaluation of health goals. - Teach clients self-care strategies to enhance fitness . - Assist clients families and communities to increase their levels of health - Educate clients to be effective health care consumers - Assist clients families and communities to develop and choose health promoting options. - Guide clients development in effective problem solving and decision making. - Reinforce clients personal and family health promoting behaviour. Levels of prevention There are 4 levels of prevention 1. Primordial prevention: It is concept is receiving special attention in the prevention of chromic diseases this is primary prevention of the emergence or development of risk factors in contribute or population groups. For e.g. many adult health problems (e.g. obesity hypertension) have their early origins in childhood because this is when the life styles are formed (e.g. smoking eating pattern physical exercise) in promotional preventions efforts are directed towards discouraging children from adopting harmful life styles. The main intervention is primordial prevention in through individuals and mass education. 2. Primary prevention Primary prevention can be defined as action taken prior to the onset of desease which removes the possibility that a desease will ever occur. It is concerned health promotions of health activities that prevent the actual occurrence of a specific illness or desease primary prevention includes health education program immunization physical and nutritional fitness activities. 3. Secondary prevention The specific intervention is early diagnosis (e.g. screening tests care finding programme) and adequate treatment it helps to arrest the desease process and restore health by seeking out unrecognized desease and treating it. 4. Tertiary prevention Can be defined as all measures available to reduce or limit impairment and disability minimize suffering caused by existing desease tertiary is direct toward rehabilitation after a deseases or condition has developed modern rehabilitation include physiological, vocational and medial components based ob team work from a variety of professions. Restoration of health To heal in to restore to health or sound some of the interventions 1. Physiological intervention Patients who receive selected drugs under go procedure and receive direct nursing skills are being help to heal. Assist the patient in the healing process providing adequate nutrition exercise rest and sleep periods and reducing exposure to micro organics by providing aseptic environment are nursing tasks that promote healing. 2. Psychological intervention
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Physician and nurses who have built a strong trust relationship with there patients can influence healing e.g. of psychological intervention are communication listening and touch are all important to healing. 3. Self care Self help or self care refers to the patients active involvement in bringing about healing. Self care is to allow the patient to take control of his or her own health. 4. Holistic healing Holistic healing implies that all possible avenues of healing must be used and that no single healing be used to the exhaustion of others. E.g. meditation and relaxation have long been used to promote healing of the mind and body. . 5. Rehabilitation Rehabilitation is a dynamic process that restores an individual to the highest possible level of function of level of function it is restoration of health.

Conclusion In India nurses are for behind with the nursing specialist. This is a challenge for Indian nurses who are working in settings which do not have facilities of newer technology. Health care delivery is largely dependant on information for effective decision making.

Bliography
Potter,perry,fundamentals of nursing.6thed.New york;Mosby.2006p.16-23 2. kozier.erb.Fundamentals of nursing.6th ed.Singpur;pearson education Pvt. Ltd 2003 p.10-13 3. Bearce p c;Judith l. m principles and practice of adult heath nursing. P. 74-82. 4. Basvanthappa B.T.Community heath nursing. 1st ed. Toronto;c.v. mosby,1984.p.27-29. 5. Barbara kozier,GlenoraErb;Fundamental of nursing.17th ed. New Delhi. Dorling Kindersley.2007.p.129-130. Journals 1. 1.Nursing service administrator,Nursing Journal of India,1998,89 p.56-57. 2. 2.Indian jornal of holistic nursing, sept.2006.p.17 3. 3The nursing journal of India march 2000.p.56-57. 4. 4.Thenursing journal of India march 1998 p.60 5. 5.Trends in nursing administration and education volume-1 january july-2008 p.54-56. 1.

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