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. n expanded role is one that a nurse assumes by virtue of education and experience. n 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 !. " #E$%&E#' The caregiver role has traditionally included those activities that assist the client physically and psychologically while preserving the client(s 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. "are)giving encompasses the physical, psychological, development and spiritual levels. The nursing process provides nurse with a framework for providing care. nurse many provide care directly or delegate it to other caregivers. s 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. *. +E ,T+" #E "--#.%N T-#' s the healthcare provider is responsible for patients care */ hours a day, the nurse serves as the primary coordinator of all other professional services committed to the care of the patients. %n this role, the nurse arranges for the necessary diagnostic testing, therapies, counseling and patient teaching sessions, and treatments. Throughout the patient(s hospitali0ation the nurse must carryout the coordinator role in such a way that the patient(s health is not compromised. 1. .&-" TE' s medical knowledge and technology have advanced, the healthcare system has become more complex. %n 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. s an advocate, the nurse is compelled to work on behalf of the patient. /. E.2" T-#' s an educator the nurse explains to client(s 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. 3ome client teaching may be unplanned and informal. 3ome may be formal and planned such as when the nurse teaches a client with diabetes to self)administer insulin in4ections. The nurse uses teaching methods and incorporates other resources such as family in teaching plans. 5. "-662N%" T-#' 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 7 or in writing to other members of the health team. The nurses must be able to communicate clearly and accurately in order for a client(s healthcare needs to be met. 8. 6 N $E#' .elivering quality care in today(s complex healthcare system required managerial knowledge and skill. The nurse manager must know how to assess the overall patient care needs, organi0e patient assignments, delegate work appropriately, and evaluate the effectiveness. 9hen managing patients care assignments the nurse manager must consider both the efficiency and effectiveness of outcomes and must be knowledgeable about the budget process. The nurse manager must know how to assess the strengths and weakness of staff and facilitate their ongoing professional development. cquisition of new skills, as well as refinement of basic skills can do much to increase staff efficiency and effectiveness. s a clinical decision)make, the nurse uses critical thinking skills throughout the nursing process to provide effective care. :. "-2N3E,,-#' "ounseling is the process of helping a client to recogni0e and cope with stressful psychological and social problems, to develop improved interpersonal relationships, and to promote personal growth. %t involves providing emotional, intellectual and psychological support. %n contrast to the psychotherapist who counsels primary healthy individuals with normal ad4ustment difficulties the nurse focuses on helping the personal develop new attitudes feelings and behaviors rather than on promoting intellectual growth. The nurse encourages the client to look at alternative behaviors, recogni0e the choices, and develop a sense of control. ;. "+ N$E $ENT' 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. <. ,E .E#' his role can be employed at different levels' individual client, =amily 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. !>. #E3E #"+ "-N326E#'
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Every profession is built on a body of descriptive knowledge. Nursing recogni0es the need to identity, verify and increase the body of scientific knowledge on which practice is based. lthough the researcher role is viewed primarily as the responsibility of doctor ally prepared nurses, all nurses can participate in the research process. %t 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. !!. "-,, @-# T-#' ccording to styles, collaboration involves / elements. %ndividual who share a common interest Purpose for the collaborate effort. Principles or ground rules for the effort 3tructure with in which effort takes place. 2sing 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 #eiter A!</1B. 3he described the nurse clinician as one who was competent in care and knowledge about care and knowledge about care. Mini u e!uca"i#ns The first clinical masters programme was developed in !<5/ by +ildegard Peplum at #ulegers university. t the !<<1 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. De$ini"i#n %nstitution of medicine defines nurse clinician as an individual who uses a recogni0ed scientific knowledge base and the authority to direct delivery of personal health services to the patients. C#nce%" nurse clinician is most likely to care directly for a patient whose diagnosis or care in complex unique or problematic. !. 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. *. %t 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.

1. The nurse clinician(s 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. /. Provide direct care of patients and also includes administration, teaching and for good patient care. T&%es #$ a%%#in" en" #$ nurse clinician !. Assis"an" clinical !irec"#rs' a clinician may have a primary appointment in the university hospital and a clinical faculty appointment in the school of nursing. *. A '#in" a%%#in" en": she has the responsibility for teaching and guiding a group of students and influences the quality of nursing care for a group of students. Func"i#ns #r r#les #$ a nurse clinician The nurse clinician role is evolved to reinforce the role of caring supporting and helping patient in needing then basic needs she would provide a wide ranges of services located to co) ordination collaboration and continuity of care. (asic $unc"i#ns #$ nurse clinician

Care $unc"i#n Cure $unc"i#n c#unseling $unc"i#n ) Palliative care ) data collection ) Physical care ) ssessment ) psychological care ) Protective care ) implementing care ) teaching patient C families ) 6ental healthcare ) evaluating the result ) guidance Care $unc"i#n !. Palliative care' alleviating pain and providing comfort as for as possible. *. Physical care' meeting the hygienic needs, nutrition and exercise. 1. Protective care' protecting the client by providing safe environment and preventing possible complications. /. 6etal health care' these include basic and technical care based on the needs of the patient. *B. "ure function' these are directly related to medical care therapeutic regimen and overall clinical management are function mainly include' ) .ata collection ) ssessment ) Planning care ) %mplementing care ) Evaluating the result 1B. "ounseling =unction' ) Psychological care ) Teaching patient and families ) Providing guidance in matters related to health ) 9orking with families for restoration and maintenance of health (r#a! $unc"i#ns $#r a nurse clinician )cs "o)ordination of patient care therapeutic and professional services "ollaboration with other members of the medical team "ontinuing of care Su* r#les #$ nurse clinician !. 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. *. Teac+er: teaching of clinical staff and student in her area e.g. %n services education.
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1. Researc+er: she should be concerned with advancement of knowledge in her clinical area and conduct study for improvement of nursing practice. /. Lea!er: she would direct supervise and organi0e the clinical nursing and participate as a care provider. 5. C#-#r!ina"#r: 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. 8. R#le #!el: 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 Prac"i"i#ner
The advance practice nurse has a master(s degree in nursing. dvanced education in pharmacology and physical assessment and certification and expertise in a speciali0ed area of practice A N !<<5B. Origin #$ Nurse Prac"i"i#ner %ncreased 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. .uring !<<>s there was great special change and political emphasis on healthcare as a right of citi0ens. ccess to health care service was a problem and therefore practitioner(s role was developed to meet the demand for primary care services. The first formal education programme for nurse practitioner was established in !<85 at the university of "olorado school of nursing. %n !<<5 nurse practitioner education was leading to master(s degree in nursing. De$ini"i#n The nurse practitioner according to the N is a skilled health care provides who utili0es critical 4udgment in the performance of comprehensive health assessment differential diagnosis. nd the prescribing of pharmacologic treatment in the direct management of cute and chromic illness and desease. %ndira $andhi nation -pen 2niversity defines nurse practitioner as a primary health care provides who assumes responsibilities of the expanded role to meet the health care needs of the groups in the country. C#nce%" #$ Nurse %rac"i"i#ner !. Nurse practitioner should have educational preparation *. Nurse practitioner is meant to provide first contact primary care to the clients or care load of patients. ll registered nurses are authori0ed to practice nursing practitioner in a term used for those assuming responsibilities of the expanded role whose work reflects the kind of nursing practice. 9hich encompasses additional function and activities beyond the scale of traditional nursing practice. 1. Nurse practitioner works with clients of all ages and health care needs. /. Nurse practitioner provides health care to clients usually in an out patient or ambulatory care or community bases selling. 5. nurse practitioner provides care for all clients with complex problems and attends more to symptoms. 8. 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. :. 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.

;. 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. <. 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. !>. The areas are women(s health occupational health mental health emergency care and acute care. E!uca"i#nal ,uali$ica"i#ns The nurse who has an advanced education and is a graduate of a nurse practitioner programme there are two types of course for nurse practitioner short)term programme award a certificate and long term programme leading of a master(s degree. Cer"i$ica"i#ns "ertification is advanced via written exam requirements very from licens are as a registered nurse to master degree up to 1yeras. Experience in clinical speciality. Place en" #$ Nurse Prac"i"i#ner 9ith intense preparation they are places in a variety of settings like community clinic. ) "ommunity health nurse practitioner ) "ommunity health specialist ) =amily nurse practitioner ) #ural health specialist ) 3chool health nurse ) -ccupational health nurse in industry ) 9omen(s health practitioner ) cute care nurse practitioner ) Pediatric nurse practitioner ) $erontological nurse practitioner The function is an autonomous manner with the authority of an independent practitioner who does not require close supervision. Clinical areas -+ere nurse %rac"i"i#ner %er$#r : !. A!ul" nurse %rac"i"i#ner: Provides primary ambulatory care to adult with a non) emergency acute or chronic illness and work in collaboration with a primary physician. *. Fa il& nurse %rac"i"i#ner: primary care for families usually in collaboration with a family care physician the practitioner meets the family(s general health care needs, manages some illness by providing direct care and guides or counsels the family needed. 1. Pe!ia"ric nurse %rac"i"i#ner: Providing health care to infant and child. /. O*s"e"rics an! g&narc#l#g& nurse %rac"i"i#ner: 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. Geria"ric nurse %rac"i"i#ner: provides ambulatory or implement care to older adults. The $NP(s activities include interventions for health maintenance illness prevention or health restoration. 8. 6edical nurse practitioner :. 3urgical nurse practitioner ;. -phthalmic nurse practitioner Func"i#ns #$ nurse %rac"i"i#ner !. Nurse practitioners are educated to perform a broad spectrum of function' *. +istory taking it is based on the interpersonal relationship and communications skills. 1. +ealth assessment
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#isk appraisal diagnosis 6anagement of acute minor ailments 6anagement of chromic condition -rder laboratory tests Prescribe medication Awhich may have to be authori0ed within a frame work of standing order approves by the health authorities on essential drugsB. <. %nitiate continue or discontinue treatment !>. #efer clients to secondary level of health care !!. 6aintain appropriate records !*. +ealth education and counseling !1. Provide preventive curative and rehabilitative for promote maintenance and restoration of health of clients. !/. Parish health areas !5. %n agencies which take care of women and children !8. Psychiatric clinics !:. .ispensaries !;. #ehabilitation centre, daycare centersB !<. -rphanage or geriatric health care *>. Emergency and acute care C+arac"eris"ics #$ "+e nurse %rac"i"i#ner r#le !. Nurse practitioner is meant to provide first contact primary care. *. Nurse practitioner role is to extend the delivery of health care service to the neglected remote or under several areas. 1. 2nder expanded role the nurse practitioner assumes delegated medical responsibilities such diagnosis and treatment of minor aliments through standing orders. /. 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. 8. #ole model of students inspiring of the higher level of nursing practice. :. "ontribute the development maintenance and revision guidelines for quality care. ;. "ontribute to the formation of professional policy. <. Evaluate the plan of care. Nurse C#unsel#r 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. +aving a through knowledge of guidance and counseling she must be able to guide her client. Tele Nursing In"r#!uc"i#n' 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 Dfor telehealth nursing practice include the following' ) 2sing protocols algorithms or guidelines to assess and address client needs systematically. ) Prioriti0ing the urgency of client needs ) .eveloping a collaborative plan of care with clients and their support system the plans of care may include wellness promotion prevention education care "ounseling desease state management and care co)ordination. ) Evaluating outcomes of practice and care.
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Tele e!icine De$ini"i#n: Telemedicine has been defined by the 9.+.- as the delivery of health care services where distance in critical factors by the health care professional using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of desease and in4uries research and evaluation and for the continuing education of health care provides all in the interest of advancing the health of the individuals and their communities. A%%lica"i#n in .eal"+ Care !. General: the every country there is need of fast exchange of information for prevention and control of the epidemics in addition to that the telemedicine is required as support system for the health care professionals deputed in remote areas and also for the members of the community. *. Tele c# unica"i#n: it can be carried out either on telephone or with the help of video conferencing. ) "onsultation between medical professionals ) "onsultation between clinician and patients ) %nvestigations and treatment of patient ) #ehabilitative care and investigation during emergency situation. 1. Diagn#sis an! re%#r"ing: cases can be diagnosis and report can be transmittes via fax or E)mail to the referral centre and expert opinion and advice can be blamed at a faster rate. %t saves money time also improve quality of care rendered to the community. /. Accessing +eal"+ in$#r a"i#n: 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. C#n"inuing e!ical e!uca"i#n: 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. 8. A!/ice #n sel$-care: good quality advice can be provided to the people on telephone for aliments of routine nature. :. .eal"+ %r# #"i#n an! %re/en"i#n #$ "+e !iseases: mass media has great role to play in educating the people particularly in disease like +%&7 %.3. ;. Me!ical rec#r!s ain"enance: patient records can be maintained stored and retrieve through the system of electronic maintenance of medical record. <. .eal"+ an! +#s%i"al a! inis"ra"i#n: 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 organi0ation. Cer"i$ie! nurse i!-i$e: The "N6 is an #N who is also educated in midwifery. The practice of nurse) midwifery involves providing independent care for women during normal pregnancy, labor and delivery, as well as care for the new born. %t may include some gynecological services such as routine papanicolan ApapB smear, family planning, and treatment for minor vaginal infections. "N6 practices with a health care agency that provides medical consultation, collaboration management and referral. iv. "ertified registered nurse anesthetist'
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3he 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. . Nurse E!uca"#r: nurse educator works primarily in schools of nursing, 3taff 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. 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. 6any hold doctorate or advanced degrees in nursing, education or administration. $enerally they have specific clinical, dministration 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 agency(s 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 speciali0ed and certified educator or an ostomy care nurse and see only a discrete population of clients. Nursing researc+er' The nurse researcher investigates problems to improve nursing care and to further define and expand the scope of nursing practice. +e 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 6aster(s degree in nursing. Nurse A! inis"ra"#r' 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 manager(s position usually requires at least baccalaureate degree in nursing , and director and nurse execution positions require master(s degree . "hief nurse executive and vice president positions in large health care organi0ations often require preparation at the doctorate level. Nurses may have advanced degrees such as master(s degree in business administration A6@ B hospital administrationA6+ B or public health A6P+B. #esponsibility 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 cauteri0ation . The director also may be responsible for auxiliary personnel such as cardiology technicians, respiratory therapist, social workers, and dietitians. &ice 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. =unctions of administrators include budgeting, staffing, strategic planning of programs and services, employee evaluation development.
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Nursing en"re%reneur' nurse usually has an advanced degree and managers a health related business. The nurse may be involved in education, consultation or research. O%era"ing r## nurse' 9hen patients are admitted before and7or after surgery the -#N monitors patients progress from the time he or she enters the operating room until he or she is dismissed to the attending staff.

Re+a*ili"a"i#n nurse: The clinical nurse specialist serves on the rehabilitation teams as educators, consultants and liaisons within their organi0ation and communities. They conduct research and help apply findings. Tra/el nurse: Traveling nurse are recruited for assignment that involves at least !1)*> hrs per week, after the nurse has the opportunity to 4oin the organi0ation as a permanent employee. Nurse %s&c+ia"ris"' 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. Cri"ical care nurse: %t offers challenges and excitement to the role of the nurse. The functions of a critical care nurse are' a. Perform basic patient care. b. dministration and maintaining medications and %& fluids. c. %dentifying cardiac arrhythmias. d. Performing "P# and defibrillation. e. "omplementary physical assessment with clinical history. f. %nterpreting and ordering diagnostic tests. g. +ealth teaching. h. %dentifying community resources. i. "ollaborating with physician regarding treatment. 4. 6onitoring haemodynamics. Nurse au"+#r' Nurses are encouraged to submit material for publications in professional 4ournals nurse education both in school7college level and clinical nurses. Pallia"i/e care nursing' Palliative means alleviate the symptoms without curing. Nurses practice holistic and family ? centered care. =or this a registered nurse needs the skills with kindness, empathy and understanding who is able to handle stress. Nurse #nc#l#gis": dvanced 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. En"er#s"# al "+era%is": Providing emotional support.. 3electing 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 en!#sc#%is":

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-ne 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. Trau a care s%ecialis"' 3he is the team member of the emergency room. %n flight nursing' 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. C# uni"& +eal"+ nurse0%u*lic +eal"+ nurse' community health nurse functions within the communal framework. 3he serves the health needs of his7her 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. a1 Occu%a"i#nal +eal"+ nurse: %t 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. *1 .#s%i"al 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. c1 .# e +eal"+ case nurse0/isi"ing nurse' lthough community7public health nursing is based on a wellness model. +ome 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. !1 Sc+##l nurse: The goal of school nursing is to support the educational process by helping students keep healthy, and teaching students and teacher(s preventive practices. 3he may be responsible for one or two schools. #esponsibilities 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 in$#r a"ics merican nursing association defines nursing informatics as a specialty that integrate nursing sciences, computer science and information science to manage and communicate data, information and knowledge in nursing practice nursing informatics facilitates the integration of data information and knowledge support patient nurses and other care provides in their decision making in all roles and settings in Eanuary !<<* the A N B congress of nursing practice designated informatics as a nursing specialty. P#si"i#n #$ nurses in nursing in$#r a"ics s&s"e 6any nurses working in this field have created then own position and titles some of the positions are' ) 3ystem analyst ) 3ystem nurse ) Pro4ector manager ) 3ystem analyst ) Nursing information specialist C+arac"eris"ic #$ nurse in$#r a"ics ) =lexibility
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) +umor ) +igh tolerance for meticulous work ) %nterest in computer literacy ) $ood verbal written and communication skills ) %ntelligent diplomatic and Eager to learn ) bility to balance technology with human needs ) 3hould be energetic creative and self starters Res%#nsi*ili"ies #$ "+e nurse in$#r a"ics ) 3ystem analysis and designing ) .evelopment of data dictionaries ) Evaluation and testing off applications for patient care ) "onfiguration of hardware and software ) Translating the language of nursing to engineers and system designers and vice versa. ) 2sing application software and computer networks ) %nstalling and maintaining hardware and software ) Programming in one or more computer systems ) "oordinating pro4ects of various si0es involving diverse team members. ) naly0e and evaluate information requirements ) .esign and implement applications to solve patient care problems. ) naly0e ethical issues concerned with safety and privacy EXPANDED AND EXTENDED ROLE OF NURSE IN COMMUNIT2 Nursing roles are ever changing the roles or set of expectations associated with given position of all health care professionals are continuously redefined in response to changing knowledge technology cost and consumer need. s health care delivery systems change the practice of nursing continues to shift from acute care to institution based settings to community settings .The new community health nurse must recogni0e the broader scope of practice. The community health nurse must be capable of performing role functions regardless of the setting of employment these role functions include' ) "linician ) dvocate ) "ollaborator ) "onsultant ) "ounselor ) Educator ) #esearcher ) "are manager R#le #$ "+e c# uni"& +eal"+ Nurse dvocate "linician "are manager #esearcher Educator
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"ollaborator

C. N

"onsultant "ounselor

Clinician "ommunity 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. 6ost nurses with a background in acute care do not have experience with a board community based 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 community(s health services in health promotion disease and in4ury, 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 De$ini"i#n: nurse practitioner is a registered nurse who has completed specific advanced nursing education Agenerally a master(s degree or doctoral degreeB and training in the diagnosis and management of common as well as complex medical conditions. Nurse practitioner provides a broad range of health care services. .is"#r& #$ nurse %rac"i"i#ner %n the late !<5>(s and early !<8>(s physician began to collaborate with nurses who had clinical experience. %n addition increasing speciali0ation in medicine led a large number of physicians to be out of primary care thus creating a shortage of primary care physician. %n !<85, the 6edicare 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. @ecause physicians were unable to meet their demand. %n !<85, ,oretta 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. T+e nurse %rac"i"i#ner '#* a& inclu!e "+e $#ll#-ing: ) .iagnosing, treating, evaluating and managing acute and chromic illness and disease ) -btaining medical histories and conducting physical examination. ) -rdering, performing and interpreting diagnostic studies AE.g. routine lab tests, bone F)ray, E"$B ) Prescribing physical therapy and other rehabilitation treatment. ) Prescribing pharmacologic treatment and therapeutic for acute and chronic illness Aextent of prescriptive authority varies by state regulationB ) Providing child care, including screening and immuni0ation. ) Providing primary and specialty care services health maintenance care for adults including annual physical check up.
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Providing care for patients in acute and critical care settings. Performing minor surgeries "ounseling and educating patients on health behavior self)care skill and treatment.

Prac"ice se""ings ) "ommunity health centre, clinic ) +ealth .epartment ) +ealth maintenance organi0ation ) +ome health care agencies ) +ospitals as hospital clinics ) +ospice centre ) Nurse practitioner office ) Nursing homes ) Private and public schools, universities and college ) 6ental health centre ) #esearch centre ) Employee health clinics Nurse3s %rac"i"i#ner s%eciali"ies ) dult nurse practitioner ttends to health needs from adolescent through advanced age. ) "ertified Nurse ? midwife Provides health care to women during pregnancy, birth and after birth and manages newborn health needs. ) "ollege health nurse practitioner Provide health care to college students. ) =amily nurse practitioner Provides health care to individuals ranging in age from new born to elderly adults ) $eriatric nurse practitioner 3peciali0e in health needs of persons 85 years of age or older ) Pediatric Nurse practitioner Provides health care to children from birth to !/ years of age ) Psychiatric mental health nurse practitioner ssess and treats problem of individuals and families that relate to emotional and mental health. ) 9omen(s health care nurse practitioners Provides management of health problem in obstetric and gynecology.
C# uni"& +eal"+ nurse generalis"

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.
C# uni"& +eal"+ nurse s%ecialis"

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
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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 individual(s families and groups are ma4or responsibilities for both groups. The present trend in community health nursing is to bring about the need for more graduate prepared clinical specialist. "ommunity health nurses are being employed through out the community health department, schools industries home health hospice and multiple other settings. A!/#ca"e The community health nurse act as advocate for the individual group or community client dvocacy in the act of speaking or acting for an individual or group of individuals who may be unable to speak for themselves. %n the health care system or larger social system. "lients 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. @ecause 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. s an advocate the nurse support the client(s right to make decision freely. Nursing action include supporting the client so that the client can make possible decision regarding health. C#lla*#ra"#r To collaborate means to work with others toward a common goal. %t is a process of 4oint 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.

"onsultant
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 . 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: "ounseling 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 counselor(s role is to listen ob4ectively clarity, provide feedback and information and guide the client through a problem solving process. The consultant is not necessarily concerned with sub4ective 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. "ounseling remains an important component of community health nursing. EDUCATOR:
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"ommunity health nursing has embraced the responsibility of educating individuals. =amilies and communities, +ealth teaching is considered one of the ma4or 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. +ealth education focuses on health promotion, health 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. [Link]: 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 analy0ing 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. s researcher, the nurse seeks to discover, investigates, understand, explain and predict phenomena the research process comprise specific actions to collect data and synthesi0e information. To manage future health concerns, the researcher will be challenged to answer research questions on issues related to +%&7 %.3 infections disease chromic physical and emotional conditions and in4ury prevention. CASE MANAGER: "oordination of care is different in a health care system with many differing public and private programs, services agencies and institutions. "ase management is the application of strategies the health care system. "ase management so comprises ma4or 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 $in!ing: "ase finding in the identification of those individuals from a population who will benefit from case management service, appropriate case were identified through the screaming of applicant, information and referral net work or brief assessments of key dimensions that showed need eligibility. Assess en": ssessment use as a full scale, multidimensional standardi0ed functional assessment of the client(s needs and resources. Care %lanning: "are planning is the core function of the care function of the case management process. The use of computer to track and samples the data collected from these tools in helpful to the nurse in providing high quality case. %mplementation''%mplementation is when the service plan is enacted. 6onitoring' the service received are evaluator reassessment and evaluation this function providers for the assessment and evaluation of the total service plan. .eal"+ %r# #"i#n ac"i/i"ies %t can be broadly classified into passive or active with strategies of health promotions are the fluoridation of municipal drinking water the fortification homogeni0ed milk with vitamin dare two examples of passive health promotion. 9ith active strategic of health promotion individuals are motivated to adopt specific health programs weight reduction and smoking isolation programs require clients to be
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actively involved in measures to improves their present and future levels of wellness while diseasing the risk of desease. In"er/en"i#ns !. .eal"+ e!uca"i#n: ,arge number of desease could be prevented with little or no medical intervention of people care adequately informed the prevention. 41 En/ir#n en" #!i$ica"i#n ) Provision of safe water ) %nstallation of sanitary and rodents ) %mprovement of honoring ) 6inimi0ing the use of in insecticide and pesticides on food crops. 1. Nu"ri"i#nal in"er/en"i#ns: 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. Nu"ri"i#n e5cess' can cause obesity alcoholism constipations hypertension causes (alances nu"ri"i#n: eat fresh food. =ruits, vegetable /. E5ercise: Exercise like nutrition should be balance and dense on a regular basis. physical exercise program couple to actuali0e physical health promotion. 5. Li$e s"&le an! *e+a/i#ural c+anges: ,ife style and behavioural changes like lack of sleep, pollution such as noise, air and environment, smoking substance abuse and obesity etc. can affect the health and cause desease and illness in man. The modifications of these factors are very important for health promotion provision of adequate rest and sleep practice of healthy habits balance diet adequate exercise. 61 S"ress anage en": ) .eveloping coping skills ) Evoke the relaxation response ) Goga, meditation, guided guided imagery .eal"+ %r# #"ing li$e s"&le %r#$ile 71 Sel$ ac"uali8a"i#n ) =ind life has purpose and goal ) =ind satisfying environment ) ,ooks forward to future ) ware of strengths and weakness ) =eel happy and content 41 .eal"+ res%#nsi*ili"& ) Periodic health check up ) #eports symptoms to physician ) #eads books about health ) -bserve body for changes )1 E5ercise ) Participate in stretching exercise ) &igorously exercise 1 times a weak ) Engages n recreational activities 91 Nu"ri"i#n ) Take in essential nutrients ) 3elect from basic food groups ) Eat three meals daily ) Eat breakfast :1 In"er%ers#nal su%%#r"
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) .iscuss the problems ) Praises other easily ) 6aintain meaningful interpersonal relationship ) 3pends time with close friends ) Express concerns and love 61 S"ress anage en" ) .aily relaxation ) ware of stress sources ) 2se meditation and relaxation exercises ) 2se pleasant bed time thoughts ) Expresses feelings ) 2se stress control methods T+e Nurses r#le in +eal"+ %r# #"i#n ) 6odel healthy life style behaviour and attitudes ) =acilitate client involvement in the assessment implemental and evaluation of health goals. ) Teach clients self)care strategies to enhance fitness . ) ssist client(s families and communities to increase their levels of health ) Educate clients to be effective health care consumers ) ssist client(s families and communities to develop and choose health promoting options. ) $uide client(s development in effective problem solving and decision making. ) #einforce client(s personal and family health promoting behaviour. Le/els #$ %re/en"i#n There are / levels of prevention !. Pri #r!ial %re/en"i#n' %t 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. =or e.g. many adult health problems Ae.g. obesity hypertensionB have their early origins in childhood because this is when the life styles are formed Ae.g. smoking eating pattern physical exerciseB 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. 41 Pri ar& %re/en"i#n Primary prevention can be defined as action taken prior to the onset of desease which removes the possibility that a desease will ever occur. %t is concerned health promotions of health activities that prevent the actual occurrence of a specific illness or desease primary prevention includes health education program immuni0ation physical and nutritional fitness activities. )1 Sec#n!ar& %re/en"i#n The specific intervention is early diagnosis Ae.g. screening tests care finding programmeB and adequate treatment it helps to arrest the desease process and restore health by seeking out unrecogni0ed desease and treating it. 91 Ter"iar& %re/en"i#n "an be defined as all measures available to reduce or limit impairment and disability minimi0e 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. Res"#ra"i#n #$ +eal"+ To heal in to restore to health or sound some of the interventions
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71 P+&si#l#gical in"er/en"i#n Patients who receive selected drugs under go procedure and receive direct nursing skills are being help to heal. ssist 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. 41 Ps&c+#l#gical in"er/en"i#n 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. 1. Sel$ care 3elf help or self care refers to the patient(s active involvement in bringing about healing. 3elf care is to allow the patient to take control of his or her own health. 91 .#lis"ic +ealing +olistic 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. . :1 Re+a*ili"a"i#n #ehabilitation is a dynamic process that restores an individual to the highest possible level of function of level of function it is restoration of health.

C#nclusi#n %n %ndia nurses are for behind with the nursing specialist. This is a challenge for %ndian nurses who are working in settings which do not have facilities of newer technology. +ealth care delivery is largely dependant on information for effective decision making.

@liography
!. *. 1. /. 5. Potter,perry,fundamentals of [Link] yorkH6osby.*>>8p.!8)*1 [Link].=undamentals of nursing.8th ed.3ingpurHpearson education Pvt. ,td *>>1 p.!>)!1 @earce p cHEudith l. m principles and practice of adult heath nursing. P. :/);*. @asvanthappa @.T."ommunity heath nursing. !st ed. TorontoHc.v. mosby,!<;/.p.*:)*<. @arbara ko0ier,$lenoraErbH=undamental of nursing.!:th ed. New .elhi. .orling Iindersley.*>>:.p.!*<)!1>. ;#urnals !. !.Nursing service administrator,Nursing Eournal of %ndia,!<<;,;< p.58)5:. *. *.%ndian 4ornal of holistic nursing, sept.*>>8.p.!: 1. 1The nursing 4ournal of %ndia march *>>>.p.58)5:. /. /.Thenursing 4ournal of %ndia march !<<; p.8> 5. [Link] in nursing administration and education volume)! 4anuary 4uly)*>>; p.5/)58.

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