INTRODUCTION

During the first five decades the nursing profession made significant progress towards developing a body of scientific knowledge, nursing practice change a response to consumer demand and involvement of new technology changes in health care delivery system and policy . A Resent debate about nursing is weather the nurses role should be expanded or extended health care delivery system an policy .

1. EXTENDED ROLE OF NURSE

 INTRODUCTION :- Extended care facilities are becoming the nurse popular means managing the health care needs of the client who require additional care . — Extended care facilities assists client with their daily activities , provide care when necessary and co-ordinate rehabilitation service.

 DEFINATION:- Extended role of nurse is a activities concerned with the patient either in hospital or community that are appropriate for delegation by doctors to nurses.

 EXTENDED ROLE OF NURSE

1 Care giver

2 Manager

3 Advocator &protector

4 Counselor

5 Nurse educator

6 Communicator

7 Rehabilitator

8 Collaborator

9 School health nurse

10 Occupational health nurse

11 Parish nurse

12 Public health nurse

13 Home care nurse

14 Rehabilitation nurse

15 Office nurse

16 Nurse epidemiologist

17 critical nurse

18 Nurse administrator

19 Nurse practitioner

20Nurse midwife

21 Community health nurse

22Occupational health nurse

23Psychiatric nurse

24Medical surgical nurse

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

MANAGER-

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

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

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

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

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

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

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

 Functions : — Direct care giver- The school nurse is expected to give immediate nursing care to the ill or injured child or the school staff members. — Case finder- the school health nurse identifies as early as possible children at risk for physical, behavioral, social or academic problems. — Case manager- help to coordinate the health care for children, with any health problem. — Consultant- provide professional information about changes in school environment and their impact on the health of children — Health educator- the nurse provides health education regarding proper nutrition or safety information ,personal hygiene to children and also to their parents

Occupational health services- – Occupational and environmental health nursing is the specially practice that provides for the delivery health and safety programmes and service to the workers and community group. – The practice focus on promotion and restoration of health, prevention of illness and injury and protection from environmental hazards.

Practices focus on… – Promotion of health – Restoration of health – Prevention of illness – Protection from hazards qFunctions — Direct nursing care- this care involved primary, secondary and tertiary prevention with nursing intervention from assessment. – eg. physical assessment, screening – Counseling-occupational nurse counsel for issues such as substance abuse and emotional or family problems – Health promotion-occupational health teaching skills and developing health education programmes especially on smoking cessation exercise, nutrition wait control and chronic illnesses family problems.

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

FUNCTIONS– -Provide a spiritual care :- spiritual care is the core of parish nurse practice and central to the healing process. – Health counselor :- health counselor explain health risk apprisal,plan for health their life style, provide support and guidance related acute and chronic, actual and potential health problems. – Health advocate :- as an advocate, parish nurse guides persons successfully for problem solving and care options. – Health educator :- as a educator ,serves to gain knowledge in order to make best choices for maintaining health, lowering health risk, preventing illness and managing diseases’ already present.

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

FUNCTION :- — Health advocate-as an advocate, public health nurse collects, monitors & analyze data and discuss with the client which services are needed.. — Care manager-public health nurses uses the nursing process of assessing, planning, implementing, & evaluating outcome to meet clients needs . — Health educator-as an educator the public health nurse identifies community needs & develop an implement activities aimed at changing behavior. — Communicable disease control-public health nursing skills are necessary for education, prevention, survivelence &investigation of communicable diseases on community.

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

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

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

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

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

CRITICAL CARE NURSE- – Qualification of critical care nurses are basic b sc ,degree or diploma in nursing and advanced preparation in critical care nursing . q Functions — Monitoring balloon angioplasty, pacemaker, hemodynamic ,bedside hemodialysis and surgical procedures. — Manages patients total care. — Performs defibrillation.

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

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

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

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

Functions of community health nurse — Home visiting — Assisting in ANC and PNC — Collection of information and data collecting — Conduct school health services — Health education

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

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

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

2. EXPANDED ROLE OF NURSE INTRODUCTION: – Expanded role of nurse is the responsibility assumed by the nurse within the field of practice . – Increasing educational opportunities for nurses, the growth of nursing as a profession and a greater concern for job . – the nursing profession offers expanded role and different kind of career opportunity.

DEFINATION:- – expanded role of nurse means enlargement of nursing within the boundaries of nursing.

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

ADVANCED NURSE PRACTITIONER- a nurse who has an advanced education and is a graduate of nurse practitioner program is employed in health care agencies. Job responsibility includes- – taking client history – — Conducting physical examination — ordering performing diagnostic test – providing primary care – consultant for individual, families and communities

NURSE CLINICIAN/CLINICAL NURSE SPECIALIST- – The clinical nurse specialist has a master degree in nursing and expertise in a specialized area of practice qFunctions- – the main function as client care provider, educator, and consultant researcher, manager and improve the quality of care provided to the client and family members.

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

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

NURSE RESEARCHER- – Nurse researcher may be employed in an academic setting, hospital, or community service agencies q Functions – The nurse researcher investigates problems to improve nursing care and to further define and expand the scope of nursing. .

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

BIBLIOGRAPHY SR NO. (Text book Author PAGE NO )

1 Advanced nursing practice Shebeer bsaheer 681-686

2 Fundamental of nursing Sr.nacy 94-96

3 Management and nursing administration Mr.veerbhdrappa 300-302

4 www.google.com

Assignment

Q1. Explain in details extended and expended role of nurse

• Qualifications: Must have requisite diploma or degree
• License to Practice: should be registered nurse in the nursing council
• Physically and Mentally fit
• Confident to take decisions in client care
• Humble and honest to gain the trust of the client
• Full fill duties
• Impartial without prejudice
• Self confident
• Humility
• Honesty
• Loyality
• Cooperative
• Good listener
• Keen observer
• Good administrator
• Good supervisor
• Impartial
• Capable
• Workmanship
• Responsible
• Accountable
• Competent
• Good judge
• Advocate
• Good human relations
• Gracious talk

ETHICS MEANS

Ethics are the rules or the principles that governs right conduct and its design to protect right of the human beings.

DEFINATION OF CODE OF ETHICS

A code of ethics is a formal statement of group’s ideals and values.

OR

It the set principles that are accepted by all the members of profession.

PURPOSES

• Standards for the behaviors of nurse & provide general guidelines for nursing action
• Helps to distinguish between right & wrong
• Enables a correct decision
• Protect the rights of individual
• It helps the student and the register nurses to practice ethically

ICN CODE OF ETHICS FOR NURSES

An international code of ethics for nurses was first adopted by the International Council of Nurses (ICN) in 1953. It has been revised at various times since, most recently with this review and revision completed in 2012.

1. NURSES AND PEOPLE

The nurse’s primary professional responsibility is to people requiring nursing care.

In providing care, the nurse promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected.

The nurse ensures that the individual receives sufficient information on which to base consent, care and related treatment.

The nurse holds in confidence personal information and uses judgement in sharing this information.

The nurse shares with society the responsibility for initiating and supporting action to meet the health and social needs Of the public, in particular those who are vulnerable populations.

2. NURSES AND PRACTICE

The nurse carries personal responsibility and accountability for nursing practice, and for maintaining competence by continual learning.

The nurse maintains a standard of personal health such that the ability to provide care is not compromised.

The nurse uses judgement regarding individual competence when accepting and delegating responsibility.

The nurse at all times maintains standards of personal conduct which reflect well on the profession and enhance public confidence.

The nurse, in providing care, ensures that use of technology and scientific advances are compatible with the safety, dignity and rights of people.

3. NURSES AND THE PROFESSION

The nurse assumes the major role in determining and implementing acceptable standards of clinical nursing practice, management, research and education.

The nurses is active in developing a core of research-based professional knowledge.

The nurse, acting through the Professional organization, participates in creating and maintaining safe, equitable social and economic working conditions in nursing.

4. NURSES AND CO-WORKER

The nurse sustains a co-operative relationship with co-workers in nursing and other fields.

The nurse takes appropriate action to safeguard individuals, families and communities when their health is endangered by a co- worker or any other person.

5. NURSFES AND SOCIETY

Participate and share responsibility with other citizens & other health professionals.

Recognize and perform the duties of citizenship

Aware of laws and regulations which affect the practice of medicine and nursing.

Assignment

1. Write the importance of Code of Ethics in nursing profession
2. Explain code of ethics in detail.

• Caring nature
• Empathic attitude
• Detail oriented
• Emotionally stable
• Adaptable
• Hardworking
• Quick thinker
• Physical endurance
• Good judgment
• Good communication skills

Caring nature

Nurses deal with the sick and injured and their families on a daily basis and must be able to show that they truly care about the situation.

Detail oriented

Nurses must remember to make entries on patients charts and to bring medications at the correct times.

Emotionally stable

Nurses feel the joy of Seeing a new baby born as well as the pain of losing a long- term patient. Emotional stability crucial to deal with the wide range of emotions nurses must endure

Adaptable

People are unpredictable at the best of times, but become even more so under stress, so a nurses typical workday will require flexibility and adaptability.

Hardworking

Nursing is a never-ending job. It ïs Unusual for a hospital or medical canter to be overstaffed, which of course means more workload on each nurse in the unit

Quick thinker

When a nurse notices something is not right with a patient, they must be able to make decisions quickly and put their plans into action instantly, because a fraction of a second can mean the difference between life and death.

Physical endurance

Nurses are on their feet all day, sometimes 12 or more hours at a time, and are often required to assist patients with activities that require physical strength.

Good judgment

A nurse must be able to look at a patients current state and accurately assess what is needed, especially during emergencies

Good communication skills

Nurses must communicate with other nurses, doctors, patients, and patients families clearly