Extended and Expanded Role of Nurses

SEMINAR
ON
EXTENDED AND EXPANDED ROLE OF
NURSE,
HEALTH PROMOTION,
PRIMARY MODEL OF PREVENTION,
FAMILY WELFARE PROGRAMME
SAKSHI RANA
M.Sc NURSING

EXTENDED AND EXPANDED
ROLE OF NURSE

EXTENDED AND EXPANDED
ROLE OF NURSE
INTRODUCTION:
Nursing is the largest of all health care
professions. As far as traditional role of nurses
are concerned the focus was on curative
aspect whereas expanded role of nurse is
assumed by virtue of education & experiences
and extended role includes the services to the
people and community.

Contt..
IMPORTANCE:
• It provides variety of services for the patients
of all age groups which may be part of
hospital or community.
• It enhances clinical decision skills.
• It provides expert knowledge and high level
of job satisfaction.

Contt..
• Health is considered as fundamental right of
individual. Nurses have to carry out wide
range of functions especially in underserved
areas like rural sector, remote regions & urban
areas. The transition of health care systems
from a disease oriented model to health
oriented model is an emerging trend.

Contt..
NEED:
There is need to expand nurses role to face new
challenges in providing comprehensive care to the
patients. Advancement i.e. role of nurse within
hospital and community will help them to become
expert in patient care and achieving satisfaction.
Thus to meet the changing health care needs of
the people, extended and expanded role of nurse
is very essential.

Contt..
EXTENDED ROLE OF NURSE:
The concept of an extended role means to
reach out. The role of a nurse in extended care
facility is one that a nurse assumes by virtue of
education, type of institution where she is
employed. Nurses are performing different
roles in variety of settings.
E.g. Hospital & community.

Contt..
• It includes the advance care to be provided to
the patient during any major surgery or
procedures focused on using various
practical skills.
• As a community health nurse, it demands
involvement of nurses in care of individuals,
families and groups which together constitute
the total population.

Contt..
• As a Family nurse practitioner she can assist
the past and present physical and psychosocial
health status of individual.
• Provide health education and counseling
including referral services for complicated
cases and the management of certain
conditions.

Contt..
• Conduct survey and use research to extend
nursing theory and to improve health practices
among the community.
• Conduct classes for training of first aid to the
workers to assist in emergencies.
• The occupational nurse has a very important
role in industrial health programs.

Contt..
• Participate in health education programs and
research project for desired change.
• As a rehabilitation nurse she develops a
therapeutic and supportive relationship with
the patient and family.
• As a nurse practitioner she provides health
care services to the neglected, remote or
underserved areas.

Contt..
• Provide treatment of minor ailments through
standing order
• Provide a package of preventive, curative and
rehabilitative services for promotion,
maintenance and restoration of community
health.
• Perform certain laboratory tests e.g. Hb
estimation.

Contt..
• Nurse Manager, administrator at district level
implements NHP through supervisor at PHC
level. Supervision to multi-purpose health
worker. Conduct training programs for MPW
community leaders like anganwadi teachers
and local leaders. Health worker at grass root
level conduct survey.

Contt..
• Palliative / Hospice Care nurse means an
agent which relieves but doesn’t care disease.
• A hospice is a system of family centered care
designed to make the terminally ill patient
comfortable and to ensure satisfactory lifestyle
through the terminal phase of illness. It is
provided for cancer patients including cardiac
and renal patients.

Contt..
EXPANDED ROLE OF NURSE:
• Expanded role of nurse involves enhancing the
nursing profession and responsibilities
assumed by a nurse within the field of
practice. India is a developing country
possessing high illiteracy rate. Lack of
education is one of the causes of high mortality
rate.

Contt..
• Expended role of nurse means
engagement of nurse role within the
boundaries of nurse. It is the
responsibility assumed by a nurse within
fiend of practice autonomy.

Contt..
1) ADVANCED PRACTICE NURSE (ANP): Generally
the most independent functioning nurse.
• Nurse has a master degree in nursing, advanced
education in pharmacology and physical assessment,
and certification and expertise in specialized area of
practice.
2) CLINICAL NURSE SPECIALIST:
• Nursing expertise in special area of practice
(medical surgical nursing, pediatric nursing,
community health nursing, gerontogic nursing)

Contt..
3) GENERALIST: A licensed practical nurse, or
LPN, typically completes a one-year training
program to earn a nursing certificate and work in
a generalist job. A generalist is one who sees the
whole unit and
family practitioners, internists and pediatricians.
4) NURSE MIDWIFE: A midwife takes care of a
pregnant woman during labour and postpartum.
They assist with things like breastfeeding and
caring for the child.

Contt..
5) NURSE PRACTITIONER: Role of nurse
practitioner is an extension of the nurse basic care
giving role.
• Acute Care Practitioner.
• Adult Nurse Practitioner.
• Pediatric Nurse Practitioner.
• Family Nurse Practitioner.
• Women's Nurse Practitioner.
• Geriatric Nurse Practitioner.

Contt..
6) NURSING ADMINISTRATOR: Manages
client care and the delivery of specific nursing
within a health care agency and begins with
position such as the charge nurse or assistant
nurse manager, then nurse manager of a
specific patient care area.

Contt..
7) NURSE RESEARCHER: Investigates
problems to improve nursing care and to
further define and expand the scope of nursing
practice. May be employed in an academic
setting, hospital, or independent professional
or community service agency.

Contt..
8) SCHOOL HEALTH NURSE: A specialized practice of
professional nursing that advances the well-being, academic
success, and lifelong achievement of students.
Goal : Supervise educational success by enhancing health.
Functions:
• Direct caregiver.
• Counselor.
• Health educator.
• Researcher
• Case finder.
• Consultant.

Contt..
9) OCCUPATIONAL HEALTH NURSE: Specialty
practice that provides for and delivery of health
and safety programmes and services to worker,
worker population and community groups.
Functions:
• Promotion and restoration of health.
• Prevention of illness and injury.
• Protection from work related and environmental
hazards.

Contt..
10) PARISH NURSE: The role that gathers in
churches, cathedrals, temples, mosques, and
acknowledge common faith tradition and respond to
health and wellness needs within the context of
populations of faith community.
Functions:
• Provider of spiritual care.
• Health counselor.
• Health advocate.
• Facilitator of support groups.

Contt..
11) PUBLIC HEALTH NURSE: A registered
nurse with special training community health.
Functions:
• Health advocate Care Manager.
• Referral Resource.
• Direct Primary Caregivers.
• Communicable Disease Control.

Contt..
12) PRIVATE DUTY NURSE: A registered
nurse or a licensed practical nurse who
provide nursing services to patients at
home or any other setting in accordance
with physician orders.

Contt..
13) HOME CARE NURSE: A nurse who provides
periodic care to patients within their home
environments as ordered by the physician.
Functions:
• Health Maintenance.
• Education.
• Illness Prevention.
• Diagnosis and Treatment of disease.
• Palliation and rehabilitation.

Contt..
14) HOSPICE NURSE: Is one who provides a
family centered care and allows clients to live and
remain at homes with comfort, independence and
dignity, while alleviating the strains caused by
terminal phase i.e. at the time of death.
15) REHABILITATION NURSE: A person who
specializing in assisting persons with disabilities
and chronic illness to attain optimal function,
health and adapt to an altered life style.

Contt..
16) NURSE EPIDEMIOLOGIST
(INFECTION CONTROL NURSE): Monitor
standards and procedures for the control and
prevention of infectious diseases and other
conditions of public health significance
including nosocomial infections.
17) MILITARY NURSE: One who provide care
to military personnel and their families.

Contt..
18) AEROSPACE NURSE: A nurse who
provides comprehensive nursing care for all
types patients during aero medical evacuation
and airlift flights.
19) TELE NURSE: One who carries out
telephonic communications with the patient.

Contt..
20) DISASTER NURSING: Define as the
adaptation of professional nursing skills in
recognizing and meeting the nursing, physical,
emotional, and social needs resulting from
disaster.
21) FORENSIC NURSING: One who suspected
to be acquainted with the basics of forensic
medicine so as to handle and preserve the
evidentiary materials.

Contt..
22) PEACE NURSE CORPS: A nurse who
performs variety of nursing activities including
immunization, periodic health evaluation and
preventive treatments.
22 PRISON NURSE: Registered nurse who work in
a prison. Can either be employed directly by
prison service or can work in the other area and
spend part of their working week in the prison
health care.

Contt..
INTRODUCTION:
Health, as the World Health Organization
(WHO) defines, is the state of complete
physical, social and mental well being and not
just the absence of disease or infirmity.

Contt..
Health is heavily influenced by factors outside
the domain of the health sector, especially
social, economic and political forces. These
forces largely shape the circumstances in
which people grow, live, work and age as well
as the systems put in place to deal with health
needs ultimately leading to inequities in health
between and within countries

Contt..
ELEMENTS OF HEALTH PROMOTION: There
are 3 key elements of health promotion;
1.GOOD GOVERNANCE FOR HEALTH:
• Health promotion requires policy makers across
all government departments to make health a
central line of government policy. This means they
must factor health implications into all the
decisions they take, and prioritize policies that
prevent people from becoming ill and protect them
from injuries

Contt..
2. HEALTH LITERACY:
• People need to acquire the knowledge, skills and
information to make healthy choices, for example
about the food they eat and healthcare services
that they need. They need to have opportunities to
make those choices. And they need to be assured
of an environment in which people can demand
further policy actions to further improve their
health.

Contt..
3. HEALTHY CITIES:
• Cities have a key role to play in promoting
good health. Strong leadership and
commitment at the municipal level is essential
to healthy urban planning and to build up
preventive measures in communities and
primary health care facilities. From healthy
cities evolve healthy countries and, ultimately,
a healthier world.

Contt..
HEALTH PROMOTION EMBLEM:
• This logo was created for the First International
Conference on Health Promotion held in Ottawa,
Canada, in 1986. At that conference, the Ottawa
Charter for Health Promotion was launched.
Since then, WHO kept this symbol as the Health
Promotion logo (HP logo), as it stands for the
approach to health promotion as outlined in the
Ottawa Charter.

Contt..
The main graphic elements of the HP logo are:
• one outside circle,
• one round spot within the circle, and
• three wings that originate from this inner spot,
one of which is breaking the outside circle.

Contt..
APPROACHES TO HEALTH PROMOTION:
• The conceptual framework to the approaches
to health promotion. It looks at the need of the
whole population.

Contt..
The population for any disease can be divided
into four groups
a) healthy population.
b) population with risk factors.
c) population with symptoms.
d) population with disease or disorder.

Contt..
COMMITMENT TO HEALTH PROMOTION:
The participants in this Conference pledge:
• To move into the arena of healthy public
policy, and to advocate a clear political
commitment to health and equity in all sectors;

Contt..
• To counteract the pressures towards harmful
products, resource depletion, unhealthy living
conditions and environments, and bad
nutrition; and to focus attention on public
health issues such as pollution, occupational
hazards, housing and settlements;

Contt..
• To respond to the health gap within and
between societies, and to tackle the inequities
in health produced by the rules and practices
of these societies.

Contt..
• To acknowledge people as the main health
resource; to support and enable them to keep
themselves, their families and friends healthy
through financial and other means, and to
accept the community as the essential voice in
matters of its health, living conditions and
well-being;

Contt..
• To reorient health services and their resources
towards the promotion of health; and to share
power with other sectors, other disciplines and,
most importantly, with people themselves;
• To recognize health and its maintenance as a
major social investment and challenge; and to
address the overall ecological issue of our ways
of living.
• The Conference urges all concerned to join them
in their commitment to a strong public health
alliance.

Contt..
HEALTH PROMOTION IN THE WORKPLACE:
• Health promotion in the workplace is an
investment in your most important asset, your
employees. Studies have shown that employees
are more likely to be on the job and performing
well when they are in optimal physical and
psychological health. Employees are also more
likely to be attracted to, remain with, and value a
company that values them.

Contt..
• Attracting the most talented workers;
• Reducing absenteeism and lost time;
• Improving on-the-job time utilization and
decision making; and
• Improving employee morale, which leads to a
reduction in turnover.

PRIMARY METHODS OF PREVENTION
INTRODUCTION:
• PREVENTION: It is defined as the actions
aim at eradicating, eliminating or minimizing
the impact of disease and disability. The
concept of prevention is best defined in the
context of levels traditionally called primary,
secondary and tertiary prevention.

Contt..
1) PRIMORDIAL PREVENTION: Primordial
prevention consist of actions & measures that
inhibit the occurrence of risk factors in the
form of environmental, economic, social, and
behavioral conditions & cultural pattern of
living etc.

Contt..
• The main intervention in primordial
prevention is through individuals and
mass education.

Contt..
2) PRIMARY PREVENTION: Primary
prevention is defined as the action taken prior
to the onset of disease, which removes the
possibility that the disease will ever occur.
• It signifies intervention in the prepathogenesis
phase of a health promotion.
• Primary prevention may be accomplished by
measures of "Health Promotion" and "Specific
Protection".

Contt..
PRIMARY
PREVENTION
HEALTH PROMOTION
-HEALTH EDUCATION
-ENVIRONMENTAL
MODIFICATION
-NUTRITIONAL INTERVENTION
-LIFE STYLE AND BEHAVIORAL
CHANGES
SPECIFIC PROTECTION
-IMMUNIZATION &
SEROPROPHYLAXIS
-CHEMOPROPHYALXIS
-USE OF SPECIFIC NUTRIENTS
-PROTECTION ANGAIST
OCCUPATIONAL HAZARDS
-SAFETY OF DRUGD AND FOODS
-CONTROL OF ENVIRONMENTAL
HAZARDS

Contt..
APPROACHES FOR PRIMARY PREVENTION:
A) POPULATION (MASS)
STRATEGY
B) HIGH RISK STRATEGY

Contt..
3) SECONDARY PREVENTION:

Contt..
Secondary prevention attempts to arrest the
disease process, restore health by seeking out
unrecognized disease and treating it before
irreversible pathological changes takes place
and reverse communicability of infectious
disease.

Contt..
3) TERTIARY PREVENTION:

Contt..
• It is used when the disease process has
advanced beyond its early stages.
• It is defined as " all the measures available to
reduce or limit impairment and disabilities and
to promote and patients' adjustment to
irremediable conditions."

Contt..
MODES OF INTERVENTION:
TERTIARY
PREVENTION
INTERVENTION
DISABILITY
LIMITATIONS
REHABILITATION

Contt..
A)DISABILITY LIMITATION: When a patient
reports late in pathogenesis phase. The mode
of intervention is disability limitations. The
objective of this intervention is to prevent or
halt the transition of the disease process from
impairment to handicap.

Contt..
Concepts of disability; DISEASE
(Accident)
IMPAIRMENT
(Loss of foot)
DISABILITY
(Cannot walk)
HANDICAP
(Unemployed)

Contt..
The following areas of concern in rehabilitation have
been identified:
(a) Medical rehabilitation - restoration of function.
(b) Vocational rehabilitation - restoration of the capacity
to earn a livelihood.
(c) Social rehabilitation - restoration of family and social
relationships.
(d) Psychological rehabilitation - restoration of personal
dignity and confidence.

Contt..
STRATERGY FOR PREVENTION:
The National Prevention Strategy, released June 16, 2011,
aims to guide our nation in the most effective and
achievable means for improving health and well-being.
The Strategy prioritizes prevention by integrating
recommendations and actions across multiple settings to
improve health and save lives.
• The Vision
• The Goal
• The Strategic Directions
• The Priorities

Contt..
1) The Vision: Working together to improve the
health and quality of life for individuals,
families, and communities by moving the
nation from a focus on sickness and disease to
one based on prevention and wellness.
2) The Goal: Increase the number of Americans
who are healthy at every stage of life.

Contt..
3) The Strategic Directions: The Strategic
Directions provide a strong foundation for all of
our nation’s prevention efforts and include core
recommendations necessary to build a prevention-
based strategy. Each Strategic Direction can
stand alone and can guide actions that will
demonstrably improve health. Together, the
Strategic Directions create the web needed to
fully support Americans in leading longer and
healthier lives.

Contt..
The four Strategic Directions are:
• Healthy and Safe Community Environments
• Clinical and Community Preventive Services
• Empowered People
• Elimination of Health Disparities

Contt..
4) The Priorities: Within the Strategy, the
Priorities provide evidenced-based
recommendations that are most likely to
reduce the burden of the leading causes of
preventable death and major illness. The
Priorities are designed to improve health and
wellness for the entire U.S. population,
including those groups disproportionately
affected by disease and injury.

Contt..
The seven Priorities are:
• Tobacco Free Living.
• Preventing Drug Abuse and Excessive Alcohol
Use.
• Healthy Eating.
• Active Living.
• Injury and Violence Free Living.
• Reproductive and Sexual Health.
• Mental and Emotional Well-Being.

Contt..
INTRODUCTION:
• FAMILY PLANNING: It means panning by
individuals or couples to have only the
children when they want them.
OR
• Family planning is the practice of controlling
the number of children in a family and the
intervals between their birth.

Contt..
FAMILY WELFARE: The term "family
welfare" is much broader in scope then family
planning. The concept of welfare is basically
related to quality of life. As such, it includes
education, nutrition, health, employment,
women's welfare and rights, shelter, safe
drinking water- all concept related with concept
of welfare.

Contt..
HISTORY OF THE FAMILY WELFARE
PROGRAMME:
• It was started in the year 1951
• The International conference on Population and
Development held in 1994 established an
international consensus on a new approach to
policies to achieve population stabilization. In
1951 India became the first country in the world
to launch a family planning programme to reduce
population growth in the country.

Contt..
• In 1977, the Govt. of India designated the "
National Family Planning Programme" as the
"National Family Welfare Programme", and
also changed the name of the Ministry of
Health and Family Planning to Ministry of
Health and Family Welfare.

Contt..
• It is the reflection of the Government's anxiety
to promote family planning through the total
welfare of the family.
• It is aimed at achieving a higher end, i.e. to
improve the quality of life of the people.
• India is the first country in the world, that
implemented the family welfare programme at
government level.

Contt..
• Health is the part of concurrent list but center
provides 100% assistance to states for this
programme.
• Government has concentrated on this programme
in various five year plans though higher priority
was accorded to it after 4th five year plan.
• Due to bad effects of emergency and faulty
propaganda, family planning suffered major
setback, during 1977-1979.

Contt..
• It was decided in National Health Policy 1983,
that Net Reproduction Rate (NRR) should be 1
by the year 2000.
• The 7th five year plan placed more emphasis
on the use of spacing methods between the
births of two children's.

Contt..
Family Welfare Programmes Mainly include:
1. Family planning information, counseling and
services to women for healthy reproduction.
2. Education about safe delivery and post delivery
of the mother and the baby and the treatment of
women before pregnancy.
3. Health care for infants immunization against
preventable diseases.
4. Prevention and treatment of sexually and
Reproductive Tract infection.

Contt..
OBJECTIVES:
• The objectives of family welfare programme
including;
• To promote the adoption of small size family
norm, on the basis of voluntary acceptance.
• To promote the use of spacing method.
• To ensure adequate supply of contraceptives to
all eligible couples within easy reach.

Contt..
• To arrange for clinical and surgical so as
to achieve the set target.
• Participation of voluntary
organizations/local leader/local self
government, in family welfare programme
at various level.

Contt..
EVALUATION OF FAMILY PLANNING:
1.Evaluation of need i.e., health, demographic and
socio-economic needs for family
planning. For example, the. current status of maternal
mortality in a given area is an
indicator of the need for family planning.
2. Evaluation of plans i.e., an assessment of the
feasibility and adequacy of programme plans.

Contt..
3. Evaluation of performance
(a) Services : Clinic services, mobile services,
postpartum services, contraceptive
distribution, follow up services, education and
motivation activities.
(b) Response : Number of new acceptors,
characteristics of acceptors

STRATEGIES FOR FAMILY WELFARE
PROGRAMME:
STRATEGIES
INTEGRATION
WITH THE
HEALTH
SERVICES
INTEGRATION
WITH THE
MATERNITY AND
CHILD HEALTH
CONCENTRATION IN
RURAL AREA
LITERACY
BREAST
FEEDING
MASS MEDIA
INCENTIVES
MINIMUM NEED
PROGRAMME
RAISING THE AGE
FOR MARRIAGE:

Contt..
ROLE OF NURSE IN FAMILY WELFARE
SERVICES:
ROLE OF
NURSE
EDUCATIONAL
FUNCTIONS AND
MOTIVATION
MANEGERIAL
FUNCTIONS
SURVEY
WORK

SUMMARY
I summarized the topic that we have discussed about
Extended and Expended role of nurse, Health Promotion,
Primary Model of Prevention, Family Welfare
Programme.
Expended and Extended Role of Nurse includes;
• Introduction.
• Importance of Extended and Expanded role of nurse.
• Needs of Extended and Expanded role of nurse.
• Extended role of nurse.
• Expanded role of nurse.

Contt..
Health Promotion includes;
• Introduction.
• Elements of Health Promotion.
• Health Promotion Emblem.
• Approaches to Health Promotion.
• Commitment to Health Promotion.
• Health Promotion in the Workplace.

Contt..
Primary Model of Prevention includes,
• Introduction.
• Level of Prevention.
• Primordial Prevention.
• Primary Prevention.
• Secondary Prevention.
• Tertiary Prevention.
• Strategy for Prevention

Contt..
Family Welfare Programme includes;
• Introduction.
• History of Family Welfare Programme.
• Objectives.
• Evaluation of Family Planning.
• Strategies of Family Welfare Programme.
• Role of community Health Nurse in Family
Welfare Services.

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