The document discusses the definitions, roles, and responsibilities of nurses in various settings. It begins by defining nursing as assisting individuals in performing activities to maintain or improve their health. It then discusses the traditional roles of nurses as caregivers, advocates, educators, counselors, communicators, and clinical decision makers. It also defines extended and expanded roles of nurses as responsibilities assumed beyond or within the traditional nursing role, respectively. Finally, it provides examples of specific nursing roles in different practice settings such as community health, schools, homes, and more.

1. EXTENDED AND EXPANDED
ROLES OF NURSE
Presentee::
Mrs. Sujata Umbarkar
M.Sc. Nursing

2. DEFINITIONS
• NURSING
Nursing is a unique function of nurse that is to
assist the individual, sick or well in performance of
those activities contributing to health, recovery or to a
peaceful death, that he/she would perform unaided if
he/she had the necessary strength, will or knowledge,
and to do this in such a way to help him gain
independence as rapidly as possible.

3. NURSE
A professional nurse is a
graduate of a recognized
nursing school, who has met
the requirement for a
registered nurse in a state in
licensed to
which she is
practice.

4. R
O
L
E

5. PROFESSIONAL RESPONSIBILTIES
AND ROLES OF THE NURSES
CAREGIVER
/ CARE
PROVIDER
ADVOCATE
EDUCATOR
CHANGE
AGENT
COUNSELOR

6. Cont….
COMMUNICATOR
CLINICAL
DECISION
MAKER
MANAGER
REHABILITATOR
RESEARCHER

7. DEFINATION
EXTENDED
 Extended role
of a nurse is the
responsibility
assumed by a
nurse beyond
the traditional
role. i.e. outside
the practice.
EXPANDED
 Expanded role
of nurse means
enlargement of
nursing within
the boundaries
of nursing.

8.  IMPORTANCE /NEED FOR EXPANDING AND EXTENDING
ROLES:
 Health is considered as fundamental right of
individual. Promotion of primary health care is to
achieve the goals of “Health for all” is a priority of
health care system.
 To provide the population with broad access to basic
health services, nurses have to carry out wide range of
functions especially in understand areas.
 The transition of health care system from a disease
oriented models to health oriented model is an
emerging trends.
 Specialization is another development, which has
major implication for nursing practice.

9. EXTENDED CARE AS A SPECTRUM OF
SERVICES
• Intermediate care: A service provided within a
hospital for patients who not only require nursing
care, but continuing medical attention, laboratory
and x-ray services.
• Domiciliary care: For patients, who are ambulatory,
need only intermittent medical attention, but need
supervision of their daily activities.
• Home care nursing: Provides physician directed
nursing, medical, social and rehabilitative services to
selected patients in their home environment.

10. Care giver
 Care giving role is a primary role of the
nurse. The provision of care to clients
combines both the arts & science of
nursing, which helps clients regain health
through healing process. Healing is more
than just curing a specific disease, although
treatment skills that promote physical health
are important to caregivers.

12. 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..

13. 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.

14. 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

15. 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 clearand relevant

17. Cont..
As an educator, the nurse explains to clients
concepts and factors about health, demonstrates
procedures such as self-care activities,
determines that the client fully understands
reinforces learning or client behavior and
evaluates the clients progress in learning. The
teaching process has four components -
assessing, planning, implementing & evaluating
– that can be viewed as parallel to nursing
process.

18.  REHABILITATOR
.

19. Cont…
 Rehabilitation is the process by which
individuals return to maximum levels of
functioning after illness, accidents or other
disability events. Usually, client experience
physical or emotional impairment that change
their lives, and the nurse helps them to adapt as
fully as possible by using her knowledge and
skills of many concepts when she learned

20. 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.

21. COLLABORATOR
 Nurse collaborates with other team
members when providing care to a
client. Quality care is given when nurse
and team members work together in
planning for the patient’s care
management. A nurse can be a good
collaborator when she is knowledgeable,
a good planner when providing patient
care.

22. SCHOOL HEALTH NURSE
 School nursing is a specialized practice of
professional nursing that facilitates the well-
being, academic success and life long
achievements of students. School heath services
have the goal of supporting educational success
by enhancing health.

23. ROLE OF THE SCHOOL NURSE
1. The school nurse provides direct health care to students
and staff.
2. The school nurse provides leadership for the provision of
health services.
3. The school nurse provides screening and referral for
health conditions.
4. The school nurse promotes a healthy school environment.
5. The school nurse promotes health.
6. The school nurse serves in a leadership role for health
policies and programs.
7. The school nurse serves as a liaison between school
personnel, family, community, and health care providers.

24. 10.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 communitygroup.
 The practice focus on promotion and
restoration of health, prevention of illness and
injury and protection from environmental
hazards.

25. 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.

26. FUNCTION OF PARISH CARE
1. Spiritual care - spiritual care is the core of parish
nurse practice and central to the healing process.
2. Health counselor health counselor explain health
risk appraisal , plan for health their life style, provide
support and Guidance related acute and chronic,
actual and potential Health problems.
3.Health advocate-as an advocate, parish nurse guides
persons successfully for problem solving and care
options.
4.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.

27. PUBLIC HEALTH NURSE
• Public
strives
health
to
nurse
promote
over
prevention
treatment.
• By correcting poor health
practices and maintaining
a safe home or work
environment, patients
lower risks to their health
and require fewer visits
to health care facilities

29. 13.PRIVATE DUTY NURSE:
Private duty nurse is 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. Patients may
receive continues nursing services beyond the
scope of care available from certified home health
care agencies (CHHAS)

30. 14. HOME CARE NURSE
Home care nurse is a nurse who provides
periodic care to patients with in their home
environment as ordered by the physician. It
includes health Maintenance, education, illness
prevention, diagnosis and treatment of disease.
Home care can be restorative care or acute care
depending upon the client condition.

31. 16. HOSPICE NURSE:
 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.
 The nurse provides care and
support for the client and family
during the terminal phase or at the
time of death. Hospice care can be
given in patients have, a hospital,
nursing home or private hospice
facility.

32. 17. OFFICE NURSE
 Office nurse is also called as clinic
nurse. Office nurse provides
patient care along with physician
in settings such as, physician
officers, forward centers and
medical office buildings.
 The main focus is on diagnosis and
treatment of specific illness rather
than health promotion. But now the
patients enroll to have regular,
physical examination.

33. 18. CAMP NURSING
Camps are temporary small
communities and provide basic
members.
services
Camp
for their
nurses work towards
attaining a healthy camp
community.
emergency
Provides
accidents and acute
care for
care for
minor illness and injuries. Plans
to avoid spread of contagious
illnesses. Screen and eliminates
health hazards from the camp
environment. Supervise that
persons abide by health related
rules.

34. 19. VOLUNTEER NURSING
•
• Nurse volunteer to provide nursing services in
community settings. Provide volunteer service for
episodic events such as health fairs, camps, church
activities, community events and community
services projects.
Volunteer nurse have an obligation to have adequate
knowledge about actual and potential situations that
may arise. Assumes responsibility for providing
accurate health information and assures that those
served receive the care they require. Maintains
records to make additional inquiries regarding the
results of advice given.

35. 20.NURSE EPIDEMIOLOGIST
Nurse epidemiologist is also called as an
Infection control nurse who monitors standards
and procedures for the control and prevention of
infectious diseases and other conditions of
public health significance including nosocromial
infections.

36. 21. MILITARY NURSE
Military nurse is called army nurse
or armed services nurse. Military
nurse is one who provides care to
military personnel and their
families. The nurse in armed
services practices in various
specialty areas such as medical,
surgical, public health,
obstetrical, pediatrics, operating
room, recovery room, nursing
education,nursing administration
etc.

37. 22. AEROSPACE NURSE
Aerospace nurse is also called as flight
nurse. Flight nurse is a nurse who provides
comprehensive nursing care for all types
patients during aero medical evacuation and
airlift flight.

38. 23. TELE NURSE
Tele nurse is one who carries out telephonic
communication with the patient, wherein the nurse’s
primary function is to provide the patient a telephonic
response to the patient’s questions regarding his or her or
a family member’s medical care or treatment. The Tele
nurse offers telephonic assessment, evaluation, referral or
advise to patients or their family members.

39. 24.DISASTER NURSING
DEFINITION
Disaster Nursing means involves response to (and
preparedness for) natural or man-made events that
affect an entire community or communities.
(Usually) involve massive numbers of casualties
and extensive property damage.

40. FUNCTIONS
• Disaster nurse should have detailed knowledge
of first aid principles , helping victims of
physical and mental trauma
• Should have experience in therapeutic
communication skills to provide psychological
and spiritual skill during times of uncertainty
• Provide care during the time of disaster
• Take measures to prevent contagious illnesses
during and after disaster

41. FORENSIC NURSE
Forensic nurse is one who is expected to be
acquainted with the basics of forensic medicine so
as to handle and preserve the evidentiary materials.

42. ROLES OF FORENSIC NURSE
• Clinical Forensic Nurse
• Sexual Assault Nurse Examiner (SANE)
• Pediatric Forensic Nurse
• Forensic Psychiatric Nurse
• Nurse Death Investigator/Coroner
• Correctional Nurse
• Legal Nurse Consultant
• Promotes health and safety through community education.
• Applies the nursing process to death investigation
across the life span
• Collaborates with interdisciplinary agencies
• Identifies trends

43. 27. PRISON NURSE
 Prison nurse is a registered nurse who works
in a prison. Prison nurses can either be
employed directly by prison service or can
work in the other areas and spend part of
their working week in prison health care.

44. 28. NURSE EPIDEMIOLOGIST
 Nurse epidemiologist searches for new
diseases and its reporting and taking part
in health programs.
FUNCTION  Administration of
general and specific
health surveys.
 Participation in early
diagnosis and treatment
Identification and
treatment of certain
specific diseases.
 Health education

45. - Nurseepidemiologistsearches for new diseases and its reporting and
taking part in health programs.

46. CRITICAL CARE NURSE-
- Qualification of critical care nurses are basic b sc
,degree or diploma in nursing and advanced
preparation in critical care nursing .
Functions
Hemodialysis and surgical procedures.
Manages patients total care.
Performs defibrillation.

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

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

49. 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.
.

50. 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.

51. 33.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.

52. 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.

53. BASIC REQUIREMENTS
• Basic nursing education
• Registered nurse
• Advance nursing certification
(Master degree in any specialization)
• Collaboration with any hospital for
referral and reimbursement

54. AREA OF PRACTICE
• Community clinics and health
centres
• Nurse – managed centres
• Home Health Care Agencies
Home Nursing
• Hospital and hospital clinics
• Hospice centres
• Nursing home
• Accident and injury/ trauma
centres

55. CONTD…
• School or college based
health clinics
• Geriatric Homes
• Ambulatory Clinics
• Midwifery Centres
• Rehabilitation Centres
• Day care dialysis unit
• First referral units

56. NURSE PRACTITIONER PROGRAMME
IN INDIA
• Indian nursing council has
developed a new nursing
course Independent Nurse
Practitioner
• 18 month post basic
diploma in midwifery to
impart all midwifery skills
to handle obstetric
emergencies

57. 1. ADVANCE PRACTICE NURSE
Advanced practice nurse is generally the most
independent functioning nurse. An advanced
practice nurse (APN) has a master’s degree in
nursing, advanced education in pharmacology
and physical assessment, and certification and
expertise in specialized are of practice.

58. 2 ) CLINICAL NURSE SPECIALIST
The clinical nurse specialist is an
advanced nurse practitioner with nursing
expertise in a specialized area of practice. An
educational prerequisite is a master’s degree
in nursing. Clinical nurse specializes in areas
such as medical-surgical nursing, psychiatric
and mental health nursing, pediatric nursing,
community health nursing.

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

60. NURSE PRACTITIONER
The nurse practitioner can be authorized to perform the
following expanded role-related functions:
• Make health assessment
• Order laboratory tests
• Identify health problems
• Diagnose minor ailments and common diseases of a
recurrent type
• Initiate, continue or discontinue treatments or refer clients
of a secondary level of health care
• Prescribe medicines(within approval of higher authorities)
• Manage the care of patients
• Maintain appropriate record

61. THE ACUTE CARE NURSE
PRACTITIONER

62. THE ACUTE CARE NURSE PRACTITIONER
• These practitioners are specially educated to deal with
advance level of nursing care for patient suffering from
critical, acute as well as chronic nature of ailments.
• It is developed in 1995 to meet the increasing need for an
APN to function in the absence of a physician or house
staff physician.
Primary responsibilities:
• The acute care nurse practitioner primarily takes care of
patients who have chronic, acute and critical illness.
• Typical environment where such nurses operate include
sub acute and acute hospital departments such as burn
unit, intensive care unit, emergency department, dialysis,
trauma units etc.

63. ii) Adult Nurse Practitioner:
Adult nurse practitioner provides primary
ambulatory care to adults with a no emergent
acute and chronic illness and in some settings
tertiary care. Adult nurse practitioners work
collaboratively with one or more primary care
physicians.

64. iii) Family Nurse Practitioner
Family nurse practitioner provides
primary ambulatory care for
families, usually in collaboration
with a family care physician.

65. iv) Pediatric Nurse
Practitioner
Pediatric nurse practitioner provides
health care to infants and children.
Pediatric nurse practitioners practice
in hospital, ambulatory care, and
emergency care and in physician’s
offices.

66. v) Women’s Health Nurse
Practitioner
Women’s health nurse practitioner
provides primary ambulatory care to
women seeking obstetrical or
gynecological health care.

67. vi) Geriatric Nurse Practitioner:
Geriatric nurse practitioner is an adult nurse
practitioner with specialization in care of the
older adult. Geriatric nurse practitioners are
trained in the special needs of the aging
adult, with emphasis in health promotion,
health maintenance and functional status.

68. c) CERTIFIED REGISTERED NURSE
ANESTHETIST
 Certified registered nurse
anesthetist is an registered
nurse who has received
advanced training in an
accredited program in
anesthesiology.
Nurse anesthetists provide
surgical anesthesia under the
guidance and supervision of an
anesthesiologist

69. d) CERTIFIED NURSE-MIDEWIFE:
Certified nurse midwife is an registered
nurse 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 of the newborn.

70. e) NURSE GENERALIST:
Nurse generalist specializes in 11 areas of
practice such as general nursing practice,
medical- surgical nursing, geriatric nursing,
pediatric nursing, perinatal nursing, college of
nursing, school nursing, community health
nursing, psychiatric and mental health nursing,
nursing continuing education and staff
development and home health nursing.

71. 2. NURSE EDUCATOR:
 Nurse educator works primarily in schools of
nursing, staff development departments of
health care agencies and client education
departments. Nursing educators need
experience in clinical practice to provide them
with practical skills and theoretical knowledge.

72. 3.NURSING ADMINISTRATOR
Nurse administrator manages client care and
the delivery of specific nursing services
within a health care agency. Nursing
administrator begins with positions such as
the charge nurse or assistant nurse manager,
then nurse manager of a specific patient care
area. Later to an upper-management position
such as assistant or associate director or
director of nursing services.

73. 4.NURSE RESEARCHER
The nurse researcher investigates problems
to improve nursing care and to further
define and expand the scope of nursing
practice. The nurse researcher may be
employed in an academic setting, hospital,
or independent professional or community
service agency. The minimal educational
requirement is a doctoral degree, with at
least a master’s degree in nursing.

74.  Specialization is gaining momentum in
health and medical science.
 The need for nursing experts to utilize
their expertise for care of the patient.
 It enhances clinical decision skills.
 It provides great challenges and
opportunities for nurses.
 It provides expert knowledge and high
level of job satisfaction.
 It provides variety of services for patient
of all age groups which may be part of
hospital or community.

75. NURSE ENTERPREUNERS
“One who creates innovation within the healthcare
organization through the introduction of a new product, a
different service, or simply a new way of doing
something” Manion (1990) .
They can build on their nursing knowledge to develop
medical devices or computerized systems for delivering
healthcare, freeing staff nurses to spend more time caring
for patients.
• FUNCTIONS
1.Leadership 2.Networking
3.Marketing 4.Business
5. Self managed development

76. 8 OPERATION 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.

77. 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.
Most nurses enjoy travel nursing for 3
reasons.
1. visiting many different locations
2. free benefits
3. higher salary with bonous.

78. 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.

79. 11) 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.

80. 12 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.

81. HOSPICE NURSE-
 The focus of hospice care is a comprehensive
physical, psychosocial emotional, and spiritual
care to terminally ill person and their families.
Hospice 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.

82. 14 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.

83. 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.

84. 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.

85. 17 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.

86. 18.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.

87. 19 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 trnds in health care.

88. 20 ETHICIST-
- A nurse who knows about legal/moral/ethical issues and
provides services for patientand 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.

89. VETERINARY NURSE
 Veterinary nursing is the support care of
animals receiving treatment within a
veterinary practice .
 A veterinary nurse works as a member of
veterinary team ,providing expert nursing
care for sick animals.
 Veterinary nurse also play a significant
role in educating owners on maintaining
the health of heir pets.

90. 1. RESEARCH INPUT
Expanded role of the registered nurse : studying nurses
perceptions.
BACKGROUND:
The role of advanced nurse practitioner in emergency care has
emerged in a number of countries, and has brought with it
confusion about titles, role boundaries, clinical accountability and
educational requirements. Initially, the role resulted from a need
for healthcare professionals to provide a service to the increased
numbers of patients presenting to hospital with less urgent
problems. Since then, the service has evolved to one where nurse
practitioners provide high- quality and cost-effective care to
persons who seek help for non- urgent, urgent or emergent
conditions in a variety of emergency care settings. However, little
research could be identified on the attitudes of relevant nursing
and medical staff towards the development of this role.

91. METHODS
A mixed method of self –administered
questionnaires and face to face interview was used
on a volunteer convenience samples of 70
registered nurses working is an acute medical unit
survey was carried out. Thirty of the 70
questionnaires (43) per cent were returned .this is
higher than expected 25-30 per cen response rate
and reflects practioner intrest in the subject of 30
respondents , two came forward for the follow up
(face to face) interview phases of the study.

92. DISCUSSIONS
An overall response considerable dissatisfaction
was demonstrated in the appearent confusion
still existing in the minds of both nurses and
other health care proffesionals regarding
expanded role issue . There was no
acknowledgement that an increase in nurses
expanded role activities provides opportunities
themselves to review the activities in which
they participate.

93. CONCLUSION
Nursing practice has been changed from the
traditional role. Nursing practice trends include
a growing variety of employment settings in
which nurses have greater independence,
autonomy and respect as members of the
health care team. Nursing roles continue to
expand and develop, broadening the focus of
nursing care and providing a more holistic and
all-encompassing domain.

94. SUMMARIZATION
• Definitions
• Professional Responsibilities and Roles of The Nurses
• Need for expanded and extended roles
• Expanded role of nurse
• Factors influencing expanded role in nursing
• Extended role of nurse
• Extended care as spectrum of services
• Guidelines to avoid legal implications while performing
advanced roles
• Challenges in implementing ANP in India
• Conclusion

95. BIBLIOGRAPHY
1. Potter Patricia A. Perry Anne G.”Fundamentals of nursing”
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