EXTENDED AND EXPANDED ROLES OF NURSE:

INTRODUCTION
The extended and expanded role of nurse can be described as a role, which goes beyond the
traditional nursing roles to include additional responsibilities and a wide range functions in
community and clinical care setting. In traditional role, qualified nurses were concentrated in
curative sector of health care system providing general nursing services.
In expanded role trained nurses are urged to move to community, institutional setting, research
etc. Hence extending their services to people.
DEFINITIONS
NURSING: (ICN Definition of 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.
According to American Nurses Association Nursing is “the protection, promotion &
optimization of health & abilities, prevention of illness and injury, alleviation of suffering
through the diagnosis & treatment of human response, and advocacy in the care of individuals,
families, communities & population”.
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 which she is licensed to practice.
NURSING AS A PROFESSION :
Nursing is not simply collection of skills and the nurse is not simply a person trained to perform
specific tasks. Nursing is a profession. In almost all the countries, nursing practice is defined and
governed by law, and entrance to profession is regulated at national or state level.
PROFESSION POSSESS FOLLOWING PRIMARY CHARACTERISTICS
 A profession requires an extended education of its members as well as a basic liberal
foundation.
 A profession has a theoretical body of knowledge leading to defined skills, norms and
abilities.
 A profession provides a specific service.
 Members of a profession have autonomy in decision making and practice.
 The profession as a whole has a code for practice.
EXTENDED ROLES OF THE NURSES
Definition
It is the responsibility assumed by the nurse beyond traditional functioning of the nurse and it is
the scope of nursing outside the hospital.
Extended Roles:
1. School Health Nurse
2. Clinical Nurse Specialist
3. Parish Nursing
4. Home Care Nurse
5. Hospice Nurse
6. Rehabilitation Nurse
7. Nurse Epidemiologist
8. Military Nurse
9. Aerospace Nurse
10. Tele Nurse
11. Disaster Nursing
12. Forensic Nurse
School Health Nurse:
In 1999, the National Association of School Nurses Board of Directors defined school nursing
as:
A specialized practice of professional nursing that advances the well being , academic success,
and life long achievement of students. To that end, school nurses facilitates positive student
responses to normal development; promote health and safety; intervene with actual and potential
health problems; provide case management services; and actively collaborate with others to build
student and family capacity for adaptation, self management, self advocacy and learning.
Role of the School Nurse:
• The school nurse provides direct health care to students and staff.
• The school nurse provides leadership for the provision of health services.
• The school nurse provides screening and referral for health conditions.
• The school nurse promotes a healthy school environment
• The school nurse promotes health.
• The school nurse serves in a leadership role for health policies and programs.
• The school nurse serves as a liaison between school personnel, family, community and
health care providers.
2. Clinical Nurse Specialist:
A clinical nurse specialist ( CNS) is an advanced practice nurse, with graduate preparation from
a program that prepares CNSs. CNSs are clinical experts in the diagnosis and treatment of
illness, and the delivery of evidence based nursing interventions (ANA, 2004).
Functions
 Direct the clinical practice includes expertise in advanced assessment, implementing
nursing care, and evaluating outcomes.
 Collaboration focuses on multidisciplinary team building.
3. Parish Nursing:
 Parish Nursing was introduced by Granger Westberg (mid 20th century) in Chicago.
 America Nurses association (ANA) uses the term Faith Community Nursing to define the
nursing speciality of parish nursing, also known as congregational nursing or church
nursing. ANA defines FCN as “ the specialized practice of professional nursing that
focuses on the international care of spirit as part of the process of promoting holistic
health and preventing or minimizing illness in a faith community”.
 A parish nurse is a registered nurse (RN) specialist who encourages physical and spiritual
health and wholeness by developing and leading programs within faith community.
 Parish nurses focuses on wellness, disease prevention and health promotion.
Function of Parish Nurse:
 Health education and teaching.
 Personal health counseling for faith community members.
 Coordinating with community health resources and acting as a church liaison.
 Organizing health support groups.
4. Home Care Nurse/ Home Health Nurse:
Also referred as domiciallry care or social care .Care provided in patients home. Licensed
individual who assist the individual may be referred to as “CAREGIVERS”. Care givers assist
the individual in bathing and dressing, as well as more specialized care, such as wound care,
medication management and IV therapy. The following tasks are some of the common daily
activities of a health nurse:
 Administering medications.
 Cleaning and dressing wounds.
  Monitoring patient health and needs.
 Documenting symptoms and vital signs.
 Providing encouragement and support.
 Provide health education.
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.
Function:
 Pain & symptom control.
 Spiritual Care
 Home Care and impatient Care
 Family Conferences
 Co-ordination of Care
 Bereavement Care
Nurse epidemiologist (Infection Control):
They monitor standards and procedures for the control and prevention of infectious disesease and
other conditions of public health significance including nosocomial infections. They must have
an experience as a supervisor.
Function:
 Conducts epidemiologic investigations.
 Provides education ( communicable disease)
 Provides ongoing in service training.
 Recommendations on infection control.
 Conducts study to determine risk factors leading to infection.
Disaster Nursing:
Disaster nursing means involves response to (and preparedness for) natural or man made events
that affects an entire community or communities. Usually involve massive numbers of casualties
and extensive property damage.
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
spritual skill during times of uncertainty.
 Provides care during the time of disaster.
  Takes measures to prevent contagious illness during and after disaster.
 Helps persons prepare for services during, cope with and adapt to life after disaster.
Military nursing:
 Serves the military by enlisting for active duty, reserve status or in the national guard.
 Promotes health and meet the health care needs of military personnel and their
dependence during war time and in time of peace.
 Armed force nursing officers advanced education.
Telenursing:
Uses telecommunication n and information technology in the provision of nursing services.
Exists when there is large physical distance between Patient and nurse.
Functions:
 Coordinates with relevant healthcare stakeholders.
 Utilizes IT support.
 Utilizes ‘High Risk Elderly Database and Alert System’.
 Utilizes protocols to guide nurses clinical decisions.
 Links with the clinical management system.
Forensic Nursing:
 Forensic means having to do with the law. Forensic nursing is application of the nursing
process to public or legal proceedings.
 Application of the forensic aspects of health care to the scientific investigation of trauma
and / or death related to medicolegal issues.
 One of the most important duties in forensic nursing is assisting in the physical and
emotional recovery of patients while protecting their rights. Forensic nurses help victims
and contribute their expertise to solve crime.
Role of forensic nurse:
 Clinical forensic nurse.
 Sexual assault nurse examiner.
 Pediatric forensic nurse.
 Forensic psychiatric nurse.
 Legal nurse consultant.
Occupational Health Nurse
Specialty practice that provides for and delivery of health and safety programs and services to
workers, worker population and community groups.
Function:
  Promotion and restoration of health
 Prevention of illness and injury and
 Protection from work related and environmental hazards.
Rehabilitation Nurse
A nurse who specializes in assisting persons with disabilities and chronic illness to attain optimal
function, health and adapt to an altered life style.

Expanded Roles of Nurse

THE EXPANDED ROLE OF A NURSE:
Definition:
Expanded role of nurse means enlargement of nursing within the boundaries of nursing.
Expanded role of nurse is the responsibility assumed by the nurse within the field of practice.
Core of nursing is primary practiced with a range of post qualifying specialist developments.
Expansion takes the boundary of specialist development furthest to embrace new dimensions
within the broadest concept nursing.
- Frost
Following are the Roles:
 Caregiver / care provider
 Advocate
 Educator
 Change agent
 Counselor
 Communicator
 Clinical decision maker
 Manager
 Rehabilitator
 Researcher
Caregiver / care provider:
The traditional and most essential role. Function as nurture, comfort provider. As caregiver, the
nurse helps the client regain heath through the healing process. The nurses address the holistic
health care needs of the client, including measures to restore emotional, spititual and social well
being. The caregiver helps the families and clients set goals and meet those goals with minimal
cost time and energy. Mothering actions and provides care and promote of the client.
Adovacate:
It involves concern for and actions on behalf of the client to bring about a change.
As a protector, the nurse helps maintain a safe environment for the client and takes steps to
prevent injury and protect the client from possible adverse effects of diagnostic or treatment
measures.
The nurse may also defend client’s rights in a general way by speaking out against politics or
actions that might endanger their well being or conflict with their rights.
Educator:
Nurse provides information and helps the client to learn or acquire new knowledge and technical
skills.
As an educator , the nurse must explain to the client concepts and facts about health, demonstrate
procedure such as self care activities, determine that the client fully understands, reinforce
learning or client behavior and evaluate progress in learning.
Encourage compliance with prescribed therapy.
Promote healthy lifestyle.
The nurse uses teaching methods that match the client’s capabilities and needs and incorporates
other resources, suchas the family, in teaching plans.
Change Agent:
The nurse initiates change or assists client to make modifications in themselves or in the system
of care

Counselor:
 Nurse helps client to recognize and cope with stressful psychologic or social problems; to
develop an improve interpersonal relationships and to promote personal growth.
 Provides emotional, intellectual and psychological support.
 Focuses on helping client to develop new attitude, feeling and behavior rather than
promoting intellectual growth.
 Encourages the client to look at alternative behavior, recognizes the choices and develops
a sense of control.
Communicator :
 The role of a nurse as a communicator is central to other nursing roles. Nursing involves
communication with client and families, other nurses and health care professionals,
resources persons and the community.
  Without clear communication, it is impossible to give care effectively. The quality of
communication is a critical factor in meeting the needs of individuals, families and
communities.
Clinical Decision Maker:
 As clinical decision maker, the nurse uses critical thinking skills throughout the nursing
process to provide effective care.
 Before undertaking any nursing action whether it is assessing the client’s condition ,
giving care, or evaluating the results of care, the nurse plans the action by deciding the
best approach for each client.
 The nurse makes these decisions alone or in collaboration and consults with other health
care professionals.
Manager :
 As a case manager, the nurse coordinates the activities of other members of the health
care team, such as nutritionists and physical therapists, when managing a group of
client’s care.
 A hospital or an insurance provider may employ case manager. The role of the person is
to review the care being provided to the client and assist with delays, such as testing or
making arrangements for discharge.
 The hospital based case manager may be part of the quality improvement department.
They may also coordinate for insurance and quality monitoring.
Rehabilitator :
 Rehabilitation is the process by which individuals returns to maximal levels of
functioning after illness, accidents or other disabling events.
 Frequently clients experience physical or emotional impairments that change their lives
and the nurse help as them to adapt as fully as possible.
Researcher :
 The nurse participants in identifying significant researchable problems.
 Paticipants in scientific investigation and must be a consumer of research findings.
 Must be aware of the research process, language of the research , a sensitive to issues
related to protecting the rights of human subjects.
NEED OF EXPANDED & EXTENDED ROLES
 Health is now recognized and proclaimed as fundamental right of citizen.
 The transition of health care system from disease oriented model to a health oriented
model is an emerging trend.
 Specialization is another development which has major implication for nursing practice.
 The need of nursing experts to utilize their expertise for care of the client.
 The search for increased status for nursing
  Economic upgradation.
THE EXPANDED ROLE OF NURSE
Expanded role of nursing means enlarging the sphere of nurse’s roles within the boundaries of
nursing or it is the responsibility assumed by a nurse in the field of practice autonomy.
Directions for expanded role of nurses
Outward
 Nurses are moving from the curative sector into community for supporting primary health
care.
 School health nursing services.
 Maternal and child health nursing services.
 Occupational health nursing services etc.
Inward
 Nurses are utilizing their expertise for direct care of client.
 Client may be individual or the family.
FACTORS INFLUENSING EXPANDED ROLE IN NURSING
 Health is now recognized and proclaimed as fundamental right of citizen.
 The transition of health care system from disease oriented model to a health oriented
model is an emerging trend.
 Specialization is another development which has major implication for nursing practice.
 The need of nursing experts to utilize their expertise for care the client.
 REFERENCES:
 Brar. K.N & Rawat.HC, “Textbook of Advanced Nursing Practice” Jaypee Brothers
Medical Publishers (P) Ltd. Page no: 945-951
 https://www.slideshare.net/ramanlalpatidar/extended-and-expanded-role-of-nurse
 https://www.slideshare.net/drjayeshpatidar/ppt-on-expanded-role-of-nurse
 https://www.slideshare.net/SimranKaur586/extended-and-expanded-role-of-nurse-
147516320
 https://www.slideshare.net/napnap19/expanded-role-of-nurses