INTRODUCTION

Nursing possess a rich history characterized by compassion, dedication and service.

Rapid changes are occurring in the health care system. Not so long ago describing the role of
RNs was simple because there were few opportunities for variation. Today exploring job
opportunities for RNs is more complicated as nurses are practicing in literally hundreds of
diverse setting with a broad variety of clients although often uncomfortable change is
inevitable and should be embraced. It is time for nursing to question and redefine its role
within the system and takes steps to bring about the future that nursing prefers to achieve. We
have to reassess our current situation in preparations for the challenges for the future.

DEFINITION OF NURSING

The word ‘Nurse’ originated from the Latin word ‘Nutrise’ meaning ‘To Nourish’.

According to Virginia Henderson (1955), Nursing is the unique function of the nurse i.e. to
assist the individual sick or well in the performance of those activities contributing to health
or its recovery (or to peaceful death) that the would perform unaided if he had the necessary
strength will or knowledge and to do this in such a way as to help him gain independence as
rapidly as possible.

Historical development of nursing education in India

 In1871, the government general hospital, madras undertook a plan to train nurse’s
.Training for midwife was given for six months with supervised nursing practice.

 In 1981, first lady health visitor course was started in lady health school Mumbai.

 Later diploma in general nursing and midwifery course was started with 3 years 9
months and later condensed to 3 years duration.

 In 1946, 4 year basic nursing training programme started at RAK College, New Delhi
and CMC Vellore.

 In 1953, post basic degree programme was started in Trivandrum.

  In 1959, the master’s programme in nursing was started at RAK College of nursing
New Delhi.

 In 1986.M Phil at RAK College of nursing, New Delhi was started.

 In 1991, the first doctoral programme in nursing was established in institute of

nursing science, MV Shetty Memorial College, Mangalore.

EDUCATIONAL PREPARATIONS FOR NURSES

The nursing council act came into existence in 1948 to constitute a council of nurses
who would safeguard the quality of nursing education in the country. The mandate was to
establish and maintain uniform standards of nursing education. Today, the India nursing
council is a statutory body that regulates nursing education in the country through
prescription, inspection, examination, certification and maintaining its stand for a uniform
syllabus at each level of nursing education they have also ensured easier measures for
equivalence, exchange and practice for nurses in any part of the country. On the other hand,
the strive for maintenance of a uniform standard and pattern of nursing education has curbed
creative development and experiments for expansion of nursing into newer horizons of caring
and function.

There are six levels of nursing education in India today. They are:

1. Multipurpose health worker female training (ANM or MPHW-F).

2. Female health supervisor training (HV or MPHS-F).

3. General nursing and midwifery (GNM).

4. BSc (N)

5. MSc (N)

6. M Phil and Ph D.

The first 3 MPHW (f) training, female health supervisor training and general nursing
are conducted in schools of nursing. The last 3 are university level courses and examinations
are conductive by the respective universities. Besides, there are several certificate and
diploma courses in specialties.

Government and changing trends and advancements in education, nursing, health

services and medical technology. The latest version of the general nursing syllabus by the
INC in 1988 has reduced the duration of the course form three and half years to three years.
The basic entrance qualification has become intermediate or class XII instead of the earlier
10th class. Both science and arts students are eligible. The focus of general education is care
of the sick in the hospital. Schools of nursing are therefore usually attached to teaching
hospital. Three board examinations are conducted, one at the end of the each year. On
passing, the candidates are registered as nursing (RM) and as midwives (RM) by the
respective state nursing councils.

Graduate Nursing Education

There are two types of graduate nursing education in India – one is of 4 year basic course
for fresh entrants and the second is a condensed post basic course for those who have
undergone the GNM course.

a. Four Year BSc (N)

Graduate Nursing education started in India in the year 1946 in CMC, vellore and in the
RAK college of nursing at Delhi University. At present several universities in India offer the
course. The entry qualification is intermediate with biological sciences, physics, and
chemistry. Some universities also give admission to those who have arts background.

The courses focuses on preparation of professional nurses for working at the beside
and for tacking up leadership roles in public health nursing. Besides nursing and medical
subjects the syllabus includes humanities, arts and allied sciences. The course also includes
managerial and teaching subjects to prepare graduates to take up first level teaching and
administrate jobs in the hospital. An introductory course in research is also given. Overall,
the graduate nursing course in the country sciences offers a board base in both arts and
sciences and lays the foundation for a holistic perspective to health and caring.
Two – year Post – basic BSc (N)

A 2 - year degree courses in nursing is offered in several uni9vesities in India. This

course was specially designed to provide higher educational opportunities for practicing
nurses. The entry requirement is that they should have completed the general nursing course
and class XII (usually with science). Most places also ask to at least 2 years experience after
completing diploma (GNM) course. Two exams are conducted by the university – one at the
end of the year, and the other at the end of the 2nd year.

b. Degree in Nursing through Distance Education.

Distance education in Post- basic nursing has also been started by Indira Gandhi
National Open University (IGNOU) in 1994. This has provided an opening for diploma
nurses all over the country to undertake higher education. The IGNOU offers courses through
its study centers throughout the country.

Postgraduate Nursing Education

Msc (N) course in is presently being offered in about ten universities in the country.
The 2-year course is designed to prepare clinical and community health nursing specialists.
Besides clinical specialization the students are also taught to conduct research in nursing. A
thesis is submitted by each student in partial fulfilment of the requirements for the degree.
Courses in education and administration are given to prepare the students to take up
responsible administrative and teaching jobs in nursing and allied health areas. The entrance
requirement is B.Sc (N) and 2 years experience as nurses. The candidates also have to pass an
entrance test. University exams are conducted at the end of the first and second years or at the
end of each seminar.

M Phill and PhD Programmes in Nursing

Till a few years ago nurses had to travel abroad to study PhD courses or seek
admission in allied disciplines. In the 80s RAK college of Nursing started and M Phill
programme as a regular and part time courses. Since then several universities started
registering candidates for PhD in Nursing. Prominent among these are MGR Medical
University, Ragiv Gandhi University of Health Sciences, SNDT University and Delhi
University. The Manipal Academy of Higher Education (MAHE) has started both MPhill and
PhD Programmes in Nursing. The INC has recently initiated a project on starting a PhD
programme in nursing through support from the WHO.

However, nurses keen to obtain doctorate degrees continue to seek admission into
universities and department with related disciplines such as community health, nutrition,
social sciences. The Jawaharlal Nehru University at New Delhi, the padmavathi Mahila
University, Thrupathi, the centre for development studies, Trivandrum and the centre for
Economics and Social sciences, Hyderabad are some of the universities and institutes where
nurses seek to obtain higher degrees.

CONTINUING EDUCATION IN NURSING

INTRODUCTION

The concept of continuing education is growing up very fast in nursing services.

Literature says nursing was the forerunner in offering continuing education for staff
development in foreign countries. This resulted in high standard of nursing service and
nursing education. Nursing is not merely confined to the traditional role of attending to the
sanitation of the ward or looking after the different needs of the patients. Today the expended
role nurses calls for intelligent assessment of the nursing needs, planning for intervention and
implementation of these interventions to meet the assessed needs and evaluation of these
interventions. Maintenance of accurate records and reports in imparting health education to
the patients are also the nurses responsibilities. The impetus for continuing education within
the discipline of nursing has resulted from nursing’s desire for continuous growth and
development. Every developing profession demands constant educational and information
renewal.

DEFINITION

Continuing education (CE) for health professionals can be defined as processes aimed
at improving health care outcomes through learning, either by individual efforts or as part of
activities, products and services developed by the employers, professional bodies or CE
Provider units.

Continuing education is “any extension of opportunities for reading, study and

training to any person and adults following their completion of or withdrawal from full time
school and college programs”, i.e. continuing education means all education that take place
beyond basic nursing school or college. It is there education for adults provided by specific
schools, centres, colleges or institutions that emphasizes flexible rather then traditional or
academic programs. It is often on part time basis, voluntarily, purpose self efforts towards the
self development of the individual by public or private agencies. Continuing education is
planned activity directed towards meeting the learning needs of the nurse following basic
nursing education, exclusive of formal post basic education. Continuing education is a part of
life long education and made mandatory under staff development programs.

Development of Continuing Education

Continuing education is the link from the basis preparation to advancement in one’s
career. CE not only upgrades professional information, but it can also be a great source of
rejuvenation and inspiration. In 1960’ s the United sates saw a movement towards continuing
education in health professional that had the nursing world debating whether CE was really
necessary and if it was: should it be mandatory for relic ensure. Now, it has made mandatory
to undergo CEs in their specialty areas in U.S. and many other countries.

In India Government institutions have made it mandatory the staff to undergo regular
staff development programs which include orientation, in-service and continuing education.
Continuing education is more a part of police matter then an in-service program. Now, central
Government implements the scheme ‘Nurse Training - continuing education for nursing
personnel’ which proposes updating knowledge of tutors. India several institutions are
offering continuing education programs in specialties like, critical care nursing, surgical
nursing, cancer nursing, neurological nursing etc. established hospitals adopt the policy of
recruiting staff who have continuing education certification for speciality areas. But unlike,
U.S, these certification programs are not accredited by the nursing councils.

Need for Continuing Education in Nursing

The need for continuing education comes from the phenomena of change.
Professional roles are altered as society changes and as knew knowledge and technology
emerge. The individual who wishes to avoid obsolesce cannot leave to chance his acquisition
of new knowledge or his ability to adopt to changing demands. If nursing profession is to
respond effectively to the challenge of developing wise leadership and competent
practitioners current social changes must be accepted and future ones foreseen. There are
forces within the nursing profession as well as in the larger society, which highlight the need
for planned programs of continuing education the delivery of healthcare depends to varying
degrees on three major sources of input-the pat lent the health care system or care setting and
the health care professional. Competence and performance of health care professional and of
the pat lent, in conjunction with the condition and performance of the care system,
collectively determine the outcome of the intervention (health care).

Purposes

 Leads to improved professional practice

 Aids in updating knowledge and skills at all levels of the organization.

 Keeps abreast of the latest trends and developments in techniques

 Equips with knowledge or current research and development

 Helps in learning new knowledge and maintain old competencies

 Develops interest and job satisfaction amongst the staff

 Develops sense of responsibilities for being competent and knowledge

 Creates supportive environment with opportunities for growth and communication

 Helps in adjusting to change

 Aids in developing leadership skills, motivation and better attitudes

 Encourage in achieving self development and self confidence

Forms of Continuing Education Programs

Continuing education programs can be formal and inservice or out side the organization.
In the United States it if mandatory for all Registered Nurses to undergo CEs in specific areas
for getting relicesure. But in India, it is not made mandatory to undergo CEs for registration.
Journal clubs, ward libraries

The most challenging aspect of continuing education is the need to foster innovative and
creative approaches to nursing care of patients. Its purpose is to achieve more and effective
behaviour in nursing practice to improve the patient care. At the others side of the coin, it
brings out the potentials of this staff and helps in deciding which persons are able to assume
more responsibility in their respective jobs according to the levels at which they function.
The content may be developed on the basic of:

1. Contents on the clinical areas like neonatal nursing, paediatric nursing, mental health
nursing, cardiopulmonary nursing, surgical nursing etc.

2. Level of group of nurses like graduates, under graduates etc.

3. Designations like staff nurses, nurse’s sister’s etc. experience like a new graduate or
nurses with three year experience in specific area so on. Steps in CE program
development

In order to increase the probability that CE programs have an impact on professional

competence performance the following steps are helpful:

1. Identify problems that focus on healthcare

2. Analyze needs or problems to determine if there is a potential educational solution

3. Identify potential facilitators of and barriers to the learning process

4. Selection educational needs based on a priority system

5. State educational goals and objectives for the selected needs

6. Select or design a learning experience to meet the goals and objectives

7. Implement the learning experience

8. Evaluate the extent to which learners achieved objectives

9. Determine the extent to which the original problems a has been reduced

10. identify any additional tasks necessary to meet the need based bon evaluation data
Need Assessment Related to Continuing Education to Patient Care

Need assessment is a critical part of a systematic approach to developing educational

projects. With in the organization. The approach to needs assessment in continuing for the
health professing is systematic process based on a carefully developed plan. The plan calls
for describing the purpose of the needs assessment activity, the uses of the findings, the
issues that will be examined and specification of the resources required. The purpose of needs
assessment is to determine better the nature, extent and priority of educational needs to
develop continuing educational programs that address the needs of the learners within the
limited resources. No matter the size or setting of continuing education design process must
be based on learning theory and the principles of adult learning.

Methods of delivery

The method of delivery of continuing education can include traditional type of classroom
lectures and laboratories. However, much continuing education makes heavy use of distance
learning, which not only includes independent study, but which can include videotaped/CD-
ROM material, broadcast programming and online/Internet delivery. In addition to
independent study, the use of conference- type group study, which can include study
networks (which can, in many instances, meet together online) as well as different types of
seminars/workshops, can be used to facilitate learning. A combination of traditional, distance
conference-type study, or two of these three types, may be used for a particular continuing
education course or program.

Philosophy of Continuing Education

It is believed that the system of higher education which provides the basic preparation for
he members of a profession must also provide opportunities for practitioners to keep abreast
of advances in their field. Adult learners must be encouraged to update regularly the obsolete
and the desire for constant renewal, and reassured that there are many interesting ways to
accomplish this goal.

Planning Continuing Education Programs

The learning needs of the adults are far different from the needs of the children
experiential learning that makes them independent and responsible for their own learning
needs. A systematic approach is necessary to provide quality continuing education activities
and services. Planning for continuing education programs follow the familiar medical model
for patient care, which includes diagnosis, treatment planning, treatment implementation and
follow-up. Planning continuing education begins with an identification of needs, followed by
setting objectives, setting educational activities, and evaluation. Congruence must be
established among needs, objectives, implementation and evaluation.

The following points must be considered when planning CEs:

 most individuals are motivated to continue their learning beyond professional

education

 participation in continuing education is strongly influenced by individual’s past

experience

 continuing education should support health professionals nature desire to learn

 Health professionals should be encouraged to accept the personal responsibility for

learning.

 CEs must be planned according to adult learning principles

Evaluating CE Activities

Continuing education programs are evaluated by the providing units. The issues
related to continuing education evaluation are:

1. Is there some logical relationship between the planned educational project and the
identified needs of participant in relation to their practice responsibilities?

2. What evidence is there that the program actually attended to the learning needs of
participants?

3. What evidence is there the clients perceived the intended relationship between the
project and their learning needs?

4. Are the project’s goals and objectives stated appropriately?

5. What evidence in there that the goals and objectives of the project have between
achieved?

6. Are the selection orientation and motivation of the faculty effective?

7. Did the faculty demonstrate appropriate instructional and interpersonal skills in

conducting the activities?

8. Did the practice nurse who attended the project have the background and experience
that were anticipated the project was planned?

9. Did any side effects occur as a result of the project?

10. Are the planned activities based on the logic and on the principles and generalizations
of management and education psychology?

11. Did the intended instructional activity operates as planned?

12. What evidence is there that rationale for deigning and implementing the project was
appropriate?

13. Are the planned physical facilities appropriate?

14. Do the instructional materials meet accepted criteria and standards of the art and
science of the of instructional materials development?

15. Were the instructional materials were used as planned?

16. What was the impact of the evaluation/

17. Is the project cost – effective?

 EXTENDED AND EXPANDED ROLE OF NURSE

DEFINITION

Extended Role:

Extended side nursing is one which a nurse assumes extended responsibility outside
the usual practice area (ie the hospital) with autonomy.

- Beare quantlett patside 1944

Expanded Role:

It is one in which a nurse assumes a expended (or) increased responsibilities in a

practice area or in most case practices with greater acodomy.

- Bease goastleft postricia 1944

EXPANDED ROLE OF NURSING

There is now a worldwide trend to extend the scope of nursing practice. Nursing
functions are being expended in both developed and developing countries.

IN THE HOSPITAL

General case units of the hospital by retaining clinical role with provision for
promotion within the clinical area.

Specialty unit of the hospital by assuming additional responsibilities.

IN THE COMMUNITY

To meet the health care needs of specific groups. Eg school health nursing, material
and child health nursing for mothers and chicken.

To function in as area of specialization for enhancing quality of case.

Eg: epidemiology dieter relief.

EXPANDED CAREER ROLES

To meet the changing health case needs of the people three categories of nurses are
defined for the expanded role.

 Nurse Practitioners

 Nurse Clinician

 Nurse specialist

NURSE PRACTIONER

Nurse practitioners are registered are registered nurse with additional skills in
physical diagnosis, psychosocial assessment and management of health illness needs in
primary case.

Role of Nurse Practitioner in Expanded nursing

 The nurse practitioners is a primary health care provider who can deliver a package
of preventive curative and rehabilitative services to a community group.
 The nurse practitioners assumes additional medical responsibilities for diagnosis and
treatment of minor aliments.
 Clients served by a nurse practitioners are generally in the ambulatory case category.
Ambulatory care refers to the type of case that can be provided without admission to
in patient or acute case units of a hospital or health case facility.
 Practice settings for the more practitioners may very
 She can fiction in the community, home, clinic, health centre, act patient department,
school or factory.
 Prescribe medicines (which may have to be authorized within a frame work of
standing orders approved by the health authorities on essential drugs)
 Maintain appropriate records
 The nurse practitioners usually serve as a primary health care provider.
Eg: second children, mothers and infants.
NURSE CLINICIANS

The term nurse clinician was first leaned by Reiter in the 1960’s. She described the
nurse clinician as a master practitioners who compliant in case and knowledgeable about
care.

The nurse clinician would be equally concerned about care and cure.

(a) CLINICIAN

Care Functions

It include basic and technical nursing case based on the needs of the patient.

These functions would encompass palliative case, physical case and protective care.

Core functions

It include three activities directly related to medical care, therapeutic regions and
overall clinical nursing management of patients.

Counseling functions

It include psychological case teaching patients and families providing guidance in

matters related to health.

(b) LEADER

She would direct supervise and organize the clinical nursing learn and participate as a
case provides.

(c) CO-ORDINATOR

She would co-ordinate the work of the clinical nursing team and in addition carry out
the role of a co-ordinate of patient, therapeutic segment and professional services.

(d) TEACHER

The would assume educational responsibilities for clinical teaching of students and
skill by means of inservice education in clinical area.
(e) ROLE MODEL

She should serve as a role model to students and stuff by demonstrating nursing care
of high quality.

(f) RESEARCHER

She would be responsible for advancement of knowledge in her clinical area, she
would need to be able to conduct researcher, for the improvement of nursing practice,
publication of papers, conducting test, trials and systematic studies.

3. NURSE SPECIALIST

The nurse specialist on impact practitioner in a specific branch of nursing with

advanced knowledge, high degree of skills and extensive experience in the care of clients or
patients in the specialty concerned.

The clinical nursing practice, the nurse specialist is a mater clinician with the high
level of knowledge, skills and competence in a specialized are of nursing like cardiac nursing,
cancer nursing etc.

ROLE OF NURSE SPECIALIST

PRACTITIONER

- The nurse specialist is an expert practitioner who maintains abstract contact with
client the client may be individual a family a group or a community specific health
illness problems.

- She is delivers expert nursing care and she has the competence to practice nursing a
area of specialization with authority, responsibility and autonomy.

- She is responsible for setting and maintaining nursing care standards in her specialty
area.
EDUCATOR

- The nurse specialist teacher and guide, nursing staff and students.

- She assumes major responsibilities for staff development and inservice education of
nursing personal.

- She organizer clinical meetings, seminar and conferences relevant to her specialty
area for ongoing education of stuff.

- She is adequately prepared to assume clinical teaching.

- She prepare learning material for students, stuff and clients.

- She participates in formal and informal teaching activities, she helps nursing students
and stuff to acquire clinical skills and utilize problem solving approach to nursing
practice.

RESEARCHER

The nurse specialist contributes to atonement of nursing knowledge and further

development of scientific nursing practice.

She conducts nursing research, investigation and clinical trials of improvement of

nursing care.

She also works for faulting research findings into practice.

CHANGE AGENT

 The nurse specialist initiates charges necessary for improvement of nursing are
 She is innovator, with her imputes and leadership skills.
 She has the ability to stimulate stuff and students to try out new methods and
techniques for improving efficiency.
CONSULTANT

The nurse specialist serves as a consultant nurse and other health workers alise her in
practice by marking referrals for problems which need to be handle by an expert in that
particulars field.

Eg: A nurse in a surgical ward may refer a patient to a psychiatric nurse for guidance and
advice in dealing with behavioral problems.

CO ORDINATOR

The nurse specialist co ordinates patients (or) client care to avoid fermentation of
care, a offends associated with technological advancement in the health care.

EXTENDED ROLE OF NURSING

Extended role in nursing is one is which a nurse assume extended responsibility

outside. The usual practice area (ie the hospital) with autonomy.

CAMP NURSING

Nurses who have summer months free of other commitments work in camps to assess
the health of the compute listen to their problem and counsel them, see that they have good
hours a rest (-8-9 hours at least). Reinforce the need for play and talk to relieve stress with
flexible humanistic approach.

Traditional corner options exist in acute care settings and community health and
parallel. The traditional medical specialty areas including medical and surgical nursing,
obstetrics and paediatrics nursing, and operation room nursing.
PSYCHATRIC NURSING

The first psychiatric training school in the united states began in 1882 in Belmont.

MATERIAL AND CHILD HEALTH NURSING

Nursing during child, coring and rearing phases. A nurse with RN & master level
specialization is qualified to practice.

PEDIATRIC NURSE PRACTIONER

To assess the needs of the child accurately and comprehensively to make sound
judgment to implement the appropriate action.

GERONTOLOGICAL NURSING

First organized, efforts were in 1940’s by the American geriatric society and
gerontological society care of the elderly.

REHABILITATION NURSING

The major goals of rehabilitation are to eliminate (or) reduce the disability and to
educate and assist. Patients to reach their maximum potential within the limitation of the
disability.

NURSE ANAESTHETIST

Administer anaesthesia founded in 1931 by national association of nurse Anaesthetist

and in 1953 was the accrediting body for BSC(n) in anaesthesia.

CASE MANAGER (OR) CLINICAL MANAGER

They may say management is that nurses role. But this has new emphasis on cost
containment and compels and greater case efficiency.

ADVANCED PRACTICE NURSE

The emergency nurse association 1996, support advanced practice nurse role as it
improves access to quality, cost effective, primary health care and specialist nursing care
requirement of patient with increasingly complex needs.
TELEPHONE TRIAGE ADVICE

- Emergency nurses association 1998, established telephone image programme.

- Uses experienced profession registered, nurses with specialist education.

- Has mandatory containing education for staff.

- Establishes clearly defined protocole

- Maintains continuous quality improvement program.

GENETIC NURSING

The genetic clinical nurse specialist. A master degree in nursing with specilisation in
genetics in a direct patient care role participates with medical genetics, genetic counselors,
social workers by psychologist for genetic education and genetic counseling.

ENTEROSTOMAL THERAPIST

Specifics duties of the therapist include provides emotional support, selecting,

appropriate appliances teaching the patient how to irrigate the stoma about care of the skin
and discussion about the diet.

PRIVATE DUTY NURSE

Provides invidualised bedside care to patients.

PALLIATIVE CARE NURSE / HOSPITAL

They are on call 24 hours / day and have to meet, the physical, psychological and
spiritual needs of the dying patient and their families.

CAREER OPPERTUNITIES FOR NURSES

Nursing is one of the most demanded career around the world. There is an increasing
demand for turned nurses across the world. Nurse can world in many aspect. Some of the
nurses cooks are discussed below.
NURSING SPECIALIST

 Nursing is the most diverse of all healthcare professions. Nurses practice in a wide
range of settings but generally nursing is divided depending on the needs of the
person being nursed. Nurses are held legally responsible and accountable for their
practices. The standard of care is that of prudent nurse. All over the world nursing
specialization is clearly a growing trend.
 The international council of nurses maintains that specialist can be determined based
on clients age (such as pediatric care), on the type of illness (such as psychiatric care),
on the practice settings (such as frontline care), on the nature of care (such as critical
care).
 A clinical Nurse specialist (CNS) an advanced practice nurse with a masters degree
prepared nurse who in an expert clinician in a defined area of nursing practice for a
selected client population & emphasizes diagnosis and treatment of illness, and the
delivery of evidence – based nursing interventions (with additional responsibility for
education & research). CNSs work as a expert clinician, educator, consultant,
researcher, & administrator. The CNS monitors the care & collaborates with
physicians, nurses & other members to advance their nursing practices and continuous
improvement of patient outcomes, nursing care. Three spheres of CNS practice are
overlapping and interrelated but each possess a distinctive focus.
o Patient / family
o Nursing Personnel
o System / Network organization
 Within the three domains of CNS practice, sparacinio (2005) identified seven core
competencies which are
 Direct clinical practice includes expertise in advanced assessment, implementing
nursing care, and evaluating outcomes.
 Expert coaching and guidance encompasses modeling clinical expertise while helping
nurses integrate new evidence into practice. It also means providing education or
teaching skills to patients and family.
 Collaboration focuses on multidisciplinary team building.
 Consultation involves reviewing alternative approaches and implementing planned
change.
  Research involves reviewing alternative approaches and implementing planned
change.
 Research involves interpreting and using research, evaluating practice, and
collaborating in research.
 Clinical and professional leadership involves responsibility for innovation and change
in the patient care system.
 Ethical decision – making involves influence in negotiating moral dilemmas,
allocating resources, directing patient care and access to care.

 Settings
Widely varied inpatient areas, including medical – surgical, paediatric, prenatal,
geriatric, psychiatric, rehabilitation, critical – care, and emergency / trauma, as well as
outpatient areas such as home health, community, public heath, occupational health,
and schools

 Desirable skills
Technical, human, and conceptual skills critical thinking and creative problem
solving, therapeutic communication and teaching skills, technical skill and
proficiency, teambuilding, supervision and delegating, responsibility and
accountability, flexibility, knowledge of resources, commitment to high standards and
quality care.

Critical care Nursing

Critical care nursing is that specialty within nursing that deals specifically with human
responses to life – threatening problems. A critical care nurse is a licensed professional nurse
who is responsible for ensuring that acutely and critically ill patients and their families
receive optimal care.

According to “The registered Nurse Population” study, 56.2% of all nurses work in a
hospital setting, and critical care nurses work wherever critically ill patients are found –
intensive care units, pediatric ICUs, neonatal ICUs, cardiac care units. Cardiac catheter labs,
telemetry units, progressive care units, emergency departments and recovery rooms.
Increasingly, critical care nurses work in home healthcare; manage care organizations,
nursing schools, outpatient surgery centres and clinics.

The roles of Critical Care Nurses

 Critical Care nurses are caring for patients who are more ill than ever before.
 The CNS is responsible for the identification, intervention and management of clinical
problems to improve care for patients and families.
 The provide direct patient care, including assessing, diagnosing, planning and
prescribing pharmacological and non pharmacological treatment of health problems.
 Their activities include risk appraisal, interpretation of diagnostic tests and providing
treatment.

Ambulatory Nursing

Nurses in this field provide care and support to individuals and families on a periodic basis
outside the hospital environment. These nurses put an emphasis on pain management and
patient education to keep those with chronic injuries and illnesses healthy and independent in
their home surroundings.

Practice roles: Staff nurse, clinical nurse specialist, nurse practitioner, nurse manager,
supervisor, director, executive.
Characteristics: Varied specialties to choose from, regular hours, less stress than
inpatient settings, collegial relationships.
Desirable skills: Phlebotomy, IV therapy, ECG triage and telephone advice, teaching,
communication skills, autonomy and intendance.

Neonatology Nursing

Neonatal nursing is a specialized nursing practice of caring for newborn infants up to 28 days
subsequent to birth. Thee are three different levels of working as a neonatal nurse: Level I
consist of caring for healthy newborns, Level II caring for either premature or ill newborns,
and Level III caring for newborns who cannot be treated in the other levels and are in need of
high technology to survive. It is the neonatal nurse’s choice whether they wish to work in the
Intensive Care unit (ICU) with the healthy born babies or with the ill and / or premature
babies.

Qualifications and Requirements: To become a neonatal nurse, the nurse should be

graduate (Registered Nurse) BSN (Bachelor of Science in Nursing) or MS (Masters of
Science in Nursing). Many require a three year minimum of clinical experience in a hospital
setting. It is required specifically for neonatal nurses that he or she has certification as a
Neonatal resuscitation Provider and / or certification in either Neonatal Intensive Care
Nursing or Neonatal Nurse Practitioner.

Certified Registered Nurse Anesthetist

Established in the 1800s Nurse anesthesia is recognized as the first clinical nursing specialty.
Nurse anesthesia practice developed in response to requests from surgeons seeking a solution
to the high morbidity & mortality The most famous nurse anesthetist of 19th Century, ALICE
MAGAW, mother of anesthesia worked at St. Mary’s Hospital in Rochester, was
instrumental in establishing a showcase of professional excellence in anesthesia & surgery. In
1909 the first formal educational programs preparing nurse anesthetist were established.
Nurse anesthetists are autonomous practitioners and are given a great deal of responsibility
when delivering anesthesia to patients. They provide anesthesia and anesthesia related care
on request assignment. The educational preparation occur at graduate level & curriculum
ranges from 24 to 36 month in an integrated program of academic & clinical study. All
programs require approximately 1000 hrs of hands on clinical experience.

Would & Ostomy Nursing / Enterostomal Therapy Nurse

Nurses in this field provide support and care for individuals with stomas, vascular and
pressure wounds, draining wounds, neuropathy wounds, and fistulas, and help patients
manage these conditions. Specializes in the prevention of pressure ulcers and management
and rehabilitation of patients without wounds, ostomies (colostomy, ileostomy, urostomy)
and incontinence.
Oncology Nursing

Cares for patients with the diagnosis of cancer in various settings, utilizes an empathic and
caring approach to patients whose diagnosis and treatment are often painful and life
threatening administers chemotherapy, conducts patients teaching, and manages illness – and
treatment – related symptoms.

Orthopedic Nursing

Orthopaedic nurses are professional nurses who have successfully passed their Boards of RN.
Many orthopaedipc nurses go on to complete graduate degrees, including masters and
doctorates.

Cares for the actual and potential health problems related to musculoskeletal function relies
on a holistic approach in their assessment of the impact of musculoskeletal conditions on self
– care, patient management of the environment, available patient resources, and support
systems.

Psychiatric Nursing

Nurses in this field and support the mental health of patient with acute of chronic psychiatric
needs. The art of using one’s self in therapeutic ways to assist patients to affect changes in
self – understanding and behaviour. Views individuals from a holistic perspective, taking into
account both physical and mental health needs while focusing on human behavior.

An advanced practice Psychiatric / Mental – Health Nurse Practitioners works in a primary

care facility, mental health clinic, a private practice, or in a hospital or community health
center. MHNPs evaluate and provide care for patients who have psychiatric disorders,
medical mental conditions or substance abuse problems. They are licensed to provide
emergency psychiatric service, psychosocial and physical assessment of their patients,
treatment plans, and to continually manage patient care. They may also serve as consultants
or as educators for families and staff; however, the MHNP has a greater focus on psychiatric
diagnosis, including the differential diagnosis of medical disorders with psychiatric
symptoms, and on medication treatment for psychiatric disorders.
Qualification

A nurse practitioner must obtain a least six years of college education. The individual must
take a four – year college degree, in nursing. After obtaining their Bachelor of Science in
Nursing (BSN) degree, Then, the candidate must complete a state – approved Master Degree
advanced nursing education program which includes at least 600 clinical hours.

Urologic Nursing

Urologic nurses care of patients across the lifespan, providing guidance and treatment for a
variety of urologic diseases and concerns. They work in all health care settings, resolving
acute problems and managing chronic conditions. Urologic nurses perform exams, perform
and interpret diagnostic studies (such as uro – dynamics), treat bladder dysfunction and
incontinence, provide patient education, and teach preventive care.

Pain Management Nursing

Men and women in this field are responsible for assessing, treating, and monitoring pain,
which is often referred to as the fifth vital sign. These nurses are responsible for educating
patients about the management of their pain, as well as making sure the patient is safe during
the administration of treatment. Pain management specialists are advanced practices nurses
with Masters Degrees and a Nurse practitioner Certificate. They may also have certifications
in Palliative Care of Advanced Oncology.

Trauma Nursing

Trauma nursing involves responding quickly to a wide variety of single – and multi – system
trauma involving different patient needs, ages, cultures and severity of presenting symptoms.
The trauma nurse must respond with decisiveness and clarity to unexpected events by
assessing, intervening, and stabilizing patients about whom there is minimal information.
Desirable skills

Medical / surgical, emergency, and / or critical – care experience (hands –on skills with IV
therapy, CPR, ventilators, cardiac monitoring, pain management, pre and postoperative care),
flexibility, stress management, decision making and assessment, assertiveness,
communication skills, motivation, and interpersonal skills.

Education: RN with BSN

Transplant Nursing
Men and women in this field work in the area of organ transplantation, providing support to
recipients of organs, living donor patients offering their organs for transplant, and their
families. These nurses are responsible for coordinating and administering care throughout the
transplantation process before, during and after surgery. These nurses are also instrumental in
providing education to patients and their families. Cares for recipients and living – donor
patients throughout the transplantation process from end – stage disease to preoperative to
intra – operative experience to aftercare and long – term follow up.

Certified Nurse Midwife

Nurse midwifery practice is an independent management of women’s health care, focusing

particularly on pregnancy, childbirth, the postpartum period, care of the newborn & the
family planning and gynaecologic needs of women. Nurses in this field provide care, support,
and education for female reproductive health. This field of nursing is often further specialized
into prenatal nursing and labor & Delivery Nursing. This practice occurs within health care
system that provides consultation, collaborative management, or referral as indicated by the
health status of the client.

Qualification: BSN with masters degree in midwifery.

Nursing Practitioner

A nurse practitioner (NP) is a registered nurse (RN) who has completed advanced education
(a minimum of a master’s degree or doctoral degree) and training in the diagnosis and
management of common medical conditions, including chronic illnesses. Nurse practitioners
provide a broad range of health care services. They provide some of the same care provided
by physicians and maintain close working relationships with physicians. An NP can serve as
a patient’s regular health care provider.

Permits duly educated and credentialed health care nursing professionals with autonomous
practice rights within their particular area of expertise including medication prescription
rights.

The American Academy of Nurse Practitioners defines Nurse practitioners as licensed

independent practitioners who practice in ambulatory, acute and long term care as primary
and / or specialty care providers

Nurse practitioners may work completely independently and autonomously of physicians or

in collaborative agreement with a physician.

Nurse practitioners see patients of all ages. The core philosophy of the field is individualized
care. Nurse practitioners focus on patients conditions as well as the effects of illness on the
lives of the patients and their families. NPs make prevention, wellness, and patient education
priorities. This can mean fewer prescriptions and less expensive treatments. Information
patients about their health care and encouraging them to participate in decisions are central to
the care provided by NPs. In addition to health care services, NPs conduct research and are
often active in patient advocacy activities.

Duties
1. Diagnosing, treating, evaluating and managing acute and chromic illness and
disease (e.g. diabetes, high blood pressure)
2. Obtaining medical histories and conducting physical examinations
3. Ordering, performing, and interpreting diagnostic studies (e.g., routine lab tests,
bone x-rays.
4. Prescribing physical therapy and other rehabilitation treatments
5. prescribing pharmacologic treatments and therapies for acute and chronic illness
6. Providing prenatal care and family planning services.
7. Providing well – child care , including screening and immunizations
 8. Providing primary and specialty care services, health maintenance care for adults.
9. Providing care for patients in acute and critical care settings
10. Performing minor surgeries and procedures with additional training under
supervision (dermatological biopsies, suturing, casting)
11. Counselling and educating patients on health behaviours, self – care skills, and
treatment options.

Nurse practitioners provide high – quality, cost – effective individualized care that is
comparable to the health care provided by physicians, and NP services are often covered by
insurance providers. Most NPs specialize in a particular field of medical care, and there are as
many types of NPs as there are medical specialties.

In some states, nurse practitioners function independent of physician involvement. NP’s can
open their own clinics and offices, they are required to work in collaboration with physicians
or under supervision of a physician. Practice in ambulatory, acute and long term care as
primary and / or specialty care providers.

Education, Licensing & Certification

1. Must be a registered nurse with Master’s Degree.
2. The candidate must complete a state – approved advanced training program that
usually specialized in field such as family practice, internal medicine, or women’s
health.

Practice Settings

The institutions in which they work may include, but are not limited to the following

 Community clinics, health centers, urgent care centers

 Health departments / Health maintenance organizations (HMOs)
 Home health care agencies / Hospice care
 Hospitals / Nursing homes Nurse parishioners practices / offices
 Private & public schools, universities and colleges
 Physician / private medical practices
Future Trends
To obtain full independence from physician collaboration or supervision in all
jurisdictions

Tele Nursing

Tele – nursing is a component of tele-health that occurs when nurses meet the Health
needs of clients whenever a large physical distance exists between patient and nurse, or
between any numbers of nurses. Tele-nursing may help solve increasing shortages of nurses;
to reduce distances and save travel time, and to keep patients out of hospital, using
information, communication and web-based systems. It has been defined as the delivery,
management and coordination of care and services provided via information and
telecommunication technologies.

Technologies used in tele nursing may include:

 Telephone (land lines and cell phones)

 Personal digital assistants (PDAs)
 Facsimile machines (faxes)
 Internet
 Video and audio conferencing
 Tele radiology
 Computer information systems

Applications

One of the most distinctive tele-nursing applications is home care. For example, patients who
are immobilized, or live in remote or difficult to reach places, citizens who have chronic
ailments, such as chronic obstructive pulmonary disease, diabetes, congestive heart disease,
or disabilitating diseases, such as neural degenerative diseases (Parkinson’s disease,
Alzheimer’s disease, ALS), etc., may stay at home and be “visited” and assisted regularly by
a nurse via videoconferencing, internet, videophone etc. still other applications of home care
are the care of patients in immediate post – surgical situations, the care of wounds, ostomies,
handicapped, etc. In normal home health care, one nurse is able to visit up to 5-7 patients per
day. Using tele – nursing, one nurse can “visit” 12-16 patients in the same amount of time.

Tele nursing is also used by call centres operated by managed care organizations, which are
staffed by registered nurses who act as case managers or perform patient triage, information
and counselling as a means of regulating patient access and flow and decrease the use of
emergency rooms.

Tele – nursing can also involve other activities such as patient education, nursing tele –
consultations, examination of result of medical tests, and assistance to physicians in the
implementation of medical treatment protocols.

Legal & Ethical Issues

 Accountability & Malpractice

 Confidentiality & safety of clinical data
 Interstate & Inter – country practice

Legal Nurse Consultant

A legal nurse consultant (LNC) is a registered nurse who uses expertise as a health care
provider and specialized training to consult on medical – related legal case. While the
attorney is the expert on legal issues, the LNC is the expert on nursing and the health care
system.

The legal nurse consultant acts as a specialized member of the litigation team whose
professional contributions are often critical to achieving a fair and just outcome for all
parties.
Role of LNC’s

LNCs assist attorneys in reading medical records and understanding medical terminology and
health care issues to achieve the best results for their clients.

A legal nurse consultant uses existing expertise as a health care professional to consult and
educate clients on specific medical and nursing issues in their cases.

LNCs screen cases for merit, assist with discovery conduct the existing literature and nursing
issues in their cases.

LNCs screen cases for merit, assist with discovery, conduct the existing literature and
medical research review medical records identify standards of care; prepare reports and
summaries on the extent of injury or illness create demonstrative evidence; and locate or act
as expert witnesses.

LNC’s may acquire knowledge of the legal system, however legal education is not a
prerequisite to the practice of legal nurse consulting.

Flight Nurse

Flight nursing is a specialty for nurses who desire autonomous practice & the opportunity to
use advanced clinical skills. A flight nurse is registered nurse who provides comprehensive
pre hospital and emergency or critical nursing care to all types (ages & from all backgrounds
with different health problems) of patients during aero medical evacuation aboard helicopter,
aircraft.

Qualification

Registered nurse with Emergency department / Critical care experience with

certification in advanced cardiac life support is necessary.
Duties of a Flight Nurse

 The Flight Nurse performs as a member of an aeromedial evacuation crew on

helicopters and airplanes – providing for in – flight management and nursing care for
all types of patients.

 Other responsibilities include planning and preparing for aeromedical evacuation

missions and preparing a patient care plan to facilitate patient care, comfort and
safety.

 Flight Nurses evaluate individual patients in flight needs and request appropriate
medications, supplies and equipment, providing continuing nursing care from
orgination to the destination facility.

 They act as liaisons between medical and operational aircrews and support personnel
in order to promote patient comfort and to expedite the mission, and also initiate
emergency treatment in the absence of a physician during in – flight medical
emergencies.

Nursing Researcher

Nursing research is the term used to describe the evidence used to support nursing practice.
Nurse education placed emphasis upon the use of evidence from research in order to
rationalize nursing interventions. In future courts may determine whether or not a nurse acted
reasonably based upon whether or not their intervention was supported by research. Clinical
nurse researcher should be a doctoral – prepared nurse with clinical & research experience.

Nursing researcher will be backbone for practice of evidence based nursing. Nursing research
also have the potential to contribute to the body of knowledge of other disciplines in the same
way that we have borrowed from others. Research methods most commonly used are
interview, case studies, focus groups and ethnography.
A CNR focus on the conduct or facilitation of research & should possess knowledge of
statistics, grants – man ship, evaluation research & administration. CNR is responsible for
designing studies & assisting staff nurses with understanding the implications of the agency
so that findings would be incorporated into practice. CNR provide guidance to the staff
regarding their role in the research.

Need
 Continuous growth and verifications of nursing knowledge.
 Developing new techniques of nursing intervention. Ex: Innovative methods of health
education
 Establishing scientific basis of existing nursing technique.
 Finding solutions to problems experienced in nursing care, problem concerning health
care.
 Determining effectively and efficiency of new techniques.

Tourism Nursing

Medical tourism is on the rise; however this healthcare trend raises significant issues
related to the safety and appropriateness of care. Medical tourists travel to undergo executive
health evaluations, ophthalmologic care, cosmetic dentistry and oral surgery, joint resurfacing
or replacement, cardiac surgery, organ and stem cell transplantation, gender reassignment
surgery, and in – vitro fertilization. However, traveling for the purpose of receiving
treatments, such as dental surgery, cosmetic surgery, nurses have a dual role in medical
tourism, namely to help clients find appropriate sites in which to obtain the desired care in
other countries and also to warm clients of possible risks and ethical / legal dilemmas.
Serving as a client coordinator may become a more common nursing role in medical tourism
as this phenomenon expands.

Nurse Case Manager

Nursing case management is a dynamic, clinically, business oriented and systematic

collaborative approach to provide and coordinate health care services to a defined population.
Nurse case mangers actively participate with their clients to identify and facilitate options and
services for meeting individuals health needs, with the goal of decreasing fragmentation and
duplication of care, and enhancing quality, cost effective clinical outcomes to be achieved
within a specified time frame.

Nurses are well suited to the role because the functions of case management closely follow
the framework of the nursing process assessment planning, implementation, and evaluation.

The nurse case manager coordinated arrangement to move the patient form acute care – to
rehabilitation – to home health – to independent living as determined by the patient needs.

Case management as a process broadens this framework and incorporates additional

components, such as patient identification or case selection resource identification advocacy
coordination, monitoring, and evaluation care; data collection and analysis; and
documentation of multiple outcomes, including cost, quality and client status.

Qualification: B.Sc., Nursing & preferably a master’s degree and advanced clinical and
managerial skills “professional nurses are uniquely prepared to he case managers by virtue of
their broad based education in the life, social and nursing sciences, their experience in
arranging and providing patient education, referrals, their awareness of the vital link between
health and environment, their orientation toward holistic and its promotion.

Occupational Health Nurse

Occupational health nurses work in a variety of setting mainly industry, health

services, commerce, and education. They can be employed as independent practitioners or as
part of a lager occupational health service team, often attached to a personnel department.
Knowledge of health promotion and education is desirable as well as an understanding of
health and safety issues, health screening, stress management and basic first aid.
Role
 The prevention of health problems, promotion of healthy living and working
conditions
 Understanding the effects of work on health and health at work
  Basic first aid and health screening
 Assistance in general administration maintenance and arrangement of health facilities
in the plant
 Emergency and primary treatment
 Handing of accidents and illnesses
 Assistance with pre-employment and other medical examinations
 Risk assessment and risk management
 Arranging follow up treatment
 Education and training and counseling
 Maintenance of records and statistics

Prison Nurse
Nursing in prisons is comparable to working as a practice nurse in a GP surgery but is
arguably more challenging, with higher concentrations of patients needs help for metal health
and substance misuse problems.

Parish Nurse

Parish nurse unites healthcare and the community through religious affiliation. Parish
nurse act as liaison / facilitator with church, community and hospital.
Role
 A health educator and teacher to promote health lifestyles and help people
understand the relationship between lifestyles, faith and well-being
 A personal health counsellor to help people sort out health problems and make
appropriate plans for handing them
 A communication link and support for community health resources and services, to
provide referrals and be a liaison for the church and its members
 A teacher of volunteers to recruit members and train them to carry out a range of
supportive Services
 An organizer of health support groups in the congregation with particular concerns
Hospice Nurse

Hospice nursing is a philosophy of care which focuses on the palliation of a

terminally ill patient’s symptoms. These symptoms can be physical, emotional, spiritual or
social in nature. Hospice nurse typically do not perform treatments that are meant to
diagnose or cure an illness and they do not seek to hasten death or primarily or unduly, to
extent life.

DUTIES

 Hospice nurse perform many nursing duties such as observing, assessing, and
recording symptoms and they still work closely with physicians, administer
medications and provide emotional support to maximize their quality of life rather
then focus on the quantity of life remaining.

 Treatment to reduce pain and other troubling symptoms as opposed to treatment to

cure.

 To coordinate the care of every hospice patient through an advising physician,

provide direct patient care, evaluate the patients’ conditions, and serve as the liaison
between families and physicians.

 They provides comfort to the patient i.e. freedom from physical, emotional, spiritual
and social pain.

SCOPE OF PRACTICE

A hospice nurse may work with a patient’s social worker, home-care aide (who may do
housework and provide hygienic care to a patients who is incapable of bathing and caring
for him-or herself), and physical, occupational, or speech therapist.

SETTING

Patient’s home, A hospital, Nursing home, private hospice facility.

INFECTION CONTROL NURSE

Nurses in this field identify and control infections that occur in the community or in a
hospital setting so that it is not passed to other clients or staff. They collect data and instigate
infection control and prevention measures. Specialize in identifying, controlling and
preventing outbreaks of infection in healthcare setting and the community. They also work
with childhood infections, STDs, HIV, TB and infections that occur during hospitalization.

Role

 Include the collection and analysis of infection-control data

 The planning, implementation and evaluation of infection prevention and control

measures

 The education of individuals about infection risk, prevention and control

 The development and revision of infection control policies and procedures

 The investigation of suspected outbreaks of infection

 The provision of consultation on infection risk assessment, prevention and control

strategies

Qualification

RN with BSN with knowledge of epidemiology and outstanding inter personnel skills
foster full participation in the infection assessment process.

TRANS-CULTURAL NURSE

In a society as diverse, health care cannot come in one from to fit the needs of
everyone. Culture influence on one’s interpretation of health and illness.

“Trans-cultural nursing is a body of knowledge that helps us provide culturally

relevant care. Trans-cultural nursing is both a specialty and a general practice area. A
substantive area of study and practices of individuals or groups of similar or different
cultures. It focuses on worldwide cultures and comparative cultural caring, health and nursing
phenomena. Trans-cultural nursing goal is to provide culture specific and universal nursing
care practices for the health and well-being of people or to help them face unfavourable
human conditions, illness or death in culturally meaningful ways

Forensic Nurse
 Forensic nursing may well be one of the fastest growing nursing speciatly in 20 th
century. Nurse in this field work with law enforcement officials to aid in the investigation of
crimes such as sexual assault, accidental death, abuse, and assault. They also treat the victims
of these crimes. Forensic nursing applies nursing science to public or legal proceedings in the
scientific investigation and treatment of trauma and death of victims of violence, criminal
activity and traumatic accident. Duties may include collection of clinical evidence,
determination of origin or circumstances of trauma, evaluation and alleviation of crime
victims’ injuries and rehabilitation of criminals. These nurses provide care to crime victims,
collect evidence, and offer health-care services within the prison system. Forensic nurses use
scientific knowledge in a legal setting. The early call was in cases of domestic violence. They
testify in court regarding scientific facts and opinions.

Space Nurse

These nurses provide on-the-ground monitoring and a full range of health services to
astronauts to determine if they meet health requirements. Maintain data to follow health of
astronauts throughout their lifetimes which is crucial to mission safety. Coordinate dietary
and fitness services. Coordinate a “sick call” service for astronauts to use before and after a
flight.

Nurse in Politics

Once a nurse realizes and experience the empowerment that can come from political
activities, he or she may choose to run for office. If nurse want to influence the out come of
policy formation they must be involved in politics. The nurse should be part of health care
policy. The nurse should participate in politics nor as spectators but as a gladiator. If nurses
do not become involved and employ a value laden approach to politics they have no power
over their own future and health care will suffer from their lack of participation. It is through
politics one influence the decision of other and exerts control over the situation and events.
Florence Nightingale was the consummate political nurse and understood how to influence
the British parliament to allocate funds to reform British military hospital and substantially
improved the health and sanitary conditions of the troops. Nurse is in a unique position to see
problem from a patient view point, the health care system view point and personal view
point. There are three levels of nurse in politics.
Nurse as Citizen:

She brings the perspective if health care to the voting booth, to public forum and
involvement in public activities. Ex: Budget cut to school district might involve elimination
of school nurses. At a school board meeting nurse can effectively speak about vital role that
school nurse provides to the health of children and the cost effectiveness of maintaining the
position.

Nurse as Activist:

Nurse activist can make changes by joining politically active nursing organization,
contributing money to political campaign, working in a campaign, lobbying decision makers
by providing pertinent statistical and anecdotal information

Nurse as Politician

The nurse politician desires to develop a legislation not just influence it. She can run
for an elected office, seek appointment to regulatory agency, be appointed to governing
board, use nursing expertise as front line policy, who can enhance health care profession.

The nurse politician can:

o Run for an elected office

o Seek appointment to regulatory agency

o Be appointed to Governing board in public or private sector

o Use nursing expertise as frontline policy maker who can enhance health care and
profession.

o Make change

 By joining politically active nursing organizations

 Contacting public official

 Working in a campaign
  Participating in community that needs health experts

Nurse Architect

Nurses in this strive to improve quality of care and patient safety through better deign
of hospital services, infrastructure. These nurses may also acquire degree in architecture.

Quality Management Nurse

The men and women in this field focus on improving quality of care and patient
safety through taking evidenced-based practices (fro computer information systems to
different pain management protocols) and implementing them in Hospitals, Long-Term Care
Facilities, Clinics, and Intensive Care Units. The application of the Total Quality
Management (TQM) philosophy within the health care sector would enhance the
development of nursing power, leadership and knowledge. The basic premise is to ensure that
outcomes in client care services are consistent with established standards. Quality
management nurses assess the compliance of the institution with established standards &
explore variations from established standards. Chart reviews & ongoing interaction with the
staff of agency are integral components of a quality management position.

Nurse Coordinator

Nurse in this position are responsible for the integration of the clinical &
administrative requirement. Example of coordinator position for a specialized area is the
organ donor coordinator, who coordinates procurement of organs & oversees the
transplantation program.

Geriatric Nurse / Old Age Home Nurse

Geriatrics is the branch of medicine that focuses on health care of the elderly. It aims
to promote health and to prevent and treat diseases and disabilities in older adults. The term
comes from the Greek geron meaning “old man” and iatros meaning “healer”. However
“Geriatrics” is considered by some as “Medical Gerontology”.

Geriatric Nurse Practitioner manages both chronic and acute health care needs of
older adults. With more then 50% of patients in hospitals over age 65, the men and women of
this specialty are a necessary force in taking care of older adults. These nurses have extensive
knowledge about the special care needed in rehabilitating and maintaining the mental and
physical health of the elderly.

Settings

Geriatric Nurses can work in Hospitals, Long Term Care Units, Nursing Homes,
Community care, Home Health, Outpatient Clinics. Geriatric / Geological nursing.

Skills

 Identification, screening and triage of acute episodic illnesses

 Medical management of commonly encountered acute and chronic illnesses

 Collaboration with interdisciplinary team

 Development of a knowledge base of community needs and resources available for

health promotion

 Health teaching, guidance and counselling of geriatric clients and their families

Duties

 Providing healthcare to the residents of long term care units and nursing homes

 Educating and supporting the families of elderly patients

 Assessing the patient’s ability to do routine daily tasks

 Working with patients with Dementia and other illnesses effecting the elderly

 Diagnosing and managing diseases

 Promoting good health

Community Health Nurse

Nurses in this field work in government and private agencies, clinics, and other
private settings. They focus on populations, working with individuals, group and families to
improve the overall health of communities. They educate about health care issues, disease
prevention, nutrition and childcare and also work with community leaders, teachers, parents
and physicians in community health education. Community health nursing is one of the
disciplines which operate within the context of community health to promote and protect
health of people at large. It combines knowledge and skill to achieve this goal.

Functions

The functions of a community health nurse have been classified broadly under the
following heads:

Administration:- The nurse is responsible for the day to day assignment of the nursing staff
and supervisor of these personnel. She provides direction and leadership to those whom she
supervises. She is responsible for planning, implementation and evaluation of a practical plan
of nursing administration with in the primary health centre and is associated sub centers.

Communication:- This involves ability to maintain good working relationship with members
of the health team, related agencies and the community. She is a link between the patient, the
family and the doctor. She participates in the staff and community meetings.

Nursing:- She provides comprehensive nursing care to individuals and families. This
includes family care of the pregnant women, before, at the time of and after delivery, care of
the new born, the premature, the infant, toddler, the school child, nutrition and family
planning.

Educator:- knowledge and skills of methods of individuals and group teaching, preparation
and use of simple teaching aids; training of dais and health workers; participation in student
training program, it any.

Research:- These is probably far more research relevant to nursing than nurses realize. A
good deal of knowledge derived from sociology and psychology is relevant to public health
nursing Viz., infant feeding and weaning, mother and child relation ship nursing needs and
practices in the community, utilization of the existing nursing services, job analysis of
nursing personnel in the team.

Advocate:- as an advocate she stands between the individual, family, community and various
specialized services. As an effective advocate she needs to possess certain qualities
willingness to take risk, assertiveness, communicability, resourceful. This role of nurse is
increasing because of increasing specialization. Manager:- they function as manager of
family health care school health care, community health care, any specific program or project
etc. as a manager she plans. Organizes coordinates, supervisor, guides, directs, reports and
evaluates.

Planner:- It is foremost function of community health nurse. Planner role depends upon her
role as a manager. Example: if she is a manager of family health care then she dose planning
of family health care by making health assessment setting up goals and objectives identifying
alternative actions, implementing and evaluating the care. She functions in collaboration with
other members of health team to carry out various activities of planning and implementation.

Organizer:- She organize the structure for the people to perform the task to achieve the set
objectives. Example: She decides who will do what, who will report to whom etc. she also
works as director and coordinator.

Domestic Violence Nurse

Nurse in this field work with children, adults, or the elderly. They may work in clinics
shelters for the abused, or do research to prevent domestic violence. Also known as: Violence
Nursing; Violence prevention Nursing; Child Abuse Nursing; and, Elder Abuse Nursing.
“Within the community and hospital setting, a nurse is more likely to see physical and sexual
abuse cases. This means that many times nurses learn to notice the subtle clues that the
patient is not willing to admit to, especially when the abuser accompanies the patient. Often,
nurses are the primary caregiver to these patients because the doctors are focused on injuries
and are often do not spend as much time with the patients. This makes the nurse a key not
quite right and should be encouraged to convey any concerns that they may have. Nurses
should also be on the lookout for more emotional abuse, which can be more difficult to spot.
If someone is abusing a person in anyway including verbal or emotional abuse while in the
care of the care of the nurse, it should not be let go, the victim should be given adequate care
including psychologists and social workers to help in the situation.”

Nursing Informatics

The prevalence of computers in society has made it imperative for the nurses to
integrate the use of computer into professional practice. Because it is no longer an option,
nurse must make good use of the computer technology to work toward the goal of improved
patient care and positive patient outcomes. Informatics was coined from the French word
informatique. Informatics was first defines by Germ (1983) as computer science plus
Information science. Informatics is more than just computers. It includes all aspects of
technology and science, from the theoretic to the applied. Learning how to use new tools and
building on capabilities provided by computers and related information technologies also are
impotent parts of the field of informatics.

Definition of Nursing Informatics

It is the specialty that integrates nursing science, computer science and information
science in identifying, collecting, processing and managing data and information top
support nursing practice administration, education, research and expansion of nursing
knowledge. The many components of nursing informatics are information processing,
language development, applications of the system of life cycle and human computer interface
issues.

Harsher describes several current and future role for nurses in informatics, both
traditional and non traditional, some of theses include:

 User liaison: nurse employed by the health care institution. Nurse in this role is
involved in installation of CIS and interfaces with system vendors, the users and
management of health care institution.

 Clinical system installer: Nurse works for the vendor who has developed and sold the
CIS to a health care institution. The nurse installer helps train users of the system and
trouble shoots the problem during the conversion to the new system.

 Product manager: They are responsible for constantly updating a current product and
keeping addressed of the new development in the field.

 System analyst/programmer
 Research programmer: establish nursing language, develop methods to build data
base of clinical information, determine how nurse use data information and
knowledge to give patient care, develop and implement appropriate methods to
evaluate nursing information systems and applications particularly diseases to their
effect on patient care.

Qualification: Bsc nursing, Computer Science or Degree in Nursing Informatics, on the job
training or receiving education outside of nursing.
 Students, CNs, educators, researchers and using administrators are all benefiting from
computer technology, students are using word processing programs to prepare course
assignments, accessing course assignments via internet etc. administrators plan their budget
through spreadsheet program to manage costs for sound financial management. Researchers
are collecting data via internet and then analyzing the data with statistics program. Nurses in
clinical settings retrieve patient data; document their interventions and view laboratory and
other results through electronic patient records.

Genetics nursing

A genetic nurse is a licensed professional nurse with special education and training in
genetics. They help people at or affected by diseases with genetic component achieve and
maintain health. Men and women in this field provide care to people with genetic diseases
and conditions. They’re also involved in screening, risk identification, and treatment of these
diseases, working with patients of all ages.

Functions

 Obtain a detailed medical and family history and construct a pedigree (family history
diagram)

 Assess and analyze hereditary and non hereditary disease risk factors.

 Identify potential genetic condition or genetic pre-deposition to disease.

 Provide genetic information and psychosocial support to individuals and families.

 Provide nursing care for patients and families at risk or affected by diseases with
genetics components.

 Provide genetics counseling

 Facilitate genetic testing and interpret genetic test results and lab reports.

Health policy Nurse

Nurses in this field are analysts, usually prepared at the phD level. They provide
expert analysis on the potential or current impact of health and government policies. They
may work with government policy-making bodies, think tanks, or schools,
Nurse Entrepreneur

Nurse Entrepreneur apply their skills and training toward establishing, promoting,
or consulting in business ventures in the health care industry. They can build on their nursing
knowledge to develop medical devices or computerized systems for delivering healthcare,
freeing staff nurses or spend more time caring for patients. An exciting, yet somewhat
frightening career alternative for nurses, is business ownership. Owning your own business is
a risk, but there is on better prepared professional then the nurse to take on the business
world. Nurses are often risk takers, which translates into the confidence to transfer our
expertise into new potentials for personal, financial, and professional success. Translating
nursing education, expertise and experience into a business can be simplified by applying the
nursing process. For example, here are some options for critical care nurses:

 Teach critical care nursing to others (one program might prepare nurses to obtain their
CCRN).

 Start a high- tech home care agency.

 Provide consulting services for enhancing quality and/or risk management policies and
procedures to various healthcare settings.

Example:

Linda Asta, BSN, RN is a urology nurse-entrepreneur, who has created the Asta-
Cath, a device which aids female patients with self-catheterization, and the Feminal, a
female urinal. In 1994 Linda created A+ Medical Products, to develop and market these and
other urological products. In this interview Linda answers our questions on a range of topics
including product design, FDA regulations for medical devices and the experience of running
her own company.

TRENDS IN NURSING EDUCATION

Trends mean movement in a particular direction. When we speak about trends in

nursing education, we mean a change currently taking place in nursing education and
influencing the profession as a whole .e.g. present trend in nursing education is toward a
higher level of education in the basic preparation of professional nurse.
 The knowledge of trend is important for all members of nursing profession. Planning
of nursing education and nursing services as well as controlling the direction in which the
professional moves are only possible if we are aware of current trends.

1. ENROLLMENT OF MEN AS NURSING STUDENTS.

Previously nursing was considered as a profession of females only. Less number of

males were entering this profession. But now trends is changing males are also becoming
members of this profession.

2. DIVERSIFICATION OF NURSING STUDENTS.

Students have greatly diverse in terms of age, race, gender, economic statues, and
leaning styles etc.

3. COMPUTER IN NURSING EDUCATION

Computers are used in all the fields with advanced technology. In nursing there is a
wide use of computer for different purpose. That’s why computer education is introduced in
nursing education.

4. UNIVERSITY BASED EDUCATION

Previously the GNM and ANM course were offered in schools of nursing that were
not affiliated to any university, nom B.sc and M.sc nursing courses are being offered to
nursing student in college of nursing affiliated to universities.

5. EXPANDED NURSING LITERATURE

Nursing literature has greatly expanded with new books, journals and reviews,
standards and policy statements.

6. ADVANCED NURSING COURSES.

Previously the nursing courses offered to nursing students were preparing them for
first line nursing post i.e. clinical nursing. But now the advanced nursing courses like M.sc
nursing and PhD in nursing have started which prepare nurses for the post of nursing
educator and nursing administrators.

7. ADVANCED CLINICAL NURSING EDUCATION.

 Nurses are supposed to perform different roles apart from the role of direct care
provider. Education plays important role in preparing nurses to assume the expanded role.
Their fore the advanced course, which prepare nurses for advanced post are coming up like
nurse midwifery practitioner , nurse anaesthetic , nurse specialist etc.

8. CRITICAL THINKING IN NURSING EDUCATION

Creative thinking in solving nursing problems has been introduced in nursing

education. This innovative approach has been introduced as a model for developing 21
century nurses.

9. COMMUNITY HEALTH ORIENTED NURSING EDUCATION

Previously there was more emphasis on education related to care of patient at hospital.
Now a day’s community health oriented nursing education has also been given emphasis in
curriculum of nursing education.

10. SUPRAVISED TRAINING BY NURSE EDUCATOR

Previously due to shortage of nursing teachers there was inadequate supervision of

nursing students. Now the ratio of teacher to student has improved and students are able to
get supervised training.

11. MORE EXPERIENCED TEACHING STAFF

More experienced and educated staffs is now available in nursing institutions for
teaching nursing students. This has been possible due to introduction of advanced courses in
nursing.

12. PROFICIENCY SCORING

Nursing is a profession which develop and refines the skills of student. Clinical
performance appraisal of nursing students is a tough for evaluators. The introduction of
proficiency scoring in nursing education has eased the job of nursing educators

13. RESEARCH I NURSING EDUCATION

One of the criteria for a profession is research. Nursing profession is evolving at a

rapid pace not only in service domain but also in education and research field. Nurses should
be prepared to do research so that they can gain insight into nursing problems. Research has
become a major area of curriculum of nursing education.

14. PERIODIC REVISION OF CURRICULUM

Accrediting bodies of respective countries are revising the curriculum of nursing

education for time to time, for eg.INC, in India. This is required so that the nurses can be
prepared according to changing needs of society, emerging health problems, advanced
technology used in health care facilities etc.

15. DISTANCE EDUCATION IN NURSING

Different universities all over the world have stated offering nursing courses through
distance education, for e.g. In India IGNOW has started the post basic B.sc nursing courses

16. COLLABORATION WITH FOREIGN UNIVERSITIES

Collaboration with different foreign universities has been established. The students
who have successfully completed the basic course in nursing and fulfil requirements are
sponsored to foreign universities for further education.

17. PRIVATISM IN NURING EDUCATION

A large number of nursing institutions are being established in private sector. This has
resulted in flourishing of nursing education thus strengthening of nursing profession.

18. INTEGRATION OF THEORY AND PRACTICE IN NURSING EDUCATION

Nursing is a profession which emphasizes the knowledge and skills related to patient
care. Their fore now days there is more stress on integration of theory and practice in nursing
education.

19. NURSING THEORIES IN NURSING EDUCATION

Nursing theories should be applied for providing effective nursing care to patients. So
the nurses should be equipped with knowledge of nursing theories. Nursing theories have
become an important component in curriculum for nurses

20. QUALITY ASSURANCE IN NURSING EDUCATION

 More emphasis on provision of quality education to the nursing students is also an
important trend. For achieving this, the government bodies have established the standards of
nursing education. Periodic inspections of nursing institution are also carried to see whether
the institution is provided according to these standards.

21. SELF EVALUATION

Previously the evaluation was totally the duty teachers. But now the trend is chancing,
self evaluation by students is also given emphasis, So that the students will get more insight
on his /her performance.

22. FINANCIAL ASSISTANCE FROM GOVERNMENT AND INTERNATIONAL

AGENCIES

Government agencies and international agencies have started given financial aid to
the nursing institution for promotion of nursing education, e.g. Ministry of family welfare and
W.H.O are providing fund to national institutes for organising workshops

23. ADVANCED EDUCATIONAL TECHNOLOGY

Advanced technology Medias like OHPs, slide projectors, computer models etc are
now used by nursing teacher to provide effective learning experience to students.

24. EMPHASIS ON LEGAL ASPECT OF NURSING

Consumers in today’s world have become more aware due to consumer product act.
Therefore, the nurses should be provided in-depth information about legal aspects in nursing.
Legal aspects of nursing are also included in curriculum of nurses.

25. ACCREDITATION OF NURSING INSTITUTUONS

All the nursing institutions that are coming up now a day’s need to get accreditation
from state nursing council and INC. This is required for checking that all the required
facilities for providing nursing education are being full filled.

26. SCHOLARSHIP AND AWARDS FOR STUDENTS

Scholarship and awards are given to the students who secure distinguished position at
different levels like college level, university level, state level and national level, e.g. TNAI
grant scholarship like TATA memorial scholarship fund, kapadia memorial fund etc.
 NURSING AS A PROFESSION

Genevieve and Roy Bixler, first wrote about the statues of nursing as a profession in
1945. In 1959 , they appraised nursing according to their original seven criteria, noting the
progress made in nursing as profession. The criteria are

1. A profession utilizes in its practice a well organized body of specialized knowledge,

which is on the intellectual level of the higher learning.

2. A profession constantly enlarges the body of knowledge , its use and improves its
technique of education and service by the use of scientific method.

3. A profession entrusts the education of its practitioners to institutions of higher

education.

4. A profession applies its body of knowledge in practical service which are vital to
human and social welfare.

5. A profession functions autonomously in the formation of professional policy and the

control of professional activity thereby.

6. A profession attracts individuals of intellectual and personal qualities who exalt

service above personal gain and who recognise their chosen occupation as a life work.

7. A profession strives to compensate its practitioners by providing freedom of action ,

opportunity for continuous professional growth and economic security.

PROFESSIONAL BEHAVIOURS OF NURSES

Miller (1985) states that the degree to which a nurse behaves as a professional is
reflected in following four behaviours.

1. Assess, plans, implements, and evaluate theory, research, and practice in nursing.
These behaviours are reflected in the entire nursing process.

2. Accepts, promotes, and maintains the interdependence of theory, research, and

practice. These three elements make nursing a profession and not task centred
activity.
 3. Communicate and disseminates theoretical knowledge and research findings to the
nursing community. Professionalism must be demonstrated by supporting,
counselling, and assisting other nurses.

4. Preserves and promotes the professional organisation as the major referent. Operation
under the umbrella of professional organisation differentiates a profession from an
organisation.

PROFESSIONAL NURSING ROLES

Benner (1984) organised seven domains upon which professional nursing roles are
based.

1. The helping role provides the foundation for the roles of care giver(client care),
colleague (helpful team member), and client advocate (person looking out for the
clients best interest)

2. A teaching – coaching function provides the foundation for the roles of teacher and
counsellor

3. The diagnostic and patient monitoring functions provides the foundation for the care
giver and critical thinker roles.

4. Effective management of rapidly changing situations provides the foundation for the
care giver , change agent and coordinator roles

5. Administration and monitoring of therapeutic interventions and regimens provides the

care giver role.

6. Monitoring of and ensuring the quality of health care practices provides the
coordinator and client advocator roles

7. Organizational and work role competence provides the foundation foe leader and
change agent role.
 NURSING THEORY APPLICATIONS

INTRODUCTION

In the changing world of nursing education nurses are having different roles in their
career and they need to adapt with various situations, so I am going to apply Roy’s adaptive
model.

INTRODUCTION

A. Sister Callista Roy began her nursing career in 1963 after receiving her BS in
nursing from Mount Saint Mary’s College, Los Angeles

B. In 1966, she received her MS in nursing, and in 1977, her doctorate in sociology
from the University of California, Los Angeles

C. She is a follow in the American Academy of nursing, an honorary nursing society

that elects nursing leaders annually.

D. In 1964, Roy began work on her model when professor Dorothy E. Johnson, a
behavioral model theorist, challenged her during a graduate seminar class to
develop a conceptual model for nursing

1. Roy based her model on Harry Helson’s work in psychophysics

2. She was also influenced by the ability of children to adopt to major changes,
which she observed when she worked in pediatric nursing

E. In 1968, Mount Saint Mary’s College in Los Angeles adopted Roy’s model as the
framework for its undergraduate nursing curriculum

F. In 1976, Roy published introduction to nursing : An Adoption Model

G. In 1984, after further clarification and refinement of the model through research
and testing, she published a revised version

SYSTEMS

a. General Information

1. Are a set of organized components related to form a whole; Roy considers the
recipient of care to be an open, adaptive system

2. Are greater then the sum of their parts

3. React to and interact with other systems in the environment

4. React as a whole; dysfunction in one component affects the entire system

 5. Have boundaries that are flexible and open to permit interaction with other
systems

6. Employ a feedback cycle of input, through put, and out put

b. Input

1. In Roy’s system, input is identified as STIMULI, which can come from the
environment or from within a person

2. Stimuli are classified as focal (immediately confronting the person),

contextual (all other stimuli that are present), or residual (nonspecific, such
as cultural beliefs or attitudes about illness)

3. Input also includes a person’s ADAPTATION LEVEL (the range of

stimuli to which a person can adapt easily)

4. Each person’s adaptation level is unique and constantly changing

c. Throughput

1. Throughput makes use of a person’s processes and effectors

2. Processes refer to the control mechanisms that a person uses as an adaptive

system

3. Effectors refer to the physiologic function, self –concept and role function
involved in adaptation.

d. Output

1. Output is the outcome of the system; when the system is a person, output refers
to the person’s behaviors

2. In Roy’s system, output is categorized as adaptive responses (those that do not

promote a person’s integrity) or ineffective responses (those that do not
promote goal achievement; for example, not taking amity per tensive
medication)

3. Adaptive responses are used when a person demonstrates behaviors that

achiveve the goals of survival, growth, reproduction, and mastery

4. These responses, or out put, provide feedback for the system

1. Coping Mechanisms

a. General information

1. Are the processes or behavior patterns that a person uses for self-control
 2. Can be inherited or learned

3. Are of two types: the regulator and the cognator; these two mechanisms are
subsystems of the person’s adaptive system (see the regulator and the
cognator, pages 106 and 107)

4. Must act tighter to maintain the integrity if the person as an adaptive system

b. Regulator

1. The regulator subsystem consists of input internal processes, and output

2. Input stimuli can come from the external environment or from within the
person

3. Internal processes-including chemical , neural and endocrine-transmit the

stimuli, causing output, a physiologic response

4. The regulator subsystem controls internal processes related to physiologic

needs (such as changes in heart rate during exercise)

c. Cognator

1. The cognator subsystem consists of input, internal processes, andoutput

2. It regulates self-concept, role function, and interdependence

3. The cognator subsystem controls internal processing learning from past

experience, judgment, and emotion (for example, a client with diabetes who
decides insulin intake based on symptoms of high blood glucose)

II. Adaptive modes

a. General Information

1. Are part of the internal processes and act as system effectors (see the person as
an Adaptive system)

2. Are categories of behavior to adapt to stimuli

3. Include physiologic function, self – concept, role function, and

interdependence; the regulator and the cognator act within these modes

4. Can be used to determine a person’s adaptation level; this level which is

exhibited by a person’s behavior; reflects the use of adaptive modes and
coping mechanisms

5. Can be used to identify adaptive or ineffective responses by observing a

person’s behavior in relation to the adaptive modes
b. Physiologic function

1. Involves the body’s basic needs and ways to adapt

2. Includes a person’ patterns of oxygenation nutrition, elimination, activity and

rest; skin integrity; senses; fluids and elecuolytes, and neurologic and
endocrine function

3. Is less abstract then the other three adaptive modes

c. Self –concept

1. Refers to beliefs and feeling about oneself

2. Comprises the physical self (includes sensation and body image),personal self
(includes self-consistency and self-ideal), and moral and ethical self (includes
self –observation and self –evaluation)

d. Role function

1. Involves behavior based on a person’s position in society

2. Is dependent on how a person interacts with others in a given situation

3. Can be classified as primary (age, sex), secondary ( husband, wife), or tertiary

(temporary role of a coach)

e. Interdependence

1. Involves a person’s relationship with significant others and support system

2. Strikes a balance between dependent behavior (seeking help, attention, and

affection) and independent behavior (taking initiative and obtaining
satisfaction from work)

3. Meets a person’s needs for love, nurturing and affection

FOUR CONCEPTS OF NURSING METAPARADIGM

a. person

 Here nurses are the persons. They have to adapt with situations by
adopting innate and acquired coping mechanisms to deal with
stressors.
b. Environment

 Is defined by Roy as all conditions, circumstances, and influences

surrounding and affecting the development and development and
behaviour of persons.

 Consist of internal and external environments which provide input

in the form of stimuli.

c. Health

 Is currently defined as Roy as a process of being an becoming an

integrated and whole person; health is viewed as a goal of the
persons behaviour and the person’s ability to an adaptive organism.

d. Nursing

 Uses the four adaptive modes to increase persons adaptation level

during health and illness.

 Employs activities that promote adaptive not ineffective, responses

in situations of health and illness.

Summary

Individual choose Nursing as a career and remain in the profession because of the
opportunities for personal & professional growth, supportive work environments &
compensations commensurate with roles and responsibilities. The futuristic nursing requires a
proactive conscious decision, to charge & to meet the revolutionary challenges of developing
non-traditional approach of research

Conclusion

Today we have discussed about educational preparations for nurses, continuing education,
career opportunities, trends in nursing and the professional advancement of nurses in detail.
There are various roles that the nurse can perform. We should aware of those opportunities
and will work for the up lift our profession. Hope in future nursing will have high dignity and
values.
Bibliography

Books

1. Ellis Janice rider and Hartley celia ‘nursing in today’s world’

9th edition, Lippincott Williams and welkin, page no 174-200.

2. Leddy and peppers ‘conceptual basis of professional nursing’,

6th edition, Lippincott Williams and wilkin , page no 2-20.

3. Sorenson’s and luckman ‘basic nursing’ 3 rd edition. w.b

Saunders company , page no 12-20, 383.

4. B.T Baswanthappa ‘text book of nursing education’, 2nd edition,

jaypee publications, New Delhi. Page no 7-10.

5. K. P Neeraja; ‘text book of education ‘jaypee publication, New

Delhi, page no 386-390.

Internet

1. www.google.com

2. www.wilkipedia.com

3. www.discovernursing.com

4. www.nursingspectrum.com

Journals

1. Nursing journal of India

2. Nursing outlook journal.