CPMS COLLEGE OF NURSING

Bonda, Amgaon, Guwahati – 26

SUBJECT: CHILD HEALTH NURSING

SEMINAR

ON

IMPORTANCE OF PRENATAL CARE AND ROLE OF PEDIATRIC NURSE

SUBMITTED TO :- SUBMITTED BY :-

Ma’am Archana Das Thaudem Mayarani Devi

Associate Professor M.sc Nursing 1stYear

M.sc Nursing Child Health Nursing Child Health Nursing

CPMS College of Nursing CPMS College of Nursing

Date of presentation: 16-05-2020

 IMPORTANCE OF PRENATAL CARE AND ROLE OF PEDIATRIC NURSE

INDEX

Sl.No. CONTENT PAGE NO.

1 Introduction
2 Definition of prenatal care
3 Aims of prenatal care
4 Objectives
5 Importance of prenatal care
6 Benefits of prenatal care
7 Comprehensive program
8 Components of prenatal care
9 Prenatal visits
10 Home visits
11 Prenatal advice
12 Specific health protection
13 High-risk pregnancy
14 Role of nurse in prenatal care
15 Role of a pediatrics nurse:
A) hospital
B) community
16 Extended and expanded roles of pediatric nurse
17 Journal
18 Conclusion
19 Bibliography
IMPORTANCE OF PRENATAL CARE AND ROLE OF A PEDIATRIC
NURSE

INTRODUCTION:
One of the most important steps to giving birth to a healthy child is taking care of
yourself first. The child’s health starts with you and is heavily influenced by the medical
history, family’s health history along with a combination of a healthy diet and exercise plan.
With the help of their doctor, mothers often go on to have healthy children and a pleasant
overall experience while pregnant.

Staying healthy starts with prenatal care. For a birth mother considering placing her
baby for adoption, the adoption agency she chooses may help with gaining access to prenatal
care. Some agencies offer mother services at no cost to the mother to help keep her and the
baby healthy throughout the pregnancy.

Majority (80%) of fetal deaths occur in the antepartum period. The important causes
of deaths are:- i) Chronic fetal hypoxia (IUGR) (ii) Maternal complications e.g. diabetes,
hypertension, infection (iii) Fetal congenital malformation and (iv) Unexplained cause.
There is progressive decline in maternal deaths all over the world. Currently more interest is
focussed to evaluate the fetal health. The primary objective of antennal fetal assessment is
to avoid fetal death. As such simultaneously with good maternal care during pregnancy and
labour, the fetal health in utero should be supervised with equal vigilance.

The concept of home care combines obstetrical concerns with the concepts of primary
health care. Such midwifery care takes into account the woman’s and her family’s personal
and social circumstances, which influence the health and well-being of her and her baby.

Community midwifery is one of the functions of community health care. It aims to

promote the well-being of mothers and babies and to support sound parenting and stable
families. It is a component of the maternal and child health (MCH) program in India, which
has its specific objectives for reduction of maternal, perinatal, infant and childhood mortality
and morbidity and promotion of reproductive health.

DEFINITION OF PRENATAL CARE:

“Periodic and regular supervision including examination and advice of a women during
pregnancy is called Antenatal care”.

Prenatal care refers to the health services that receive from a trained health care provider like
physician or midwife while pregnant. Prenatal care encompasses advice and coaching, like
diet and exercise tips; education about the changes of the body that is going through,
including what to expect and how to handle it; and exams and procedures that will monitor
the baby’s progress along the way. The supervision should be of a regular and periodic nature
in accordance with the need of the individual.

AIMS:
The main aim of prenatal care is to achieve at the end of a pregnancy- a healthy mother
and a healthy baby. Ideally, this care should begin soon after conception and continue
throughout pregnancy. Some of the other aims are –

- To screen the high risk cases.

- To prevent or detect or treat at the any earliest complication.

- To ensure continued medical surveillance and prophylaxis.

- To educate the mother about the physiology of pregnancy and labour by demonstrations,
charts and diagrams so that fear is removed and psychology is improved.

- To screen out the high risk factors that affect the growth of the fetus.

- To ensure satisfactory growth and well-being of the fetus throughout pregnancy.

- To discuss with the couple about the place, time and mode of the delivery, provisionally and
care of the new-born.

- To motivate the couple about the need of family planning

- To advice the mother about breast-feeding, post-natal care and immunization.

OBJECTIVES:
- The primary objective of antennal fetal assessment is to avoid fetal death.
- To ensure a normal pregnancy with delivery of a healthy baby from a healthy mother.

- Promote, protect and maintain the health of the mother during pregnancy.

- Detect “high risk” pregnancies and give the mothers special attention.

- Foresee complications and prevent them.

- Remove anxiety and fear associated with delivery.

- Reduce maternal and infant mortality and morbidity.

- Teach mother, elements of childcare, nutrition, personal hygiene and environmental

sanitation.

- Sensitize the mother to the need for family planning.

IMPORTANCE OF PRENATAL CARE:

- To confirm pregnancy & assess the period of gestation.

- To prevent maternal & neo natal tetanus.

- To facilitate health education regarding diet, rest, avoidance of unnecessary travel &
preparation for delivery.

- To detect and treat complications at the earliest possible time.

- To ensure that the pregnant women and her fetus are in the best possible health.

- To prepare the women for labor, lactation and care of her infant.

BENEFITS OF PRENATAL CARE:

a) It facilitates screening for health and socio economic factors likely to have a negative
effect on pregnancy.
b) It offers specific treatment when an abnormal condition is identified.
c) It is education centred on what to expect in pregnancy, symptoms that may suggest
problems and preparation for childbirth.
d) It encourages women to seek skilled care at childbirth.
e) It reduces stillbirths, childbirth complications and newborn and maternal deaths.

Prenatal care is a comprehensive program which consist from:

1) Pre-conceptional care

2) Prompt diagnosis of pregnancy

3) Initial prenatal evaluation

 Pre-conceptional care: Because health during pregnancy depends on health before

pregnancy, pre-conceptional care should logically be an integral prelude to prenatal
care.

Comprehensive preconceptional care program has the potential to assist women by

reducing risks, promoting healthy lifestyles, and improving readiness for
pregnancy.

 Prompt diagnosis of pregnancy: The diagnosis of pregnancy usually begins when a

women presents with symptoms, and possibly a positive home urine pregnancy test
result.
Clinical findings and symptoms may indicate an early pregnancy:
 The abrupt cessation of menstruation in a healthy reproductive-aged woman
who previously has experienced spontaneous, cyclical, predictable menses is
highly suggestive of pregnancy. Amenorrhea is not a reliable indication of
pregnancy until 10 days or more after expected menses onset. When a second
menstrual period is missed, the probability of pregnancy is much greater.
Uterine bleeding somewhat suggestive of menstruation occurs occasionally
after conception.
 Nausea and vomiting

Nausea occurs in 80% of nulliparous and 60% of multiparous women. For

many pregnant women this is the first sign of pregnancy with the symptoms
occurring even before the first period is missed.

The nausea and vomiting usually disappears by 16 weeks gestation and

lessens in severity after about 12 weeks.

 Change in cervical mucus

Dried cervical mucus examined microscopically has characteristic patterns
dependent on the stage of the ovarian cycle and the presence or absence of
pregnancy. Mucus crystallization necessary for the production of the fern
 pattern is dependent on an increased sodium chloride concentration. Cervical
mucus is relatively rich in sodium chloride when estrogen, but not
progesterone, is being produced. Thus , from approximately the 7th to the 18th
day of the cycle, a fern like pattern is seen.
 Anatomical changes in the breasts that accompany pregnancy are
characteristic during a first pregnancy
 Change in uterus size: During the first few weeks of pregnancy, the increase in
uterine size is limited principally to the antero-posterior diameter. By 12
weeks, the body of the uterus is almost globular with an average diameter of 8
cm. At 6 to 8 weeks menstrual age, a from cervix is felt which contrasts with
the now softer fundus and compressible interposed softened isthmus – the
Hegar sign. The softening at the isthmus may be so marked that the cervix and
the body of the uterus seem to be separate organs.
 Pregnancy test
- Measurement of hCG: Detection of hCG in maternal blood and urine
provides the basis for endocrine tests of pregnancy.
Human chronic gonadotrophin (Hcg) is a glycoprotein hormone that contains
two carbohydrate side chains: alpha (a) and beta (b). The (a) subunit is
identical to that of follicle stimulating hormone (FSH), luteinizing hormone
(LH) and thyrotrophin (TSH). The (b) subunit is immunologically specific.
HCG is secreted by the trophoblast cells of the fertilized ovum and later by the
definitive placenta.
Trophoblast cells produce hCG in amounts that increase exponentially
following implantation. With a sensitive test, the hormone can be detected in
maternal plasma or urine by 8 to 9 days after ovulation.
False-positive hCG test results are rare (Braunstein, 2002). A few women
have circulating serum factors that may interact with the hCG antibody.
 Home pregnancy test: This is a test done at home where the woman urinates
on a pregnancy test kit strip. Two main sorts are available: a double band of
blue or a central spot of pink indicates a positive test while a single band of
blue or absence of a pink spot indicates a negative pregnancy test.
 Initial prenatal evaluation: Prenatal care should be initiated as soon as there is a
reasonable likelihood of pregnancy.
The major goals are to:
 Define the health status of the mother and fetus.
 Estimate a plan for continuing obstetrical care.
  Initiate a plan for continuing obstetrical care.

The three components of prenatal care are:

1) Early and continuing risk assessment.

 To reduce the risk of pregnancy complications.

Following a healthy, safe diet; getting regular exercise as advised by a healthy care
provider; and avoiding exposure to potentially harmful substances such as lead and
radiation can help reduce the risk for problems during pregnancy and ensure the
infant’s health and development. Controlling existing conditions, such as high blood
pressure and diabetes, is important to avoid serious complications in pregnancy such
as preeclampsia.
 Reduce the infant’s risk for complications.
Tobacco, smoke and alcohol use during pregnancy have been shown to increase the
risk for Sudden Infant Death Syndrome, alcohol use also increases the risk for fetal
alcohol spectrum disorders, which can cause a variety of problems such as abnormal
facial features, having a small head, poor co-ordination, poor memory, intellectual
disability, and problems with the heart, kidneys, or bones. According to one recent
study supported by the NH, these and other long-term problems can occur even with
low levels of prenatal alcohol exposure.

2) Health promotion.

Health promotion consists of providing information on proposed care, enhancing

general knowledge of pregnancy and parenting, and promoting and supporting healthful
behaviours.

3) Medical and psychological interventions and follow-up

Help ensure the medications taken are safe. Certain medications including some acne
treatments and dietary herbal supplements, are not safe o take during pregnancy. For
example:The acne medicine isotretinoin (such as Amnesteem and Claravis). This medicine is
very likely to cause birth defects also some antibiotics, likely to cause birth defects also some
antibiotics such as doxycycline and tetracycline.

Prenatal visits
Ideally, the care should begin soon after conception and continue throughout
pregnancy. A schedule to follow for the mother is to attend the antennal clinic once a month
during the first seven months, twice a month during the next months and thereafter once a
week if everything is normal. In India a large proportion of mothers are low socio-economic
group for whom attendance at the antenatal clinic may mean loss of daily wages and hence a
minimum of three visits are encouraged as below:

 First visit, as soon as the pregnancy is known or at 20th week.

 Second visit, at 32nd week.
 Third visit, at 36th week.

Further visits may be made if justified by the condition of the mother. At least one
visit should be paid in the home of the mother.

The First Prenatal Visit:

Provides the opportunity to:

 Obtain general medical history and reproductive history.

- Review outcome of previous pregnancies and assess pregnancy risk. Obtain
previous records if any abnormal outcome.
- Perform genetic history, screening for inherited illness and malformations.
- Such reproductive histories as preterm birth, low birth weight, preeclampsia,
stillbirth, congenital anomalies, and gestational diabetes are important to obtain
because of the substantial risk for recurrence.
- Women with prior caesarean delivery should be asked about the circumstances of
the delivery, and discussion about options for the mode of delivery for the current
pregnancy should be initiated.
 Conduct physical examination.
- Clinicians should be familiar with physical findings associated with normal
pregnancy, such as systolic murmurs, exaggerated splitting , and S3 during cardiac
auscultation, or spider angiomas, palmar erythema, Linea Nigra, and Striae
Gravidarum on inspection of the skin. During the breast examination, clinicians
should initiate discussion about breastfeeding.
- A pelvic examination should be performed and Pap smear status documented or
obtained, to rule out infections like chlamydia, syphilis Gonorrhoea and Bacteria
Vaginitis.
 Laboratory examination
 Complete urine analysis – A complete urine analysis will give the further
details about the health condition for the mother. Urine test during pregnancy
look for the following:
a) Diabetes – High levels of glucose (or sugar) in urine may indicate pre-
existing type 1 or type 2 diabetes or, later or in pregnancy, gestational
diabetes. Gestational diabetes is also tested for with a glucose (blood sugar)
screening between weeks 24 and 28 of pregnancy.
b) Preeclampsia – Protein in urine is sometimes a sign of preeclampsia, or
pregnancy-induced high blood pressure.
c) A urinary tract infection (UTI) – Red or white blood cells in urine may be a
sign of a UTI.
d) Dehydration – Dark, tea-coloured urine usually signals that need to drink
more water. Two common causes for preterm contractions include
dehydration and UTIs, but it is treatable.

 Stool examination – This test is done to check for a variety of possible

conditions, including:
a) Allergy or inflammation in the body, such as part of the evaluation of milk
protein allergy in infants.
b) Infection, as caused by some types of bacteria, viruses, or parasites that
invade the gastrointestinal system.
c) Digestive problems, such as the malabsorption of certain sugars, fats, or
nutrients.
d) Bleeding inside of the gastrointestinal tract.

 Complete blood count including Hbg estimation – This test is done to

determine any health issues that the pregnant mother may develop. This test
monitors the RBCs that carry oxygen throughout the body. The CBC also
determines the count of RBC, WBC And Platelets. WBC will monitor the
mother have any diseases like sickle cell anemia or leukemia. And platelets
will monitor for clotting of blood, if the count is too low, it means that the
blood will not clot soon enough and while the number being high means that
the mother is susceptible to sudden internal blood clots and haemorrhages.
For haemoglobin level it will monitor the oxygen level in the blood.

 Serological examination – This test is done to diagnose multiple illness

brucellosis, amebiasis, measles, rubella, HIV, syphilis, fungal infection.
  Blood grouping and Rh determination
 Chest X-ray, if needed
 Gonorrhoea test, if needed

On subsequent visits:
At each return visit, steps are taken to determine the well-being of mother and fetus.
Certain information is considered especially important for example assessment of gestational
age and accurate measurement of blood pressure.

Evaluate typically includes:

 Fetal
 Heart rate(s)
- The fetal heart can first be heard in most women between 16 and 19 weeks when
carefully auscultated with a standard non-amplified stethoscope. By 21 weeks,
audible fetal heart sounds were present in 95%, and by 22 weeks they were heard in
all. The fetal heart rate now ranges from 110 to 160 bpm.
 Fetal Size
- To monitor the growth of the baby.
 Amount of amniotic fluid
- The amount of amniotic fluid increases until the beginning of the third trimester. At
the peak of 34 to 36 weeks, may carry about a quart of amniotic fluid. After that, it
generally decreases until birth.
Low levels of amniotic fluid can make complications during labour more likely.
The main concern is that the fluid level will get so low that the baby’s movements or
contractions will compress the umbilical cord.
 Fetal movements
- Fetal movements should be felt 6-10 times in two hours.

 Maternal

 Blood pressure
- High blood pressure during pregnancy is defined as reading of 140/90 or higher,
even if just one of the numbers is elevated. Severe chronic hypertension is 160/110 or
higher.
  Weight
- Monitoring of weight gain is believed to prevent gestational hypertension and fetal
macrosomia. There is irrefutable evidence that maternal weight gain during
pregnancy influences birthweight.
 Symptoms – including headache, altered vision, abdominal pain, nausea and
vomiting, bleeding, vaginal fluid leakage, and dysuria.
 Laboratory tests including urine examination and haemoglobin estimation.
 Iron and folic supplementation and medication as needed.
 Immunization against tetanus.
 Height in centimeters of uterine fundus from symphysis pubic
- Between 20 and 24 weeks, the height of the uterine fundus measured in centimeters
correlates closely with gestational age in weeks. The fundal height should be
measured as the distance over the abdominal wall from the top of the symphysis pubis
to the top of the fundus.
 Vaginal examination late in pregnancy to monitor the clinical estimation of the pelvic
capacity and its general configuration. Also check for consistency, effacement, and
dilatation of the cervix. This is mostly done from 37-40 weeks.
 Group or individual teaching on nutrition, self-care, family planning, delivery and
parenthood.
 Home visiting by a female health worker or trained dai ( trained traditional birth
attendant)
 Referral services, when necessary.

Risk Approach

While continuing to provide appropriate care for all mothers, ‘high risk’ cases must be
identified as early as possible and arrangements to be made for skilled care. These cases
comprise the following:

 Elderly primigravida (30 years and above)

 Short staturated primigravida
 Malpresentations, e.g. breech, transverse lie, etc.
 Antepartum haemorrhage, threatened abortion
 Anemia
 Preeclampsia and eclampsia
 Twins or hydramnios
 Previous stillbirth, intrauterine death, manual removal of placenta
  Elderly grand multipara
 Prolonged pregnancy (14 days beyond expected date of delivery)
 Previous caesarean or instrumental delivery
 Pregnancy associated with medical conditions, e.g. cardiovascular disease, kidney
disease, diabetes, tuberculosis, liver disease, etc.

The purpose of risk approach is to provide maximum services to all pregnant women with
attention to those who need them most. Maximum utilization of all resources, including
human resources is involved in such care. Services of traditional birth attendants,
community health workers and women’s groups are utilized. The risk strategy is expected
to lead to improvements in both the quality and coverage of health care at the levels,
particularly at primary health care level.

Pregnancy interventions and continuous test

 First trimester screen
- A screening test done at 11 to 14 weeks to detect higher risk of chromosomal
disorders, including Down syndrome and trisomy 18. It also can reveal multiple
births.
 Provide indicated genetic carrier testing, e.g. Tay- Sachs Disease, Sickle cell disease,
hemoglobinopathies.
 Screen for STDs, including HIV, and counsel about prevention strategies.
- HIV is a virus that attacks CD4 cells in the body and can lead to AIDS. If a mother
is infected with HIV and not taking her anti-retroviral there is a chance of passing it to
the baby, it can be passed through genital fluid and breast milk in the case. This
medications are mostly prescribed at the second trimester. After birth for 6 weeks the
baby will still be given medications for preventive measures.
 Test urine for protein and glucose at each visit to rule out diabetes, kidney damage
and pre-eclampsia. Ketone in the urine is due to decrease in amount of carbohydrate
so the body starts braking down fat to store as energy.
 Test for triple marker (alpha fetoprotein, BHCG, estriol) at 15-17 weeks to screen for
Down’s syndrome and neural tube defects.
 Perform mid-trimester genetic amniocentesis for women over age of 35 and others at
increased risk.
- This test can diagnose certain birth defects, including Down syndrome, Cystic
fibrosis, Spinal bifida. The test is performed at 14 to 20 weeks. It may be suggested
 for couples at higher risk for genetic disorders. It also provides DNA for paternity
testing.
 Perform ultrasound at 18- 20 weeks to screen for other anomalies.
Reasons for ultrasound:
 Check for multiple fetus. In this situation, ultrasonography is invaluable in
determining the number of fetuses, the chorionicity, fetal presentations,
evidence of growth retardation and fetal anomaly, the presence of placenta
previa, and any suggestion of twin-to-twin transfusion.
 Diagnosis and confirmation of early pregnancy. The gestational sac can be
visualized as early as four and half weeks of gestation and the yolk sac at
about five weeks. The embryo can be observed and measured by about five
and a half weeks. Ultrasound can also very importantly confirm the site of the
pregnancy within the cavity of the uterus.
 Assess possible risk of miscarriage, ectopic pregnancy.
 Placental localization.
- Ultrasonography has become indispensible in the localization of the site of
the placenta and determining its lower edges, thus making a diagnosis or an
exclusion of placenta previa. Other placental abnormalities in conditions such
as diabetes, fetal hydrops, Rh isoimmunisation and severe intrauterine growth
retardation can also be assessed.
 Fetal malformation e.g. club foot, spinal bifida, cleft palate.
 Determine intrauterine growth retardation.
 Doppler ultrasound during pregnancy to check fetal umbilical blood flow,
placental blood flow and blood flow in the heart and brain. It is done at each
visit to monitor the fetal heart beat. Normal heart rate at 6 weeks is around 90-
110 beats per min (bpm) and at 9 weeks is 140-170 bpm. At 5-8 weeks a
bradycardia ( less than 90bpm) is associated with a high risk of miscarriage.
 Rescreen for gonorrhoea, chlamydia, syphilis, and group B streptococcus in mid –
term trimester.
Gonorrhoea and Chlamydia are STD that can lead to pelvic inflammatory disease if
not treated.
Group B streptococcus is a type of bacteria that live in the vagina and rectum, but it
could be passed to the baby during birth, which can lead to death. Group B
streptococcus is tested between 35 or 37 weeks, if its high in the flora of the vagina
antibiotics are given to treat it.
 Instruct about the course of normal pregnancy, warning signs, e.g. decreased fetal
movement, rupture of membranes, bleeding, uterine contractions.
 Ensure control of blood sugar for women with diabetes mellitus.
Perform glucose load test ( 50 gram glu, one hour blood sugar) at 24 – 28 weeks to
screen for gestational diabetes.
 Determine blood type and screen for blood type antibody (Rh, other blood group
sensitization).
Rh negative women where the fetus’s father is positive, leads to Rh positive
pregnancy. During birth, the mother may be exposed to the infant’s blood, and this
causes the development of antibodies, which may affect the health of subsequent Rh+
pregnancies. In mild cases, the fetus may have mild anemia with reticulocytosis. In
moderate or severe cases the fetus may have a more marked anemia and
erythroblastosis fetalis. When the disease is very severe it may cause hydrops fetalis
or stillbirth. Rh disease is generally preventable y treating the mother dring pregnancy
or soon after delivery with an intramuscular injection of anti- RhD immunoglobulin
(Rho(D) immune globulin).Administration of Rh immune globulin to Rh negative
mother’s is done at 28 weeks.
 Determine haemoglobin or hematocrit, diagnose and treat anemia.
Pregnant women need more iron than normal for the increased amount of blood they
produce during pregnancy. Symptoms of a deficiency in iron include feeling tired or
faint, experiencing shortness of breathe, and becoming pale. Because these symptoms
are common for all pregnant women, health care providers check iron levels
throughout pregnancy.
The ACOG recommends 27 milligrams of iron daily to reduce the risk for iron-
deficiency anemia. Some women may need extra iron through iron supplements.
 Screen for hemoglobinopathy.
This is done at 26-28 weeks. The sickle cell hemoglobinopathies (HbS S, HbS C, and
HbS - Thal) are haemolytic anemias characterized by recurrent painful crises,
systemic infection, and infraction of various organ systems. There is increased risk for
fetal death, so routine care is needed which includes ultrasound assessment of fetal
growth and prenatal fetal heart rate monitoring.
 Screen for tuberculosis; evaluate positives and treat. (for example women with HIV
have a high risk of contacting TB)
 Encourage weight gain for very slender women. Assess maternal weight and
adequacy of nutrition, counsel about diet, obtain additional food sources if needed.
 Screen for use of tobacco, alcohol and other drugs. Because they can cause preterm
birth and sudden infant death syndrome.
 A brief five step intervention program, referred to as the “ 5A’s ”model, is
recommended in clinical practice to help pregnant women quit smoking.
The 5 A’s included the following:
 Ask about tobacco use
 Advise to quit
 Assess willingness to make a quit attempt
 Assist in quit attempt
 Arrange follow-up

 Counsel about avoiding environmental exposure to volatile household chemical.

 Counsel about avoiding exposure to sick children who might have transmissible viral
illness.
 Determine adequacy of living conditions and seek improvement if needed.
 Determine if women is being abused and arrange help if needed.
 Non stress test – Performed after 28 weeks to monitor baby’s health.
 Prescribed folic acid .
 Biophysical profile (BPP) – Test used in the third trimester to monitor the overall
health of the baby and to help decide if the baby should be delivered early.

Home visits
Home visits are paid by the Female Health Worker or Public Health Nurse. If the delivery is
planned at home, several visits are required. The home visit will provide opportunities to
study the environmental and social conditions at home and to provide prenatal advice. In the
home environment, the woman will have more confidence to make an informed decision
about home birth.

Prenatal Advice
A major component of antenatal care is prenatal advice or education. The mother is more
receptive to advice concerning herself and her baby at this time than any other time. The
topics should cover not only the specific problems of pregnancy and childbirth but must also
include family and child health care.

a) Diet – A balanced diet is of utmost importance during pregnancy and lactation to

meet the increased needs of the mother, and to prevent nutritional stress. On an
average a pregnant women, gains about 12.5 kg of weight during pregnancy. The diet
 should be nutritious, balanced, light and easily digestible and rich in protein , minerals
and vitamin. Iron and folic acid supplementation should be given. The diet should be
increase in later stages of pregnancy.

Requirements during first trimester

Nutrients Non-pregnant and First Second Third

non- lactating trimester trimester trimester
mothers

Energy 9205 kJ (2200 kcals) +0 +240 +425

Protein 46 g +0 +0 +25
Vitamin 700 RAE +0 +70 +70
A
.Fe 18 mg +0 +9 +0
Folate 400µg +0 +200 µg +0
Ca 1000 mg +0 +0 +0
Zn 8 mg +0 +3 mg +0

b) Personal Hygiene

- Advice regarding personal hygiene is equally important. The need to bathe everyday and to
wear clean clothes should be explained.

- About 8 hours of sleep and at least 2 hours rest after midday meals should be advised.

- Constipation should be avoided by regular intake of green leafy vegetables, fruits and extra
fluid.

- Purgatives such as caster oil to relieve constipation should be avoided.

- Light household work should be encouraged but manual physical labor during pregnancy
may be adversely affect the fetus.
- Smoking should be cut down to a minimum, as heavy smoking by the mother can result in
babies much smaller than average size due to placental insufficiency.

- Heavy drinking may lead to various physical and mental problems of the babies. It may be
associated with fetal alcohol syndrome ( FAS), which includes intrauterine growth
retardation and developmental delay.

- Advice should also be given about dental care and sexual behaviour during pregnancy.
Sexual intercourse should be restricted during the last trimester of pregnancy.

c) Drugs

- The use of drugs that are not absolutely essential should be discouraged as certain drugs
taken by the mother during pregnancy may affect the fetus adversely and cause fatal
malformations. Some of the drugs known to cause damage include streptomycin that may
cause eight nerve damage and deafness in the fetus, iodide containing drugs that may cause
congenital goiter, corticosteroids that may impair fetal growth, sex hormones that produce
virulism and tetracyclines that affect the growth of bones and enamel formation of teeth.

d) Radiation

- Exposure to radiation is a positive danger to the developing fetus. The most common source
of radiation is abdominal X-ray during pregnancy. It causes congenital malformation such as
microcephaly. Hence, X-ray examination in pregnancy should be carried out only for definite
indications.

e) Warning signs

- The mother should be given instructions that she should report immediately, any of the
following warning signals: swelling of the feet, convulsions, headache, burning of the vision,
bleeding or discharge per vagina and any other unusual symptoms.

f) Childcare

- Mothers attending antenatal clinics must be given mother craft education that consists of
nutrition education, hygiene and childrearing, childbirth preparation and family planning
information.

Specific Health Protection

Specific protection for pregnant women’s health is an essential aspect of prenatal care. This
is because 50-60% of women, belonging to low socio-economic groups, are anaemic in the
last trimester of pregnancy. The major causative factors are iron and folic acid deficiencies.
The government of India has initiated a program in which 60 mg of elemental iron and 500
mcg of folic acid are being distributed daily to pregnant women through antenatal clinics,
primary health centres and their sub-centres.

a) Other Nutritional Deficiencies

- Protection is required against other nutritional deficiencies that may occur during pregnancy
such as protein, vitamin and mineral deficiencies. In some MCH centres fresh milk is
supplied free of cost to all expectant and lactating mothers; where this is not possible
skimmed milk is given, vitamin A and D capsules are also supplied free of cost.

b) Tetanus protection

- If the mother was not immunized earlier, two doses of tetanus toxoid should be given, the
first dose at 16th to 20th week and the second dose at 20th to 24th week of pregnancy. For a
women who has been immunized earlier, one booster dose will be sufficient. When such a
booster dose is given, it will provide necessary cover for subsequent pregnancies for the next
five years.

c) Syphilis

- Syphilitic infection in the woman is transmissible to the fetus, especially when she is
suffering from primary or secondary stages after the 6 th month of pregnancy. Neurological
damage with mental retardation is one of the most serious complications. Blood should be
tested for syphilis (VDRL) at the first visit and late in pregnancy. Ten daily injections of
procaine penicillin (600,000 units) are usually adequate to treat the infection.

d) German Measles

- Rubella infection contracted during the first 16 weeks of pregnancy can cause major defects
such as cataract, deafness and congenital heart diseases. Vaccination of all women of child
bearing age, who are seronegative, is desirable. Before vaccinating, it is desirable that
pregnancy is ruled out and effective contraception be maintained for eight weeks after
vaccination because of possible risk to the fetus from the virus.

e) Rh Status
- It is a routine procedure in antenatal clinics to test the blood for Rhesus type in early
pregnancy. If the women is Rh-positive , she is kept under surveillance for determination of
Rh-antibody levels during antenatal period. The blood is further examined at 28 th week and
34th to 36th week of gestation for antibodies.

- Rh anti-D immunoglobulin should be given at 28th week of gestation so that sensitization

during the first pregnancy can be prevented.

- If the baby is Rh-positive, the Rh anti-D immunoglobulin is given again within 72 hours of
delivery. It should also be given after abortion

f) HIV infections

- About one-third of the children of HIV-positive mothers become infected through the
placenta or during delivery or by breast feed. The risk of transmission is higher if the mother
is newly infected or if she has already developed AIDS. Prenatal testing for HIV infection
should be done as early as possible for pregnant women who are at risk.

g) Prenatal Genetic Screening

- Screening for genetic abnormalities and for direct evidence of structural anomalies is
performed in pregnancy in order to make the option of therapeutic abortion available when
severe defects are detected.

h) Mental Preparation

- Mental preparation is an important as physical or mental preparation. Sufficient time and

opportunity must be given to expectant mothers to have free and frank talk on all aspects of
pregnancy and delivery. The “mother craft” classes at the MCH centres help a great deal in
removing their fears and in gaining confidence.

i) Family Planning

Family planning is related to every phase of the maternity cycle. Educational and
motivational efforts must be initiated during the antenatal period. If the mother has had two
or more children, she should be motivated for puerperal sterilization.

High-risk pregnancy
Pregnancies with a greater chance of complications are called “ high risk ”. But this
doesn’t mean there will be problems.
The following factors may increase the risk of problems during pregnancy:

 Very young age or older than 35

 Overweight or underweight
 Problems in previous pregnancy
 Health conditions like high BP, diabetes, autoimmune disorders, cancer, and HIV
 Pregnancy with twins or other multiples

 Health promotion also may develop during pregnancies that make it high-risk, such as
gestational diabetes or preeclampsia.
 Women with high-risk pregnancies need prenatal care more often and sometimes
from a specially trained doctor.
 In case of post term pregnancy: Post term pregnancy is when gestational age has
passed above 40-42 weeks.
 Ultrasound is conducted weekly for amniotic fluid volume, fetal heart rate is
monitored twice a week and in most induction is advised.

ROLE OF NURSE IN PRENATAL CARE

1. REGISTRATION- The nurse has to do registration of the prenatal mother so that to
assess the following condition-

 To assess the health status

 To identify and manage high risk cases

 To estimate EDD more accurately

 To give the first dose of TT (after 12 weeks)

 To help the woman for an early and safe abortion (MTP) if it is required by her

 To start the regular dose of folic acid during the first trimester

2. PRENATAL SERVICES FOR MOTHERS

- Health history

- Physical examination
- Laboratory Examination

• Urine/Stool/Blood(Count)/Hb/Serological/Blood group(Rh also)

• Pap test(if facilities)/ Chest X-Ray and Gonorrhea test(if needed)

- High risk approach  IFA and necessary medications

- TT Immunization

- Health education

- Home visit

- Referral(if needed)

3. MAINTENANCE OF RECORDS

- Antenatal Card

- Antenatal register

4. ANTENATAL CHECKUP HISTORY

(i) To diagnose pregnancy

(ii) To identify any complications during previous pregnancies

(iii) To identify any medical/obstetric condition(s) that may complicate this pregnancy

• Calculation of EDD

• Ask for the first day of the last menstrual cycle (LMP)

• Ask for the date when the foetal movements were first felt(quickening)

• Also assess the fundal height to estimate the gestational age

• Ask for any test done to confirm pregnancy EDD= LMP + 9 months + 7 days Age of
the woman
 • Complications when <16 years/>40 year Order of the pregnancy

• Primigravida and multipara are at risk Birth interval

• Ideally should be >3 years

5. SYMPTOMS DURING THE PRESENT PREGNANCY

• Symptoms indicating discomfort

- nausea and vomiting

- heartburn

- constipation

- frequency of urination

• Symptoms indicating that a complication may be arising

- fever

- vaginal discharge/bleeding

- palpitations

- breathlessness at rest

- generalized swelling of the body; puffiness of the face

- oliguria

- decreased or absent foetal movements

6. PREVIOUS PREGNANCIES/OBSTETRIC HISTORY

- Number of earlier pregnancies/abortions/deliveries

- Number of premature birth(s)/stillbirth(s)/neonatal deaths

- Hypertensive disorders of pregnancy (history of convulsions)

- Prolonged/obstructed labour
- Malpresentation

- APH/PPH

- Modes of deliveries (normal/assisted/caesarean section)

- Birth weight of the previous baby

- Any surgery on the reproductive tract

- Iso-immunization (Rh-ve) in the previous pregnancy (Any costly inj. Given to her within 72
hours of her previous delivery

7. HISTORY OF ANY SYSTEMIC ILLNESS

- Hypertension

- Diabetes

- Heart Disease

- Tuberculosis

- Renal Disease

- Convulsions

- Asthma

- Rashes

- Jaundice

- Family history of systemic illness

- History of drug intake or allergies

- History of intake of habit-forming substances (tobacco, alcohol)

8. INVESTIGATION - The nurse should undergo following investigation-

• CBC

• Blood grouping & Rh typing

• Urine R/E

• RBS

• VDRL

• HBS Ag

• Ultrasound - Ultrasound early pregnancy (preferably at 10-13 weeks) to: -

- Determine gestational age

- Detect multiple pregnancies

- Help with later screening for Down's syndrome

9. ULTRASOUND (cont’d) At 11-14 weeks: screening for Down's syndrome, with other
tests if available. At 18-20 weeks: offer screening with ultrasound for congenital anomalies.
At 36 weeks: for foetal maturity, placenta praevia.

10. ANTENATAL ADVICE - DIET should be: nutritious , balanced , light, easily
digestible, rich in protein, mineral and vitamin with woman’s choice , iron & folic acid
supplementation.

11.REST & SLEEP

- Night 8 hours ,Day 2 hours (Lt side)

- Avoid heavy work (especially lifting heavy weights)

- Avoid the supine position (especially in late pregnancy, if it is necessary, a small pillow
under the lower back at the level of the pelvis should be used)

12. BOWEL

• Regular bowel movement may be facilitated by regulation of diet, taking plenty fluid,
vegetable and milk

13. ABSISTENCE

• Should be avoided in 1st trimester and last 6 weeks

14. TRAVELLING should be avoided in -

• 1st trimester

• last 6 weeks Air travelling is contraindicated in Placenta praevia , Preeclampsia and

Severe anemia

15. IMMUNIZATION indicated -

• TT

• HAV

• HBV

• Rabies Contraindicated

• Live virus vaccine (rubella measles, mumps, Varicella)

16. PERSONAL HYGIENE

• The nurse should advice the mother regarding the personal hygiene and its importance.

17. RADIATION

• The nurse should advice the mother to avoid the X-rays and drugs like Sedative ,
Anticoagulant, Antithyrodism, Hormones& Antibiotics should be avoided . Occupational
hazards like Lead, mercury, X ray s& ethylene oxide must be avoided.

18.DANGER/WARNING SIGNS

• High fever with/without abd. pain, feels too weak to get out of bed

• Fast/difficult breathing

• Decreased or absent foetal movements

• Excessive vomiting (woman is unable to take food/fluids)

• Any bleeding P/V during pregnancy

• Heavy (>500 ml) vaginal bleeding during and following delivery

• Severe headache with blurred vision

• Convulsions or loss of consciousness

• Labour lasting longer than 12 hours

• Failure of the placenta to come out within 30 minutes of delivery

• Preterm labour

• Premature or pre-labour rupture of membranes (PROM)

• Continuous severe abdominal pain

19. HEALTH EDUCATION - The nurse should advice the mother regarding

• Breast feeding

• Nutrition

• Family planning

• Postnatal exercises

• Child care

• Dental care

• Clothing, shoes and belt

• Care of breast

• Smoking and alcohol

• Birth plan

• Mental preparation

• Diet

• Sleep and rest

• To avoid stressor

• Minor ailments.

ROLE OF PEDIATRIC NURSE

A role is a pattern of behaviour structured around specific rights and duties that are
associated with particular status within a group. There are different kinds of roles, for
example:

1) An achieved role is the one an individual chooses or earns through his or her own
efforts and actions such as the role of a nurse.
2) An ascribed role is acquired by the individual automatically at birth or on the
attainment of certain age.

Pediatrics is the science and art dealing with the health of infants, children and adolescents,
their growth and development and enhancing their ability to achieve full potential as an adult.

Thus, pediatrics and nursing are two field with a common aim and target of nurturing a child,
starting from birth.

Pediatric nursing is the specialized area of nursing practice concerning the care of children
during wellness and illness. It includes preventive, promotive, curative and rehabilitative care
of children. It emphasizes on all round development of body, mind and spirit of growing
individual.

Pediatric nursing practice is concerned with-

1) Wellbeing of the children towards optimal functioning.

2) Integration of developmental needs of children into nursing care with holistic
approach.
3) Delivering care to the family child unit.
4) Interdisciplinary team approach to plan and provide child care in comprehensive
manner.
5) Focusing on the ethical, moral and legal problems regarding child care.

Goals of pediatric nursing:

1) To provide skillful, intelligent, need based comprehensive care to the children in

health and sickness.
2) To interpreted the basics needs of the children to their parents and family members
and to guide them in child care.
3) To promote growth and development of children towards optimum state of health for
functioning at the peak of their capacity in future.
4) To prevent disease and alleviate suffering in children.
Qualities of pediatric nurse:

A pediatric nurse should have all the desirable and preferable qualities of a professional
nurse. More than those professional nurse should possess the following qualities to be a
pediatric nurse. She should: -

1) Be a loving person and have liking for the children.

2) Have patience, pleasant appearance and ability to understand the child’s behaviour.
3) Be able to maintain good interpersonal relationship and to provide safety and security
to the children.
4) Be friendly, honest, gentle, diligent and humorous.
5) Have good observations, judgement and communication ability- based on scientific
knowledge and experience.
6) Be well informed, skillful, responsible, truthful and trustworthy.

ROLE OF A PEDIATRICS NURSE:

A) HOSPITAL
The ever-expanding demands of medical and nursing practice, emerging challenges in
different aspect of a child care, consumer demands and improved technology have
necessitated the highly specialized roles of pediatric nurse.

The role of pediatric nurse is both caring and curing. Caring is a continuous process in both
wellness and illness. It refers as helping, guiding and counseling. Curing refers to the act of
diagnosis and management, usually during illness. Pediatric nurse have the responsibilities of
providing nursing care in hospital, home, clinic, school and community where and their
parents have health and counseling needs.

The role of pediatric nurse may vary from one health institution to others, but the basic
responsibilities remain the same. It may vary depending upon the educational preparation of
the pediatric of the pediatric nurse and exposure to the specialized training. The
characteristics social behaviour of the pediatric nurse as role model for the child care can be
summarized as follows:
1) PRIMARY CAREGIVER: pediatric nurse should provide preventive, promotive,
curative and rehabilitative care in all levels of health services, as therapeutic agent. She/he
acts as case finder and compassionate skilled caregiver as needed by the today’s society. In
hospital, care of sick children i.e. comfort, feeding, bathing, safety, etc. are the basic
responsibilities of pediatric nurse. Health assessment, immunization, primary health care and
referral are basic responsibilities at the community level as quality care provider.

2) HEALTH EDUCATOR: important role of the pediatric nurse is to deliver planned and
incidental health teaching and information’s to the parents, significant others and children
and to create awareness about healthy lifestyle and maintenance of health. Change in health
behaviour and attitude and to develop healthful practice regarding child care should be
initiated by the pediatric nurse as change agent, teacher and health educator.

3) NURSE- COUNSELOR: problem solving approach and necessary guidance in health

hazard so children to minimize or to solve the problem and to help the parents and family
members for independent decision making in different situations are essential role of
pediatric nurse in the present health care delivery system.

4) SOCIAL WORKER: pediatric nurse can do case work especially for children and try to
alleviate social problems related to child health. She/he can participate in available social
services or refer the child and family for necessary social support from the child welfare
agencies.

5) TEAM COORDINATOR AND COLLABORATOR: pediatric nurse should work

together and in combination with other health team members towards better child health care.
She/ he should act as a liaison among the members and maintain good interpersonal
relationship. The nurse interprets the objectives of health care to the family and co-ordinates
nursing services with other services necessary for the child. Co-operations and good
communications among team members should be promoted by the nurse.

6) MANAGER: the pediatric nurse is the manager of pediatric care in hospital, clinics and
community. She/he should organize the care orderly for successful outcome with better
prognosis and good health.

7) CHILD CARE ADVOCATE: child or family advocacy is basic aspect to comprehensive

family centered care. As an advocate, the pediatric nurse can assist the child to obtain best
care possible from the particular units. Advocacy can range from consulting dietary
department for special foods to arrange team meeting to discuss plan of care.
8) RECREATIONIST: this supportive role of pediatric nurse is important for the child to
adjust to the crisis imposed by illness or hospitalization. She/he can organize play facilities
for recreation and diversion for child’s emotional outlet.

9) NURSE CONSULTANT: the pediatric nurse can act as consultant to guide the parents
and family members for maintenance and promotion of health and prevention of childhood
illness. The nurse can promote self-care within the family and prepare self-care agent for the
children who are unable to take care of their own health. The nurse can help the older
children to become responsible for their own lives. The nurse assesses the children’s ability
to do self-care activities and assist them in developing the ways of self-care and self-
responsibility.

10) RESEARCHER: Nursing research is an integral part of professional nursing. Pediatric

nurse should participate or perform research projects related to child health. Clinical and
applied research provide the basis for changes in nursing practice and improvements in the
health care of children.

Besides the above roles, pediatric nurses have to respond to the social need with expanded
roles. The independent role of pediatric nurse reflects the expansion of the role as pediatric
nurse practitioner, pediatric clinical nurse, specialist, etc. new roles and responsibilities can
be added to the pediatric nurse in changing situations of child care in future.

ROLE OF NURSE IN THE CARE OF CHILDREN

Caring refers to an act of helping, guiding and counselling. In the nurse-parent-child
relationship recovery of the child occurs within the framework of caring for all family
members.

A) AREAS OF CARE: each adult and child have basic human needs, physical, social,
emotional and intellectual. The fulfilment of which is essential for life, and is the motiving
force behind human behaviour.

1) Physiological needs for survival and stimulation: water, air, food, warmth,
elimination, rest, activity and avoidance of pain.
2) Safety and security needs: safety, protection and security are to be met after
meeting the physiological needs.
3) Needs for love and belongings: affection, closeness, intimacy, are all very
essential needs of the child.
 4) Needs for recognition and self-esteem: the child needs to be recognized and
esteemed as an individual from birth and to be helped to develop self esteem
during the period of growth.
5) Need for creativity and self-actualization: once physiologic needs have been met
and the child is feeling secure, loved and esteemed, the need for self-actualization
arise. When the school child is hospitalized, age appropriate activities are
provided, such as materials for creating new objects.
6) Cognitive needs for knowledge and comprehension: seeking of knowledge and the
discovery and the understanding of new ideas are common in children. When the
school age children are hospitalized for a prolonged period, not only creative
activities but also school work is provided to fulfill this need.
7) Aesthetic needs: individuals vary in their development of aesthetic taste. For
instance, when adolescents want to hang brightly color posters in their room and
the parents do not want the room to be disturbed, conflicts may occur.

B) CONCEPT RELATING TO CHILD OF CARE

Health promotion and the prevention of illness, health maintenance and health restoration are
the three areas of care to be considered in assisting children and their families to achieve the
highest level of wellness possible.

C) HEALTH PROMOTION AND PREVENTION OF ILLNESS

The nurse must help families, their children to strive for higher level of wellness and to
prevent illness whenever possible. The nurse can fulfill these goals through individual or
group education of parents, children, school teachers and other groups whose concern is for
the health of the children.

D) CARE OF ILL CHILD IN PEDIATRIC UNIT

Pediatric unit: it must meet the needs of children and of their parents. Needs of children can
be classified under 3 main headings:

 Adequate provision for care

 Protection from physical dangers e.g. infection and accidents.
 Protection from psychologically threatening environment.

E) NEWBORN AND PEDIATRIC ICU

Newborn infants or children requiring intensive care include those with congenital anomalies
or major anomalies or major illness of the newborn; coma; pneumonia etc. children who are
seriously ill from poisioning or trauma are also cared for in the intensive care unit.

Intermediate care unit: to this the children are moved from the intensive care unit when the
condition improves.

F) PREPARATION FOR HOSPITALIZATION: Hospitalization may be traumatic event

for children, but it can also be a positive psychologic experience for them if they are prepared
for it properly. Hospitalization is a completely new experience to infants and young children
when they are taken to the paeditrician. They make friendship with the doctor and the nurses
but it takes time to mix with other patients in the hospital.

G) CHILD POPULATION: Of the massive load of more than 750 million people in India’s
soil today, 40 % are children under the age of 15 years i.e. equal to the total population of
North America. Of these, 17 per cent are under the age of 5 years. In contrast, children from
only 10-15 percent of the population in the developed countries. As per the provisional
census 2011, India has recorded an aggregrate child population of 158789287 which
comprises of a rural child population of 117585514 and an urban child population of
41203773.

H) MORTALITY AND MORBIDITY IN INFANCY AND CHILDHOOD:

Child health cannot be studied as an isolated entity. The morbidity and mortality rates are
directly related to several factors which are closely interlinked, e.g. family size, family
income, various age groups and specific diseases. These are best considered under the
following heads:

 Neonatal mortality rate: this refers to the number of deaths occurring within the
first 28 days of birth per 1000 live births. Neonatal mortality rates are high in
India when compared to the more developed countries of the west.
 Stillbirth is the ratio of stillbirths to total number of live births multiplied by 1000.
Placenta previa, toxemia of pregnancy, and traumatic deliveries are countributary
factors to a high stillbirth rate.
 Perinatal mortality rate is the ratio of total number of deaths, including stillbirth,
occurring within 7days of birth to the total number of live and stillbirth, multiplied
by 1000. Some common causes of perinatal mortality are-
- Prematurity
- Low birth weight
 - Multiple pregnancy
- Birth trauma
- Asphyxia
- Infections
- Congenital abnormalities
 Infant mortality rate is the ratio of deaths occurring between birth and one year to
the total number of live births multiplied by 1000. IMR is higher in the rural areas
when compared to urban regions. Children in the age group of – years constitute
15% of the population; they account for 44 % of deaths and 22% of these are
below one year of age. The IMR of the urban sector is 65.2 and that of rural sector
is 113.7. The current IMR is 95.
 School period 5-14 years mortality rate: here there is a steep fall in the mortality
rates from the pre-school age group, and it compares well with the western
figures.
 Maternal mortality rate (MMR): it is the number of maternal deaths per 1000 live
births and is the efficiency index of the obstetric services available in a country.
Major causes are anaemia, infection, etc. Maternal mortality has been
scientifically reduced in the developed countries. The current MMR in India is
3.50.

B) COMMUNITY HEALTH NURSE

The roles of community health nurses today are wider and much more comprehensive than
even before. They are more independent, place greater emphasis on the prevention of illness
and maximizing wellness and more than even morally, legally accountable for professional
behaviour.

The functions of community health nursing represents those broad areas of responsibility that
the community health nurse expected to assume. These functions vary according to the
education and experience and designation for which the nurse is employed. The nursing care
in the community is directed to promotion and preservation of health, prevention and early
detection of alterations in health and restoration of health.

CONCEPT OF ROLE IN COMMUNITY HEALTH NURSING

There was a time when the nurses were meant only for carrying out the orders of physicians
for curing the diseases. Now the traditional role of an assistant to doctor has been changed in
the following ways with the evolution of community.
The nursing has evolved from that of focusing on illness in the care of patients only in the
hospital to concern for promotion, restoration and maintenance of health in all settings of a
community.

More and more nurses are assuming roles in industries, school, community agencies, clinic
and convalescent homes where care is health oriented rather than illness – oriented.

The role of nurse moved from merely following physicians’ orders to a collaborative or joint
working relationship with medicine and other disciplines concerned with health care.

In community health setting, the role of a collaborator, advisor, consultant, advocate,

preventor of illness, promoter of health, provider of direct care, good observer, potentiator,
manager, participant in planning and primary health care practitioner are being incorporated
into nursing practices.

1) COLLABORATOR: The community health nurse works collaboratively with patients

and also with members of the health team in assessing, planning, implementing and
evaluating interventions. The patient may be an individual, a family or a group of persons in
the community.

2) ADVISER: Since community health nurses work with the families in the community, they
naturally develop a good inter personal relationship with the people of a particular
community. However, individuals and families are looking towards the nurse as an adviser
mainly in practical and emergency matters which relates to health . Acceptance of advices
from the community health nurse are well documented.

3) CONSULTANT: Sometimes the community health nurses are consulted by the

authorities in planning a programme as there is a source of information in relation to
particular programme which is to be organized, for immunization programme. As a
consultant, the nurse shares nursing knowledge and expertise to help solve a problem or meet
a need.

4) ADVOCATE: Community health nurse is an advocate of patients rights in relation to

their care. Nurse will act as an advocate as far as health of the particular individual is
concerned. She encourage the individual to take right food for maintaining health, right drugs
for the treatment and refers to right services at right place, whenever needed. As a patient’s
advocate the nurse provides the patient with sufficient information to make the necessary
health care decision. The nurse also supports the patients rights to make these decisions. The
nurse explains, protects and defends the rights of the patient.
5) PREVENTER OF ILLNESS: The primary focus of community health nursing is
prevention of illness. The nurse practices disease prevention in such endeavor as conducting
immunization clinics, assisting with case findings during outbreak of cholera and other
epidemics, nutrition counselling and many more diseases preventing programmes. A
community health nurse acts as an epidemiologist in this direction and uses epidemiological
skills before or during the outbreak of communicable diseases.

6) PROMOTER OF HEALTH: the major component of nursing care is health promotion.

The role of health promoter includes consideration of the unique individual characteristics as
well as predictable health needs of a community member. She also acts as a health educator,
teaching self examination of breast to mothers or teaching self care to the individual during
house visit.

7) PROVIDER OF DIRECT CARE: the nurse who works in the community is authorized
to provide required care. The nurse provide direct care in many ways. He/ she carries
standing orders of physicians while giving continued care to individuals who needed it at
their doors, during home visits. The nurse provides appropriate care including bed-baths,
range of motion exercises, treatment of minor ailments and also provides first-aid and
emergency nursing care.

8) GOOD OBSERVER: community health nurse is expected to be alert to any deviation

from expected behaviour with respect to illness, growth and development, response to drugs
and general well- being of an individual, family and community. As an observer , the nurse is
supposed to be aware of the surroundings and reports unusual occurrence of disease
symptoms, environmental threats, unusual stresses in the community which may cause threat
to the health of community.

9) POTENTIATOR: the individuals have their own potentials to maintain their health, but
by virtue of his/her specialization in the community health and nursing practice, the nurse is
expected to act as a potentiator. This role is achieved by assuming central position in
enabling the individual family or group to make decision about health, to take appropriate
and prompt action and by dealing constructively with inescapable diseases and death by
providing care, arranging health promotion and disease prevention programmes regularly.

10) MANAGER: The community health nurse assumes the role of manager in a variety of
situations. He/she is expected to organize and manage various planned programmes of health
and assume leadership of nursing team for supervision of nursing and other auxiliary
personnel.
11) PARTICIPANT IN PLANNING: as a representative of nursing community, health
nurse will be molding decisions not only about nursing but also about community health and
health related facets of education and welfare programmes. The decision of timing and
method of approach of a particular programme to succeed e.g. immunization programme is
taken by a community nurse.

12) PRIMARY HEALTH CARE PRACTITIONER: since community health nurses have
to play many roles according to health situations in the community , they are the fit persons
to take up prominent position in the community health setting, particularly in PHC
programmes. These roles may be primary health care practitioner; middle level manager; and
administrator of nursing services within the health services programme .

The role of nurses in PHC is to:

 Arouse people’s awareness of an interest in health particularly in measures that

would promote their general well- being and wholeness.
 Develop the capacities of the people to investigate and assess their health status,
needs, resources- inside and outside the community, the decision making process
and how values, beliefs and knowledge are propagated in the community.
 Equip the people in the community with appropriate knowledge and health care
competence to attend to common simple medical conditions with stress on the use
of indigenous resources.
 Develop and sharpen people’s ability to analyses critically their problems and the
process involved in their solution so that they will always be conscious of their
role in the social transformation.
 Enhance local initiating, leadership and co-operation in the solution of identified
health needs and problems and to develop mechanism, whereby their efforts
could be linked with those of other community groups involved in health and
other socially transforming programmes.
 Link herself/himself with the rest of health professionals and in order to
continually sustain his/her work of social transformation.

EXTENDED AND EXPANDED ROLES OF PEDIATRIC NURSE:

EXPANDED ROLE:
Expanded role of nursing means enlargement of nurse role within the boundaries of
nurse.
 Expanded role of nurse is the responsibility assumed by a nurse within field of
practice autonomy.

Expanded roles includes

1) Care giver
2) Manager
3) Protector and Advocate.
4) Counsellor.
5) Communicator
6) Educator
7) Rehabilitator
8) Collaborator.

1) CARE GIVER: A nurse is a caregiver for patients and helps to manage physical needs,
prevent illness, and treat health conditions. To do this, they need to observe and monitor the
patient, recording any relevant information to aid in treatment decision-making.

Throughout the treatment process, the nurse follows the progress of the patient and acts
accordingly with the patient’s best interests in mind. The care provided by a nurse extends
beyond the administration of medications and other therapies. They are responsible for the
holistic care of patients, which encompasses the psychosocial, developmental, cultural, and
spiritual needs of the individual.

The nurse they will try to give the best care using her knowledge and skill and also to provide
comforts to patients.

2) MANAGER: Nurse managers are responsible for managing human and financial
resources; ensuring patient and staff satisfaction; maintaining a safe environment for staff,
patients, and visitors; ensuring standards and quality of care are maintained; and aligning the
unit's goals with the hospital's strategic goals.

The nurse works with other healthcare workers as the manager of care and ensures that the
patient's care is cohesive. The nurse directs and coordinates care by both professionals and
non-professionals to confirm that a patient's goals are being met.
The nurse is also responsible for continuity from the moment a patient enters the hospital
setting to the time they are discharged home and beyond. This may even include overseeing
home care instructions. For nurses in the hospital setting, the nurse is responsible for
prioritizing and managing the care of multiple patients at the same time, which adds another
dimension to this process.

3) PROTECTOR OR ADVOCATE: The patient is the first priority of the nurse. The role
of the nurse is to advocate for the best interests of the patient and to maintain the patient’s
dignity throughout treatment and care. This may include making suggestions in the treatment
plan of patients, in collaboration with other health professionals.

This is particularly important because patients who are unwell are often unable to
comprehend medical situations and act as they usually would. It is the role of the nurse to
support the patient and represent the patient’s best interests at all times, especially when
treatment decisions are being made.

SIX WAYS NURSES CAN ADVOCATE FOR PATIENTS:

1. Ensure Safety. Ensure that the patient is safe when being treated in a healthcare
facility, and when they are discharged by communicating with case managers or
social workers about the patient’s need for home health or assistance after discharge,
so that it is arranged before they go home.
2. Give Patients a Voice. Give patients a voice when they are vulnerable by staying in
the room with them while the doctor explains their diagnosis and treatment options to
help them ask questions, get answers, and translate information from medical jargon.
3. Educate. Educate patients on how to manage their current or chronic condition to
improve the quality of their everyday life is an important way nurses can make a
difference. Patients undergoing chemotherapy can benefit from the nurse teaching
them how to take their anti-nausea medication in a way that will be most effective for
them and will allow them to feel better between treatments.
4. Protect Patients’ Rights. Protect patients’ rights by knowing their wishes¾this might
include communicating those to a difficult family member who might disagree with
the patient’s choices and could upset the patient.
5. Double Check for Errors. Everyone makes mistakes. Nurses can catch, stop, and fix
errors, and flag conflicting orders, information, or oversights by physicians or others
caring for the patient. Read the orders and previous documentation carefully, double
check with other nurses and the pharmacist, and call the doctor if something is
unclear before administering chemotherapy.
 6. Connect Patients to Resources. Help patients find resources inside or outside the
hospital to support their well-being. Be aware of resources in the community that you
can share with the patient such as financial assistance, transportation, patient or
caregiver support networks, or helping them meet other needs.

4) COUNSELLOR: Counsellor is a person who is involved in counselling. It refers to a

person who is concerned with the profession of giving advice on various things such as
academic matters, vocational issues and personal relationships.

ROLE OF A COUNSELLOR: -

- Personal/Social Counsellor : assist students in learning to cope with the social, emotional
problems such as anxiety, depression, grief and loss, relationship issues, homesickness and
substance abuse, assist in personal and physical development, help in utilization of leisure
time

 Educational Counsellor support in academic success and solve. Issues that may be
barriers to success guide in understanding policy and adjust with curriculum.
Assist in the choice of subject, courses and studies, college help students to
improve their study habits. Help in future job and education. Aware about various
opportunities regarding education. Help to change in his illogical thinking and
unhappiness.

 Vocational Counsellor. Helping students become aware of the many occupations

to consider. Interpreting an occupational interest inventory to a student. Assist
individual to choose occupation according their interest, ability. Role-playing a
job interview in preparation for the real thing. Help to person to adopt a vocation.
Help to achieve goal of vocation.

 Avocational counsellor: Provide opportunities for participation in extracurricular

activities. Assist students in developing hobbies and interests. Provide awareness
for recreation. Improve interest in games and other forms of recreation. Assist in
using leisure time profitably.

 Family and Marriage Counsellor: Assess family situation, conduct therapy

program to develop effective and satisfactory relationships; sometimes referral to
other programs to treat individual problem of one member that results in family
conflict (e.g. addictions, anger)
  Addictions Counsellor: Identify addictions; support and encourage recovery;
develop treatment plans and prepare written reports on progress; educate
community about prevention programs

 Genetic Counsellor, analyse clues from family history of sickness; perform

genetic testing; provide medical information about genetic disorders; identify
risks and show options to solve problems

 Rehabilitation Counsellor Assess physical, emotional, mental obstacles the client

faces, work with other therapists to design rehabilitation programs to overcome
these, monitor and keep record of progress

 Bereavement Counsellors: develop plan to cope and grieve in a healthy way; they
work in hospices, group homes, health care/rehabilitation facilities, hospitals,
funeral homes, or private practice E.g. Death of spouse

 Crisis Counsellors: Help people in sudden crisis, distress, with suicidal intentions,
victims of crime, tragedy. Assess the client’s situation and provide emotional and
mental health support, help the client to understand that their situation is common,
and they will return to their normal functionality.The counsellor should stabilize
the mental health of the patient through emotional support and the offering of
resources. Developing skills to deal with coping Such skills may include
exploring and listing different solutions to problems, stress lowering techniques,
and techniques for positive thinking.

 Pastoral or religious and spiritual Counsellors: Provide personal counselling

within a religious and spiritual dimension, provides patients and families spiritual
and emotional support and guidance. He is responsible for the coordination and
provision of spiritual care as indicated in each patient's Plan of Care

PREPARATION OF COUNSELLOR
EDUCATION: Master’s or Bachelor’s degree in teaching and education. They should have
basic in principles and practice of the Guidance programme and additional area of training
either in behavior science or community health.

EXPERIENCE: 2 years in teaching or counselling experience. 1 year of work experience in

the field of school programme. 3-6 months counselling experience, significant experience in
social activities.

PERSONAL FITNESS: - Have good Aptitude – interest – Activities – personality. He should

show positive interest and ability to work with people.

Counsellor is very important person in process of counselling. He help in many situations is

affecting the individual's ability to carry out their daily life, or preventing them to make
important decisions. So for good counselling require a professional, qualified expert
counsellor.

5) COMMUNICATOR:

As a communicator, the nurse understands that effective communication techniques can help
improve the healthcare environment. Barriers to effective communication can inhibit the
healing process. The nurse has to communicate effectively with the patient and family
members as well as other members of the healthcare team. In addition, the nurse is
responsible for written communication, or patient charting, which is a key component to
continuity of care.

6) EDUCATOR: Nurses are also responsible for ensuring that patients are able to
understand their health, illnesses, medications, and treatments to the best of their ability. This
is of essence when patients are discharged from hospital and will need to take control of their
own treatments.

A nurse should take the time to explain to the patient and their family or caregiver what to do
and what to expect when they leave the hospital or medical clinic. They should also make
sure that the patient feels supported and knows where to seek additional information, if
needed, is crucial.

7) REHABILITATOR: The goal of rehabilitation nursing is to assist individuals with a

disability and/or chronic illness to attain and maintain maximum function. The rehabilitation
staff nurse assists clients in adapting to an altered lifestyle, while providing a therapeutic
environment for client's and their family's development. The rehabilitation staff nurse designs
and implements treatment strategies that are based on scientific nursing theory related to self-
care and that promote physical, psychosocial, and spiritual health. The rehabilitation staff
nurse works in inpatient and outpatient settings that can be found in a range of acute to
subacute rehabilitation facilities. This role description has been developed by staff nurses to
clarify and specify the responsibilities of the staff nurse in a rehabilitation setting and to
promote professionalism based on the established scope and standards of rehabilitation
nursing practice.

8) COLLABORATOR

 Develops goals, in collaboration with clients, their families, and the rehabilitation
team, that are oriented to wellness behavior and are reality based and that encourage
socialization with others, and promote maximal independence for patients with
disabilities or chronic disabling conditions
 Participates in the interdisciplinary team process at team conferences and other team
meetings and offers input into team decision making
 Intervenes with team members and other healthcare professionals to ensure that the
optimal opportunity for recovery is made available to the client, the most significant
member of the rehabilitation team

Collaborates with team members to achieve cost-effective care by utilizing appropriate

clinical measures to meet emergent physical, psychosocial, and spiritual situations.

ADVANCED PRACTICE NURSE: Advanced practice nurses complete the equivalent of a

master's-level graduate program in their specialty. They must also pass an exam in the subject
area. Advanced practice nurses include nurse anaesthetists, nurse-midwives, nurse
practitioners and clinical nurse specialists. Clinical nurse specialists focus on a specific area,
oncology or paediatrics or psychiatric-mental health, for example, it is generally the most
independent functioning nurse. An advanced practice nurse has a master’s degree in nursing,
advanced education in pharmacology and physical assessment, and certification and expertise
in specialized are of practice.

CLINICAL NURSE PRACTICE: Nursing expertise in a specialized area of

practice(medical surgical nursing, psychiatric, mental health nursing and pediatric nursing,
community health nursing, gerontogic nursing)

NURSE GENERALIST: The educational curriculum for nurses is designed to prepare them
to work in any health-care setting. A licensed practical nurse, or LPN, typically completes a
one-year training program to earn a nursing certificate and work in a generalist job. A
registered nurse, or RN, has either an associate's degree or a bachelor of science in nursing.
New LPNs might be assigned to permanent duties immediately, but most new RN hires in
hospitals or clinics do rotations in different departments to learn the ropes. Only after at least
a few months of experience do RNs start to choose specialties, and must have at least one
year of experience as a generalist before applying to a specialty or advanced practice nurse
training program.

NURSE MIDWIFE: Nurse midwives specialize in treating pregnant woman and the birth of
their children. Their advanced training allows them to provide prenatal and postpartum care,
deliver babies, advise patients throughout their pregnancy and also counsel patients on family
planning and birth control methods. Nurse midwives work in private practices and with
hospitals.

NURSE ANESTHELIST: Nurse anaesthetists provide anaesthesia and monitor patients

during medical procedures. Similar to the role of an anaesthesiologist, nurse anaesthetists
prepare patients for medical procedures that require anaesthesia and monitor patients during
and after the procedures. They work in health care setting such as hospitals, outpatient care
facilities, dental offices and other medical environments.

NURSE PRACTITIONER: A nurse practitioners can be a primary care provider. Like

general practice physicians, nurse practitioners diagnose and treat illnesses and injuries,
develop treatment plans and prescribe medication for patients. Nurse practitioners can
specialize in a specific medical discipline or practice in general medicine. They can work in a
variety of clinical settings such as physician’s offices, hospitals, nursing homes or
independently. The role of a nurse practitioner is an extension of the nurses basic care giving
role.

 Acute care practitioner

 Adult nurse practitioner
 Pediatric nurse practitioner
 Family nurse practitioner
 Women’s health nurse practitioner
 Geriatric nurse practitioner.

NURSING ADMINISTRATOR: Nurse administrator manages client care and the delivery
of specific nursing services within a health care agency.

Nursing administrator begins with positions such as the charge nurse or assistant nurse
manager, then nurse manager of a specific patient care area.
NURSE RESEARCHER: the nurse researcher investigates problems to improve nursing
care and to further define and expand the scope of nursing practice. The nurse researcher may
be employed in an academic setting, or independent professional or community service
agency.

EXTENDED ROLES:
Nurses role in extended care facilities is one that a nurse assumes by virtue of education, type
of institution in which she is employed or experienced. It is the scope of nursing services
outside the hospital. The concept of extended role is to reach out. The role of a nurse cannot
remain static. the knowledge and skill of a nurse need to be broadened.

Extended roles of nursing include

1) School health nurse
2) Occupational health nurse
3) Parish nurse
4) Public health nurse
5) Private duty nurse
6) Home care nurse
7) Hospice nurse
8) Rehabilitation nurse
9) Nurse epidemiologist
10) Military nurse
11) Aerospace nurse
12) Tele nurse
13) Disaster nursing
14) Forensic nurse
15) Prison nurse
16) Peace nurse corps

1) SCHOOL HEALTH NURSE: The school nurse provides health education by

providing health information to individual students and groups of students
through health education, science, and other classes. The school nurse assists
on health education curriculum development teams and may also provide programs for staff,
families, and the community.

Goal: Supporting educational success by enhancing health.

Functions:

 The school nurse provides Direct care to students for injuries and acute illness for
all students and long term management of students with special health car needs.
Responsibilities include assessment and treatment within the scope of professional
nursing practice, communications with parents, referral to physicians, and
provision or supervision of prescribed nursing care. The school health nurse ha a
unique role in provision of school health services for children with special health
needs, including children with chronic illness and disabilities of various degrees
of severity.
 The school health nurse provides leadership for the provision of health services.
As the health care expert within the school, the school nurse assesses the overall
system of care and develops a plan for ensuring the health needs are met.
Responsibilities include developments of plans for responding to emergencies
and disasters and confidential communication and documentation of student
health information.
 The school health nurse provides screening and referral for health conditions.
Health screening can decrease the negative effects of health problems on
education by identifying students with potential underlying medical problems
early and referring them for treatment as appropriate community resources
promote optimal outcomes . screening includes but is not limited to vision,
hearing and BMI assessments.
 The school nurse promotes a health school a healthy school environment. The
school nurse provide for the physical and emotional safety of the school
community by monitoring immunizations , ensuring appropriate exclusion for
infectious illness and reporting communicable diseases as require=red by law. In
addition, the school health nurse provides for the safety of the environment by
participating in the environmental safety monitoring(playgrounds, indoor air
quality and potential hazards. They also participate in the implementation of a
plan for prevention and management of school violence, bullying , disasters etc.

Qualifications: B.Sc(N)+ Certificate in school nursing

2) OCCUPATIONAL HEALTH NURSE: Specialty practice that provides services to

workers, worker community groups and Delivers health and safety programmes.
Occupational health nurses work with employers and employees to identify health and safety
needs in the workplace. To meet those needs, occupational health nurses:
  Coordinate and deliver services and programs.
 Promote an interdisciplinary approach to health care and advocate for the employee’s
right to prevention-oriented, cost-effective health and safety programs.
 Encourage workers to take responsibility for their own health through health
education and disease management programs, such as smoking cessation,
exercise/fitness, nutrition and weight control, stress management, control of chronic
illnesses and effective use of medical services.
 Monitor the health status of workers, worker populations and community groups.
 Conduct research on the effects of workplace exposures, gathering health and hazard
data.

Functions:

 Promotion and restoration of health

 Prevention of illness and injury
 Protection from work related and environmental hazards

Working Conditions:

 Occupational health nurses work in manufacturing and production facilities,

hospitals and medical centers as well as in other employment sectors, including
government. Workplace activities might include health and wellness, case
management, ergonomics, workplace safety, infection control, disaster
preparedness and others such as travel health. Occupational health nurses fill a
variety of roles in their jobs, including clinicians, case managers, educators,
directors and consultants. The work schedule is typically Monday through Friday,
but may vary, depending upon the work environment, position and
responsibilities.

Qualification: BSC(N)+ certification in occupational health nursing, industrial hygiene,

occupation medicine and safety.

Certification in occupational health nursing is available through The American Board for
Occupational Health Nurses, Inc. To become a certified occupational health nurse, you must
be a registered nurse (RN) with an appropriate degree in nursing, have worked as an RN
within the field of occupational health for at least 3,000 hours within the previous five years
(or have participated in an occupational health nurse certificate program or graduate level
education in occupational health) and pass a certification examination.
3) PARISH NURSE

What Is a Parish Nurse? A parish nurse, also known as a faith community nurse, is a nurse
who cares for members of a parish or faith community. They integrate faith and healing to
promote wellness within the community they serve.

It is a relatively new specialty of nursing, beginning in the 1980s in Chicago. According to

the Health Ministries Association, it was officially recognized as a specialty in 1998 by
the American Nurses Association. Scope and standards of practice for faith community
nurses were first published at that time as well.

The role that gathers in churches, cathedrals, temples, or mosques and acknowledge common
faith traditions. Parish nurse respond to health and wellness needs within the context of
populations of faith communities.

How to Become a Parish Nurse?

A parish nurse should have a keen sense of community, the desire to help others, and have an
unshakeable foundation and knowledge in their spiritual beliefs. As with any nurse, they
must demonstrate compassion and patience with the community they serve. Since parish
nursing can be emotionally demanding, nurses should be able to adequately handle stress and
emotionally draining situations and have a dedicated support system of their own.

Where Do Parish Nurses Work?

Most parish nurses work in churches, but they can also work in social services agencies and
hospitals. Most hospitals have chapels, chaplains, and other spiritual leaders available for
patient care needs. Some hospitals are faith-based organizations as well. They can also work
independently, providing spiritual guidance and healing to members of their faith community

What Does a Parish Nurse Do?

Parish nurses work similarly to holistic nurses- incorporating mind, body, and spirit to assist
members of their community to heal and maintain overall health. Specifically, parish nurses
may:

 Provide preventive health screenings

 Visit members of their parish in homes or hospitals
 Counsel parishioners on medical or health issues
 Volunteer in various community service establishments (shelter, soup kitchens, etc.)
  Provide community resources to parishioners
 Educate patients on preventive health/health maintenance
 Lead support groups

What Are the Roles & Duties of a Parish Nurse?

Parish nurses take a holistic approach to health and wellness, to include spiritual wellness.
Roles and duties include:

 Providing spiritual support to patients when faced with difficult health issues
 Serving as a liaison between patients, the community, and members of the health care
team
 Mentoring volunteers and other members of their parish
 Starting up support groups
 Serving as a patient advocate/resource person
 Educating patients on the importance of faith in relation to health and wellness

Functions:

 Provider of spiritual care

 Health counselor
 Health advocate
 Health education
 Facilitator of support groups
 Trainer of volunteers
 Liaison to community resources and referral agent

Qualification: BSC(N)+3-5 years experience evidence of a mature faith.

Those interested in the specialty of parish nursing should first pursue a nursing degree
through a two or four-year university. Obtaining an Associate's Degree in Nursing (ADN) or
a Bachelor's of Science in Nursing (BSN) degree is required. Many organizations prefer
BSN-educated nurses, as they complete training in community/public health, which is a large
component of parish nursing.

After completion of an accredited nursing program, successful completion of the NCLEX-

RN is required for licensure.
4) PUBLIC HEALTH NURSE: A registered nurse with special training community health.

A public health nurse is a registered nurse (RN) who advocates for positive changes in
population health. This exciting career gives nurses the opportunity to work directly within
communities to educate people and give them the tools they need to improve their health
outcomes.

Activities of public health nursing:

1. Evaluating health trends and risk factors of population groups and helping to
determine priorities for targeted interventions.
2. Working with communities or specific population groups within the community to
develop public policy and targeted health promotion and disease prevention activities.
3. Participating in assessing and evaluating health care services to ensure that people are
informed of available programs and services and assisted in the utilization of those
services.
4. Providing essential input to interdisciplinary programs that monitor, anticipate, and
respond to public health problems in population groups.
5. Providing health education, care management, and primary care to individuals and
families who are members of vulnerable population and high-risk groups.

Functions:

 Health advocate
 Care manager
 Referral resources
 Health educator
 Direct primary caregivers
 Communicable disease control
 Disaster preparedness

Qualification: BSC(N)+social and behavioral sciences, epidemiology, environmental health

current treatment modalities, and health care delivery options.

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

How to become a Private Duty Nurse?

Possessing only a bachelor’s degree in nursing is rather premature to venture PDN. It is
necessary for one to undergo clinical experience, trainings and seminars to equip oneself to
actual patient care. PDN should have at least the following qualifications:

 At least one year of clinical experience

 Basic life support training
 First aid training
 Intravenous therapy course
 Attended several nursing seminars and forums

6) HOME CARE NURSE: Home care nurse is a nurse who provides periodic care to
patients with in their home environment as ordered by the physician.

Goal of home care nursing:

The main goal of home nursing service is to treat an illness or injury. The home nursing
services usually entails wound care for pressure sores or surgical wound, patient and care –
giver education, Intravenous or nutrition therapy, injections, rehabilitation therapies and
monitoring serious illness and unstable health status.

Vaccination:
Get vaccinated at home and stay safe from infectious diseases. We provide vaccination for
H1N1, Typhoid, Pneumonia, Hepatitis and more by qualified nurses at home.

Post-Surgical Care:
Post-surgical care is critical, and includes everything from pain management & feeding to
respiratory management & fluid management. Get well sooner under the care of our nurses,
who will help you with all of this in the comfort of your home.

Urinary Catheterisation Care:

Our nurses are well trained and can help you with the process of Urine catheterization care at
your home; be it catheter insertion, catheter removal or bladder wash

Wound Dressing:
Did you know that the healing process varies depending on the wound type? Our nurses are
experienced in handling varied types of wounds-post-operation surgical wounds, infected
wounds and pressure sores and will accordingly provide appropriate wound care for a faster
recovery.
Oxygen Administration:
Oxygen administration is required in both acute and chronic conditions like trauma,
haemorrhage, shock, breathlessness, pulmonary disease, and more. Don’t panic if you require
one. Call a Portae nurse home and sit back, while she does the needful.

Injection:
Save yourself the trouble of travel and long hospital hour for a minor process like injection
administration or IV infusion. Just book with us a home nurse and an experienced and
registered nurse will come visit you at home to administer the required injection or IV
infusion.

Functions:

 Health maintenance
 Education
 Illness prevention
 Diagnosis and treatment of disease
 Palliative care

Qualification: BSC(N)+professional practice in any community health setting.

7) HOSPICE NURSE: The term “hospice nurse” is a broad term that is used to describe the
variety of medical professionals that care for patients towards the end of their lives.
Commonly the term is used to refer to CHPNs, Certified Hospice and Palliative Nurses or
CHPLNs, Certified Hospice and Palliative Licensed Nurses.

Hospice nurse is one who provides a family centered care and allows clients to live and
remain at homes with comfort, independence and dignity, while alleviating the strains caused
by terminal phase i.e. at the time of death.

Functions:

 Pain and symptoms control.

 Spiritual care
 Home care and impatient care
 Family conferences
 Co-ordination of care
 Bereavement care.
8) REHABILITATION NURSE: Rehabilitation nurse is a nurse who specializes in
assisting persons with disabilities and chronic illness to attain optimal function, health and
adapt to an altered life style. Rehabilitation nurses may practice in a variety of settings,
including:

 Hospitals
 Inpatient rehabilitation centres
 Outpatient rehabilitation centres
 Long-term care facilities
 Community and home health settings
 Insurance companies
 Private practice
 Schools
 Industrial health centres

What Are the Educational Requirements for Rehabilitation Nurses?

Whether it's obtaining a BSN (Bachelors of Science in Nursing) or an ADN (Associates of

Science in Nursing), earning a nursing degree is the first step toward beginning a career as a
rehabilitation nurse. Upon earning a nursing degree, you can then apply to take the NCLEX-
RN licensing examination. Once this exam has been successfully passed, you will be eligible
to apply for a registered nursing license via your state's nursing board. Additionally, there are
continuing education courses that are available which introduce RNs to basic rehabilitation
nursing concepts.

Typically, advanced practice nurses will hold an MSN specific to their role as nurse
practitioners (NPs) and clinical nurse specialists (CNSs). Currently, master's degrees specific
to advanced practice rehabilitation nursing simply don't exist.

Registered nurses (RNs), can, however, pursue post-graduate degrees such as:

 Ph.D. in Rehabilitation Science

 Executive Masters in Rehabilitation Administration
 Master of Health Science (MHS) Degree in Rehabilitation Sciences
Qualification: BSC(N)+ certification in rehabilitation nursing.

What Are the Roles and Duties of a Rehabilitation Nurse?

 The primary objective of rehabilitation nursing is to assist patients in recovering and
regaining independence and functionality following an injury, disability, or illness. A
rehab nurse typically handles the following:
 Educates and assists patients to live with and appropriately manage chronic illnesses
and injuries
 Assists patients in returning to their normal lives following a serious illness or injury
 Prepares clients and their loved ones for future self-management and decision-making
responsibilities by encouraging clients' independence and ongoing goal achievement
 Teaches specific rehabilitation nursing techniques to help clients and their families
develop the self-care skills necessary to move toward full rehabilitation
 Coordinates nursing activities in collaboration with additional members of the
interdisciplinary rehabilitation team to facilitate achievement of overall goals
 Acts as an educational and informational resource and role model for both nursing
staff, patients, and other clinical staff
 Performs hands-on nursing care by utilizing the nursing process to achieve quality
outcomes for clients
 Shares pertinent information occurring in the disease processes underlying disabilities

9) NURSE EPIDEMIOLOGIST:

What Is a Nurse Epidemiologist?

In simple terms, nurse epidemiologists are health professionals who work in hospital settings
and strive to provide exceptional patient care while limiting the risk of the spread of disease
or infection for visitors, staff members, and patients alike. They are responsible for
conducting epidemiological investigations, as well as reviewing patients who may have the
potential for infection. They are also responsible for monitoring patient care behaviour to
ensure that no risks are taken that might lead to the transmission of infectious diseases.

They monitor standards and procedures for the control and prevention of infectious diseases
and other conditions of public health significance including nosocomial infections.

Nurse have a range of key skills including:

 compassion
 patience
 ability to multi-task
 critical thinking
  emotional stability
 knowledge of measures for infection control
 experience with various nursing equipment

Functions:

 Conducts epidemiologic investigations.

 Provides education about communicable diseases.
 Provide ongoing Inservice training.
 Recommendation on isolated infection.
 Conduct study to determine risk factors leading to infections.
 Conducts surveillance of infection outbreaks.

Qualifications: B.Sc.(N), M.Sc.(N)+ Supervisory experience.

10) MILITARY NURSE:

What Is a Military Nurse?

Military nurses are licensed registered nurses who are contracted to provide medical care
specifically to patients in military clinics and hospitals. Much like traditional registered
nurses who treat civilians, military nurses monitor wounds for infection, prepare patients for
surgical procedures, and administer preoperative and postoperative care for those inside the
military. Not only will military nurses have the chance to travel and see the world, but they
also have access to excellent education and are compensated for time spent studying. They
also enjoy excellent benefits, such as free healthcare. Additionally, job responsibilities for
military nurses include monitoring the pain and comfort levels of patients, assisting the
disabled to care for themselves, and providing psychological and emotional support.

Where Do Military Nurses Work?

Military nurses are required to make at least a three-year commitment to serve their country.
Traditionally, military nurses are stationed in a new region about every three years. There
may be required travel just about anywhere abroad to help with emergency situations if they
do happen to arise. Most nurses in the military are stationed at military/government facilities.
Some, however, will serve in makeshift facilities as they near the front lines with combat
units.

The most common places you will find military nurses working in are:
  Military Hospitals
 Military Clinics
 V.A. Hospitals/Clinics
 Pop-up/makeshift nursing facilities in and around combat zone.

ROLES AND DUTIES OF MILITARY NURSE:

The primary functions and obligations of active military nurses are to:
 Treat wounded soldiers and other military personnel
 Treat service members' families
 Set up military triage in war zones
 Treat patients worldwide
 Provide vaccinations to children in developing countries
 Assist in any humanitarian relief efforts the U.S. military might be engaged in
 Provide emergency care to victims affected by natural disasters
 Prescribe medication
 Work in pre-operative settings applying anaesthesia

11) AEROSPACE NURSE: Flight nurse is a nurse who provides comprehensive nursing
care for all types patients during aero medical evacuation and airlift flight.

What Is A Space Nurse?

Beyond space missions, the majority of aerospace nurses today provide critical and
emergency care during transport for patients who are air evacuated. These nurses are trained
to deal with the unique challenges of patient care in an unstable setting with limited
resources. In addition, they have to know how to deal with decompression sickness that often
happens in flight.

On the space front, there are also nurses who are involved in the care of astronauts prior to
launch, and who are on standby when they touch down. They perform pre- and post-launch
assessments and provide instructions to astronauts for how to handle medical emergencies
while in flight.

The First NASA Nurse: The pioneer of this profession was Dee O’Hara, who became the first
nurse to work with the original seven Mercury astronauts back in the 1960s. She continued
working with astronauts in the Gemini, Apollo and Skylab programs.
Qualification: GNM/BSc Nursing + minimum of 12 months of assignment is mandatory to an
aeromedical evacuation unit and at least 100 hours of flying time logged as a flight nurse.

12) TELENURSE: Tele nurse is one who carries out tele phonic communication with the
patient.

Telehealth nurses are Registered Nurses that use telecommunication technology such as

video, phone, email, and messaging to provide high-quality care to patients. Telehealth
nursing is beneficial not only to the patients, but also to the healthcare system.

Telehealth nurses often help patients with minor health problems and can help determine if
patients need to seek emergency care, make an in-person appointment with a physician, or
can be treated without further guidance. Telehealth nursing is beneficial not only to the
patients, but also to the healthcare system. Telehealth nurses have a variety of job
responsibilities. These will vary depending on the job location and specialty. These
responsibilities may include:

 Scheduling appointments and referring patients to specialists

 Assisting and consulting with patients over the phone or via video chat services
 Educating patients on different ways to manage their symptoms
 Monitoring patient’s oxygen levels, health rate, respiration, and blood glucose
 Pre-surgical and post-surgical care  
 Assisting doctors in reducing patient load
 Providing medical advice for patients with minor health issues
 Supporting medical response teams in bringing patients into the hospital

Telehealth nurses can work in a variety of settings. Generally, they work from home or in
a telephone triage centre. Depending on the specialization, telehealth nurses may also
work in the following locations:

 Physician's offices
 Hospitals
 Trauma centres
 Crisis hotlines
 Outpatient care facilities
 Poison control centres

Qualification: BSc+ Special certification course or training in telenursing.

13) DISASTER NURSING:

Disaster nursing can be defined as the adaptation of professional nursing skills in recognizing
and meeting the nursing, physical, emotional, and social needs resulting from a disaster.

Disaster nursing involves response to & preparedness for natural and man-made that affects
an entire community (communities) that massive number of casualties and extensive property
damage.

Disaster nursing can be defined as 'The adaptation of professional nursing knowledge, skills
and attitude in recognizing and meeting the nursing, health and emotional needs of disaster
victims by WHO

Goals of disaster nursing:

The overall goal of disaster nursing is to achieve the best possible level of health for the
people and the community involved in the disaster.

Other goals of disaster nursing are •

- To meet the immediate basic survival needs of populations affected by disasters (water,
food, shelter, and security).

- To identify the potential for a second disaster.

- To appraise both risks an resources in the environment.

-  To correct inequalities in access to health care or appropriate resources,

- To empower survivors to participate in and advocate for their own health and well-being.

- To respect cultural, lingual, and religious diversity in individuals and families and to apply
this principle in all health promotion activities.

- To promote the highest achievable quality of life for survivors.

Qualification: a registered nurse with special training program on disaster.

14) FORENSIC NURSE:

Forensic nurse is one who is expected to be acquainted with the basics of forensic medicine
so as to handle and preserve the evidentiary materials. Nurses—they are critical members of
any healthcare organization and vital to a patient’s successful recovery. Nurses are in charge
of the ins and outs of daily patient care and are instrumental for doctors and patients alike.
Nursing is an extremely rewarding profession—nurses work to help patients recover each and
every day and often are

What is forensic nursing?

Forensic nurses are specially trained registered nurses (RNs) and serve victims of abuse,
violence, human trafficking, and more. Their job responsibilities may include: collecting
evidence, photographing injuries for evidence, working with victims of domestic abuse or
violence, connecting with law enforcement and legal teams to help victims, providing
testimony in court cases, working with medical examiners when victims die, as well as all
traditional nursing responsibilities.

Traditional nursing responsibilities will usually include recording vitals, administering

medication and treatment, talking to patients about their health history, assisting doctors in
their procedures, and more.

Qualification: registered nurse with certification in forensic nursing or special training

program in the field of forensic science.

15) PRISON NURSE: Prison nurse is a registered nurse who works in a prison. Prison
nurses can either be employed directly by prison service or can work in other areas and send
part of their working week in prison health care.

Functions:

 Delivers high quality treatment and care within a custodial setting while
maintaining a secure and safe environment.
 Improves health behavior mental health of prisoners, which have a significant
impact on preventing re-offending.

16) PEACE NURSE CORPS: Peace nurse cops is a nurse who performs variety of nursing
activities in remote areas of the world.

Functions:

 Prevention and health education.

 Plan, coordinate and provide health education to volunteers.
 Provide preventive health services, including immunizations, periodic health
evaluations and preventive treatment.
JOURNAL
Title: Importance of prenatal care in reducing stillbirth

Author: Goldenberg RL., McClure EM.

Published on: 21 April 2017

Abstract:

Objective

To explore still-birth risk across gestation in three provinces of South Africa with different
antenatal care schedules.
Design

Retrospective audit of perinatal death data using South Africa's Perinatal Problem
Identification Programme.

Setting

In 2008, the Basic Antenatal Care Programme was introduced in Limpopo and Mpumalanga
provinces, reducing appointments to five visits at booking, 20, 26, 32, 38 weeks and 41
weeks if required. In the Western Cape province seven appointments remained at booking,
20, 26, 32, 34, 36, 38 and 41 weeks if required.

Population

All audited stillbirths (n = 4211) between October 2013 to August 2015 in Limpopo,
Mpumalanga and Western Cape.

Methods

Stillbirth risk (26–42 weeks of gestation, >1000 g) across gestation was calculated using
Yudkin's method. Stillbirth risk was compared between provinces and relative risks were
calculated between Limpopo/ Mpumalanga and Western Cape.

Main outcome measures

Still-birth risk across gestation.

Results

Stillbirth risk peaked at 38 weeks of gestation in Limpopo (relative risk [RR] 3.11, 95% CI
2.40–4.03, P < 0.001)and Mpumalanga (RR 3.09, 95% CI 2.37–4.02, P < 0.001) compared
with Western Cape, where no peak was observed. Stillbirth risk at 38 weeks gestation in
Limpopo and Mpumalanga were statistically greater than both the 37 and 39 weeks gestation
within provinces (P < 0.001). As expected, a peak at 41 weeks of gestation was observed in
all provinces.

Conclusions

The increased period of stillbirth risk occurs after a 6‐week absence of antenatal care. This
calls for a refocus on the impact of reduced antenatal care visits during the third trimester.
CONCLUSION:
Prenatal care serves important functions of medical screening and surveillance Opportunity
for educating mothers and for planning the birth itself We should support efforts to remove
the barriers to prenatal care in our communities

The care of families throughout the pregnancy, delivery, and post-partum, and the
longitudinal care of families throughout the lifecycle, enables family physicians and their
patients to view prenatal care as part of an ongoing relationship.

The health of children is a product of complex, dynamic processes produced by the

interaction of external influences, such as children’s family, social, and physical
environments, and their genes, biology, and behaviours. Because children are rapidly
changing and developing in response to these interactions, the developmental process plays
an important role in shaping and determining their health. Nonetheless, the routine
approaches to defining and measuring health in many national, state, and local data collection
and measurement efforts are adult-based and capture neither the developmental essence of
nor the multiple influences on children’s health. Pediatrics nursing has greatly affected the
medical field in the United States. They are now the main medical caregivers of children. Its
development over the years helped saved many young lives.

REFERENCES

 Jacob A, A Comprehensive Textbook of Midwifery. New Delhi : Jaypee Brothers

Medical Publishers (P) Ltd, 2015;577-81.
 Basavanthapa B.T., Community Health Nursing. Peevee S. Vihas and Company
Medical Publishers India, 2011;4-29.
 Dutta P., Pediatric Nursing ,2nd ed. New Delhi : Jaypee Brothers Medical Publishers
(P) Ltd. Page no. 12-17.
 Hockmberry M.J., Wilson D., Essential of Pediatric Nursing, 8th ed. Page no. 21-22.
 Singh J., Pediatric Nursing, 4th ed. N.R. Brothers Publishers, 2009. Page no. 2-16.
 Gupta P., Essentials Pediatric Nursing.2nd ed. CBS Publishers and Distributors Pvt.
Ltd. 2010. Page no. 4-18.
 Available from http://www.registered nursing org. staff writer , oct.19,2020.
 Available from http://www.wgu.edu Forensic Nursing Salary and job description,
feb.17,2020.
 Goldenberg RL., McClure EM. Importance of prenatal care in reducing stillbirth, 21
April2017.Availablefrom:https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/147
1-0528.14645.