roles and responsibilities of community health nurse practioner, midwifery practioner, decision making, preofessionalism, legal issues

1. ROLE AND RESPONSIBILITIES OF
COMMUNITY HEALTH NURSE
PRACTITIONERS
NURSE MIDWIFERY PRACTITIONERS
DECISION MAKING SKILLS,
PROFESSIONALISM,
LEGAL ISSUES
Submitted by: Ms. Arushi Negi
M.Sc. Nursing Ist year
SUBMITTED TO : Ms. Seema Rani
Associate Professor,
RCON , Jamia Hamdard

2. INTRODUCTION
•A community nurse can serve direct care, educate
individuals or the public, advocate for health improvements,
and perform research in community health.
•There are innumerable roles which are performed by
community health nurses working in various community
health settings.

3. ROLES AND FUNCTIONS OF COMMUNITY
HEALTH NURSE PRACTIONER
Care Provider
• The community health nurse
provides care to entire family, group
of people and even the community at
large.
• She provides omprehensive care ,but
more emphasis is given to the
promotion of health and prevention
of diseases.

4. SENSITIVE OBSERVER :
It is important for a Community health nurse to observe and
take actions with respect to determinants of health.
It includes :
Observation
of people
with respect
to any any
health
problem
Observatio
n of
lifestyle of
people
Observation
of
environment
al conditions
Observation
of resources
available

5. EDUCATOR
• The ultimate aim is to help people gain knowledge , modify health behaviour and help in becoming self
dependent .
• Education may be planned and structured. Ex: when a nurse plans and teaches a group of teenage
mothers regarding care of child.
• Education may be incidental and unplanned. Ex: when a nurse teaches a school child abut dirty nails.
• She pleads for their cause by speaking and acting on their behalf.
• She explains to them about the services available and guides them about how to use these services .
• As an effective advocate the community health she needs to possess certain qualities which are:
• Willingness to take risk , Assertiveness ,Communicability, Resource-fulness.
ADVOCATE

6. CONCERNED ADVISER
• The community health nurse acts as an adviser. She gives suggestions and advises
in practical situations which require immediate action
• example: An antenatal mother having threatened abortion
CHANGE AGENT :
• She serves as a potentiate or a catalyst. She makes others more effective by
increasing their capabilities to cope up with health problems and provide care to
themselves .
MANAGER
• They are expected to act as a manager at various levels. As a manager she plans
, organises, coordinates, supervises, guides, directs , reports and evaluates.

7. PLANNER
Planning is the foremost function
of community health nurse.
She gets involved in overall
planning of community health care
or in planning of any specific
programme for any particular
group or for the whole community.
ORGANIZER
Second function as a manager .She
plans any programme, organises
structure and sets objectives.
She’ll make arrangements, assigns
the tasks for the smooth
functioning.

8. • Their role is to ensure that work is done as planned and
organized.
• She has to motivate them , direct and guide them to reach
desired objectives.
• Ensure the effective communication within the team.
DIRECTOR
AND CO-
ORDINATOR
• Once any care/service/programme is planned
and implemented, it becomes essential for the
nurse manager to monitor the plan to make sure whether it
is proceeding in its direction or there are some difficulties
encountered to reach the intended objectives.
• Once she identifies the difficulties, she then takes
corrective measures according to the situation so that
objectives are attained.
CONTROLLER
AND
EVALUATOR

9. • Community health nurse functions as a leader when she performs the
role of a nurse manager.
• She leads the group by giving them directions, ensuring biway
communication, providing supervision and guidance and by co-ordinating
their activities and infrastructure etc.
LEADERSHIP
ROLE
• Community health problems cannot be solved by a single health worker.
It involves many people,who work together in a team.
• The team includes health personnel working in an agency, outside
the agency, personnel from other sectors; voluntary organisations and
community people. The community health nurse collaborates with them
• Each member in the team has a unique role and specific responsibilities
in meeting health needs
COLLABORATOR

10. RESEARCHER
• In the researcher role community health
nurses engage in systematic
investigation, collection, and analysis of
data to solve problems and enhance
community health nursing practice.
• Based on the research result
community nurse improve their service
quality and improve community people
health.

11. ROLES OF MIDWIFERY NURSE
PRACTIONER :
• Midwifery facilitates development of
gate-keeping mechanism by catering to
most of the normal childbirths and
referring only the complicated cases to
higher healthcare facility.
• It encourages task shifting from doctors
to midwives in relation to promotion
and conducting of physiological normal
births.

12. General competencies
Midwives act as advocates for RMC
Recognize abnormalities and complications and implement appropriate
treatment .
The midwife will work in partnership with women,to give women the necessary support
The midwife will also educate women so that they have knowledge about how to have a
healthier pregnancy and a better birth
Midwives plan the care of the mother, and this involves assessing, planning, evaluating and
implementing
Midwives may also work inter-professionally; with doctors, nurses, and other health care
providers as part of a maternity care team

13. • Family planning , monitoring the progression of
pregnancy
• The midwife understands, promotes and facilitates the
physiological processes of pregnancy and childbirth,
identifies deviations or complications that may arise in
mother and baby, obtains appropriate medical assistance,
and implements emergency measures as necessary.
Pre-
pregnancy
and antenatal
care
• Promote normal birth with respectful care
• Manage safe and spontaneous vaginal births and prevent
complications.
• Stabilizing emergencies and referral as necessary and
provide immediate care of newborn
Care during
labour and
childbirth

14. Ongoing care of the women and
newborns
• Provide postnatal care for the woman, and newborn
• Detect, stabilize and refer postnatal complications
• Midwives will ensure that the mother has skin-to-skin contact with
her baby immediately after the birth, and maintains that for as long
as she wants.
• Provide immediate postpartum family planning
• Midwives will work independently and will be supervised and
supported by on duty Medical Officer/Specialist when complications
are identified.

15. Referral linkages
• Forward linkage with higher healthcare facility
• Backward linkage or integration is limited to building capacities
of ANMs, HSCs, PHCs and Health and Wellness Centres staff for
early identification of complication and timely referral, or for
home deliveries
• Public-private partnerships with established linkages can be
explored in hard-to-reach and tribal areas to increase access to
healthcare facilities

16. PROFESSIONALISM IN CHN
INTRODUCTION
• A nurse is a healthcare professional who, in collaboration with other members
of a health care team, is responsible for: treatment, safety, and recovery of
acutely or chronically-ill individuals; health promotion and maintenance
within families, communites and populations; and, treatment of life-
threatening emergencies in a wide range of health care settings.
• Profession: A profession is an occupation with ethical components, ie.
devoted to the promotion of human and social welfare. The services and
knowledge by a profession are based on specialized skills.

17. DIFFERENCE BETWEEN
OCCUPATION AND PROFESSION
Occupation
• Training may occur in the job,
• Length of training varies
• Values, beliefs and ethics are not
prominent factors of preparation
• Commitment and personal
identification vary.
• People often change job
• Accountabilitv rests with the
employer
Profession
• Education takes place in a college
• Education is prolonged
• Values, ethics, beliefs are an
integral part of preparation
• Commitment and personal
identification strong
• People unlikely to change
profession
• Accountability rests with an
individual

18. CHARACTERISTICS OF A PROFESSION
Has a theoretical
body of knowledge
leading to defined
skills, abilities, and
norms.
Provides scientific
service
Has autonomy in
decision-making and
practice.
Has a whole code of
ethical practice.
Requires an
extended education
as well as a basic
liberal foundation,
Extensive period of
formal training
Control over work
performance
Credentialing system
to certify
competence
Legal reinforcement
of professional
standards
Public acceptance.

19. NURSING AS A PROFESSION
• Nursing profession is not simply a collection of specific skills
and nurse but she is a person conscientious in actions,
knowledgeable in the subject and responsible to self and others.
• Nursing as a profession has a scientific base of knowledge and
skills that provide coordinated services, which include care
of sick, promotion and restoration of health and prevention of
illnesses; thus meaning physical, social, psychological and
spiritual needs of human beings.

20. ACCOUNTABILITY IN NURSING
Hierarchy of
Accountability
• individual level: Accountability is reflected In nurse's ethical
integrity.
• institutional level: It is reflected in the statement of philosophy
and objectives of nursing department and nursing audts
• professional level: It is reflected in standard of practice
developed by national or provincial nursing associations.
• societal level: It is reflected in legislated nurse practice acts.
Accountability is the legal obligation in healthcare nursing within healthcare.

21. Types of Nursing Accountability
Fiscal
accountabilify:
concerned with
financial probity and
the ability to trace
and
explain expenditure.
Process
Accountability:
concerned with
the use of proper
procedures
Program
accountability:
concerned with
the activities
undertaken and
their quality.
Priorities
accountability:
This deals with the
relevance
or appropriateness
of
chosen'activities.

22. LEGALAND ETHICALASPECTS IN
NURSING
When a person becomes a member of a profession, he accepts the responsibility of living up to
the code of ethics for the profession. A code of ethics is used to guide professional behavior.
There are six kinds of authorities which give guidance to legal responsibility for nursing
practice. These are:
1. The Central Government Acts.
2.The State Government Act.
3. The International Code for nurses subscribed to by the TNAI.
4. Institutional rules and regulations.
5.Standing orders.
6.Precedent or an example of court decision has been made in a same case.

23. LEGAL RESPONSIBILITIES OF
NURSES
Responsibility of appointing and assigning
Responsibility in quality control
Equipment
Responsibility for observation and reporting
Responsibility to protect public
Responsibility for record keeping and reporting
Responsibility for the death and dying
Knowledge regarding institutional rules and policies

24. LEGAL SAFEGUARD IN NURSING
PRACTICE
Licensure
Good samaritan law:
The laws exempt
doctors and nurses
from liability when
they are rendered first
aid during emergency.
Good rapport: A
lawsuit is often
circumvented when the
nursing staff threats
the client with
warrants and caring.
Standing order
Standard
care
Contract:
written consent
of the patient.
Correct
identity
Counting of
sponges,
instruments and
needles
Drug
maintenance :
misuse of
drugs.
Documentation
Patient's
property
Reporting

25. CODE OF ETHICS
Within any given profession, a code of ethics serves as a means of self-regulation and a source
of guidelines for individual behavior and responsibility. Professional codes of ethics are a
system rules and principles by which that profession is expected to regulate its members and
demonstrate its responsibilities to the society.
In India, nurses are following the international Council of Nurses Code for Nurses 1993, as
given below:
Nurses and People
• The nurse's primary responsibility is to that person
who requires nursing care.
• The nurse provides care, promotes an environment in
which the values, costumes and spiritual beliefs of
the individual are respected.
• The nurse holds confidence, personal information and
uses judgment in sharing their information.
Nurses and Practice
• The nurse maintains the highest standard of nursing
care possible within the reality of a specific situation.
• The nurse uses judgment in relation to individual
competence when accepting and delegating
responsibilities.
• The nurse when acting in a professional capacity
should, at all times, maintain standard of personal
conduct which reflects credit upon the profession.

26. Nurses and Society
• The nurse shares with other citizens the responsibility for initiating and supporting actions to
meet the health and social needs of the public.
Nurses and Coworkers
• The nurse sustains a cooperative relationship with coworkers in nursing and other fields.
• The nurse takes appropriate actions to safeguard the individual when his care is endangered
by coworkers or any other person.
Nurses and the Profession
• The nurse plays the major role in determining and implementing desirable standard of nursing
practice and nursing education
• The nurse is active in developing a care of professional knowledge.
• The nurse acting through the professional organization, participates in establishing and
maintaining equitable, social and economic working.

27. ETHICAL PRINCIPLES IN DECISION
MAKING
Autonomy:
informed
consent is
direct
reflection of
autonomy.
Beneficence: The
beneficence
principle states
that the actions
one takes should
be in an effort to
promote the
good.
Nonmaleficenc
e: The
principles of
nonmaieficenc
e state that
one should do
no harm.
Veracity: It
means
"obligation
to tell the
truth".
Justice: It
concern the
issues that
persons should
be treated
equally and
fairly.
Fidelity: It
is keeping
one's
promises
and
commitme
nt.
Confidentiality:
It is the duty to
respect
privileged
information.

28. TORTS
Torts a civil wrong made against a person or property A tort can be
any of the following :
• The denial of a person’s legal right
• The failure to comply with a public duty
• The failure to perform a private duty that results in harm to another.
Categories of torts
• Unintentional Torts
• Intentional Torts.

29. Intentional Torts
• any intentional acts that are
reasonably foreseeable to cause harm to an
individual, and that do so.
• Assault: when a person puts another person
in fear of a harmful or offensive contact. •
• Battery: it is an intentional touching of
another’s body without the other’s consent.
• Fraud: it results from a deliberate deception
intended to produce unlawful gains.
• False imprisonment: it occurs when a client is
not allowed to leave a health care facility
when there is no legal justification to detain
the client or when restraining devices are
used without an appropriate clinical need.
• Invasion of privacy: it includes violating
confidentiality intruding on private client or
family matters, and sharing client information
with unauthorized persons .
Unintentional Torts
• Negligence: It is conduct that falls below the
standard of care that a reasonable person
ordinarily would use in a similar circumstances
or it is described as lack of proper care and
attention carelessness.
• Malpractice: failure to meet the standards of
acceptable care which results in harm to
another person, • Medication errors • Failure
to follow a physician‘s orders

30. ROLES AND FUNCTIONS OF NURSE
IN ETHICAL ISSUES
Accepts that some ambiguity and uncertainty must be a part of all ethical decision-making.
Accepts that negative outcomes occur in ethical decision-making despite high quality problem-solving and decisina
Demonstrates risk taking in ethical decision-making.
Role models ethical decision-making
Actively advocates for clients, subordinates and professionals.
Clearly communicates expected ethical standard of behavior.
Uses a systematic approach to problem-solving or decision-making
Uses established ethical framework to clarify values and believes.
Applies principles of ethical reasoning to define what beliefs or values from the basis of decision-making.
Recognizes and rewards ethical conduct of subordinates.
Takes appropriate action when subordinates use unethical conduct.

31. SUMMARY
Through this topic we came to know about roles and
responsibilities of community health nurse practioner,
midwifery practioner, professionalism, difference between
occupation and profession, characterstics, nursing as a
profession, accountability , legal and ethical aspects in
nursing, legal responsibilities of nurses , code of ethics,
ethical issues, torts and role of nurse in ethical issues.

32. CONCLUSION
• A community nurse can serve direct care, educate individuals or
the public, advocate for health improvements, and perform
research in community health. It is the job of a community health
nurse to help and keep the community health problems under
control.
• There are innumerable roles which are performed by community
health nurses working in various community health settings.

33. BIBLIOGRAPHY
• Gulani K.K., Community health nursing (principles and practices
), second edition, 2013, kumar pubishing house, pg no- 47 to 51
and 549 to 554
• Brar Navdeep kaur, Textbook of advance nursing practice, 3rd
edition , the health sciences publishers, page no - 11-27
• Guidelines for midwifery practioner by NHM , available at:
https://nhm.gov.in/New_Updates_2018/NHM_Components/RMN
CHA/MH/Guidelines/Guidelines_on_Midwifery_Services_in_In
dia.pdf