Mapping the Future of Environmental Health and Nursing: Strategies for Integrating National Competencies into Nursing Practice

Abstract

Nurses are increasingly the primary contact for clients concerned about health problems related to their environment. In response to the need for nursing expertise in the field of environmental health, the Institute of Medicine (IOM), Agency for Toxic Substances and Disease Registry (ATSDR), and National Institute of Nursing Research (NINR) have designed core competencies for the nursing profession. The IOM competencies focus on four areas: (1) knowledge and concepts; (2) assessment and referral; advocacy, ethics, and risk communication; and (4) legislation and regulation. The competencies establish a baseline of knowledge and awareness in order for nurses to prevent and minimize health problems associated with exposure to environmental agents. To address the known difficulties of incorporating new priorities into established practice, nurses attending an environmental health short course participated in a nominal group process focusing on the question, "What specific actions can we take to bring environmental health into the mainstream of nursing practice?" This exercise was designed to bring the concepts of the national initiatives (IOM, NINR, ATSDR) to the awareness of individual nurses involved in the direct delivery of care. Results include 38 action items nurses identified as improving awareness and utilization of environmental health principles. The top five ideas were: (1) get environmental health listed as a requirement or competency in undergraduate nursing education; (2) improve working relationships with interdepartmental persons-a team approach; (3) strategically place students in essential organizations such as NIOSH, ATSDR, or CDC; (4) educate nurse educators; and (5) create environmental health awards in nursing. The 38 original ideas were also reorganized into a five-tiered conceptual model. The concepts of this model include: (1) developing partnerships; (2) strengthening publications; (3) enhancing continuing education; (4) updating nursing practice; and (5) strengthening schools of nursing. The model serves as a road map for action in building environmental health capacity within mainstream nursing.

Barriers and Facilitators in the Delivery of Environmental Risk Reduction by Public Health Nurses in the Home Setting

“…Nurses constitute the largest group of health care workers and have contact with a large and diverse segment of the population (Gebbie, Rosenstock, & Hernandez, 2003). Moreover, they are often the first, and sometimes only, contact that individuals have with the formal health care system, particularly for clients concerned about EH (Larsson & Butterfield, 2002).…”

Barriers and Facilitators to the Incorporation of Environmental Health into Public Health Nursing Practice

“…Central to these recommendations was a clear statement that EH should be reemphasized in the scope of responsibilities for nursing practice. Other initiatives such as the Environmental Health Nursing Initiative sponsored by the Agency for Toxic Substances and Disease Registry (ATSDR) and the National Institute of Nursing Research (NINR) have reinforced the idea that as powerful stakeholders in public health, nurses should actively participate in addressing the EH of their constituents (Larsson & Butterfield, 2002).…”

Transfusing our lifeblood: Reframing research impact through inter-disciplinary collaboration between health geography and nurse education

“…Furthermore, 'natural environment' has become a well-trodden area of interest in nursing research, paralleling the emergence of the green movement (see Kleffel, 1991;Schuster and Brown, 1994;Chinn, 1996). Whilst much of this work is locally-focused and concerned with pollution and 'environmental health' (Grady et al, 1997;Larsson and Butterfield, 2002;Sweeney and de Peyster, 2005), some considers the impacts on health of broader global climate and ecosystems change (Kleffel, 1996;Kirk, 2002;Laustsen, 2006;Andrews, 2009).…”