Nursing, Health, and the Environment (1995) / Chapter Skim
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3 Nursing Practice
3 Nursing Practice
Pages 39-68
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From page 39... ...
When environmental health concerns are missed, an opportunity for prevention is lost, and public health is less well served. Although not every illness has an environmental etiology, nearly everyone will have a health problem related to an environmental hazard for which evaluation or advice is appropriate in terms of good nursing practice.
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From page 40... ...
The most widely accepted framework for nursing practice currently in use is the nursing process of assessment, diagnosis, planning, intervention, and evaluation. A model to guide medical and nursing practice specific to environmental health concerns established by the California Public Health Foundation (CPHF, 1992)
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From page 41... ...
During the assessment phase of the nursing process, data are gathered to determine a patient's state of health and to identify factors that may affect well-being. This activity includes eliciting a health history to identify previous illnesses and injuries, allergies, family health patterns, and psychosocial factors affecting health.
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From page 42... ...
This extension of nursing advocacy is often essential for addressing environmentally related health issues because they are frequently intertwined with social and political factors. Interventions focusing exclusively on the individual patient are rarely effective as primary prevention methods in matters of environmental health.
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From page 43... ...
Application of the nursing process to environmental health concerns requires an expansion of the tools and processes used to assess patients, reason diagnostically, and develop treatments and interventions that consider environmental factors. Responsibilities for implementing clinical services relevant to environmental health will vary according to practice settings; however, the nursing process is a useful framework for applying environmental health concepts in all settings and roles.
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From page 44... ...
(see Box 3.1~. Eliciting an environmental health history, another investigative activity, is one of the most important actions for enhancing the environmental health content in nursing practice, because information derived from the history is essential to all other nursing activities related to environmental health.
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From page 45... ...
relationship between your current symptoms and activities at work, home, or other environments? The investigative role of nurses may extend to their being part of a community or interdisciplinary public health assessment team.
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From page 46... ...
The interactive process of exchanging information on technical hazards and the human response, both physiological and emotional, calls for professionals who can listen, interpret, clarify, and reframe questions and information in emotionally charged and sometimes hostile situations. The basic patient education role of nurses with individuals and families fin this report, when referring to the interaction between health professionals and individuals who are potentially affected by exposure to environmental hazards, the term risk communication will be used.
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From page 47... ...
Nurses and other health care providers often need to help individual patients locate and secure access to specialized services for health problems related to environmental hazards. They may also be called upon to contact individuals, agencies, and organizations outside the health care system, working on behalf of patients or communities to change hazardous conditions and prevent future health problems.
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From page 48... ...
Effective interventions for environmentally related illness require collaborative efforts from many disciplines due to the complex nature of environmental health issues, the rapidly advancing science base in environmental health, and the need for primary prevention strategies that often must involve professionals from fields other than nursing. Such collaboration includes ongoing dialogue and fluidity of roles and responsibilities.
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From page 50... ...
Individuals practicing in public health and occupational health and their professional associations support interdisciplinary models of practice. Professions involved in addressing environmental health concerns include, but are not limited to, specialists in industrial hygiene, toxicology, safety, ergonomics, engineering, hydrogeology, medicine, and occupational health.
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From page 51... ...
The American Public Health Association, an interdisciplinary professional society, provides a forum for building consensus on emerging public health needs and disseminating innovative strategies to address these needs, including environmental health issues. Professional associations can have a major influence on the integration of environmental health concepts into general and specialty nursing practice, and they must be considered in strategies for altering nursing practice to include environmental health issues.
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From page 52... ...
For example, migrant workers and farmers may be unwilling to jeopardize their income for issues of health and safety; likewise, residential and commercial development may be deemed more important to community leaders than the resulting noise, air, and water pollution. Concern about the confidentiality of health information obtained from employees is significant, especially when occupational health nurses are threatened by managers with job termination if they do not relinquish specific health and medical information about a worker.
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From page 53... ...
(2) Identify by test content outlines and key words those certification examinations that have environmental health concepts among the test items.
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From page 54... ...
Test content outlines of two examinations included environmental science: community health nurse and clinical specialist in community health nursing practice. The pediatric nurse practitioner examination content outline dedicated a section to environmental issues, and the general nursing practice test content outline noted the influence of "environmental and occupational factors" in consideration of health promotion, disease prevention, and control.
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From page 55... ...
Enhancing environmental health content in nursing practice will involve an elaboration of existing skills and perspectives, such as including environmental factors in history taking and seeking methods of primary prevention to eliminate illness and injury. Fundingfor Public Health Recent efforts toward health care reform on both federal and state levels focus attention on improving access to care for the sick through
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From page 56... ...
Public Health in America (PHS, 1994) describes the core functions of public health as follows: prevents epidemics and the spread of disease, protects against environmental hazards, prevents injuries, promotes and encourages healthy behaviors, responds to disasters and assists communities in recovery, and assures the quality and accessibility of health services.
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From page 57... ...
Responsibilities of Nurses Whatever their practice roles and settings nurses must be prepared to recognize the early signs and symptoms of illness that are the result of exposure to environmental hazards. In addition, practicing nurses must consider their professional responsibilities in this arena as they are applied through the nursing process.
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From page 58... ...
At this point, the nurse would plan and implement primary prevention strategies with the family to reduce or eliminate environmental health risks, for example, by teaching appropriate procedures for handling food and water to prevent gastrointestinal problems. This should include information on the possible sources and routes of contamination of food and water.
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From page 60... ...
Because of the public health nurse's knowledge of environmental hazards and health risks, the nurse knew that fertilizers are one of the most common causes of nitrate contamination of drinking water. During the visit, the public health nurse advised the family of the hazards and of ways to avoid further illness.
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From page 61... ...
What about other infants in this community who may have been exposed to the same or similar environmental hazards? Even though the use of bottled water for the infant's formula offered a short-term solution to the immediate health threat, the nurse's role did not end at this point.
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From page 62... ...
The environmental health competencies for nurses in generalist practice presented in Box 3.4 were adapted by the committee from competencies set forth by the International Council of Nurses (Appendix A) and by Lipscomb, 1994a (Appendix C)
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From page 63... ...
Many factors influence changes in nursing practice, including professional associations, new and unfamiliar ethical dilemmas, credentialing requirements, funding for "public-health"-related activities, and overall changes in health care delivery. Barriers to and incentives for changing nursing practice to routinely include consideration of environmental health problems have been described in this chapter, along with recommendations and strategies to address these factors.
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From page 64... ...
Institutional policies that support access to and use of these resources will help nurses realize their potential in addressing environmentally related illnesses. Strategies for Achieving Recommendation 3.2: 1.
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From page 65... ...
2. Promote interdisciplinary approaches to environmental health issues in nursing practice, education, and research with funding support from private and public agencies and through recommendations from nursing professional associations, including American Association of Colleges of Nursing (AACN)
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From page 66... ...
Educator Role: Risk Communication Recommendation 3.4: Communication should extend beyond coun seZing individual patients andfamiZies tofaciZitating the exchange of information on environmental hazards and community responses. Rationale: Nurses can build on existing interviewing and activelisten~ng skills to provide an essential linkage among environmental scientists; medical and environmental epidemiologists; and individuals, neighborhoods, or community groups in communicating about risks and hazards.
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From page 67... ...
2. Include occupational and environmental health content related to ethical issues in nursing and public health curricula.
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From page 68... ...
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