and rehabilitation. Less emphasis was placed on preventive care in general, including the elimination of harmful environments and the enhancement of healthful environments.

This trend continues in nursing today. Environmental health currently receives scant attention in nursing education and research (Rogers, 1991, 1994; Snyder et al., 1994). Neither the present organizational structure of nursing practice nor the reimbursement mechanisms presently in place for nurses favor the development of nursing skills related to environmental health hazards. In fact, numerous barriers discourage or prevent nurses from fulfilling their potential in this regard. Environmental health hazards have come to be perceived as something separate from the usual practice of nursing rather than as a set of concerns integral to its mission.

Nevertheless, nurses remain well positioned to address the potential health effects from environmental hazards at both the individual and community levels. The 2.2 million registered nurses in the United States make up the nation's largest group of health care providers (HRSA, 1992). On a daily basis, regardless of specialty or practice site, nurses meet people who are at risk or ill because of hazards in the environment such as contaminated food or drinking water, toxic waste, occupational exposures to harmful substances and conditions, lead and radon in the home, and health-threatening conditions related to poverty. The health benefits to patients from nurses' better education and fuller involvement in addressing environmental health concerns are potentially enormous.

The intent of this report is to remind providers, planners, administrators, observers, and receivers of nursing services that environmental health concerns should not be left to others or relegated to a small group of nursing specialists. On the contrary, these concerns are relevant to the entire nursing community, being part and parcel of the holistic health approach that nursing at its best has always championed.

DEFINING ENVIRONMENTAL HEALTH

The committee recognizes a need to distinguish between issues of environmental health and issues more specific to the science of ecology. The primary focus of this report is on the adverse health outcomes that may be associated with exposure to environmental hazards rather than efforts to conserve natural resources. This is in no way intended to diminish the importance of ecological issues.

The environmental hazards of concern in this report fall into four widely accepted classes: chemical, physical, biological, and psychosocial. Such hazards may be naturally occurring, such as radon or ultraviolet light from the sun, or they may be manmade (or "constructed"), such as



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