Second, the current focus of this Institute of Medicine (IOM) initiative is environmental health. Although the committee's definition of environmental health encompasses occupational health, the two areas are not treated in parallel within this initiative, as in the 1988 IOM report on primary care physicians. This appendix is based on the committee's working definition of environmental health in its general approach to the curriculum. However, some of the content in the proposed curriculum is considered parallel between occupational health and environmental health, such as history taking and the regulatory framework.

By way of introducing the recommendations for the specific content, a nursing curriculum that incorporates essential content in environmental health must be grounded in the basic principles of epidemiology and toxicology and must incorporate the concept of risk and its application to groups and individuals. Such curricula should be viewed not only as enhancing the environmental health content of the curriculum but also as preparing nurses to more successfully contribute to overall disease prevention and health promotion efforts.

ESSENTIAL CURRICULAR CONTENT

The essential curricular content can be grouped into the following four areas: nursing and the environment, legislation and regulations, exposure recognition and principles of control, and health consequences. The area of nursing and the environment includes a definition and framework for environment different from the current use of the term in nursing. This area also includes an articulation of nursing's role in promoting environmental health, for example, in areas of environmental justice and advocacy. The important area of risk perception and risk communication is also included within this category, although this content would be sequenced differently in an actual curriculum. Legislation and regulations must include an overview of major environmental and occupational legislation. Exposure assessment includes an understanding of the basic principles of toxicology, such as routes of exposure and dose (i.e., dose-response and time-dose characteristics). A basic understanding of the principles of controlling exposures is also included because this knowledge is essential to preventing environmental illnesses. Lastly, the area of health consequences includes the ability to take an environmental and occupational history, basic knowledge of sentinel environmental illnesses, and the ability to recognize when referral to a specialist is indicated.

The length of the program of study (e.g., Bachelor of Science in Nursing [BSN] versus Associate Degree [AD]) and the presence of community health- and policy-focused course work will dictate the level of detail possible. It should be the goal of all basic nursing programs to incorporate



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