growing public concern and apprehension about the potential adverse health effects associated with exposure to substances in the home, the workplace, and in the other community settings. Unfortunately, most health care providers, including nurses, are inadequately prepared to identify or respond appropriately to such hazards or conditions.

A comprehensive approach to nursing practice (as well as other health care professions) requires the awareness, recognition, and treatment of critical factors that affect individual and community health, even if these factors are not obvious at first to patients or providers. A child who has a behavior problem in school because of lead poisoning; a young adult who has respiratory problems due to the inhalation of solvents while working in the garage at home; a worker who is exhibiting neurological symptoms related to handling chemicals on the job; and a retired person whose rash is caused by a garden pesticide are all examples of people who have been affected by environmental health hazards in ways that could easily be misinterpreted in the absence of information about the origin of the problem.

Nurses are well positioned to address environmental health hazards, both on an individual and community level, for a number of reasons: They are the largest group of health care providers in the United States (2.2 million), and generally speaking, they have more opportunities than other health care providers to talk in-depth with patients. In addition, they are often the only health care providers who visit patients in their homes, workplaces, and local communities, thus gaining firsthand knowledge of the potential environmental hazards present in these settings. The close interaction of nurses with patients and the "on-site" aspects of nursing care provide tremendous opportunities for nurses to detect previously unrecognized health problems, including those related to environmental exposures, and to initiate appropriate interventions. Finally, there is a good fit between environmental health concerns, the historical development of the nursing profession, and core nursing values.

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 focus 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



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