Diagnosis occurs with the culmination of objective and subjective data collection. In this phase of the nursing process health problems are identified and described. Depending upon their practice setting, nurses may use the diagnostic terms established by the North American Nursing Diagnosis Association (NANDA) or medical diagnostic terminology, as is often the case with APNs who are nurse practitioners. Routine consideration of environmental factors that affect health is essential in the diagnostic phase of the nursing process; without knowledge of such factors, problems may be misdiagnosed and subsequent interventions will address environmental issues haphazardly, if at all.

Planning/outcomes is the phase of the nursing process in which optimal outcomes are identified. A range of interventions are identified to address the health problem, and plans for implementing those interventions are developed. The ability to establish interventions that address environmentally related illnesses depends on a nurse's ability to formulate diagnoses that include consideration of environmental factors. Without attention to environmental factors, intervention plans are likely to focus on secondary- and tertiary-level activities (care and cure) rather than primary prevention strategies.

Intervention is the component of the nursing process in which the nurse implements activities to promote health, and prevent or alleviate illness and injury. The nurse may act as educator in this part of the nursing process, informing patients, families, workers, and communities about hazards in the environment and how to protect themselves. Effective interventions require a knowledge of resources, including texts, databases, and professional experts, and an ability to access these resources.

Intervention also includes the role of advocate. Although nurses are familiar with the concept of advocacy on behalf of individual patients, often they have not been trained in techniques of advocacy for populations or in settings other than health care facilities. Nurses need to extend the concept of advocacy to include activities on behalf of communities and other groups and in settings such as the workplace or community meetings. 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.

Evaluation, the final step in the nursing process, can be conducted on numerous levels and frequently results in additional interventions. The health outcomes of an individual are one method of determining the effectiveness of nursing interventions. Another measure of effective intervention in environmentally related illness is an evaluation of hazard abatement methods. Has the hazard been contained or removed from the environment of the individual? Are others living in the area protected



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