Advocacy that goes beyond helping an individual patient and enters the realm of health policy is not yet acceptable and expected nursing practice for all nurses. To prepare the profession for a broader range of advocacy activities, nursing curriculum and continuing education programs may come to include content on such skills as lobbying, use of the media, mediation, expert testimony, and community organizing. In the meantime, whether with institutional support or on their own, nurses who are stretching the definitional boundaries of advocacy practice will need to build skills in areas that were likely not part of their basic nursing education.

NURSING EDUCATION

The majority of nurses confronting environmental health problems have not received adequate basic preparation to recognize and respond to them, will not attend graduate school, and must rely on continuing education programs to sustain and augment their level of knowledge. A national survey of occupational and environmental health content in baccalaureate nursing schools indicated that only one-third included occupational and environmental health factors as part of routine patient assessment. In addition, in its Seventh Report to the President and the U.S. Congress, the U.S. Department of Health and Human Services noted not only significant shortages of occupational and environmental health personnel but also a serious deficit in nurses' educational preparation concerning basic theories, principles, and methods of public health. Lacking the training and education necessary to recognize the health effects of environmental agents, nurses cannot begin to intervene appropriately to prevent further illnesses, injuries, or fatalities.

Opportunities for nurses to learn about, obtain experience in, and otherwise develop expertise in environmental health are quite limited. Educational resources intended specifically for training nurses in this area are almost nonexistent. There are no nursing texts or professional nursing organizations with a primary focus on environmental health issues, and there are no graduate-level training programs in schools of nursing that focus on environmental health. One indicator of nursing education's lack of emphasis on environmental health is the limited content included in nursing textbooks. Federal support for nursing programs in environmental health is currently limited to a small number of graduate level training programs sponsored by the National Institute for Occupational Safety and Health.

To better prepare nurses for the environmental aspects of nursing practice, the environmental health curriculum content in all levels of nursing education should be enhanced. The committee recognizes that integrating



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