Nursing education has developed its own reforms in tandem with higher education and with other health professions education. These reforms echo the need for nursing education to reexamine the values of environmental health in policy, nursing research, education, practice, and service (AACN, 1991; ANA, 1991; NLN, 1992).
Although professional nursing education has traditionally included the concepts of health promotion, disease prevention, health protection, risk reduction, and population-based practice in its baccalaureate nursing degree programs, the scope and depth of such concepts and content are not consistent among programs. Commonly used nursing texts also vary in their inclusion of environmental health information. Nurses, along with physicians and pharmacists, report that the education they received regarding disease prevention was fair or poor in contrast to the excellent or good ratings of training they received regarding disease treatment or intervention (Shugars et al., 1991b).
In Nursing's Agenda for Health Care Reform (ANA, 1991), three premises underlie the framework for change relative to nursing education and environmental health: (1) that primary health care plays a basic and prominent role in service delivery, (2) that a better balance exists between the prevailing orientation to illness and cure and a new commitment to wellness and care, and (3) that nursing's long-term policy agenda must consider relationships among many factors, of which environmental factors are noted. This policy document asserts that nurses who are prepared from a primary health care framework with an emphasis on prevention and environmental factors will be the providers of choice in improving the health status of the U.S. population.
Addressing nursing's need to accept the challenge of what she termed environmental compatibility, then-president of the American Academy of Nursing, Nola Pender, pointed out that by the year 2010, 70 percent of nurses will be practicing outside of acute-care facilities. To prepare for this shift, Pender indicates the need for curricula in schools of nursing to change. She underscores that attention in nursing education (actually, education in all health professions) should focus on high-risk environments and laments that "nursing curricula often fail to address environmental issues in-depth throughout the curriculum" (Pender, 1992, p. 201).