health content in medical-surgical nursing courses was identified by 0.8 percent–6.8 percent (mean) of the respondents and in occupational health nursing courses by 0.6 percent–1.4 percent (mean) of the respondents. The unavailability of a description of the presence and location of the environmental health content by those who did not respond to the survey raises a concern. If the lack of a response (47 percent) reflects an absence of environmental health content, then the environmental health content currently offered in nursing curricula nationwide may be seriously overestimated.

Neufer (1994) points to the incongruity that community health nurses have not been leaders in the field of environmental health, despite their early reliance on Florence Nightingale's emphasis on environment. One indicator of nursing education's emphasis (or lack of it) on environmental health is the content included in current textbooks. In her review of current texts in community health, Neufer identified no text as having all of the factors necessary to address the concepts of environmental health in nursing. She concluded that ''although health professionals are becoming more aware of the public health hazards of pollution, community health nurses have not applied their skills in assessing and diagnosing related community health problems." Furthermore, because no text includes all of Neufer's factors, the conclusion follows that these environmental health content areas are not being taught in basic community health courses. Neufer emphasizes that, "the profession must grasp the challenges necessary to promote environmental health" (Neufer, 1994, p. 161).

The importance of environmental health in graduate nursing programs was described in a national sample of 967 leaders in community health nursing service and education, with 588 (61 percent) responding (Selby et al., 1990). Environmental health sciences was a clearly designated target content area for master's-level community health nursing education in the official documents of ANA (1980, 1986), and the Council on Education for Public Health (CEPH, 1986). Environmental health was rank ordered 18 – 26 of the 43 content areas considered to be core parts of the master's-level community health nursing curriculum by both service and education respondents.

A 1994 University of Minnesota study based on a review of 23 catalogs of schools of nursing with graduate programs in public health or community health nursing found that 17 percent (N = 4) required a course in environmental health (Ostwalt and Josten, 1994). In contrast, schools of public health that are accredited by CEPH must provide courses in five content areas, of which environmental health sciences is a requisite area (CEPH, 1986, p. 14). In a recent survey of 187 U.S. nurse practitioner programs, valid responses (90 questionnaires; 48 percent) revealed that



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