more than two-thirds of nurse practitioner program directors believed that greater emphasis should be placed on environmental health. Barriers to change included overcrowded curricula and inadequate faculty preparation. Two factors identified as most likely to facilitate the inclusion of environmental health were, first, the availability of nurse faculty with expertise and, second, access to information resources related to environmental health. Recommendations included (1) the incorporation of environmental health in case history or problem-based instructional designs, (2) inclusion of environmental health risks in patient- or community-assessment learning activities, and (3) use of educational resources such as the Agency for Toxic Substances and Disease Registry Newsletter and other training programs (Bellack et al., 1995).

The National Institute for Occupational Safety and Health (NIOSH) provides funding for academic preparation and continuing education in the areas of occupational medicine and nursing, occupational safety, and industrial hygiene. NIOSH has established 14 Educational Resources Center (ERC) programs throughout the country in university settings since 1977 for the education and training of health professionals about occupational health in an interdisciplinary environment. Among the subjects of these programs are risk management and safety, environmental health practice, chemical process hazards, hazardous substance management, and environment and work physiology. The ERCs target occupational health and safety, a subset of the domain of environmental health education (DHHS, 1991).

The Institute of Medicine (IOM) Committee on Enhancing Environmental Health in Nursing Practice conducted 12 focus groups across the country that included leaders of national nursing organizations; practicing nurses prepared from associate, diploma, baccalaureate, master's, and doctoral nursing programs; nurse practitioners; community, public health, and occupational health nurses; nurse educators; and nurse researchers (see Appendix E). Many of the participants illuminated the dilemma of crowded curricula and acknowledged that curricular reform in nursing education was a necessary part of reexamining the competencies required for nurses to deliver health care. Inclusion of environmental health concepts in all basic nursing curricula was recommended as a strategy for reform, as was a shift to context-of-care and community-based practice skills as foundations for nursing interventions. Participants supported the inclusion of general environmental health content and assessment skills in basic nursing courses, with an integration of environmental science as applied to basic and health sciences in pharmacology, physiology, and pathophysiology courses. Some participants voiced concern that environmental assessment was not sufficient and indicated that risk assessment, risk communication, and referrals are necessary skills for all basic



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