appropriately evaluated by identifying the specific content additions and then testing for the comprehension, retention, and application of that information. For example, if environmentally caused diseases are included in an existing medical-surgical course in an associate degree or diploma program, the concepts of assessment, referral, and risk communication should be examination items or clinical performance components of a student's evaluation.

For a community health nursing course in a baccalaureate program, the impact of adding content on environmental health policy advocacy should be assessed by evaluating a student's understanding and application of policy and its influence in the didactic portion or in clinical work in a public health agency or community health organization. At the graduate level, evaluations of environmental health content in specialty areas need to be conducted within the master's courses associated with the specialty, such as specific environmental health risks for the elderly in gerontological nursing. As a further illustration, a master's level research course should include epidemiologic environmental health studies, and an evaluation of relevant concepts and critique methods could be done via examination items or an essay.

At this time, licensure tests and specialty certification examinations use a role validation method of test content development. That is, the content of nursing practice in the field largely determines what is tested in the examinations. If nurses do not include environmental health in their practice, it is unrealistic to expect that such content would be covered in the examinations. Therefore, evaluations of curriculum with enhanced environmental health content would currently focus only on the major course(s) in which the additional content has been integrated. The specific method of course and student evaluation used is the prerogative of the faculty responsible for the course as a whole.

Other effects of expanding environmental health content in nursing programs may include changes in faculty awareness and attitudes, increased administrative support for environmental health content, and its inclusion in a variety of educational (e.g., continuing education and distance learning) and health services (e.g., individual or group faculty practices) offered by the school of nursing.

The ultimate objective, and perhaps the most difficult one to measure accurately, is the incorporation of environmental health content into nursing education and practice and the continuous evaluation of how effective it is accomplished in maintaining and promoting the health of individuals, families, and communities. Nonetheless, improvement in the health of all persons by the avoidance or reduction of environmentally induced illness or injury is a worthwhile goal for revising the curricula of nursing education programs.

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