National Academies Press: OpenBook

Nursing, Health, and the Environment (1995)

Chapter: Front matter

Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×

Nursing, Health, & the Environment

Strengthening the Relationship to Improve the Public's Health

Andrew M. Pope, Meta A. Snyder, and Lillian H. Mood, Editors

Committee on Enhancing Environmental Health Content in Nursing Practice

Division of Health Promotion and Disease Prevention

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C.
1995

Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×

National Academy Press
2101 Constitution Avenue, N.W. Washington, D.C. 20418

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is President of the Institute of Medicine.

This project was supported by funds from the Agency for Toxic Substances and Disease Registry, the National Institute for Occupational Safety and Health, National Institute of Nursing Research, National Institute of Environmental Health Sciences, Health Resources and Services Administration, and the Environmental Protection Agency (contract number U61/ATU398777-01).

Library of Congress Cataloging-in-Publication Data

Nursing, health, and the environment : strengthening the relationship to improve the public's health / Andrew M. Pope, Meta A. Snyder, and Lillian H. Mood, editors ; Committee on Enhancing Environmental Health Content in Nursing Practice, Division of Health Promotion and Disease Prevention, Institute of Medicine.

p. cm

Includes bibliographical references and index.

ISBN 0-309-05298-X

1. Environmental health. 2. Nursing. 3. Industrial nursing. I. Pope, Andrew Mac Pherson, 1950- . II. Snyder, Meta A. III. Mood, Lillian H. IV. Institute of Medicine (U.S.). Committee on Enhancing Environmental Health Content in Nursing Practice.

(DNLM: 1. Environmental Health—nurses' instruction. 2. Environmental exposure—nurses′ instruction. 3. Occupational Health—nurses' instruction. 4. Nursing. WA 30 N974 1995]

RA566.N87 1995

610.73—dc20

DNLM/DLC

for Library of Congress 95-39601

CIP

Copyright 1995 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America.

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.

Cover Photograph: 1910. Courtesy of Visiting Nurse Service of New York.

Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×

COMMITTEE ON ENHANCING ENVIRONMENTAL HEALTH CONTENT IN NURSING PRACTICE

LILLIAN H. MOOD (Chair), Director,

Risk Communication, Environmental Quality Control, South Carolina Department of Health and Environmental Control, Columbia

ELIZABETH T. ANDERSON, Professor,

School of Nursing, University of Texas, Galveston

HENRY A. ANDERSON, Chief Medical Officer for Occupational and Environmental Health,

Wisconsin Division of Health, Madison

NORMAN DePAUL BROWN, Associate Professor,

College of Nursing, University of Arkansas, Little Rock

GAIL F. BUCKLER, Clinical Instructor,

Environmental and Occupational Health Sciences Institute, University of Medicine and Dentistry of New Jersey—Robert Wood Johnson Medical School, and Rutgers, the State University of New Jersey; and

Assistant Professor of Clinical Nursing,

School of Nursing, University of Medicine and Dentistry of New Jersey

ANN H. CARY, Associate Dean,

School of Nursing, Louisiana State University Medical Center, New Orleans

SUE K. DONALDSON, Dean,

School of Nursing, Johns Hopkins University

GERALDENE FELTON, Dean,

College of Nursing, University of Iowa

ELAINE L. LARSON, Dean,

School of Nursing, Georgetown University

CAROLYN NEEDLEMAN, Professor,

Graduate School of Social Work and Social Research, Bryn Mawr College

DOROTHY S. ODA, Professor,

School of Nursing, University of California, San Francisco

RANDOLPH F.R. RASCH, Assistant Professor,

School of Nursing, University of North Carolina, Chapel Hill

KATHLEEN M. REST, Assistant Professor,

University of Massachusetts Medical School, Worcester

BONNIE ROGERS, Director,

Occupational Health Nursing, University of North Carolina, Chapel Hill

META A. SNYDER,

National Center for Hazard Communication, University of Maryland, College Park

Liaison to the Institute of Medicine's Board on Health Promotion and Disease Prevention

Jean Goeppinger, Chair,

Department of Community and Mental Health, School of Nursing, University of North Carolina, Chapel Hill

Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×

Study Staff

Andrew M. Pope, Study Director

Carrie E. Ingalls, Research Assistant

Michael A. Stoto, Director,

Division of Health Promotion and Disease Prevention

Donna Thompson, Administrative Associate

Mona Brinegar, Financial Assistant

Laura Baird, Librarian

Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×

Preface

In this time of local and global environmental concerns, people—as individuals and communities—look increasingly to the health care system for information and advice on identifying and reducing health risks associated with environmental (including workplace) exposure to potential hazards, and for diagnosis and treatment of the diseases caused by such exposures. Nurses are often the first point of contact for patients and concerned individuals, and are in positions to provide considerable support. However, most nurses have little, if any, formal preparation in the field of environmental health.

In response to a growing awareness of the need to enhance occupational and environmental health content in the practice of nursing, a workshop was conducted by the Institute of Medicine (IOM) in May 1993 to assess the need for an IOM study on the role of nurses in occupational and environmental health and to clarify the associated areas of education, training, and research that such a study would involve. It was an illuminating and successful workshop, chaired by Bonnie Rogers, that provided resounding affirmation of the need for the IOM to conduct a full-scale study of issues related to enhancing environmental health content in the practice of nursing.

Following the workshop, and at the request of a consortium of federal agencies, the IOM established the Committee on Enhancing Environmental Health Content in Nursing Practice to carry out the study. Working from the premise that the environment, including the work environment, is a fundamentally important factor in determining the health of individuals

Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×

and populations, the committee defined essential competencies and curriculum content in environmental health; recommended methods for developing nursing faculty expertise in environmental health; developed strategies for enhancing the dissemination and integration of environmental health content in nursing practice; and identified research issues that would benefit from study by a combination of environmental health and nursing investigators.

I have been privileged to chair the study committee; it is comprised of an amazing group of experts in nursing and environmental practice, education, and research, encompassing a variety of disciplines and diverse perspectives. We particularly benefitted from a deliberate overlap in membership with the IOM Committee on Curriculum Development in Environmental Medicine, which had similar objectives yo ours, that is, enhancing environmental health in health care delivery, only with a focus on physicians and medical education.

One of the hallmarks of the committee's work was the mutual respect present among the members. This group's work was an example of true interdisciplinary teamwork—the valuing of differences, openness to others' ideas, a willingness to explore all options, an absence of jockeying for position or recognition, and a generous giving of time, effort, and plain hard work.

The committee met several times during the course of a year, beginning in May 1994, and worked hard at both identifying and resolving issues, and at writing, rewriting, and revising segments of the report. We met as a whole and in small groups with individual and group assignments. Our discussions were held face to face and via conference calls, through FAX, and over the internet. We assembled an even wider circle of opinion and expertise than that represented by the committee through focus groups, surveys, guest presentations, commissioned papers, and literature and research reviews.

Three themes emerged in the process of the study:

  1. The environment is a primary determinant of health, and environmental health hazards affect all aspects of life and all areas of nursing practice.

  2. Nurses are well positioned for addressing environmental health concerns of individuals and communities. Nurses are the largest group of health professionals; they have great variety in their settings and locations of practice; environmental health is a good fit with the values of the nursing profession regarding disease prevention and social justice; and nurses are trusted by the public.

  3. There is a need to enhance the emphasis and awareness of environmental threats to the health of populations served by all areas of nursing practice. This will require changes in practice, education, and research.

Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×

This study is not an exercise in defining a new nursing specialty. We recognize that experts will be needed to guide the changes described, and ways are suggested to facilitate the development of those experts. We also realize that some nurses will choose to make environmental issues the primary focus of their practice. Our emphasis, however, is on the role that every nurse can and should play in addressing environmental health issues.

The competencies described for nurses are enhancements of content and focus, as well as some new dimensions of nursing practice. The competencies extend, but are continuous with, nurses' existing roles as investigators, educators, and advocates. The committee's report indicates the need for change for all practicing nurses. Change can seem overwhelming, but it can also be a source of new energy and new interest. Through careful investigation and thoughtful consideration, the committee has made recommendations and proposed strategies for accomplishing these goals. It is not our intent to be prescriptive, but rather to stimulate and challenge the thinking and action of all nurses.

Finally, on behalf of the committee I want to acknowledge all of those who assisted us along the way. A list of these people is presented in Appendix H, but in particular I want to thank M. Virginia Ruth, Barbara Sattler, and Meta Snyder (who also served on the committee) for their assistance in both initiating the study and for providing thoughtful input throughout its tenure. In addition, the workshop and focus group participants deserve recognition for helping us clarify our objectives and the current needs in the field of nursing. The sponsors, of course, are appreciated not only for their initiative and financial support, but also for their substantive contributions and guidance. In particular, we thank the following sponsors: from ATSDR, Max Lum, Diane Narkunas, and Donna Orti; from NIEHS, Anne Sassaman; from NINR, Patricia Moritz; from NIOSH, Bernie Kuchinski and Jane Lipscomb; from EPA, Gershon Bergeisen; and from HRSA, Marla Salmon and Moira Shannon. Perhaps most importantly, I want to thank the IOM for taking the initiative to develop this activity, and for the staff's tireless efforts in guiding us through the shoals of committee work, and for making it an enjoyable, valuable experience.

It was a pleasure to work with such competent professionals on a topic of such fundamental importance. I can only hope that our efforts will indeed enhance the environmental health content of nursing practice and thereby enlarge the indispensable contribution that nurses make to the health of the public. Florence Nightingale would be proud.

Lilian H. Mood

Chair

Page viii Cite
Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×
This page in the original is blank.
Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×

Acronyms


AACN

American Association of Colleges of Nursing

AAOHN

American Association of Occupational Health Nurses

ABOHN

American Board for Occupational Health Nurses

ACHNE

Association of Community Health Nurse Educators

ANA

American Nurses Association

ANCC

American Nurses Credentialing Center

AOEC

Association of Occupational and Environmental Clinics

APN

advanced practice nurses

ATSDR

Agency for Toxic Substances and Disease Registry


BLS

Bureau of Labor Statistics


CAI

Computer-assisted instruction

CD-ROM

compact disk read-only memory

CDC

Centers for Disease Control and Prevention

CFCs

chlorofluorocarbons

CPHF

California Public Health Foundation


DHHS

Department of Health and Human Services

DoD

Department of Defense


HRSA

Health Resources and Services Administration


ICN

International Council of Nursing

Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×

IOM

Institute of Medicine

IRB

institutional review board


LPN

licensed practical nurse


MFS

medical fee schedule


NACNEP

National Advisory Council for Nurse Education and Practice

NANDA

North American Nursing Diagnosis Association

NBCSN

National Boards for Certification of School Nurses

NCEH

National Center for Environmental Health

NCLEX

National Council Licensure Examination for Registered Nurses

NCSBN

National Council of State Boards of Nursing

NIEHS

National Institute of Environmental Health Sciences

NIJ

National Institute of Justice

NINR

National Institute of Nursing Research

NIOSH

National Institute for Occupational Safety and Health

NLN

National League for Nursing

NP

nurse practitioner


OSHA

Occupational Safety and Health Administration


PPRC

Physician Payment Review Commission


RN

registered nurse


STTI

Sigma Theta Tau International


TRI

Toxic Chemical Release Inventory

Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×
   

Nursing Competencies in Environmental Health,

 

62

   

Conclusion,

 

62

   

Recommendations,

 

63

4

 

NURSING EDUCATION AND PROFESSIONAL DEVELOPMENT

 

69

   

Factors Affecting Nursing Curricula,

 

70

   

Nursing Education Pathways,

 

72

   

Model Program Development,

 

78

   

Methods for Enhancing Dissemination of Environmental Health Content in Nursing Education at All Levels,

 

86

   

Role of Federal, State, and Local Health Agencies,

 

92

   

Methods for Evaluating Effectiveness of Curriculum,

 

95

   

Recommendations,

 

98

5

 

NURSING RESEARCH

 

103

   

Nursing Research Perspective,

 

104

   

Multidisciplinary Research Base for Nursing Practice,

 

105

   

Review of Nursing Research in Environmental Health,

 

106

   

Meeting the Need for Nursing Research in Environmental Health,

 

112

   

Recommendations,

 

118

 

 

References

 

121

 

 

APPENDIXES

 

 

   

A Position Statement from the International Council of Nurses: The Nurse's Role in Safeguarding the Human Environment

 

131

   

B Environmental Hazards for the Nurse as a Worker

 

134

   

C Environmental Health Curricula

 

142

   

D Environmental Health Resources: Agencies, Organizations, Services, General References, and Tables of Environmental Health Hazards

 

148

   

E Focus Group Summary and List of Participants

 

239

   

F Nursing Advocacy at the Policy Level: Strategies and Resources

 

253

   

G Taking an Exposure History

 

263

   

H Acknowledgments

 

271

   

I Committee and Staff Biographies

 

273

 

 

INDEX

 

279

Page xiii Cite
Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×

Nursing, Health, & the Environment

Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×

'An Angel of Mercy." Florence Nightingale at a soldier's bedside at Scutari.

Mezzotint engraving (1855). Property of Duke University Medical Center Library, History of Medicine Collections, Durham, NC.

Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×
Page R1
Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×
Page R2
Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×
Page R3
Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×
Page R4
Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×
Page R5
Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×
Page R6
Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×
Page R7
Page viii Cite
Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×
Page R8
Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×
Page R9
Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×
Page R10
Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×
Page R11
Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×
Page R12
Page xiii Cite
Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×
Page R13
Suggested Citation:"Front matter." Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.
×
Page R14
Next: Executive Summary »
Nursing, Health, and the Environment Get This Book
×
Buy Hardback | $65.00
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

America's nurses, an estimated 2 million strong, are often at the frontlines in confronting environmental health hazards. Yet most nurses have not received adequate training to manage these hazards.

Nursing, Health, and the Environment explores the effects that environmental hazards (including those in the workplace) have on the health of patients and communities and proposes specific strategies for preparing nurses to address them.

The committee documents the magnitude of environmental hazards and discusses the importance of the relationship between nursing, health, and the environment from three broad perspectives

  • Practice--The authors address environmental health issues in the nursing process, potential controversies over nurses taking a more activist stance on environmental health issues, and more.
  • Education--The volume presents the status of environmental health content in nursing curricula and credentialing, and specific strategies for incorporating more environmental health into nursing preparation.
  • Research--The book includes a survey of the available knowledge base and options for expanding nursing research as it relates to environmental health hazards.
  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!