Authors

  1. Sattler, Barbara DrPH, RN, FAAN
  2. Issue Editor

Article Content

Environmental Health: A New Domain for All Nurses

In spring 2010, the President's Cancer Panel, in its annual report to the President, conceded that the federal government had been grossly underestimating the contribution that environmental carcinogens in our air, water, food, and products are having on the US burden of human cancer. This report provides us, as nurses, with a blueprint for action. The report highlights only a handful of well-known carcinogens, but it indicates the critical need for sweeping reform of chemical policies. The current prediction for cancer diagnosis during our lifetime-1:2 for men and 1:3 for women-raises to code red the need for policies that will reduce our population-wide exposures to unnecessary carcinogens.

 

With daily news of environmentally related health risks, it is critical that nurses develop their capacity to assess and address these risks. Nursing is perfectly poised to take on this responsibility: as of June 2010, environmental health is now a defined domain for nursing. The American Nurses Association, with its Scope and Standards of Practice for Nursing, created a new "Environmental Health Standard" that now firmly plants responsibility for environmental health knowledge, skills, and advocacy in the profession of nursing. Nursing must take on the role of learning about the relationship between environmental exposures and human health, developing assessment tools, applying nursing interventions, and engaging in policy and advocacy.

 

In 2009, nurses from around the country created the Alliance of Nurses for Healthy Environments (ANHE) (http://www.enviRN.org), a collaborative effort of individual nurses and nursing organizations that are committed to the integration of environmental health into nursing education, practice, research, and advocacy/policy. It has created a host of resources and initiatives to support nurses as they venture into this new area.

 

The work of this new alliance has been broad. It has created an interactive, Web-based Knowledge Network (http://www.enviRN.org) that includes environmental health "essentials" for all nurses and curricula integration materials for nursing faculty. It is supporting efforts to integrate environmental health into clinical practice and efforts to "green" health care settings through training programs, webinars, and online resources. It has worked collaboratively with the nurses from Health Care Without Harm (http://www.noharm.org), another organization dedicated to greening the health care sector.

 

Along with the directors of the National Institute of Nursing Research and the National Institute of Environmental Health Sciences, ANHE's Research Work Group is developing a national strategic plan for environmental health and nursing research that will include enhanced nursing research funding for this new topic area to help with building our knowledge of evidence-based practice. Finally, the Policy/Advocacy Work Group of ANHE has been addressing a range of state and federal legislation, including national policies on safe chemical management, global warming, and safe cosmetics.

 

In our clinical practice, nurses can play an important role in the prevention of environmentally related health risks by implementing environmental health histories and addressing the risks that are identified through patient education and anticipatory guidance for risk reduction. They can implement strategies for environmentally preferable purchasing by choosing the healthiest and safest options that protect patients' health, employees' health, and the health of the environment. And nurses can create, lead, and engage in "green teams" and other organized efforts to promote environmentally healthy and sustainable activities within their workplaces.

 

In their article about integrating environmental health into family planning clinics, Worthington et al demonstrate how we can incorporate environmental health science into primary and specialty care by including environmental health risks in our history taking and our patient education functions.

 

A nurse midwife from Washington State who attended a workshop on environmental health had her routine mammogram the following day. She had learned about the toxic chemicals that can lurk unquestioned in so many of our everyday products. She looked with new caution at the wipe she was handed to remove deodorant residue from her underarm-a customary practice in the thousands of mammography centers around the country. When she returned home, she looked up the ingredients of the wipe and discovered a potential carcinogen made up the ingredients list. She immediately took action by alerting the mammography center about her concern and they, in turn, made a commitment to find a safer alternative.

 

There are 2 points worth noting in this little scenario: the first is that nurses have great potential to assess risks and address environmental health risks, regardless of the location, and the second is that environmentally preferable purchasing is a particular practice that all nurses can help influence, particularly in their work settings. There is much work to be done to organize ourselves and our health care delivery system in which we work to truly integrate environmental health into our practice.

 

Issue Editor

 

Barbara Sattler, DrPH, RN, FAAN