Volume 34, No. 4 • March/April 2013

Resources for Integrating Environmental Health Content into the Curriculum Kathryn P. Jackman-Murphy, MSN, RN

very day, nurses are called on to facilities and beyond. Nurses must have respond to common health com- the information and resources to protect E plaints and diseases that may be themselves to ensure their health and linked to environmental factors, such as safety and to protect the health and safe- asthma, diabetes, lead poisoning, and ty of their families and the communities cancer. To meet the growing need to pre- where they live and work. vent health risks associated with environ- Shaping an environmentally savvy mental exposure, environmental health nurse must begin in nursing school. content must be integrated into the cur- Environmental health content can be riculum of all pre-licensure nursing pro- introduced in the very first lecture. For grams. Registered nurses play a key role example, in the Connecticut Community as primary health providers in a variety of College Nursing Program (CT-CCNP), the care settings, and all RNs have opportuni- first freshmen lecture, “Contemporary ties to evaluate clients for environmental Nursing Practice,” teaches students about and occupational exposures and poten- historical leaders in nursing, including tial risks. As a profession, modern nursing Florence Nightingale. The students are has viewed health holistically by recog- given details on Nightingale’s contribu- nizing the importance of the environment health concerns that may have a variety tions to nursing including reforming hos- in work, home, and recreational settings. of environmental components. In fact, pitals, improving the standards of care for In 2010, the American Nurses many common health complaints and casualties of the Crimean War, and creat- Association (ANA) updated the document diseases may be linked to environmental ing and implementing public health poli- Nursing: Scope and Standards of Practice, factors. All nurses can play an integral cies (Berman, 2008). which reflects the evolution of nursing role to advocate for healthier environ- In 2009, the National Student practice with the inclusion of environ- ments for clients, communities, and them- Nurses’ Association (NSNA) House of mental health into the role of the regis- selves by identifying sources of preventa- Delegates took a leadership role in pro- tered nurse. Standard 16 states: “The reg- ble exposures and developing strategies moting environmental health by adopt- istered nurse practices in an environmen- to minimize or eliminate them. Just as ing the resolution, “In Support of tally safe and healthy manner” (ANA, vital, nurses must have environmental Increasing Environmental Health Advo- 2010, p. 11). Not new to nursing practice and occupational health information to cacy and Education.” The resolution con- and standards, the inclusion of environ- protect themselves from potential harm- tained three components: to encourage mental health practice and advocacy are ful exposure in the workplace. its constituents to advocate for environ- long standing in the foundation of nurs- It is critical for nurses to have knowl- mental health awareness, to advocate for ing’s heritage, as evidenced in the writ- edge of environmental dangers and the inclusion of environmental health ings of Florence Nightingale (1912) in access to resources to address hazards in education into nursing curricula, and for Notes on Nursing: What it is and What it is every health care delivery setting. Nurses NSNA to demonstrate its commitment to Not. As sister Callista Roy commented on and other health care team members are increased environmental health aware- Nightingale’s work (1992), “No amount of exposed to hazardous materials including ness by becoming a Beacon of The medical knowledge will lessen the housekeeping chemicals, medication, Luminary Project (if feasible). This resolu- accountability for nurses to do what nurs- radiation, anesthetic gases, sharps, and es do; that is, manage the environment to infectious waste. Exposure to these toxins Kathryn P. Jackman-Murphy, MSN, RN, promote positive life processes” (p. 66). can lead to increased rates of asthma, is an Assistant Professor of Nursing, It is imperative that environmental miscarriage, certain cancers, and Naugatuck Valley Community College, health information be included in the increased rates of birth defects. As front- Waterbury, CT. She is the Environmental ‘toolbox’ that every nurse brings into his line health care workers, nurses have a Nurse Consultant for the Connecticut Nurses’ or her compass of care. In everyday prac- unique role as champions for positive Association. tice, nurses are expected to respond to environmental change within health care

Volume 34, No. 4 • March/April 2013 1 tion is a call to action for all nursing pro- potential sources for asbestos and lead health by improving the health of the grams to give future leaders in nursing paint. The risk of lead poisoning for chil- environment (Luminary Project, 2013). the tools they need to advocate for envi- dren in the area is high and should be There are many stories in The Luminary ronmental health. considered during physical assessment. Project of nurses making a difference to Environmental health education in The students also take notice of resources reduce environmental health risks in the the nursing curriculum may also include within the community that may decrease United States and beyond. Students can Florence Nightingale as the first docu- the area’s carbon footprint. For example, explore the stories and experience the mented environmental nurse. Nightin- are there stores in the area for residents passion that each luminary has for envi- gale recognized that nurses play an inte- to walk to, avoiding the need for a car or ronmental issues and become inspired to gral role in identifying risks and imple- mass transportation? During the wind- pursue changes in their own backyard. menting environmentally responsible shield survey, the students can consider Many of the nurses participating in The practices in hospitals and communities. the amount of safe “green” spaces includ- Luminary Project are eager to be mentors Nightingale observed that the patient’s ing trees, grass, and gardens that are to nurses and students interested in environment had an important role not available for activities, socialization, and improving environmental health and only in the patient’s illness, but also in the reflection. awareness. patient’s recovery. In Notes on Nursing: NSNA encourages school and state As one of the most trusted profes- What It Is and What It Is Not, Nightingale chapters to conduct community health sions, the education of nurses must noted, “the symptoms or the sufferings projects. These projects may address spe- include environmental health content so generally considered to be inevitable and cific environmentally related illnesses that they can protect themselves, co- incident to the disease are very often not (such as lead poisoning), encourage com- workers, their families, and communities. symptoms of the disease at all, but of munities to replace plastic bags with recy- The public’s increasing awareness of all something quite different – of the want of clable bags, and teach school children things “green” and how the environment fresh air, or of light, or of warmth, or of how to recognize sources of pollution and affects health creates a demand for nurs- quiet, or of cleanliness, or of punctuality hazardous waste. Each year, NSNA recog- es to comprehend the connection and care in the administration of diet, of nizes chapters for their work in communi- between human health and the environ- each or of all of these. And this quite as ty health through an awards program ment. All nurses, current and future, are much in private as in hospital nursing” and in the NSNA Leadership University called to action to play a pivotal role to (1912, p. 8). program (NSNA, 2013). improve human health by improving the Environmental health education can There are many tools to assist educa- health of the environment. DN continue throughout a student’s progres- tors to integrate evidenced-based envi- sion in the nursing program. In nearly ronmental health information into their References every content area, information about nursing curriculum. The Alliance of Nurses Alliance of Nurses for Healthy Environments. (2013). environmental health can be readily inte- for Healthy Environments (ANHE) (www. EnviRN navigation guide. Retrieved from http:// envirn.org/pg/groups/24526/for-educators/ grated. For example, in the context of envirn.org) is the “on-line presence for all American Nurses Association (ANA). (2010). Nursing: vital signs, this would include informing nurses interested in environmental Scope and standards of practice (2nd ed.). Silver students of the dangers of mercury that health.” There are four main workgroups Spring, MD: Author. may be in thermometers still used in within ANHE: Education, Practice, Re- Berman, A.S. (2008). Fundamentals of nursing. Upper some homes and devices containing mer- search, and Policy/Advocacy (each with Saddle River, NJ: Pearson Education, Inc. cury in some patient care areas. Mercury open membership). The site includes a Luminary Project, The. (2012). The Luminary Project: Nurses lighting the way to environmental health. is a strong neurotoxin that can damage “road map” of nursing curricular content Retrieved from http://www.theluminaryproject. the brain and kidneys and cause injury to areas aligned with the nursing competen- org a developing fetus (National Library of cies of the National League for Nursing’s National League for Nursing (NLN). (2010). Outcomes Medicine, 2013). In pharmacology, mak- Outcomes and Competencies for Graduates and competencies for graduates of practical/ ing the students aware of proper disposal of Practical/Vocational, Diploma, Associate vocational, diploma, associate degree, baccalau- of unwanted medications can be a crucial Degree, Baccalaureate, Master’s, Practice reate, master’s, practice doctorate, and research doctorate programs in nursing. New York: link in avoiding contamination of water Doctorate, and Research Doctorate Programs Author. supplies. Students can carry this informa- in Nursing (2010); and ANA’s Nursing: Scope National Library of Medicine. (2013). MedlinePlus: tion into each clinical setting including and Standards of Practice (2010). Each con- Mercury. Retrieved from http://www.nlm.nih. community health nursing, where they tent area contains suggested activities for gov/medlineplus/mercury.html can provide education regarding safer inclusion of environmental health content National Network of Libraries of Medicine (NN/LM). disposal of medications to wider audi- and associated activities in pre-licensure (2013). Guide 1: Set the direction with a com- munity assessment. Retrieved from http://nnlm. ences. programs are available on the ANHE Web gov/outreach/community/planning.html In community health nursing, nurs- site. An electronic textbook on the site National Student Nurses’ Association (NSNA). (2009). ing students can play active roles in sur- includes curriculum recommendations, Resolutions 2009. Retrieved from http://www. veying the environmental health of their teaching strategies and tools, and an nsna.org/Portals/0/Skins/NSNA/pdf/Resolution community by completing an informal EnviRN Navigation Guide (ANHE, 2013). 2009.pdf “windshield” survey (National Network of Leadership classes may consider uti- Nightingale, F. (1912). Notes on nursing: What it is, and what it is not [Electronic version]. New York: Libraries of Medicine, 2013). Students lizing The Luminary Project as a source for D. Appelton. Retrieved from http://books. drive around the community and assess information about nurses making a differ- google.com/books?id=emANAAAAYAAJ& the strengths and deficits of the geo- ence in environmental health in projects. Roy, C. (1992). Vigor, variables, and vision: graphical area. For example, students can “The Luminary Project: Nurses Lighting Commentary on Florence Nightingale. In Carroll, note the type of housing available in the the Way to Environmental Health,” is an D.P. (Ed.), Notes on Nursing: What it is and what area. In their research, the students may effort to capture the illuminating stories of it is not (Commemorative Edition). Philadelphia: Lippincott, Williams & Wilkins. consider an area with older homes as nurses’ activities to improve human

2 Volume 34, No. 4 • March/April 2013 2013 NCLEX-RN Test Plan Now in Effect he 2013 NCLEX-RN Test Plan based on maintenance of client safe- Parenteral Therapies, Reduction of Risk (https://www.ncsbn.org/2013_NCL ty and decreasing the occurrence of Potential, and Physiological Adaptation T EX_RN_Test_Plan.pdf) went into complications. categories of the RN test plan. effect on April 1, 2013. A number of The following content changes were These changes to the test plan are changes/clarifications were made be - made in each of the Client Needs also outlined in the 2013 NCLEX-RN tween the 2010 NCLEX-RN Test Plan and Categories: Detailed Test Plan, which offers a more thorough and comprehensive listing of the 2013 NCLEX-RN Test Plan, including: • In the first category, Management of content for each client needs category and • The definition of client as the individ- Care, there was an increase in subcategory as outlined in the test plan. ual, family, or group, which includes emphasis by 1%. The 2013 NCLEX-RN Detailed Test Plan significant others and population, • In the second category, Safety and was added. exists in two versions, a Candidate Version Infection Control, there was an (https://www.ncsbn.org/2013_NCLEX_ • The new test plan further clarifies the increase by 1%. NCLEX setting in order to help the RN_Detailed_Test_Plan_Candidate.pdf) • In the third category, Health Pro - and an Item Writer/Item Re viewer/ Nurse public better understand the NCLEX motion and Maintenance, Health and exam and potential exam questions. Educator Version (https://www.ncsbn.org/ Wellness was subsumed under 2013_NCLEX_RN_Detailed_Test_Plan_ • The results from the 2011 RN Practice Health Promotion and Maintenance Educator.pdf). The versions are identical Analysis: Linking the NCLEX-RN content and Principles of Teaching/ in content except the Item Writer/Item Examination to Practice suggested that Learning was removed as a bullet Reviewer/Nurse Educator Version offers the Management of Care and Safety because it is an integrated process an item writing guide and a section with and Infection Control client needs found throughout the entire test plan. case scenarios to provide nurse educators categories of the RN test plan • In the fourth category, Psycho social with additional item examples. required an increase in test plan per- Integrity, Substance Use Disorder The NCLEX-RN Test Plan is reviewed centages (which is the percentage of was added to Chemical and Other every three years by NCSBN. Changes are items in the test plan content area Dependencies, and Cultural Diversity based upon empirical data collected from that will be on each exam). In gener- was replaced by Cultural Awareness/ several sources, including newly licensed al, the practice of newly licensed Cultural Influences on Health for clar- nurses, the expert opinion of the boards nurses suggests activities in these ification. of nursing and the NCLEX Examination two areas have increased in signifi- No changes were made to the Basic Commit tee. For more information, go to cance of frequency and criticality Care and Comfort, Pharmacological and https://www.ncsbn.org/nclex.htm. DN

NSNA Upcoming Events Jesse Kennedy Elected 2013-2014 President of the National Student NSNA Annual Summer Nurses’ Association Leadership Conference he National Student Nurses’ Association is pleased to July 26, 2013 announce the election of Jesse Kennedy as the 2013-2014 NSNA President. Elections were held on April 6, 2013, dur- Mt. Sinai Hospital, New York, NY T st ing the 61 Annual Convention in Charlotte, North Carolina. Mr. Kennedy is finishing his final semester at Lane Community College 31 st Annual MidYear in Eugene, Oregon, where he will earn an Associate Degree in Nursing (ADN) in June 2013. His education continues this fall as he Career Planning Conference looks forward to earning a Bachelor of Science in Nursing (BSN) at “Navigating the Journey to Your Future Career” Oregon Health and Sciences University. November 7-10, 2013 Mr. Kennedy knew he would run for NSNA leadership after attending the NSNA 60th Annual Convention in April 2012. “The Galt House, Louisville, KY amount of energy and inspiration that I received from that week Program includes special faculty program and was indescribable,” he says. “I knew that I wanted to be a part of continuing education credit. this impressive group of student leaders and help lead this amazing organization.” He hopes to energize and empower students to make a differ- 62nd Annual NSNA Convention ence in their individual communities. “I am extremely passionate about advocating for my fellow student nurses, nurses, and April 9-13, 2014 patients,” he says. “I want to ensure that NSNA students know that Gaylord Opryland Resort, Nashville, TN there are resources to ensure their success in making a lasting dif- ference in their community.” Looking ahead beyond his years at NSNA, Mr. Kennedy hopes Visit www.nsna.org for complete details to pursue a Master of Science in Nursing degree and eventually on these and other upcoming events. operate a wellness clinic. DN

Volume 34, No. 4 • March/April 2013 3 PRSRT STD Anthony J. Jannetti, Inc. US Postage East Holly Avenue, Box 56 CHANGE SERVICE PAID Volume 34, No. 4 • March/April 2013 REQUESTED Pitman, NJ 08071-0056 Deptford, NJ Editor Permit #142 Diane J. Mancino, EdD, RN, CAE, FAAN President, NSNA Jesse Kennedy Executive Director Diane Mancino, EdD, RN, CAE, FAAN Art Director Jack Bryant Managing Editor Katie R. Brownlow, ELS Layout and Design Specialist Darin Peters Publisher Anthony J. Jannetti Advisory Board 2013-2014 G. Rumay Alexander, EdD, RN Michael L. Evans, PhD, RN, NEA-BC, FAAN Florence L. Huey, MS, FNP Mary P. Tarbox, EdD, RN Rebecca M. Wheeler, MA, RN Dean’s Notes is indexed in Cum ulative Index to Nursing & Allied Health Literature. Dean’s Notes is published five times a year (September/October, November/December, January/February, March/April, and May/June) by Anthony J. Jannetti Inc., East Holly Avenue, Box 56, Pitman, New Jersey 08071-0056. Telephone 856.256.2300. FAX 856.589.7463. All rights reserved. No part of this publication may be reproduced without the express written permission of the publisher. Address changes should include mailing label and be forwarded to the publisher.

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NCSBN Celebrates 35th Anniversary with Donation to FNSNA

he National Council of State Boards of Nursing (NCSBN) MSC, MPhil, RGN, RMN, CEO of the International Council of is making two special donations, totaling $170,000, in Nurses. “Thanks to donations such as these we have enabled celebration of its 35 years of nursing regulatory success. over 130 girls to complete high school; many of whom have T gone on to tertiary education. By supporting these girls, the NCSBN will donate $135,000 to the Foundation of the National Student Nurses’ Association (FNSNA) to provide scholar- NCSBN is showing solidarity with their nursing colleagues in ships to qualified undergraduate nursing students. FNSNA was sub-Saharan Africa, whose harsh working conditions may created in 1969 to honor Frances Tompkins, NSNA’s first Executive threaten the livelihood and future of their children. We know Director. Since 1974, FNSNA has awarded more than $2 million in that educating girls leads to better health for themselves, their scholarships to undergraduate nursing students. The NCSBN families and their communities, and we thank the NCSBN for Endowed Scholarship Fund was established in 2009. their generous gift.” “This generous contribution for undergraduate nursing edu- These donations will be presented during NCSBN’s anniver- cation will support students to achieve their educational goals. sary celebrations at its Annual Meeting and Delegate Assembly, Scholarships not only provide financial support, they inspire stu- August 14-16, 2013, in Providence, RI. dents to maximize their potential and to reach new heights as Founded March 15, 1978, as an independent not-for profit they prepare for their nursing careers. We sincerely appreciate all organization, NCSBN was created to lessen the burdens of state of the support that the NCSBN provides for undergraduate nurs- governments and bring together boards of nursing (BONs) to act ing education,” stated Diane J. Mancino, EdD, RN, CAE, FAAN. and counsel together on matters of common interest. NCSBN’s NCSBN will also donate $35,000 to the Florence membership is comprised of the BONs in the 50 states, the Nightingale International Foundation for its Girl Child Education District of Columbia, and four U.S. territories — American Samoa, Fund (GCEF), to support the primary and secondary schooling of Guam, Northern Mariana Islands, and the Virgin Islands. There girls under the age of 18 in developing countries whose nurse are also 12 associate members that are either nursing regulato- parent or parents have died. This donation will go toward school ry bodies or empowered regulatory authorities from other coun- fees, uniforms, shoes and books. FNIF is the International tries or territories. NCSBN Member Boards protect the public by Council of Nurses’ (ICN) premier foundation; it supports and ensuring that safe and competent nursing care is provided by complements the work and objectives of ICN. licensed nurses. These BONs regulate more than 3 million “ICN is sincerely grateful to NCSBN for its generous support licensed nurses, the second largest group of licensed profession- of the Girl Child Education Fund,” said David C. Benton, BSC, als in the U.S. DN

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