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Environmental Health in Nursing ALLIANCE OF NURSES FOR HEALTHY ENVIRONMENTS Environmental Health in Nursing Editors: Jeanne Leffers, PhD, RN, FAAN Claudia M. Smith, PhD, MPH, RN-BC Katie Huffling, RN, MS, CNM RuthPage McDermott-Levy, 1 PhD, MPH, RN Alliance of Nurses for Healthy Environments Barbara Sattler, DrPH, RN, FAAN Title: Environmental Health in Nursing Publisher: Alliance of Nurses for Healthy Environments www.enviRN.org Editors: Jeanne Leffers, PhD, RN, FAAN, Claudia M. Smith, PhD, MPH, RN-BC, Katie Huffling, RN, MS, CNM, Ruth McDermott-Levy, PhD, MPH, RN, Barbara Sattler, DrPH, RN, FAAN Acknowledgements: The entire Alliance of Nurses for Healthy Environments (ANHE) is responsible for this effort. Each contributing author and member of the four workgroups (Education, Policy/Advocacy, Practice and Research) was essential to the development of this book. We would also like to thank Brenda Afzal, MS, RN for her work in launching the textbook from its beginning as an idea and to assist in moving it to its completion. Copyright November 2016 by the Alliance of Nurses for Healthy Environments This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/. Page ii Alliance of Nurses for Healthy Environments CONTENTS INTRODUCTION…………………………………………………………………………………………………………..V UNIT 1: WHY NURSING……………………………………………………………………………………………………1 Why Nurses are Involved with Environmental Health………………………………………………….2 Environmental Health and Families/Homes……………………………………………………………..6 Environmental Health in the School Setting…………………………………………………………….8 Environmental Health Nursing at the Community Level………………………………………………10 Faith Community: An Environmental Partner……………………………………………………..……12 Spotlight on Nurses…………………………………………………………………………………….14 Desired Environmental Health Competencies for Registered Nurses..…………….…………………20 UNIT 11: HARMFUL ENVIRONMENTAL EXPOSURES AND VULNERABLE POPULATIONS………………………..…23 Harmful Environmental Exposures and Vulnerable Populations.…………………….…………………24 Vulnerable Populations - Anticipatory Guidance..…………………….……………………………..…34 Immigrants and Refugees as a Vulnerable Population.……………………………….…………………41 UNIT 111: ENVIRONMENTAL HEALTH SCIENCES………………………………………………………………………45 Ecology, Ecosystems, and Watersheds.…………………….……………………………………………46 Introduction to Toxicology.…………………….………………………………..………………………47 Carcinogens.……………………………………………….……………………………………………48 Criteria Air Pollutants.………………………….………….……………………………………………50 Chemicals of Concern: Flame Retardants.…………….……….…………………………….……….…54 Health Effects of Heavy Metals…………………………….……………………………………………60 Environmental Public Health Tracking..…………………….……………………………………………66 Introduction to Risk Assessment in Environmental Health.…….………………………………………67 UNIT IV: PRACTICE SETTINGS……..……………………………………………………………………………………..70 Nurse Exposure in Work.………………………………….……………………………………………71 Hazardous Exposures in Healthcare.…………………….………………………..………………….…72 Pharmaceutical Waste.…………………….………………………….…………………………………75 Green Team……………………………………….……….………………………………………….…77 UNIT V: SUSTAINABLE COMMUNITIES…….…………………………………………………………………………….78 Introduction to Tox Town…………………….…………………………………………………………79 Green Building……………………….….………………………………………………………………80 Green Cleaning in Homes.…………………….……………………………………………………..…82 Transportation and Health Implications..…………………….…………………………………………86 Brownfields and Nursing Implications.…………………….……………………………………………87 Antibiotic Use in Agriculture: Public and Environmental Health Impact.…………………….…………90 Environmental Justice..…………………….……………………….……………………………………98 UNIT VI: CLIMATE CHANGE……………………………………………………………………………………………..109 Climate and Health..…………………….…………….………….………………………………….…109 Page iii Alliance of Nurses for Healthy Environments UNIT VII: ENERGY.…………………………………………………………….…………………….……………….……121 Introduction to the ANA Energy Resolution…………………….………………………………….…122 Unconventional Natural Gas Development and Nursing.…………………….…………………….…123 UNIT VIII: ADVOCACY……………………………………………………………………………………………………129 Using Nursing Process to Guide Advocacy for Environmental Health.….………………………….…130 Coalition Building: A Powerful Political Strategy…..……….……….……………………………….…133 Case Study in Environmental Health Advocacy…….…….……………………….……………………139 Chemical Policy Reform - Toxic Chemicals in the Environment: Efforts to Control and Regulate……142 Anatomy of a Legislative Meeting….…………………………………………………………..…….…144 UNIT IX: RESEARCH…….…………………………………………………………….…………………………….……145 Maria Amaya, PhD, RNC, WHNP-BC….…………………………………………………………….…146 Adelita Cantu, PhD, RN….…………………………………….…………………………………….…148 Viki Chaudrue, EdD, MSN, RN….…..……………….……………………………………………….…150 Rosemary Chaudry, PhD, RN, MHA, MPH, PHCNS-BC….………………………………………….…151 Linda McCauley, RN, PhD, FAAN, FAAOHN…..…………………………………………………….…152 Ruth McDermott-Levy, PhD, MPH, RN….…..……………………………………………………….…153 Barbara Polivka, PhD, RN….…..…………………………………………………….……………….…155 Elizabeth C Schenk, PhD, MHI, RN…….…………………………………………………………….…156 UNIT X: CONCLUSION………………………………………………………………………………………………….158 Page iv Alliance of Nurses for Healthy Environments INTRODUCTION: environment and health. Through the intervening years portions of this book were completed and made available The Alliance of Nurses for Healthy Environments on the ANHE website. For this 2016 edition, earlier (ANHE) was begun in December 2008 when a gathering portions were updated and new information was of 50 nurses representing national nursing organizations completed to offer our first PDF version of this met to advance environmental health in nursing. The textbook. At the present time other contributors are Mission of ANHE is: Promoting healthy people and completing additional material to add to this body of healthy environments by educating and leading the work that will be added in future versions. nursing profession, advancing research, incorporating evidence-based practice, and influencing policy. According The value of this online textbook is that it can reach a to the ANHE Wingspread Statement of 2009 “The wide audience of nurses across the globe, is freely Alliance will guide the nursing profession by accessible, and has hyperlinks built into the chapters to strengthening education, advancing research, bring the reader directly to well established and evidence incorporating evidence- based practice and influencing based information from governmental and non- policy to promote healthy people and healthy governmental agencies and organizations. The book is environments.” In response to the 1995 Institute of organized into 9 units that address a board range of Medicine (IOM) report, Nursing, Health and the topics essential for nurse knowledge in environmental Environment, ANHE developed strategies to assure that health. nurses have access to education about environmental Unit 1 Why Nursing? serves to inform the reader of the health factors that affect nursing practice and the relevance of environmental health content for nursing populations that nurses serve. The IOM report noted practice as well as mandates from not only the 1995 IOM that no accrediting or regulating body mandated that report but also the inclusion of environmental health environmental health content be included. This holds true (currently Standard 17) into the ANA Scope and today. Further, the report recommended that Standards of Practice: Nursing beginning as Standard 16 • environmental health content be included into all in 2010. levels of nursing education as well as for professional Unit 2 Harmful Environmental Exposures and development; Vulnerable Populations provides an overview of • environmental health content be included in nursing populations across the lifespan and their specific licensure and certification examinations; vulnerabilities as well as specific populations such as workers, immigrants and persons with alterations in • education environmental health should be cognitive and physical abilities. interdisciplinary; Unit 3 Environmental Health Sciences includes • environmental health content be part of life-long information about sciences that inform environmental learning and continuing education for nurses in health such as ecology, toxicology, epidemiology and risk practice; and assessment. • resources and educational opportunities should be Unit 4 Practice Settings addresses hazardous exposures available through public and private organizations and in healthcare, Green Teams, green cleaning in hospitals, agencies. and pharmaceutical waste. To address these recommendations the Education Unit 5 Sustainable Communities provides Workgroup of ANHE was formed and strategic goals environmental health content that looks at communities. were established. This includes information on green building initiatives, At that time of ANHE’s inception, one of the goals was to green cleaning in homes, transportation, Brownfields, develop an open access electronic textbook for nurses food, antibiotic use in agriculture and environmental and other health professionals. The offerings differ from a justice. typical textbook in that some are written as chapters Unit 6 Climate Change informs the reader about the that would be familiar to most readers, others are impact of climate change on health and its implications presentations with voice added, and some are for nursing practice. educational strategies that target academic and professional development educators. The contributors Unit 7 Energy introduces the ANA resolution on include experts in special areas salient to the
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