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