Environmental health nursing education: One school's journey.

Nurse educators have long recognized the need for an increased focus on environmental health education in nursing. For decades, schools of nursing have answered the call to action put forth by the Institute of Medicine and the American Nurses Association to incorporate environmental health content into nursing curricula. This article details the experiences of faculty and staff at the University of Maryland School of Nursing as they launched a national environmental health nursing organization, developed individual undergraduate elective courses on environmental health and climate change, and created a post-baccalaureate certificate program. We also report student registration and evaluation data from five environmental health courses over 10 years. Five hundred five undergraduate and 291 graduate nursing students from a variety of programs received formal environmental health education. Relevance of content was consistently highly rated, ranging from 4.17 to 4.61 out of 5, and students completed projects on a wide range of environmental health topics. Graduates of the certificate program have greatly impacted their communities in the areas of nursing practice, education, and policy.

Association of Community Health Nursing Educators 2020 Research Priorities and Research in Action Model.

OBJECTIVE: The Association of Community/Public Health Nurse Educators (ACHNE) Research Priorities Subcommittee presents a report on the state of the science of public health nursing education. DESIGN: Whittemore and Knafl's (Journal of Advanced Nursing, 2005, 52, 546) five-step integrative review was used. SAMPLE: Fifty-two articles were reviewed. MEASUREMENTS: Braun et al's. (Handbook of research methods in health social sciences, 2019, 843) thematic analysis methods were used. RESULTS: Four themes emerged: (a) Community/Public Health Nursing Education and teaching strategies/modalities; (b) Clinical teaching and learning partnerships; (c) Environmental health and emergency response; and, (d) Cultural competence and awareness. CONCLUSIONS: Themes informed the following research priorities: (a) a need for rigorous scientific studies highlighting the impact and effectiveness of Community/Public Health Nursing Education; (b) a need for evidence on faculty development, support and training related to community/public health activities; (c) a need for evidence on impact of Community/Public Health Nursing teaching on communities and students, and (d) a need for evidence on impact of C/PHNE strategies on long-term student knowledge, attitudes or behavior (competencies). Finally, a Research in Action Model is proposed as a means for continued forward movement of the discipline, connecting the three fundamental driving mechanisms.

Evaluation of the Children's Environmental Health Network's environmental stewardship checklist responses.

Children are subject to multiple hazards on a daily basis, including in child care facilities. Research has shown that children in the child care setting may be exposed to lead, radon, pesticides, and multiple chemicals that are associated with known or suspected adverse health effects. The authors' study used an existing environmental health endorsement program to describe current practices of child care facilities as related to environmental health and safety. The facilities varied greatly in size and were located mainly in the U.S. with a few from Canada and Australia. A few checklist items had nearly a 100% positive response rate; however, some of the items had more than 10% of the facilities answer "false" or "don't know." Although many areas exist in which these sampled child care facilities are being environmentally responsible, further education is needed, particularly as related to the use of wall-to-wall carpeting, radon testing, aerosols, and air fresheners.

Innovating to meet AACN essentials in a bachelor of science in nursing program.

Our large, two campus (one urban and one suburban) and two track (RN-BSN and Entry-level BSN) program has revised our BSN curriculum to reflect the new Level One American Association of Colleges of Nursing (AACN) The Essentials: Core Competencies for Professional Nursing Education (AACN, 2021). This article describes the work to revise the curriculum to meet the demands of contemporary nursing education with increased elective choices for Generation Z learners, professional role courses on wellness and resiliency, a course on palliative care and symptom management, increased clinical hours to include virtual simulation and more community and public health experiences, and increased innovative student experiences with our clinical partners. A revised clinical evaluation tool (CET) was also developed to evaluate students in competency-based education and to reflect our new program outcomes.

Women's perceptions of childbirth risk and place of birth.

In the United States, clinical interventions such as epidurals, intravenous infusions, oxytocin, and intrauterine pressure catheters are used almost routinely in births in the hospital setting, despite evidence that the overutilization of such interventions likely plays a key role in increasing the need for cesarean section (CS).' In 2010, according to the U.S. Centers for Disease Control and Prevention, approximately 32.8 percent of births in the U.S. were by CS.2 The U.S. National Institutes of Health has reported that CS increases avoidable maternal and neonatal morbidity and mortality.3To increase understanding of what might motivate the overuse of CS in the U.S., we investigated the factors that influenced women's decision making around childbirth, because women's conscious and unconscious choices about giving birth could influence whether they would choose or allow delivery by CS. In this article, we report findings about women's decisions related to place of birth-at home or in a hospital. We found that choosing a place of birth was significant in how women in our study attempted to mitigate their perceptions of the risks of childbirth for themselves and their infant. Concern for the safety of the infant was a central, driving factor in the decisions women made about giving birth, and this concern heightened their perceptions of the risks of childbirth. Heightened perceptions of risk about the safety of the fetus during childbirth were found to affect women's ability to accurately assess the risk of using clinical interventions such as the time of admission, epidural anesthesia, oxytocin, or cesarean birth, which has important implications for clinical practice, prenatal education, perinatal research, medical decision making, and informed consent.

Environmental health effects of concentrated animal feeding operations: implications for nurses.

Changes in livestock farming over the last 50 years have led to the increase of large-scale livestock farms called concentrated animal feeding operations (CAFOs). These farms pose a threat to the environment by polluting the air and nearby ground and surface waters. In addition, adverse health effects have been found in CAFO workers and CAFO neighbors. A multitude of respiratory effects have been noted by workers and neighbors, some of which are severe enough to cause workers to leave the industry. The mental health of CAFO neighbors appears to suffer as well, mainly because of noxious odors and stress. Concentrated animal feeding operations also contribute to the growth of antibiotic-resistant bacteria, which have the potential to harm populations nationwide. Although research is being done on this topic around the world, the nursing literature contains very little information on health effects from CAFOs. Occupational, community, and public health nurses should be aware of the dangers from CAFOs and should participate in caring practices, research, and advocacy to diminish the risks.

Systematic Review and Meta-Analysis of the Effect of Nutrients on Blood Lead Levels in Pregnancy.

OBJECTIVE: To synthesize experimental and nonexperimental research on the relationship between nutrients and blood lead levels in pregnant women. We also performed a meta-analysis on a subgroup of studies on calcium and blood lead levels. DATA SOURCES: PubMed, Embase, and CINAHL databases were searched in July 2019. STUDY SELECTION: We included articles published in English in any year that reported the results of experimental or observational studies on the effect of nutrients on blood lead levels in pregnancy. DATA EXTRACTION: Three nurse reviewers extracted data and appraised the studies using tools from the Joanna Briggs Institute. DATA SYNTHESIS AND META-ANALYSIS: We included 28 studies from 16 countries. Study authors examined 14 distinct nutrients, with calcium being the most frequent. The metaregression included nine analyses of the effect of calcium on blood lead levels and showed a small but significant inverse relationship. The quality of evidence for the effect of calcium on lead levels was high. Eleven analyses were related to the effect of iron on blood lead levels. The quality of evidence was high, and we found mostly negative associations between iron intake and blood lead levels. The quality of evidence for the remaining nutrients was moderate, with few significant findings. CONCLUSION: Targeted nutritional interventions may be beneficial for pregnant women with current lead exposure or a history of elevated lead levels, particularly those with calcium- or iron-deficient diets. More rigorously designed studies are needed in this area.

CE: Health and the Human Microbiome: A Primer for Nurses.

: The profound impact of the human microbiome on health makes it imperative that nurses understand the basic structures and functions of the various microbial communities. In studying the human microbiome, advances in DNA and RNA sequencing technology offer benefits over traditional culture-based methods. Such technology has permitted more thorough investigations of microbial communities, particularly those of the gastrointestinal (GI) and female reproductive tracts. Although individual variations exist, each site exhibits distinct compositions. The diverse GI microbiota aid in digestion, mood regulation, and vitamin synthesis. While many factors affect the composition and functions of the GI microbiota, diet likely exerts the strongest influence. Vaginal microbiota tend to be less diverse, and mainly serve to protect women from infection. The composition of the vaginal microbiota is influenced by sexual activity, hygienic practices, medications, smoking, and other factors. Our increasing knowledge about the structures and functions of the GI and vaginal microbiota allows nurses to provide targeted, evidence-based education and care for various populations.

Deprivation status and the hospital costs of an emergency medical admission.

BACKGROUND: Deprivation has been shown to adversely affect health outcomes. However, whether deprivation increases hospitalisation costs is uncertain. We have examined the relationship between deprivation and the costs of emergency medical admissions in a single centre between 2008-2014. METHODS: We calculated the total hospital costs of emergency admissions related to their deprivation status, based on area of residence (Electoral Division - small census area). We used truncated Poisson and quantile regression methods to examine relationships between predictor variables and total hospital episode costs. RESULTS: Over the study period, 29,508 episodes were recorded in 15,932 patients. Compared with the least deprived (Q1), the incidence rate ratios (IRR) for annual costs were increased to Q3 1.15 (95% CI: 1.12, 1.19), Q4 2.39 (95% CI: 2.30, 2.49) and Q5 2.76 (95% CI: 2.68, 2.85). The margin statistic cost estimate per thousand population increased from 183.8 K€ in Q1 to 507.9 K€ in Q5. The total bed days/1000 population increased as follows (compared with Q1): Q3 IRR 1.41 (95% CI: 1.37, 1.45), Q4 1.96 (95% CI: 1.89, 2.03) and Q5 3.04 (95% CI: 2.96, 3.12). The margin statistic bed day estimate (/1000 population) increased from 218.7 in Q1 to 664.0 in Q5. CONCLUSION: Deprivation status had a profound impact on total hospital costs for emergency medical admissions. This was primarily mediated through a tripling of total bed days in the most deprived groups.

A randomized controlled trial to improve outcomes utilizing various warming techniques during cesarean birth.

OBJECTIVE: To examine the effect of various warming methods during cesarean birth (CB) on maternal core body temperature, maternal hypothermia, and other maternal and neonatal outcomes. DESIGN: Three-arm randomized controlled trial. SETTING: Perinatal unit in a large community hospital in the mid-Atlantic United States. PARTICIPANTS: Two hundred twenty-six (226) pregnant women undergoing planned CB. METHODS: Women were randomly assigned to one of three groups (usual care, warmed fluids, or warmed underbody pad). Warming treatments began preoperatively and continued for 2 hours postoperatively. Study nurses measured outcomes at defined intervals. RESULTS: Both warming techniques affected maternal temperatures and the incidence of hypothermia. The warmed fluids group had significantly higher temperatures in the operating room, whereas the warmed underbody pad group had significantly higher temperatures in the recovery room. Although none of the other outcomes was statistically different among groups, the findings have implications for practice. Apgar scores were proportionately lower in the usual care group, and maternal request for additional warming was proportionately higher in the usual care group. CONCLUSION: This study adds information on ways to maintain maternal normothermia during surgery. By understanding maternal hypothermia during CB, nurses can use best practice to obtain optimal maternal and neonatal outcomes.

Choice? Factors That Influence Women's Decision Making for Childbirth.

This article reports the findings from a mixed-methods study on factors that influence women's decisions about birth, with the view that women's decision making about birth can affect the use of cesarean surgery. Data was collected from focus groups and structured postpartum interviews and was analyzed using the Consensual Qualitative Research method. The findings relate specifically to the factors reported as influential in making decisions about birth including how the women categorized, prioritized, and/or favored certain types of knowledge about modes of birth. Four major information categories were identified but only stories about birth and/or attending a birth appeared to have a lasting effect on birth choices. These findings have implications for prenatal and perinatal education and nursing practice.