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.

Farmworkers: Environmental Health and Social Determinants.

The health implications of food and agriculture production are not generally part of the nursing curriculum and yet nurses understand that vulnerable populations, such as farmworkers, may need special attention in terms of health education, disease prevention, and access to mental health and healthcare services. Nurses also learn about the social determinants of health and increasingly are applying this knowledge to health and wellness in their communities. This article will consider the health impacts of the social determinants and both environmental and occupational exposures experienced by farmworkers and the associated implications for the nursing profession. As health professionals one can help to give voice to this often-voiceless population. Working with farmworkers in partnership is key and working with the Migrant Clinicians Network and other advocacy organizations on state and federal policies that will improve working and living conditions for farmworkers and their families is crucial.

Using Fume Hood to Reduce Nurses' Exposure to Particulate Matters Dispersed Into the Air During Pill Crushing.

BACKGROUND: Pill crushing is a common practice in patient care settings. Crushing pills can disperse particulate matter (PM) into indoor air. The PM is a widespread air pollutant composed of microscopic particles and droplets of various sizes and may carry active and/or inactive ingredients nurses can inhale. This study aimed to quantify PM sizes and concentration in indoor air when pills are crushed and examine the role of a fume hood in reducing particulate pollution. METHODS: Two scenarios (with and without a fume hood) representing nurses' pill-crushing behaviors were set up in a positive-pressure cleanroom. Two acetaminophen tablets (325 mg/tablet) were crushed into powder and mixed with unsweetened applesauce. The PM sizes and concentrations were measured before and during crushing. RESULTS: Different sizes of PM, including inhalable, respirable, and thoracic particles, were emitted during medication crushing. The total count of all particle sizes and mass concentrations of particles were significantly lower during crushing when a fume hood was used (p = .00). CONCLUSION: Pill crushing increases PM and should be considered a workplace safety health hazard for nurses. Healthcare professionals should work under a fume hood when crushing pills and wear proper protective equipment. The findings of significant particulate pollution related to pill crushing suggest that further research is warranted.

Reducing hazardous chemical exposures in the neonatal intensive care unit: a new role for nurses.

A wide range of toxic chemicals have been found in the umbilical cord blood of newborns, indicating the potential for health risks from chemical exposure that begin in utero. The neonatal intensive care unit (NICU) setting may also have potential chemical exposures that create health risks. Given the extreme vulnerability of this patient population, it is critical to minimize unnecessary hazardous chemicals. Neonatal intensive care unit nurses have an important role to play in making the NICU as safe as possible for their patients and themselves. This article will focus on the human health effects of several chemical exposures commonly found in the NICU for which nurses can help to eliminate or select safer alternatives: (1) diethylhexyl phthalates (a plasticizer commonly found in intravenous tubing/bags and other products); (2) bisphenol A (commonly found in the lining of baby formula cans); (3) personal care products used in the NICU; (4) cleaning, sterilants, and disinfectants; and (5) mercury. A tool for assessing environmental health risks will be presented and associated intervention options including purchasing policies; hospital-wide chemical policies; and development of institutional infrastructures, such as Green Teams, to address NICU and hospital-wide environmental health concerns. Nursing's evolving role in environmental health will be reviewed.

Potential health effects related to pesticide use on athletic fields.

OBJECTIVES: Children come in contact with athletic fields on a daily basis. How these fields are maintained may have an impact on children's potential exposure to pesticides and associated health effects. DESIGN AND SAMPLE: This is a cross-sectional, descriptive study that utilized a survey to assess playing field maintenance practices regarding the use of pesticides. Athletic fields (N = 101) in Maryland were stratified by population density and randomly selected. MEASURES: A survey was administered to field managers (n = 33) to assess maintenance practices, including the use of pesticides. Analysis included descriptive statistics and generalized estimating equations. RESULTS: Managers of 66 fields (65.3%) reported applying pesticides, mainly herbicides (57.4%). Managers of urban and suburban fields were less likely to apply pesticides than managers of rural fields. Combined cultivation practice was also a significant predictor of increased pesticide use. CONCLUSIONS: The use of pesticides on athletic fields presents many possible health hazards. Results indicate that there is a significant risk of exposure to pesticide for children engaged in sports activities. Given that children are also often concurrently exposed to pesticides as food residues and from home pest management, we need to examine opportunities to reduce their exposures. Both policy and practice questions are raised.

Association between ozone and emergency department visits: an ecological study.

The objective of this study was to examine the association between the levels of ozone concentration and emergency department (ED) visits for respiratory and cardiovascular conditions in Maryland in the United States by considering temporal and spatial characteristics, including socioeconomic status (SES), as a covariate. This study used multiple large datasets derived from government agencies for data of ozone, weather, census, and ED visits to represent Maryland in the summer of 2002. Block kriging was used to estimate the daily ozone and weather factors by ZIP code-day level. Results from a negative binomial regression showed that a 10-ppb increment of the 8-hr ozone level as a three-day average was associated with increased respiratory ED visits by 2.4%, after adjusting for weather factors, SES, and day of the week. For cardiovascular ED visits, an increment of 10 ppb of the 8-hr ozone level as a five-day average increased by 3.5%.

Starting a health care system green team.

The health care industry is often overlooked as a major source of industrial pollution, but as this becomes more recognized, many health care facilities are beginning to pursue green efforts. The OR is a prime example of an area of health care that is working to lessen its environmental impact. Nurses can play key roles in identifying areas of waste and presenting ideas about recovering secondary materials. For instance, although infection prevention measures encourage one-time use of some products, nurses can investigate how to reprocess these items so they can be reused. This article examines how the efforts of a Green Team can affect a hospital's waste stream. A health care Green Team can facilitate a medical facility's quest for knowledge and awareness of its effect on the waste stream and environment.

Nurses' role in children's environmental health protection.

There is a growing body of evidence regarding the presence of toxic pollutants in the air, water, soil, food, and indoor environments, and the health effects of these pollutants on humans. Children have special vulnerabilities to environmental risks in their homes, schools, and communities. Children's susceptibility to environmental risks stem from biological, behavioral, and socio-economic factors. Environmental standards are not always protective of children's health, and in some instances, no standards exist. Addressing children's vulnerabilities and decreasing their exposures require a multi-faceted and multi-disciplinary approach with clinical, public health, and policy interventions. Preventing exposure to hazardous levels of pollution is largely the role of the public health community, environmental protection agencies, and the policy makers who create the enabling laws. The Institute of Medicine (IOM) (1995) has recommended the integration of environmental health into nursing practice, education, research, and policy/advocacy work. This article identifies areas in each of these categories in which nurses can enhance their practice regarding children's environmental health. In addressing children's environmental health, nurses' expanded roles can include a range of activities, such as anticipatory guidance, health education, public health interface, improved health tracking, environmental health research, and legislative/regulatory engagement.

Organophosphate insecticide exposure: A clinical consideration of chlorpyrifos regulation.

BACKGROUND AND PURPOSE: In March 2017, the Environmental Protection Agency (EPA) reversed course on a proposal to ban the agricultural use of the organophosphate (OP) insecticide chlorpyrifos (CPF). The purpose of this article is to examine the evidence leading to this controversial decision and provide clinically applicable health promotion guidance for nurse practitioners on CPF exposure and risk reduction measures. METHODS: Environmental Protection Agency documents on CPF regulation and corresponding research referenced within the EPA reports are reviewed. Evidence-based health promotion strategies obtained through PubMed, CINAHL, Center for Disease Control and Prevention, and National Institutes of Health sources are summarized. CONCLUSIONS: Available data suggest a potential association between CPF exposure and adverse neurodevelopmental outcomes. Particularly vulnerable populations are pregnant women, children younger than two years, and agricultural workers. There may be genetic variability in susceptibility to environmental toxins. IMPLICATIONS FOR PRACTICE: Because of the extensive use of the OP CPF in agriculture and other community-based settings throughout the United States, nurse practitioners should be knowledgeable of the evidence regarding CPF exposure and be prepared to provide health promotion guidance to patients in clinical practice. Nurse practitioners should also consider their role in advocacy for healthy environments and the protection of vulnerable populations as it relates to agricultural insecticide exposure.

Healthy choices: transforming our hospitals into environmentally healthy and safe places.

While it is commonly understood that the quality of the air we breath and the water we drink can impact our health, it is often more difficult to recognize that our choices of the health care products, along with the way we dispose of them, and the chemicals we spray on our foods or use to clean and disinfect may actually compromise the environment and consequently our health. This article will guide nurses and other health care professionals as they transform our hospitals into environmentally healthy and safe places by helping them adhere to environmentally preferable purchasing policies, follow environmentally conscious waste management strategies, decrease use of chemical pollutants, promote use of healthy foods, and provide leadership in environmental stewardship.

Policy perspectives in environmental health: nursing's evolving role.

The nursing community has become increasingly active in the environmental health policy arena by exerting its influence at the local, state, and national environmental health policy levels; on media-specific issues; and in the work-related venues where they have influence. Nurses are valued and trusted by policy makers, and should be active in policy efforts to increase access to public health information such as potentially hazardous chemicals in the air, water, food, soil, and land. Given the global nature of environmental contamination, it is critical that nursing's international organization becomes active in environmental health policies. Promotion of healthy environments should be translated to organizational position papers and practice recommendations within nursing and nursing specialty organizations.

Developing curriculum recommendations for environmental health in nursing.

In 2010, the American Nurses Association (ANA) added an environmental health standard to the ANA Scope and Standards of Practice requiring that nurses implement environmental health strategies in nursing practice. To prepare nurse educators to integrate environmental health at all educational levels, nursing faculty members from the Alliance of Nurses for Healthy Environments developed environmental health competencies and curricular recommendations that address this need. Internet URLs are included for environmental health curricula for each level of nursing education.

Environmental health of children.

Pediatric primary health care providers are responsible for providing comprehensive care to children. This includes assessing for and identifying the effect of environmental hazards on children's health and managing conditions that may result from exposure to environmental toxins. This article begins by reviewing the unique developmental, biologic, and behavioral characteristics of children and age-specific issues that make them particularly vulnerable to toxins. It then provides the reader with general assessment and management strategies related to environmental toxins, including an assessment tool that can be used in a pediatric primary care office. The qualities of selected toxins that have been implicated in childhood illnesses are discussed. Routes of exposure, signs and symptoms of toxicity, and assessment and management approaches are presented specifically for lead, mercury, environmental tobacco smoke, particulate matter, asbestos, radon, molds, and pesticides. Because prevention is the best intervention in environmental health, the article emphasizes ways pediatric providers can work with caregivers to prevent or minimize exposure.