Environmental Health

Environmental health assessment

Air (indoor/outdoor), water, land, or food Chemical, biological, or radiological Environmental health assessment - "I PREPARE" - questions to ask when taking an environmental history and to determine the environmental exposure history (p. 95 in text) - Windshield survey: helpful first step to understanding the potential environmental health risks in a community - Environmental databases - Environmental health assessment form - Inquire/observe about unintended environmental exposures

Reducing environmental health risks

Apply the basic principles of disease prevention Risk communication: the right information to the right people at the right time Ethics: essential for making ethical decisions regarding environmental health Governmental Environmental Protection: - Manages environmental exposures through the development and enforcements of standards and regulations - Educates public about risks and risk reductions - Environmental Protection Agency; Food and Drug Administration; Department of Agriculture; local health department

Nursing process to environmental health

Assessment Diagnosis Goal setting Planning Intervention Evaluation

Roles for nurses in environmental health

Assessment Referral Community involvement and public participation Risk communication Epidemiologic investigations Policy development

Florence Nightingale

Crimean war - insisted on strict sanitary conditions & saved many lives Practiced and wrote about how the quality of the environment influenced health and recovery from illness

Lillian Wald & Mary Brewster

Early in the twentieth century, Lillian Wald and Mary Brewster worked to improve the environment of the Henry Street neighborhood They aimed to improve physical environment and social conditions that affected health

Healthy People 2020 objectives related to environmental health

Eliminate elevated blood lead levels in children Minimize the risks to human health and the environment posed by hazardous sites Reduce pesticide exposures Reduce the amount of toxic pollutants Reduce indoor allergen levels Decrease the number of U.S. homes that are found to have lead based paint

Multidisciplinary approaches including nursing competencies

Geologists, meteorologists, and chemists all contribute information to help understand when humans may be exposed to hazardous chemicals, radiation (such as radon), and biological contaminants Nurses also might set up blood-leading screening programs through the local health department, educate local health providers to encourage them to systematically test children for lead poisoning

I PREPARE

Investigate potential exposures Present work Residence Environmental concerns Past work Activities Referrals and resources Educate

Referral resources

No single source of information about environmental health is available, nor is there a single resource to which individuals or a community can be referred if they suspect an environmental problem Starting points - The environmental epidemiology unit or toxicology unit of your state health department or environmental agency - Environmental health experts in nursing or medical schools, or schools of public health - Association of Occupational and Environmental Clinics Information is widely accessible on the internet, but finding an actual person to assist you or the communities you serve may not be as easy

Advocacy

Nurses have responsibilities to be informed consumers and to be advocates for citizens in their community regarding environmental health issues

Poverty and exposure to environmental hazards

People who live in poverty are more likely to be exposed to environmental hazards due to things like crowded living conditions, living closer to hazardous wastes, having poorer quality foods available to them and being exposed to hazards such as lead in paint, pollution in the air or water or working in hazardous jobs

Risk Assessment

Process to determine the probability of a health threat associated with an exposure Assessing risks in vulnerable populations: Children are especially at risk - Breathe more rapidly than adults = great exposure to air pollutants - Bodies work differently than adults: blood-brain barrier, kidneys, growing bodies Pregnant women must be careful for infant's development

Toxicology

The basic science that studies the health effects associated with chemical exposures When assessing a community's environmental health status, be sure to review the general health status of the community to identify members who may have higher risk factors as well as to assess the environmental exposures

The Right to Know Laws

The public has a right to know about hazardous chemicals in the environment Consumer Confidence Report (CCR): employees have the right to know through the federal Hazard Communication Standard. Employers must have a list of all hazardous chemicals used on site. Each of these chemicals should have an associated chemical information sheet, known as the Material Safety Data Sheet (MSDS) written by the chemical manufacturer

Epidemiology

The science that helps us understand the strength of the association between exposures and health effects in human populations Epidemiology triangle: agent, host, & environment Environmental surveillances, such as childhood lead registries, use of epidemiological methods to track and analyze incidence, prevalence, and health outcomes

As communicators and educators, nurses can do the following:

Write letters to local newspapers responding to environmental health issues affecting the community. Serve as a credible source of information at community gatherings, formal governmental hearings, and professional nursing forums. Volunteer to serve on state, local, or federal commissions. Know the zoning and permit laws that regulate the effects of industry and land use on the community. Read, listen, and ask questions. As informed citizens nurses can lead in fostering community action to address threats to environmental health.