Ecosystems

• Dynamic communities in which all organisms, including humans, exist; humans cannot live outside of these systems
• Studying ecosystems provides understanding of:
  • The relationship between humans and the environment
  • Why environmental health knowledge is important for nurses

Sustainability

• Based on the need for humans and the environment to coexist
• Consideration of present and future needs
• Key aspects:
  • Food and fuel limitations of the natural environment
  • Protection of the environment
  • Promotion of healthy characteristics in the population

Upstream Focus

• John McKinley (1979) in A Case for Focusing Upstream identified root causes of disease and related factors
• Related concepts in environmental health nursing:
  • Health disparities
  • Social determinants of health
  • Environmental justice
• PHNs as “sentinels of surveillance”:
  • Detect unusual illness patterns
  • Respond to environmental emergencies

Question #1

• Statement: Is the following statement true or false? The precautionary principle identifies root causes of disease and related factors.
• Answer: False
• Rationale: It was John McKinley’s book, A Case for Focusing Upstream, that identified root causes of disease and related factors.

Determining Risk

Precautionary principle

• Definition: “When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically.”
• Source: Science and Environmental Health Network (SEHN). (2018). Precautionary principle. Retrieved from https://www.sehn.org

Health risk assessment

• Systematic evaluation of risk of specific exposure
• Four steps:
  1) Identification of the hazard
  2) Exposure assessment
  3) Characterization of the health risk
  4) Risk management
• Number of steps: $4$

Health impact assessment

• Systematic evaluation of a planned change to a community before change occurs
• Six steps:
  1) Screening
  2) Scoping
  3) Assessment
  4) Recommendations
  5) Reporting
  6) Monitoring and evaluation
• Number of steps: $6$

Specific Vulnerabilities

• Pregnant women and fetuses:
  • Fetal loss and recurrent miscarriage
  • Low-birth-weight infants
  • Menstrual abnormalities
  • Reproductive malformations and dysfunctions
• Infants and children
• Epigenetics

Sciences for Environmental Health

• Environmental epidemiology:
  • Focuses on environmental exposures and risks that contribute to adverse health effects
• Toxicology:
  • Study of how body processes toxicants and their ultimate effects in the body
  • Includes exposure pathways and biomonitoring
• Risk assessment
• Risk management

Core Functions of Public Health Nursing

• Assessment:
  • Monitoring health status
  • Diagnosing and investigating individual, home, and community environmental health hazards
• Policy development:
  • Informing, educating, empowering the community
  • Mobilizing community partnerships and activities
  • Developing policies and efforts to support health
• Assurance:
  • Enforcing laws and regulations

Environmental Factors to Assess in the Community (1–7)

#1

• Built environment
• Climate change
• Land use
• Toxic exposures:
  • Air
  • Water
  • Food
• Toxic waste
• Radiation

#2 Built environment (more details)

• All aspects of environment not naturally occurring
• Includes:
  • Physical structures (e.g., homes, schools, workplaces, dams, roadways, buildings)
  • Features that contribute to social cohesiveness or disruption

#3 Climate change

• Significant changes in measures of climate over decades or longer:
  • Global temperature
  • Precipitation
  • Wind patterns
• Role of PHN in preparing for surge events

#4 Land use

• Zoning regulations and enforcement
• Industries and their toxic releases
• Transportation (types, sidewalks, bikeways)
• Recreational space
  • Green space
  • Use of fertilizers or pesticides
  • Safe play areas for children
  • Tree ordinances

#5 Air, water, food exposures

• Air pollution: Air quality index
• Water pollution: Lack of clean water and sanitation; point and nonpoint sources of contamination
• Food contamination: Genetic modification; microbial outbreaks

#6 Toxic waste

• Plastics
• Solvent wastes
• Dioxins
• Wastes from electroplating and similar operations
• Wastes from oil refineries
• Organic chemicals
• Pesticides
• Explosives

#7 Radiation

• Ionizing:
  • Radon gas
  • Cosmic radiation from the atmosphere
• Nonionizing:
  • Infrared
  • Microwave
  • Radio waves

Question #2

• Which is a component of land use?
  • A. Air quality index
  • B. Point and nonpoint sources of contamination
  • C. Genetic modification
  • D. Zoning regulations
• Answer: D. Zoning regulations
• Rationale: Zoning regulations and their enforcement are aspects of land use. Air quality index is an aspect of air pollution. Point/nonpoint sources of contamination are aspects of water pollution. Genetic modification is an aspect of food contamination.

Environmental Factors to Assess in the Community (6–7) continued

#6 Toxic waste

• (as above)

#7 Radiation

• (as above)

Question #3

• Statement: Is the following statement true or false? Radon gas is an example of nonionizing radiation.
• Answer: False
• Rationale: Radon gas is an example of ionizing radiation.

Question #4

• Statement: Advocating for changes in legislation to address environmental threats to community health is a role of the PHN.
• Answer: True
• Rationale:
  • Nurses can begin environmental advocacy by writing letters to legislators in support of health-protective laws (e.g., sustainable energy, improved air quality, ecological agricultural practices).
  • Important nursing actions related to environmental policy include advocating for health-protective policies and informing community members about health risks related to the issue.

Strategies for Nursing Action in Environmental Health

Strategy #1

• Learn about possible environmental health threats
• Assess clients’ environment and detect health hazards
• Plan collaboratively with citizens and other professionals to devise protective and preventive strategies
• Assist with the implementation of programs
• Take action to correct situations in which health hazards exist

Strategy #2

• Educate consumers and assist them to practice preventive measures
• Take action to promote the development of policies and legislation that enhance consumer protection and promote a healthier environment
• Assist with and promote program evaluation to determine the effectiveness of environmental health efforts
• Apply environmentally related research findings and participate in nursing research

Connections to Practice and Ethics

• Ethical imperative for nurses to protect vulnerable populations (pregnant women, fetuses, infants, children) from environmental harms
• Practical relevance: use of risk assessment and impact assessment in planning community interventions
• Policy advocacy is a core nursing responsibility to translate evidence into protective laws and regulations
• Community engagement and transparency are essential for sustainable health improvements