Standard 16. Environmental Health
Karen Ballard RN, MA, FAAN
Standard 16. Environmental Health. The registered nurse practices in an environmentally safe and healthy manner.
Definition and Explanation of the Standard
In 1995, Lillian Mood, an early nurse environmental health activist, observed that environmental health was “a good fit with the values of the nursing profession regarding disease prevention and social justice” (Mood, 1995, p. vii). This observation underscores the critical role that nurses have played and continue to play in assessing and addressing health issues associated with the cleanliness and healthiness of the environment for their patients, themselves, and others in their workplaces. The American Nurses Association (ANA) considers environmental health, as adapted from the World Health Organization (WHO, 1992), to embrace “those aspects of human health, including quality of life, that are determined by physical, chemical, biological, social, and psychological problems in the environment and also refers to the theory and practice of assessing, correcting, controlling, and preventing those factors in the environment that can potentially affect the health of present and future generations” (ANA, 2010, p. 65). The environment in which a registered nurse (RN) practices includes the “surrounding context, milieu, conditions, or atmosphere” (ANA, 2010, p. 64).
In her First Rule of Nursing, Florence Nightingale (1859) cautioned nurses to “[k]eep the air within as pure as the air without.” The International Council of Nurses (ICN, 1992, p. 1) has observed that
the concern of nurses is for people’s health—its promotion, its maintenance, its restoration. The healthy lives of people depend ultimately on the health of Planet Earth—its soil, its water, its oceans, its atmosphere, its biological diversity—all of the elements which constitute people’s natural environment. By extension, therefore, nurses need to be concerned with the promotion, maintenance, and restoration of health of the natural environment, particularly with the pollution, degradation, and destruction of that environment being caused by human activities.
Both ANA and ICN have stressed the vital roles that nurses can play in reducing the ecological footprint of the healthcare industry and in mitigating the impact of the disposal of medical wastes including pharmaceuticals on communities and the global environment (ANA, 2004a, 2004b, 2006; ICN, 2002, 2010).
The competencies for Standard 16 are based on ANA’s Principles of Environmental Health for Nursing Practice with Implementation Strategies (ANA, 2007).
Knowledge of environmental health concepts is essential to nursing practice.
The Precautionary Principle guides nurses in their practice to use products and practices that do not harm human health or the environment and to take preventive action in the face of uncertainty.
Nurses have a right to work in an environment that is safe and healthy.
Healthy environments are sustained through multidisciplinary collaboration.
Choices of materials, products, technology, and practices in the environment that affect nursing practice are based on the best evidence available.
Approaches to promoting a healthy environment respect the diverse values, beliefs, cultures, and circumstances of patients and their families.
Nurses participate in assessing the quality of the environment in which they practice and live.
Nurses, other healthcare workers, patients, and communities have the right to know relevant and timely information about the potentially harmful products, chemicals, pollutants, and hazards to which they are exposed.
Nurses participate in research of best practices that promote a safe and healthy environment.
Nurses must be supported in advocating for and implementing environmental health principles in nursing practice.
There is increasing scientific evidence about the association between environmental exposures to heavy metals, pesticides, air and water pollution, and other environmental toxins and about a wide array of health outcomes, including reproductive and developmental problems; cancer; neurological, immunological, and metabolic disorders; and asthma and other respiratory illnesses (EWG, 2005, 2007, 2008, 2009). The current chemical burden experienced by individuals is unprecedented in human history (Goldman & Koduru, 2000). It is also recognized that several environmentally influenced health problems are on a steep rise in the United States: autism, asthma, obesity, certain childhood cancers, and infertility.
RNs handle many different therapeutic chemicals and drugs with differing side effects and exposure rates in the course of their practice. In addition, nurses can experience health reactions to diverse, chronic workplace exposures to hazardous cleaning, disinfecting, and sterilizing agents; radiation; mercury; and other chemicals (EWG, 2007). In one study of physicians and nurses, 18 of the same chemicals were detected in every single participant; all 20 participants had at least five of the six major types of chemicals tested; 13 participants tested positive for all six of these major chemical types; and all participants had bisphenol-A, phthalates, polybrominated diphenylethers (PBDEs), and perfluorocarbons (PFCs)—priority chemicals for regulation by the U.S. Environmental Protection Agency (EPA) and associated with chronic illness, such as cancer and endocrine malfunction (PSR, 2009).
Nurses have an immense capacity to affect environmental conditions for their patients, themselves, and their communities. In addition to their work in reducing harmful chemical, biological, and radiological exposures, nurses can improve the public’s health by promoting positive workplace and community environments. Nurses can advocate for green spaces and walkable communities, safe and healthy buildings, and use of environmentally preferable products.
Application of the Standard in Practice
Education
Concerning health and illness, all nurses need to acquire basic knowledge of scientific environmental health concepts, including the basic mechanisms and pathways of exposure to environmental hazards; the prevention and control strategies; and the interrelationships of individuals, communities, populations, and the environment, including the workplace. This knowledge includes assessing the practice environment for factors—such as sound, odor, noise, and light—that threaten health and never serving as a “transfer agent” for the transmittal of infectious materials from the healthcare facility to one’s home and community.
Nurse educators must incorporate environmental concepts, principles, and competencies in both basic and advanced curricula across the learning continuum. A single class or course is not sufficient to meet this critical learning need. Curricula must include basic principles of toxicology; disease-specific and toxic-specific information; information on environmental risks in the home, healthcare facility, community, and workplace; methods for environmental and occupational history taking; and ways to expand the nursing process to include the environment as a separate and important domain in assessment. Additional content is needed about the following:
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