Pioneering the Environmental Health Frontier

Alabama Nurse,  Mar-May 2005  by Sattler, Barbara

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Pioneer (pi-o-neer) 1. One who ventures into unknown or unclaimed territory to settle

2. An innovator

Whenever a new health issue has emerged, there has been a nurse who immediately sought to understand it. These inquisitive souls want to comprehend the science, consider the practice implications, and began to recognize how it might affect their patients, their families, and the community. Such nurses are the pioneering spirits among us.

We have seen the same early explorers emerge within the nursing profession in regard to environmental health risks. Like pioneering nurse Nancy Rothman, RN, PhD, who taught inner-city children in Philadelphia to sing a rap song each time they washed their hands so they would wash them long enough to significantly reduce the ambient lead-based paint dust that might have accumulated there. Or like pioneering Holly Shaner, RN, MBA, who several years ago couldn't reconcile her recycling obsession at home with the complete lack of waste segregation in her hospital. Holly helped move her hospital, and then many more hospitals, toward a more environmentally sound approach to waste management, especially waste segregation and recycling. And like nurse Robyn Gilden, RN, MS, whose knowledge of the laws and regulations affecting hazardous waste sites has helped communities gain access to and understanding of the information about health risks in their contaminated neighborhoods.

Each of these nurses has forged a new trail. And each of them has a story - a story that can be translated into collective wisdom for the nursing profession. The ANA, in collaboration with the Health Care Without Harm Campaign, is developing a project to collect examples of such new trails in environmental health and arrange them into a compendium of success stories and case studies. This initiative will help us to share and celebrate in the knowledge, ingenuity, and achievements of our early pioneers and then allow us to adopt and adapt them for ourselves. The "Luminary Project", as it is titled for the light it will shed, is part of a larger effort to raise awareness and build capacity within the nursing profession on issues related to health and the environment.

At the 2004 annual meeting of state nursing lobbyists, over 30 nurse lobbyists attended an all day workshop on environmental health policy. During the meeting, these nursing leaders were asked to describe the environmental health risks in their homes, work, schools, and communities. They rushed to fill their flipcharts with words like: pesticides, carbon monoxide, lead, mercury, diesel exhaust, toxic waste sites, and so on. Interestingly, when groups of high school student from inner-city Baltimore are asked to fill their flipcharts, they are just as quick to write: pesticides, carbon monoxide, lead, mercury, diesel exhaust, toxic waste sites, and so on. And the same litany of exposures is noted by 2nd year medical students. When any of these groups are asked to describe the specific health effects associated with the exposures, there is less confidence in the room. Interestingly, many of the high school students are able to tell us the health effects associated with lead exposure, often from their own family-based experiences with lead poisoning. Otherwise, the answers are very general: lead harms the brain; diesel exhaust is bad for the lungs.

Five conclusions result from these observations:

* First, the popular media (radio, TV, magazines, and newspapers) is doing a really good job at raising our awareness about many environmental health risks

* Second, we as nurses often know just as much about environmental health risks as everyone else (and little more)

* Third, although we know that there are risks, we don't know or are not confident regarding our knowledge about the human health effects associated with specific exposures - which organ systems are affected; the associated signs and symptoms; or the appropriate clinical or public health management (including medical tests, and/or environmental exposure testing, and risk reduction/management interventions)

* Fourth, this lack of knowledge often translates into inaction on the environmental health front - in both our practice and advocacy

* Five, we therefore need more nursing pioneers in environmental health.

If you start investigating an environmental health risk, you may find an absence of practical recommendations. Except for the most common exposures like lead or CO, nothing is likely to show up in the nursing literature. A comprehensive investigation can be a tall task - we must learn about the health and environmental sciences related to the risk. And we must learn more, because health and science knowledge is not sufficient when we are addressing environmental health risks. There are political and economic influences, and public health consequences that must be considered. Environmental health is both complicated and essential for nurses to understand.

However, before you feel overwhelmed by the idea of jumping into environmental health, consider this: