Assignment: Environmental Health

Assignment: Environmental Health

Assignment: Environmental Health

Week 2 discussion Discussion Part One Mary, a registered nurse, decided that she wants to become a CNP. She applied and was accepted to the Family Nurse Practitioner program at Chamberlain College of Nursing. She received a course curriculum which outlined the courses necessary to complete her degree. One of the early courses in the program curriculum is NR-501 Theoretical Basis for Advanced Nursing Practice. You are a student colleague of Mary’s enrolled in the same class. On the class Q & A discussion board, Mary posted, “I took nursing theory classes fifteen years ago in my bachelor’s program. I don’t understand why I need to take theory classes again.” Discussion Question: How would you respond? Develop a logical response to Mary’s post. Provide evidence to support your arguments. Discussion Part Two Mary wrote, “All nursing theories are the same and certainly there is no connection to APN practice.” Discussion Question: How would you respond? Develop a logical response to Mary’s post. Provide evidence to support your arguments. Discussion Part Three The following response on the discussion board was posted by the course instructor: “The advanced practice roles of CNM, CNP, CNS, and CRNA require an intensive set of clinical skills, understandings, and integrative abilities that synthesize advanced practice nursing knowledge.” Discussion Question: What does the course instructor mean by “integrative abilities”? Provide evidence to support your response.

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n watching diseases, both in private homes and in public hospitals, the thing which strikes the experienced observer most forcibly is this, that the symptoms or the sufferings generally considered to be inevitable and incident to the disease are very often not symptoms of the disease at all, but of something quite different—of the want of fresh air, or of light, or of warmth, or of quiet, or of cleanliness, or of punctuality and care in the administration of diet, of each or of all of these.

—Florence Nightingale, 1860, p. 8

Environmental determinants of health and disease are pervasive and integral to the assessment, diagnosis, intervention, planning, and evaluation components of nursing practice. However, environmental factors that affect health are commonly overlooked in routine patient assessments. When environmental health concerns are missed, an opportunity for prevention is lost, and public health is less well served.

Although not every illness has an environmental etiology, nearly everyone will have a health problem related to an environmental hazard for which evaluation or advice is appropriate in terms of good nursing practice. It is important in nursing practice to identify not only the hazards that contribute to a current diagnosis (e.g., exposure to lead-contaminated dust resulting in elevated blood lead levels, and outdoor ozone or indoor allergens exacerbating childhood asthma), but also those that have not yet caused illness but are amenable to intervention (e.g., friable asbestos, radon, formaldehyde gases from building materials, and carbon monoxide and nitrogen oxides from poorly ventilated furnaces). By taking a proactive approach, nurses can initiate preventive actions to abate hazards before they manifest as disease. Thus, consideration of environmental health concepts as a core nursing function will vastly strengthen nursing’s contribution to disease prevention.

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Nursing Practice and Responsibilities in Environmental Health
The practice of nursing is guided by standards and definitions established by leaders of nursing in professional associations and to some extent by governmental agencies such as the Public Health Service’s Bureau of Health Professions. Systematic frameworks for the practice of nursing also guide nurses in actual nursing performance. The most widely accepted framework for nursing practice currently in use is the nursing process of assessment, diagnosis, planning, intervention, and evaluation. A model to guide medical and nursing practice specific to environmental health concerns established by the California Public Health Foundation (CPHF, 1992) consists of three roles: investigator, educator, and advocate.

Awareness of the formal descriptions, definitions, and systems of nursing practice is useful for determining how environmental health concepts and related activities fit into nursing as it is currently practiced. A brief overview of the definitions and systems that guide nursing practice and their application to environmental health concerns is presented in the following section to demonstrate the “fit” between nursing practice and environmental health issues. The integration of environmental health concerns into nursing’s scope of practice and the profession’s philosophy of health and health care also illustrate nursing’s historic and continued concern about environmental influences on human health.

Definition of Nursing Practice
The American Nurses Association (ANA) provides leadership in determining the goals, objectives, and professional practice of nursing. ANA defines nursing as ” … a caring-based practice in which processes of diagnosis and treatment are applied to human experiences of health and illness” (ANA, 1994).

ANA describes three basic nursing activities that explicitly include issues related to the environment and health, a preventive approach to health, and concern for populations as well as individuals:

1.
Restorative practices modify the impact of illness and disease.
2.
Supportive practices are oriented toward modification of relationships or the environment to support health.
3.
Promotive practices mobilize healthy patterns of living, foster personal and familial development, and support self-defined goals of individuals, families, and communities.
Thus, major concepts and activities necessary to address environmental factors that can affect the health of individuals and populations are within the scope of practice and definition of nursing set forth by the ANA.
The Nursing Process
The nursing process, consisting of assessment, diagnosis, planning/outcomes, intervention, and evaluation, has been described as the core and essence of nursing, central to all nursing actions. It is a deliberate, logical, and rational problem solving process whereby the practice of nursing is performed systematically. The nursing process includes continuous input from patients, their families, or communities through all phases from assessment to evaluation. Diagnoses, planning, and interventions may be altered at any stage based upon new information from the patient or any other source. As far as possible, the patient should have an active and equal role in the nursing process, constricted only by physical or emotional limitations on their ability to participate.

It is worth noting that the nursing process was developed for the care of individuals, and has since expanded to include a role in the care of families and communities. Application of the nursing process to environmental health issues may require nurses to employ various phases of the process in new ways. For example, the intervention may be recommending a change in the source of drinking water that affects a whole neighborhood or community. The process is compatible with the framework of investigator, educator, and advocate, established by the California Public Health Foundation (1992) to address nursing roles and responsibilities particular to environmental health issues. The CPHF framework augments rather than duplicates the nursing process.

During the assessment phase of the nursing process, data are gathered to determine a patient’s state of health and to identify factors that may affect well-being. This activity includes eliciting a health history to identify previous illnesses and injuries, allergies, family health patterns, and psychosocial factors affecting health. Environmental health components of history taking can be integrated into the routine assessment of patients by including questions about prior exposure to chemical, physical, or biological hazards and about temporal relationships between the onset of symptoms and activities performed before or during the occurrence of symptoms. During an assessment, the nurse should be alert to patterns of co-morbidity among patients, family members, and communities that are indicative of environmental etiologies. Nurses also conduct assessments during visits to patients in their homes and places of work, gaining first hand information about environmental factors that may adversely affect health.