National Organization for Public Health Nursing Essay

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Hi Maria

I liked your post and how you mentioned the history of public health. Public health nursing is a very interesting and diverse specialty of nursing.

According to the American Public Health Association (APHA) (2020) in 1920 the Public Health Nurse (PHN) was established. In 1922 they held their first meeting with 175 PHN. The focus was training and education PHN to have a skilled workforce. In 1988 the PHN chair person started an assembly with the advisers of four organizations, the American Nurses Association, the Association of Community health and Nurse Educators, the Association of Public Health Nurses and the PHN Section/ APHA. In 1989 this together created the Quad Council Coalition of Public Health, which today includes the National Association of School Nurses.

PHN have a goal of responding to the needs of the vulnerable population and current social issues, that is why I admire public health and the great work they do.National Organization for Public Health Nursing Essay

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Public health nursing is the act of promoting and protecting the health of the community rather than an individual person by emphasizing prevention. Public health nursing roles originated in the late 1800s focusing on environmental conditions such as sanitation, control of communicable diseases, education for health, prevention of disease and disability, and care of aged and sick persons in their homes (Lancaster, 2016). The emphasis on prevention versus cure is a concept that is still very relevant in practice today. Nurses can learn from mistakes made in the past and use this information to guide public health nursing today (Lancaster, 2016).

Some significant milestones occurred in the history of public health nursing which made it what it is today. In 1860, Florence Nightingale established training schools or nurses. In 1872, the American Public Health Association was established. In 1881, Clara Barton and her acquaintances founded the American Red Cross. In 1885, the Visiting Nurses Association was established. In 1903, the First Nurse Practice Act was passed. In 1912, the National Organization for Public Health Nursing was formed. In 1946, nurses were classified as professionals. In 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (Lancaster, 2016).National Organization for Public Health Nursing Essay

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:National Organization for Public Health Nursing Essay

Restorative practices modify the impact of illness and disease.

Supportive practices are oriented toward modification of relationships or the environment to support health.

Promotive practices mobilize healthy patterns of living, foster personal and familial development, and support self-defined goals of individuals, families, and communities.

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Suggested Citation:”3 Nursing Practice.” Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.×
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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.National Organization for Public Health Nursing Essay

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.National Organization for Public Health Nursing Essay

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.National Organization for Public Health Nursing Essay

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Suggested Citation:”3 Nursing Practice.” Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.×
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Diagnosis occurs with the culmination of objective and subjective data collection. In this phase of the nursing process health problems are identified and described. Depending upon their practice setting, nurses may use the diagnostic terms established by the North American Nursing Diagnosis Association (NANDA) or medical diagnostic terminology, as is often the case with APNs who are nurse practitioners. Routine consideration of environmental factors that affect health is essential in the diagnostic phase of the nursing process; without knowledge of such factors, problems may be misdiagnosed and subsequent interventions will address environmental issues haphazardly, if at all.

Planning/outcomes is the phase of the nursing process in which optimal outcomes are identified. A range of interventions are identified to address the health problem, and plans for implementing those interventions are developed. The ability to establish interventions that address environmentally related illnesses depends on a nurse’s ability to formulate diagnoses that include consideration of environmental factors. Without attention to environmental factors, intervention plans are likely to focus on secondary- and tertiary-level activities (care and cure) rather than primary prevention strategies.National Organization for Public Health Nursing Essay

Intervention is the component of the nursing process in which the nurse implements activities to promote health, and prevent or alleviate illness and injury. The nurse may act as educator in this part of the nursing process, informing patients, families, workers, and communities about hazards in the environment and how to protect themselves. Effective interventions require a knowledge of resources, including texts, databases, and professional experts, and an ability to access these resources.

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Intervention also includes the role of advocate. Although nurses are familiar with the concept of advocacy on behalf of individual patients, often they have not been trained in techniques of advocacy for populations or in settings other than health care facilities. Nurses need to extend the concept of advocacy to include activities on behalf of communities and other groups and in settings such as the workplace or community meetings. This extension of nursing advocacy is often essential for addressing environmentally related health issues because they are frequently intertwined with social and political factors. Interventions focusing exclusively on the individual patient are rarely effective as primary prevention methods in matters of environmental health.National Organization for Public Health Nursing Essay

Evaluation, the final step in the nursing process, can be conducted on numerous levels and frequently results in additional interventions. The health outcomes of an individual are one method of determining the effectiveness of nursing interventions. Another measure of effective intervention in environmentally related illness is an evaluation of hazard abatement methods. Has the hazard been contained or removed from the environment of the individual? Are others living in the area protected

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Suggested Citation:”3 Nursing Practice.” Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.×
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from exposure? Evaluation should also include an assessment of the effectiveness of interventions directed toward other populations at similar risk, for example, other family members, co-workers, and community members. Were the existence of the hazard and protective measures communicated clearly and consistently to those at risk? Was effective treatment provided to others at risk who experienced symptoms? Are measures being taken to prevent similar incidents of exposure in the future? Are the patient, work population, and community satisfied with the interventions used to identify and abate hazardous conditions related to the environment? Are those affected by the hazard satisfied with the health care that was provided, including educational interventions and medical treatment? These questions and the answers to them provide nurses and other health care providers with important information for determining the effectiveness of interventions undertaken in a particular incident and in identifying more effective measures for dealing with similar problems in the future.National Organization for Public Health Nursing Essay

Application of the nursing process to environmental health concerns requires an expansion of the tools and processes used to assess patients, reason diagnostically, and develop treatments and interventions that consider environmental factors. Responsibilities for implementing clinical services relevant to environmental health will vary according to practice settings; however, the nursing process is a useful framework for applying environmental health concepts in all settings and roles.

Scope of Responsibilities
A nurse’s role in addressing environmental health issues can be conceptualized in a variety of ways. The nursing process can be augmented or integrated with other models of practice, such as the CPHF model, which consists of three roles for the health professional: investigator, educator, and advocate (CPHF, 1992). The role of investigator supports the assessment and evaluation phases of the nursing process, while the roles of educator and advocate would be carried out as interventions. This framework incorporates a range of activities, including working with communities and on matters of public policy, that may be unfamiliar to nurses who structure their practice within the more traditional framework of the nursing process applied to individual patient care.National Organization for Public Health Nursing Essay

Role as Investigator
Nurses may act as investigators by

taking careful environmental health histories and looking for trends in exposure, illness, and injury;

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Suggested Citation:”3 Nursing Practice.” Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.×
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being alert to environmental factors that influence health;

working with interdisciplinary teams and with agencies to determine if an environmental exposure is affecting the health of a community;National Organization for Public Health Nursing Essay

initiating or engaging in research to identify and control environmental exposures that adversely affect human health; and

working with public and private institutions to perform risk and hazard assessments.

In actual practice, this role may include home visits to look for peeling or chipping lead paint in the residences of young children or to identify the use of poorly vented wood stoves in the home of an asthmatic child. It may also involve entering a work site to assess conditions that affect worker health and safety, including ergonomic hazards, chemical exposures, or mechanical hazards such as poorly guarded conveyor belts. Moreover, the practice of nursing itself is uniquely hazardous. A discussion of the hazards to nurses (and other health care workers) is presented in Appendix B.National Organization for Public Health Nursing Essay

One example of a nurse as investigator is a situation that occurred in 1992 in Brownsville, Texas, a town on the Mexican border. A nurse working in the labor and delivery department of a local community hospital noticed what seemed to be an unusual number of neonates born with a relatively rare but devasting birth defect, anencephaly. The nurse subsequently reviewed all birth records for the previous year and found that the incidence of children born with this defect in her facility was significantly greater than the national rate: 30 cases per 10,000 births versus 10 cases per 10,000 births, respectively. Further investigations suggested contamination of groundwater and surface water sources with chemicals known to cause adverse health outcomes of this nature (Suro, 1992) (see Box 3.1).National Organization for Public Health Nursing Essay

Eliciting an environmental health history, another investigative activity, is one of the most important actions for enhancing the environmental health content in nursing practice, because information derived from the history is essential to all other nursing activities related to environmental health. Through the environmental history, a nurse may uncover exposures to hazardous substances that neither the patient nor the clinician had suspected as etiologic agents of existing symptoms or disease. Methods and tools for taking a complete environmental health history have been well described (Goldman and Peters, 1981; Tarcher, 1992). Sample forms for taking a comprehensive environmental health history are included in Appendix G. Three key questions to be included in all histories of adult patients are the following:National Organization for Public Health Nursing Essay

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Suggested Citation:”3 Nursing Practice.” Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.×
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Box 3.1
Sentinel Health Events and Disease Clustering

Environmental health concerns often surface in a community when residents or others notice an unusual pattern of illness, for which an environmental cause is suspected. Perhaps residents notice ”too many” cases of childhood leukemia in a particular neighborhood near a waste dump. Perhaps local health professionals discover a common disease such as asthma or breast cancer occurring in a community at much higher rates than would normally be expected. Perhaps several cases of a relatively rare disease are detected among individuals who work at the same plant or live on the same street. Suspicion might be triggered by even a single case of illness that breaks the usual profile for that disease, such as a cardiac arrest in a 20 year-old when such an event would normally occur at an older age. This might occur following exposure to carbon monoxide, fluorocarbons, or hydrocarbons, for example.National Organization for Public Health Nursing Essay

Such atypical patterns, whether in community populations or in individuals, are called sentinel health events (see Rutstein et al., 1983). When investigated, they may turn out to be coincidental, with no particular relationship to environmental factors, or there may have been misperceptions of the pattern in the first place (Schulte, 1988). However, they can also signal larger health problems related to environmental hazards, such as pesticide poisoning, heatstroke, lead and other heavy metal poisonings, or respiratory diseases triggered by poor air quality (DHHS, 1990).National Organization for Public Health Nursing Essay

Detection of a sentinel health event should lead to investigation of the subpopulation of individuals who may be at risk for similar adverse health effects. This population-based approach to the tracking of environmental health concerns has been formally recommended by the U.S. Department of Health and Human Services (DHHS). In 1990, that agency recommended the establishment of 35 state plans to define and track sentinel environmental diseases (DHHS, 1990). Such tracking systems lead to early detection of disease and primary prevention through the control of hazards before they cause illness in others. However, the plan requires the assistance of a workforce adequately educated in environmental health. To contribute to this effort, nurses must adopt an orientation that is somewhat different from that currently provided in their education, roles, and practice activities.National Organization for Public Health Nursing Essay

What are your current and past longest-held jobs? (For children and teenagers, the question can be modified to: Where do you spend your day, and what do you do there?)

Have you had any recent exposure to chemicals (including dusts, mists, and fumes) or radiation?

Have you noticed any (temporal) relationship between your current symptoms and activities at work, home, or other environments?

The investigative role of nurses may extend to their being part of a community or interdisciplinary public health assessment team. The Assessment National Organization for Public Health Nursing Essay

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Suggested Citation:”3 Nursing Practice.” Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.×
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Protocol for Excellence in Public Health (NACHO, 1991) and ATSDR’s Public Health Assessment process (Lybarger et at., 1993) involve identifying risk factors and exposures that affect the health of the community. Both processes also emphasize soliciting and incorporating community health concerns as part of the assessment. Nurses skilled in interviewing, active-listening, and group processes, as well as epidemiological methods, can be invaluable team members.

Role as Educator
Nurses have long served as patient educators; they teach patients how to get out of bed following surgery, how to change a dressing, the possible side effects of medication, and the importance of diet and exercise in maintaining health. This role can be expanded to include educating patients, families, workers, and communities about the possible adverse effects of exposure to environmental hazards and how to reduce or eliminate such exposures. This type of education is commonly referred to by public agencies and environmental health specialists as hazard or risk communication.(1) Nurses can further develop this role by providing information to create environmentally safe homes, schools, day-care settings, workplaces, and communities. As role models, nurses can conduct their practice and lives in an environmentally safe manner, that is, by limiting unnecessary exposure to chemicals or by carrying out routine duties in a manner that minimizes injury due to ergonomic hazards. Nurses can act as educators by speaking at community gatherings and becoming involved in community-level activities related to the environment and human health. They may also participate in risk or hazard communication for public health agencies.National Organization for Public Health Nursing Essay

The original focus of risk communication was on developing and delivering a message from an expert or agency to the public, in order to help the public better understand a situation and its implications for their health and well-being. This definition is widening to incorporate a two-way dialogue between regulators or managers and the public (Cutter, 1993). The interactive process of exchanging information on technical hazards and the human response, both physiological and emotional, calls for professionals who can listen, interpret, clarify, and reframe questions and information in emotionally charged and sometimes hostile situations. The basic patient education role of nurses with individuals and families

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In this report, when referring to the interaction between health professionals and individuals who are potentially affected by exposure to environmental hazards, the term risk communication will be used.National Organization for Public Health Nursing Essay

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Suggested Citation:”3 Nursing Practice.” Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.×
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will need expansion to include communication with entire communities and the general public if they are to fill an essential niche in environmental health. The ability to assess the target audience, develop a message that is meaningful and understandable, choose a method or media for conveying the message, and conduct community-level conflict resolution are skills beyond the current preparation of most nurses.

The basic skills of linking individual needs with information and other resources will need to be broadened to include community linkages with environmental experts who may be outside the usual network of nursing referrals. The need to expand nursing’s role in environmental health is not obvious to many nurses, for several reasons. First, no role models (faculty, supervisors) have alerted them to the potential hazards of environmental exposures. As a result, nurses are not aware that certain substances are highly hazardous to human health or that certain environmental conditions are contributing significantly, although insidiously, to the morbidity and mortality of the populations they serve. Second, nurses suspect, or are questioned by their patients about, the safety of certain conditions, but they do not know where to find accurate information about environmental hazards and measures to control them. Nurses who have attended NIOSH sponsored educational programs in occupational health can assist other nurses in learning about environmental issues by acting as guest lecturers in schools of nursing and as preceptors in the field of occupational health. Further support of this nature will enhance the ability of nurse generalists to educate their patient populations about environmental health issues.National Organization for Public Health Nursing Essay

Role as Advocate
In theory, the human health aspects of environmental problems can be isolated and dealt within traditional medical systems. In practice, these issues usually unfold in a highly charged social and political context. Nurses and other health care providers often need to help individual patients locate and secure access to specialized services for health problems related to environmental hazards. They may also be called upon to contact individuals, agencies, and organizations outside the health care system, working on behalf of patients or communities to change hazardous conditions and prevent future health problems.

It is generally agreed that the interests of patients, workers, or community members are best served by empowering them to act as their own advocates. However, nurses’ scientific knowledge and experience in speaking with scientists, physicians, and other authorities equip them to be effective advocates in some situations where individual citizens are likely to feel intimidated. This role is particularly important when advocacy National Organization for Public Health Nursing Essay

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Suggested Citation:”3 Nursing Practice.” Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.×
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involves communication with public health agencies and private industry, wherein inquiries by individual citizens sometimes meet with responses that fail to address their concerns.

Establishing the legitimacy of advocacy activities as elements of nursing practice will require concerted effort among educators and leaders in the nursing profession. Environmental health issues are highly intertwined with social and political policies; thus, in the area of environmental health, advocacy is needed at the policy level as well as on behalf of individual clients. Advocacy as one component of the nurse’s role is essential if a stronger, more prevention-oriented model of nursing practice is to be established. A more in-depth discussion of the practice of advocacy by nurses is provided in Box 3.2 and Appendix F.National Organization for Public Health Nursing Essay

Interdisciplinary Aspects of Environmental Health
Environmental hazards and their health effects rarely lend themselves to simple solutions applied from a single discipline. Effective interventions for environmentally related illness require collaborative efforts from many disciplines due to the complex nature of environmental health issues, the rapidly advancing science base in environmental health, and the need for primary prevention strategies that often must involve professionals from fields other than nursing. Such collaboration includes ongoing dialogue and fluidity of roles and responsibilities.National Organization for Public Health Nursing Essay

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Nurses are accustomed to working with members of other disciplines toward a shared goal, although it is often in a multidisciplinary manner, with members of each discipline performing their activities independently and with clear role delineation. Various nursing associations and other health professions advocate a more collaborative approach to health problems that is highly interactive and more likely to be termed interdisciplinary. This issue is important to consider in order to most effectively address environmental health issues.

The ANA’s draft Nursing Social Policy Statement notes that nursing has an “external boundary” that interacts with other professions in response to changing societal needs and the advance of scientific knowledge. The boundaries are fluid rather than firmly defined, with members of various professions cooperating in the exchange of knowledge, techniques, and ideas on how to deliver quality health care. Collaborative practice, with some overlap of function, enables members of various disciplines to interact with a shared overall mission (ANA, 1994).National Organization for Public Health Nursing Essay

The National League for Nursing (NLN) has described several aspects of the complex nature of health care: technological advances that increase access to information, the need to educate professionals to recognize patterns and engage in innovative problem solving rather than simply

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Suggested Citation:”3 Nursing Practice.” Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.×
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BOX 3.2
Advocacy Practice

Interventions in environmental health problems often require nurses and other health care professionals to assume the roles of advocate, activist, and policy planner on behalf of a single patient or population of patients. Patient advocacy within the health care setting is familiar to most, if not all, nurses; for example, bringing a patient’s concerns to the attention of the physician. However, advocacy that goes beyond the health care system is a new kind of activity for many nurses, who may feel ill equipped to translate research and practice issues into health policy terms.National Organization for Public Health Nursing Essay

Most nursing professionals are comfortable with the idea of case advocacy on behalf of an individual patient, even when it involves aggressive action in the interests of the patient. Where ambivalence occurs is over policy-level (class) advocacy aimed at changing environmental conditions that are detrimental to populations of patients. For some members of the profession, the latter kinds of activity will seem unprofessional, overly political, and inappropriate for nurses. Others will regard it as an expression of nursing’s true mission, going back to the profession’s origins as crusaders for social justice, as embodied in the practice Florence Nightingale and Lillian Wald. Nurses interested in advocacy practice will find many pressures and incentives encouraging them to define this activity around the needs of individual patients. Policy-level advocacy for structural change is not emphasized in nursing education, not fully legitimized by the field’s professional associations (although it is popular among student members), and not welcomed by the majority of employers and hospital administrators. In the area of environmental health, however, nurses are likely to be drawn into a fuller range of advocacy activities whether they are prepared for these roles or not. Therefore, the issue is not whether to undertake policy advocacy, but rather how to do it in a way that is sophisticated, realistic, and constructive. Anxiety about advocacy roles can be lessened considerably by building familiarity with a wider range of advocacy techniques, not all of which are necessarily adversarial.National Organization for Public Health Nursing Essay

There are many ways to conceptualize and practice advocacy in health and human services, and there are many heated debates about what true advocacy means. Different starting premises are possible. For example, who determines what is needed: the professional or those directly affected? Should professionals acting as advocates aim simply to solve the current problem, or should they, in addition, try to empower patients and communities to solve similar problems for themselves in the future? Is public conflict something always to be avoided in advocacy efforts, or is it sometimes useful? In thinking about such questions, nurses can draw on literature from other professional fields with advocacy dimensions such as social work, city planning, education, public health, law, and mediation. Based on a review of advocacy literature, Appendix F presents some useful conceptual frameworks for understanding different forms of advocacy and different advocacy strategies.National Organization for Public Health Nursing Essay

Advocacy that goes beyond helping an individual patient and enters the realm of health policy is not yet acceptable and expected practice for all nurses. To prepare the profession for a broader range of advocacy activities, nursing curriculum and continuing education programs may come to include content on lobbying, use of media, mediation, expert testimony, community organizing, and the like. In the meantime, whether with institutional support or on their own, nurses who are stretching the definitional boundaries of advocacy practice will need to build skills that were likely not part of their basic nursing education. Appendix F lists some of the self-training and support resources available for health and human services professionals interested in advocacy practice at the policy level.National Organization for Public Health Nursing Essay

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Suggested Citation:”3 Nursing Practice.” Institute of Medicine. 1995. Nursing, Health, and the Environment. Washington, DC: The National Academies Press. doi: 10.17226/4986.×
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mastering didactic content, and an increasingly broad and integrated knowledge base that is not discipline specific (NLN, 1992). These issues are particularly relevant to environmental health, a field that requires (1) an ability to access information that is current and comprehensive, (2) the ability to recognize patterns of disease, and (3) engagement in interdisciplinary actions to gain expertise from disciplines such as physics, sociology, political science, history, and ecology as well as various health disciplines.

A great deal of emphasis has recently been placed on the idea of collaboration as a component of the interdisciplinary approach:National Organization for Public Health Nursing Essay

The ability to co-labor (collaborate) is clearly vital when the plethora of health professionals and their increasing specialization and role differentiation combine with the complexity of patient care demands to make interdependency among professionals essential (AACN, 1995).

Others have written in the same vein, stressing the urgent need for interdisciplinary training in the health professions (IOM, 1988) and collaborative practice between nurses and physicians (Fagin and Lynaugh, 1992). Unfortunately, despite the clear mandate for interdisciplinary practice, many barriers to such arrangements exist; these include restrictive licensure and practice laws and inadequate interdisciplinary education (AACN, 1995; Safriet, 1994).National Organization for Public Health Nursing Essay

Individuals practicing in public health and occupational health and their professional associations support interdisciplinary models of practice. Professions involved in addressing environmental health concerns include, but are not limited to, specialists in industrial hygiene, toxicology, safety, ergonomics, engineering, hydrogeology, medicine, and occupational health. Nurses must know the types of knowledge, functions, and practice that constitute these disciplines, and of equal importance, other health professionals must be aware of the knowledge base, functions, and practice of nurses.National Organization for Public Health Nursing Essay

Nursing offers a unique and invaluable perspective on environmentally related health issues. However, to incorporate environmental health concerns into their practice, nurses will need to function as members of interdisciplinary teams. To accomplish this, (1) training of health professionals must put greater emphasis on developing skills for interprofessional collaboration, negotiation, critical thinking, and mutual problem solving; (2) there must be opportunities for interdisciplinary interaction throughout professional education and clinical practice; and (3) existing barriers to interdisciplinary collaboration and practice must be removed.National Organization for Public Health Nursing Essay

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