Nurses: Are You Environmental Health Stewards? What healthcare practice produces dioxin?

			Your Colleagues Responded:
	Exposing cytotoxic drugs to air		13%
	Incineration of polyvinyl chloride products	Correct Answer	51%
	Mixing bleach and ammonia for cleaning		25%
	Improper disposal of alkaline batteries		11%

What toxic gas is believed to leach into water supplies as a result of fracking?

			Your Colleagues Responded:
	Methane	Correct Answer	71%
	Nitrogen		8%
	Helium		2%
	Argon		19%

What vegetable contains the highest concentration of pesticides?

			Your Colleagues Responded:
	Onions		19%
	Asparagus		13%
	Cauliflower		24%
	Kale/collard greens	Correct Answer	43%

The farming of which food produces the most greenhouse gases?

			Your Colleagues Responded:
	Beef	Correct Answer	71%
	Chicken		8%
	Wheat		8%
	Soybeans		13%

What naturally occurring carcinogen can be found in rice and tap water?

			Your Colleagues Responded:
	Phytoestrogens		11%
	Aflatoxins		10%
	Arsenic	Correct Answer	66%
	Nitrosamines		12%

Chemicals that mimic or block hormones are called:

			Your Colleagues Responded:
	Prohormones		15%
	Steroids		9%
	Neurotransmitter antagonists		12%
	Endocrine disruptors	Correct Answer	64%

When an activity threatens harm to the environment or human health, measures should be taken even if cause-and-effect relationships are not fully established. This is the:

			Your Colleagues Responded:
	Public trust doctrine		32%
	Precautionary principle	Correct Answer	53%
	Hippocratic oath		6%
	Nightingale pledge		2%
	Code of environmentally preferable purchasing		8%

Which of the following exposes patients to ionizing radiation?

			Your Colleagues Responded:
	Laser surgery		10%
	Doppler ultrasonography		1%
	MRI spectroscopy		24%
	CT	Correct Answer	55%
	Lithotripsy		10%

What carcinogen is added as a preservative to many personal care products?

			Your Colleagues Responded:
	Formaldehyde	Correct Answer	41%
	Chloracetamide		6%
	Parabens		41%
	Triclosan		12%

Which of the following words on a label means that a personal care product contains no hazardous substances?

			Your Colleagues Responded:
	Dermatologist tested		3%
	Hypoallergenic		5%
	All natural ingredients		7%
	Fragrance-free		0%
	None of the above	Correct Answer	77%
	All of the above		8%

One out of every 14 newborns is exposed to unsafe levels of which neurotoxin?

			Your Colleagues Responded:
	Iodine		9%
	Lead		58%
	Methylmercury	Correct Answer	24%
	Glutamate		9%

What drinking water is recommended by the Environmental Working Group?

			Your Colleagues Responded:
	Bottled water		5%
	Bottled spring water		9%
	Tap water		17%
	Filtered tap water	Correct Answer	69%

Environmental Health and Nurses

Environmental health has been steadily gaining momentum as we learn about not only the effects of the environment on human health, but also evidence-based strategies to mitigate those effects. The scope of environmental health is massive, because the environment is "everything around us -- the air we breathe, the water we drink and use, and the food we consume. It's also the chemicals, radiation, microbes, and physical forces with which we come into contact."

The ways in which human health can be influenced by the environment are so numerous that nurses can easily become overwhelmed and confused about their role in environmental health. These feelings can multiply the more nurses learn about the health implications of the environment. "Thinking they have to do everything sometimes keeps nurses from doing anything," explains Barbara Sattler, RN, DrPh, Professor, University of San Francisco, School of Nursing and Health Professions.

She's right. It's very easy to think, "I can't influence everything my patients eat and drink, what they do for a living, or the type of car they drive. I can't force them to stop smoking, to use sunscreen, or move to a cleaner city." This kind of thinking can easily become incapacitating.

Sattler suggests that nurses take a breath, step back, and learn about some very simple steps to begin incorporating environmental exposure assessments into their everyday nursing practice. Such assessments prompt pediatric nurses to ask their patients and parents about potential risks from household and outdoor use of pesticides, obstetric nurses and midwives to ask about lead-based paint dust in their patients' homes, and all nurses to consider other likely exposures to their patient populations.

Environmental Health Is Not a Subspecialty

Although there are many environmental health experts in nursing, Sattler warns that environmental health is not the purview of a defined cadre of nurses, in the manner of forensics, informatics, or wound care nursing. Environmental health must be integrated into the practice of all nurses, regardless of setting of care or population served. The environmental health experts, like Sattler, are the leaders, researchers, and educators who can help nursing as a whole to embrace and encourage environmental health for their patients.

To accomplish this, nurses with interest and expertise in environmental health created the Alliance of Nurses for Healthy Environments (ANHE). The ANHE is a network of nurses from every corner of nursing, both clinical and academic, who share the belief that the environment and health are inextricably connected, and that nurses can influence whether this connection is negative or positive. Nurses from around the world participate in this virtual organization to learn more about environmental health or to join a workgroup dedicated to education, practice, research, or advocacy in environmental health. Nurses and nurse specialty organizations are encouraged to join the EnviroRN community at ANHE.