Nursing, Lack of

Historical Perspective

Florence Nightingale, the founder of nursing, believed in a holistic approach to health promotion and disease prevention, and that adequate light, clean air and water, and sanitary living conditions were essential to health. Lillian Wald, who founded the Visiting Nurse Service in the late 1800s, recognized the importance of proper hygiene and sanitation and taught new immigrants—who lived in cramped, squalid conditions in New York tenement buildings—the relationship between cleanliness and health. However, nursing's emphasis on living conditions and the immediate environment gradually changed throughout the 1900s.

Environmental health was particularly relevant to nursing at the turn of the century, when nurses worked primarily in the community and living conditions were not to today's standards. However, as public health improved, most notably after World War II, nursing became more hospital based and patient focused. In the 1960s, authors such as Paul Ehrlich, who wrote The Population Bomb, and Rachel Carson, who wrote Silent Spring, precipitated a shift in attitudes by bringing public attention to issues of overpopulation and environmental degradation. Slowly, the general public became aware of the importance of taking personal responsibility for the impact of its behavior on human health and the environment, and the environmental movement was born. As the environmental movement became more mainstream, the healthcare industry became aware of its role in contributing to environmental pollution.

As the largest group of healthcare providers globally, nurses are in a unique position to promote and protect health and to reduce environmental hazards in homes, hospital settings, and communities. The nursing profession actively works to address green health through new initiatives in education, research, and practice.

Within the last 25 years, nursing has renewed its interest in the environment and acknowledged the significant role the profession has to play in improving health in this area. Since the 1980s, when the terms green health and sustainable development first came into common usage, the profession of nursing has gradually evolved to define its role more broadly in addressing environmental health through nursing practice, research, education, and advocacy at the individual and population levels.

Nursing's Renewed Focus on Environmental Health

In 1986, the International Council of Nurses issued a position statement, “The Nurse's Role in Safeguarding the Human Environment.” The statement defined the nurse's role as [Page 323]helping to detect the ill effects of the environment on human health and vice versa. However, it was not until the Institute of Medicine (IOM) released Nursing, Health, & the Environment: Strengthening the Relationship to Improve the Public's Health, in 1995 that guidelines were established that began to define the role of nursing in addressing chemical, physical, biological, and psychosocial environmental health hazards. The report called for the inclusion of environmental content in nursing education at all levels, and that general competencies should be achieved by all nurses related to (1) basic knowledge and concepts of environmental health, (2) assessment and referral for conditions with suspected environmental causes, (3) knowledge of the role of advocacy, ethics, and risk communication in patient care and community intervention, and (4) an understanding of policy and legislation and regulation related to environmental health.

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