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Population Health for Nurses

14.5 Nursing Practice and Responsibilities in Environmental Health

Population Health for Nurses14.5 Nursing Practice and Responsibilities in Environmental Health

Learning Outcomes

By the end of this section, you should be able to:

  • 14.5.1 Describe strategies to integrate environmental health into nursing practice.
  • 14.5.2 Identify strategies for nurses to address climate change.
  • 14.5.3 Explain the role of the nurse as an advocate for environmental health and environmental justice.

Environmental health is an essential component of nursing practice as it has a significant impact on client and population health and outcomes. The integration of environmental health into nursing practice requires a series of strategic steps, including the use of a hierarchy of controls to prevent exposure to environmental contaminants. Let’s look at the strategies for integrating environmental health into nursing practice, the importance of environmental justice, and the role of nurses as environmental advocates.

Nurses have a unique opportunity to be environmental advocates and leaders (Butterfield, 2021). Occupying an accepted role as educators and global citizens, nurses can leverage their public image and platform to promote environmental health through partnerships with colleagues in public health, medicine, behavioral health, schools, public offices, and the community (Butterfield, 2021).

Integrating Environmental Health into Nursing Practice

Nurses have a responsibility to address the impact of environmental burdens, discuss the effects of climate change, protect the rights of future generations, and advocate for vulnerable populations and communities (Lilienfeld et al., 2018). All nurses should strive to incorporate environmental science and translation into their research and practice (McCauley & Hayes, 2021). Nurses working with individuals should conduct environmental assessments along with collecting other client-specific information, considering the potential long-term impact of environmental exposures, including effects on physical health, mental health, and development.

Core Functions

Public health nurses perform the core functions of assessment, policy development, and assurance to serve as a framework for addressing environmental health issues and promoting healthier communities.

Assessment: Conduct comprehensive assessments to identify environmental health hazards and concerns in the community. Perform data collection and analysis to identify sources of pollution, assess exposure risks, and evaluate the impact of the environment on health. Examples include performing environmental health assessments for individuals and communities.

Policy Development: Develop and advocate for policies and plans that promote a healthy environment. Collaborate with community partners and local governments to drive policies that positively impact the environment. Examples include advocating for clean water and policies that consider climate change.

Assurance: Monitor and evaluate the implementation and effectiveness of environmental policies and programs. Ensure action when hazards are identified or regulations violated. Examples include educating the community about contaminated water, ensuring that a safe alternative is provided, and advocating for infrastructure updates.


Nurses have a pivotal role in safeguarding environmental health by implementing prevention interventions across the continuum of health care. It is critical to consider the upstream approach mentioned earlier in the chapter when developing interventions. For example, consider the community’s potential hazards at each level of prevention. At the primary prevention level, nurses focus on promoting awareness, education, and advocacy to prevent environmental health risks before they occur. Secondary prevention encompasses early detection and intervention to mitigate risk and impact. Tertiary prevention focuses on minimizing the impact of already existing environmental health concerns by enhancing patient outcomes and facilitating recovery.

Primary Interventions:

  • Provide education about the importance of environmental health and strategies for reducing risk and improving outcomes.
  • Engage and empower communities to adopt healthy practices and policies that contribute to a cleaner environment, such as proper waste management and updating infrastructure.
  • Advocate for policies to reduce air pollution and hazardous waste in the community.
  • Advocate for policies to promote environmental protection, such as green building practices.

Secondary Interventions:

  • Conduct regular environmental health assessments to identify individuals, groups, and communities at risk.
  • Establish surveillance systems based on the community’s potential hazards to monitor environmental health indicators, detect signs of issues, and intervene promptly.
  • Screen for home hazards such as lead and mold.

Tertiary Interventions:

  • Provide care and interventions to individuals affected by severe health consequences of environmental hazards.
  • Develop emergency response plans specific to the community’s hazards and needs to manage environmental disasters and extreme weather events.
  • Engage in research to better understand the health impacts of various environmental hazards among clients.

Climate Change, Justice, and Advocacy

Nurses have distinctive strengths for addressing climate change. As the most trusted professionals in the United States, nurses are positioned to be powerful messengers for climate-related information. Nurses are trained communicators and often serve as the first point of contact for health and health care, providing an opportunity to incorporate environmental health assessments, climate change education, and interventions. Nurses working in the community are closely connected to vulnerable populations and can address issues of climate equity and justice (Figure 14.9) (Butterfield et al., 2021). Becoming involved in a professional nursing organization promoting climate justice provides nurses with resources and a platform from which to make transformative changes (Alliance of Nurses for Healthy Environments, 2023).

Young people rally in front of a government building holding a sign that says Kids Want Climate Justice.
Figure 14.9 Young people mobilize for climate justice. (credit: “Kids Want Climate Justice, Minnesota March For Science, St Paul” by Lorie Shaull/Flickr, CC BY 2.0)

Primary Interventions:

  • Educate the community about the health risks of climate change (Lokmic-Tomkins et al., 2023).
  • Encourage community engagement with climate change mitigation efforts, such as community gardens, recycling programs, and energy-efficient practices (Salvador Costa et al., 2023).
  • Provide information on adaptive behaviors to increase resilience, such as staying hydrated during heat waves.
  • Collaborate with local authorities to advocate for climate-resilient infrastructure such as renewable energy initiatives and developing clean, efficient, and adequate public transportation (Salvador Costa et al., 2023).
  • Ensure that communities are prepared for extreme weather events by promoting the development of cooling centers, evacuation routes, and emergency shelters.
  • Facilitate connections between community members and community partners to increase social cohesion and resilience.
  • Integrate climate-focused education and patient-centered conversations into nursing practice (Lokmic‐Tomkins et al., 2023).

Secondary Interventions:

  • Conduct screenings to identify vulnerable populations within the community and develop strategies to protect their health during climate-related events.
  • Ensure that community members receive timely information and advice on staying safe, such as staying indoors during extreme heat or using masks during poor air quality periods.
  • Establish or ensure surveillance systems to monitor health outcomes associated with climate change (Lokmic-Tomkins et al., 2023).

Tertiary Interventions:

  • Establish plans for providing health care services in the aftermath of climate-related events.
  • Ensure that health care facilities are equipped to manage crises triggered by extreme weather events and climate-related disasters (Salvador Costa et al., 2023).
  • Train health care professionals to recognize and address health issues related to or exacerbated by climate change.
  • Evaluate the effectiveness of interventions and policies aimed at mitigating and adapting to climate change health risks and recommend improvements based on findings.
  • Work with communities to adapt to identified climate change risks and needs (Dion et al., 2022).
  • Provide mental health support and referrals for those affected by the psychological stressors of climate-related events.

Case Reflection

The Nurse’s Role in Advocating for a Healthy Envirionment

Let’s continue following Nurse Regis, who has been caring for Mr. Harper. Read the scenario, and then respond to the questions that follow.

Having established a link between Mr. Harper’s deteriorating health and his environmental conditions, Nurse Regis decides to advocate for the wider community, arranging for the county to conduct a risk assessment, pollutant measurement, and environmental monitoring. Nurse Regis also initiates an educational intervention to inform community members about the potential health hazards in their environment and strategies to mitigate them. During the session, several neighbors express concern about the increasing amount of rain and runoff in the area, especially since the damp conditions have led to mold in several homes.

  1. What is the nurse’s role in advocating for a community facing environmental health issues? What specific steps and actions should be taken?
  2. How might the precautionary principle impact decisions for this community?
  3. What interprofessional collaborations can the nurse initiate to address the environmental health concerns in this community?
  4. How might climate change continue to impact the health of Mr. Harper and his neighbors? What actions might be taken to mitigate the risks they face due to climate change?

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