Integrating environmental health into nurse practitioner training-childhood pesticide exposure risk assessment, prevention, and management

Environmental health knowledge and competences in Basque health workers. A comparison of different professional profiles

Environmental exposures are responsible for a quarter of morbidity and mortality rates globally. Primary care professionals work in a privileged position to detect and intervene on environmental health matters. Nevertheless, due to lack of specific training, international literature shows that primary care health professionals have limited skills to deal with those. The objectives of this study were to assess the levels of environmental health (EH) knowledge and competence of a sample of 446 health professionals and students in the Basque Country and explore the presence that EH has on their daily practice. Only a very small proportion of participants had received training and took environmental clinical history regularly. Participants were confident to deal, and actually dealt, with tobacco, pollen and sun exposures but less able to address topics like biomarkers, pesticides and endocrine disruptors. Finally, and in accordance to previous works, we found moderate levels of EH knowledge and skills in our sample, and observed that nurses and nursing students reported higher EH skills than other professional profiles but scored lower in knowledge. Despite the manifold impacts of environmental exposures on health, interventions to strengthen health professionals' EH competence are required.

Eliminating Take-Home Exposures: Recognizing the Role of Occupational Health and Safety in Broader Community Health

Toxic contaminants inadvertently brought from the workplace to the home, known as take-home or paraoccupational exposures, have often been framed as a problem that arises due to unsanitary worker behavior. This review article conceptualizes take-home exposures as a public health hazard by (i) investigating the history of take-home contaminants and how they have been studied, (ii) arguing that an ecosocial view of the problem is essential for effective prevention, (iii) summarizing key structural vulnerabilities that lead populations to be at risk, and (iv) discussing future research and prevention effort needs. This article reframes take-home exposures as one of many chronic pathways that contributes to persistent health disparities among workers, their families, and communities. Including the role of work in community health will increase the comprehensiveness of prevention efforts for contaminants such as lead and pesticides that contribute to environmental disparities.

Evaluating a South African mobile application for healthcare professionals to improve diagnosis and notification of pesticide poisonings

BACKGROUND

Mobile health is a fast-developing field. The use of mobile health applications by healthcare professionals (HCPs) globally has increased considerably. While several studies in high income countries have investigated the use of mobile applications by HCPs in clinical practice, few have been conducted in low- and middle-income countries. The University of Cape Town developed a pesticide notification guideline which has been adapted and embedded into a South African Essential Medical Guidance mobile application. This study evaluated the usefulness of the guideline within a mobile application for improving the ability of HCPs to diagnose and notify on acute pesticide poisonings (APPs).

METHODS

A descriptive online questionnaire, with 15 open- and 20 closed-ended questions, was completed by 50 South African emergency medicine physicians and registrars (i.e. medical doctors training as specialists) between December 2015 to February 2016. Descriptive statistics were used to calculate response frequencies and percentages using SPSS version 23. Texts from the open-ended questions were thematically analysed. Fisher's exact test was applied to determine associations.

RESULTS

A significant association was found between participants' knowledge that APP is a notifiable condition, and ever reporting the poisoning to the National Department of Health (p = 0.005). Thirty four percent of the participants were aware of the guideline within the Essential Medical Guidance application despite only seven participants having used it. Those who used the guideline found it provided useful information for the identification of unlabelled pesticides products and promoted reporting these cases to the National Department of Health for surveillance purposes. In addition, it appeared to facilitate the prompt diagnosis and treatment of APP cases, and most intended to continue using it for training and educational purposes.

CONCLUSIONS

Mobile health applications appear to support overburdened medical education programmes and promote better patient care. However, since most participants were not aware of the existence of the pesticide guideline within the studied essential medicine application, there is potential for the use of healthcare applications to play a more central role in healthcare systems and medical training. Furthermore, the field of medical informatics could support HCPs through mobile applications in improving reporting of APP.

The concept of exposure in environmental health for nursing

AIM

To report an analysis of the concept of exposure in environmental health for nursing.

BACKGROUND

The importance of the environment has long been recognized in nursing, although the nature and scope of the concept and how it influences health have varied over time. Exposure is the sufficient and necessary link between environment and health. In nursing practice, the word 'exposure' has been used frequently with no clear standard definition.

DESIGN

Concept analysis using Kim's first-level analytics.

DATA SOURCES

Chronological review (1980-2015) of the nursing science literature was conducted through ProQuest Dissertations and Theses and CINAHL, followed by a multi-disciplinary search through PubMed (1980-2015), texts and the Internet to compare definitions and measurements of exposure and related concepts.

METHODS

Explicit and implicit conceptual definitions and measurements of exposure were identified, categorized and analysed.

RESULTS

The newly defined concept of 'exposure' is a process involves three phases: 1, contact is made between a target and one or more agents in the same environment; 2, the agent accesses the target by one or more routes of entry; and 3, the agent enters the target by crossing a barrier or boundary. Existing measurements related to each phase are identified and discussed. Definitions of 'target' and 'agent' were refined for congruency.

CONCLUSION

Consistent use of terms as defined is critical to development of nursing knowledge. These concepts should be incorporated into nursing-related research to evaluate their usefulness to nursing. Alignment of this concept with relevant theories should be critically examined.

Integrating environmental health into nurse practitioner training-childhood pesticide exposure risk assessment, prevention, and management

The use of pesticides in agriculture, public places, and private homes and gardens is ubiquitous throughout the United States. Children are particularly vulnerable to pesticide exposure because of immature biological and developmental processes. Thus, it is important that primary health care providers identify clients at risk for pesticide exposure and poisoning and know how to respond effectively if clients experience exposure. However, many primary health care providers are not adequately trained or prepared to manage the health-related effects of pesticide exposure. Recent efforts, supported by the U.S. Environmental Protection Agency, have addressed this shortcoming in nursing and medical education. A primary initiative is to find ways to integrate basic environmental health content, specifically regarding pesticide exposure, into nursing and medical curricula. As one strategy to achieve this, a pilot case study was developed by revising and enhancing an existing pediatric case study used in a required course for nurse practitioner students. The aim was to raise students' awareness of risk assessment, prevention, and appropriate care strategies for pesticide exposure. Evaluation of students' experience with the pilot case study suggested it was a meaningful and valued addition to their training, as well as an efficient way to introduce environmental health content into primary health care provider curricula.