Field Learning Experiences in Environmental Health at USF College of Nursing

1. Field Learning Experiences in Environmental Health at USF College of Nursing P.I. - Candace Burns, PhD, ARNP Nancy Menzel, PhD (c), RN Grace Erickson, PhD, RN

3. ASPH/HRSA Cooperative Agreement • August 2000 – August 2001 • Award: $24,392; included student travel $$ • Proposal identified the lack of environmental health in the nursing curriculum • Proposal linked objectives to HP2010 regarding population health status

4. USF College of Nursing • Undergraduate, master’s, and doctoral programs • Undergraduate includes unlicensed curriculum (~70 students a year, increasing to ~140 a year in 2002) • BSN completion program for RNs (~150 students per year) • One main and four regional campuses

5. College of Public Health • The only college of public health in Florida • Dr. Burns holds a joint appointment in both the College of Nursing and the College of Public Health • COPH has a strong Environmental and Occupational Health Department • Is a NIOSH Education and Research Center

6. Objectives • Plan and implement 6 hour clinical experience for undergraduate BSN nursing students • Establish environmental field experience as permanent part of curriculum • To revise Community Health course curriculum to include environmental objectives • To integrate environmental health into the whole curriculum • To evaluate the short and long-term effects of the environmental field experience program.

7. USF Motivation for Project • Enliven Community Health field experiences • See new possibilities for population-based health assessments/interventions • Acquaint students with other subspecialties in nursing: Occupational health, environmental health • Establish new links with community agencies • Recruit students for the dual degree master’s program in occupational health nursing

8. By the numbers… • In the grant period of one year (3 semesters), 228 undergraduate (licensed and unlicensed) students were placed in over 40 different environmental/occupational health field settings for a one day (6 hour) experience

9. Where Did They Go? • Departments of Health, Environmental Divisions • Division of Professional Regulation, Restaurant Inspection Branch • Department of Emergency Management, Disaster Planning Drills • Occupational health departments in area employers: furniture warehouse, fertilizer manufacturer, phosphate miners • Environmental conferences

10. Student Answering the Phone at a Poison Control Center

11. Students Attending Water Supply and Quality Conference

12. Student Taking BP at an EPA Brownfields-Funded Health Clinic: Environmental Justice

13. Pinellas County Air Quality Monitoring Station

14. Students Observing a Polluted Creek Up Close and Personal(double click movie to make it run)

15. Kennedy Space Center

16. Features • Community Health Nursing has a course web site • Students completed an on-line module and quiz in environmental health basics before going to their assignments • Students took an ATSDR environmental exposure history on a client in their regular clinical settings and turned it in for evaluation/credit • Spring semester 2001: Commander Cherryll Ranger, Nurse Health Educator for ATSDR, was a guest speaker in Community Health

17. Features • Students completed an Environmental Field Experience Project and an associated PowerPoint show to present in person to classmates at their clinical sites • Students also posted the PowerPoint show on the course web site for all students in the class to view • The next few slides are an example of one student’s work

18. FLORIDA POISON INFORMATION CENTER TAMPA Jill Harrison March 26, 2001

19. Laws Governing Agency • Florida Statute 395.1027 • Establishes 3 regional poison control centers for the state • Must be at a Level 1 Trauma Center and be affiliated with an accredited medical school or college of pharmacy • Establishes goals for case management of poison cases, prevention education, consultation, and data collection and reporting

20. Public Health Problem Focus • Poisonings that occur in the 21 county service area • Answers to help prevent poisonings

21. Field Experience Description • Oriented to Unit • Attended Presentation as part of Tampa General’s Trauma Day • Listened to phone calls • Questions answered by staff related to the unit

22. Agency’s Purpose for Field Activity • Competent, dedicated staff • Micronedex database • 1.125 Million in funding through Children’s Medical Services • Handles approximately 200 calls a day • Most poisonings are children under six • Meets national standards

23. Findings of Field Visit • Educate RNs to the capabilities of the Poison Information Center • Education of Poison Topics • Education of Poisoning Prevention

24. Effectiveness of Agency • Meets national standards of 70% poisonings managed at home • Matches national standards of fatalities • Handles all requests for information about poisoning prevention • Would like to increase awareness of the Center and its free access • Would like to expand prevention education

25. Recommendations for Next Time • Their educator would be an excellent guest lecturer for Community Health • Encourage more students to view the workings of this facility

26. Faculty Development • There are between five and seven Community Health clinical instructors each semester • Most are specialists in other disciplines • Program manager provided them with on going development and support in environmental/occupational health

27. Clinical Site Development • Almost all sites were new to the CON • Received leads from the College of Public Health • Program Manager emphasized the benefits to both sides from allowing students to participate in a field experience • Program Manager sent letters of appreciation

28. Student Reactions • Overwhelmingly positive • Many of those who were reluctant to complete the assignment at first wrote enthusiastic e-mails and reports after their experiences • Several were pleased to have an experience creating PowerPoint shows.

29. Clinical Site Reactions • Almost all were glad they participated • Challenges: • Some students didn’t show up as scheduled; communication with sites needs improvement • One site burned out by having too many groups of students in one semester; consider burden on agency when making assignments • Some agencies interested in making such experiences a regular part of each semester

30. What Now? • Looking for ways to manage large numbers of students and still provide a quality experience • This semester, the students are conducting an environmental/occupational audit at their regular clinical assignment site: schools, clinics, health agencies • Faculty development and support continues

31. Are You Next?

32. For more information:Candace Burns: cburns@hsc.usf.eduNancy Menzel: nmenzel@hsc.usf.edu

33. Environmental Health Basics NUR 4636 L Community Health Clinical

35. Environmental Health • Many agents cause acute or chronic health effects in the population • Nurses are at the forefront for recognizing environmental agents and their effect on human health

36. Environmental Agents • Lead-based paint in houses • Ambient air pollution (e.g., ozone, particulate matter, and toxic chemicals) • Indoor air pollutants (e.g., molds, formaldehyde, carbon monoxide, and tobacco smoke) • Pathogens in food and drinking water (e.g., cryptosporidia and E. coli O157:H7)

37. Environmental Agents (Cont.) • Pesticide residues in food (e.g., organophosphates and pesticides that are suspected carcinogens) • Disinfection byproducts in drinking water • Stressors that cause injury (e.g., automobiles and firearms in the home) • Hazards in the work environment • Natural disasters

38. Federal Regulatory Agencies • Occupational Safety and Health Administration (OSHA) (workplace safety) • Environmental Protection Agency (EPA) (environmental pollution control) • Food and Drug Administration (FDA) (regulates purity of food and drugs) • US Department of Agriculture (USDA) (regulates food supply)

39. Risk Management • Pollution Prevention Hierarchy (most to least effective) • Reduction of pollution at the source • Waste minimization • Reuse • Recycle • Emissions controls • Cleanup

40. Environmental Justice • Pollution risks are not distributed evenly • Polluting industries, sources of air pollution, and waste disposal operations are concentrated in certain low income and minority communities

41. Adverse Community Effects • Some popular books and films have highlighted environmental/occupational problems: • Erin Brockovich: chromium in drinking water in California associated with a cluster of cancers • A Civil Action: solvents in drinking water in Woburn, MA associated with a cluster of childhood leukemias • Norma Rae: Poor working conditions for cotton mill employees

42. Community Awareness • Often, a community will tolerate polluting industries or companies with substandard safety standards as a trade off for economic benefits • Nurses are in a position to recognize environmental threats and provide community activism and guidance

43. Case Study (1/12/2001) A new report out this morning has some Bay area residents alarmed. The Environmental Protection Agency report says if you lived near or went to school near the Tarpon Springs Stauffer chemical plant you may develop health problems in the future. Ronnie Wilson, an ombudsman for the Agency for Toxic Substances and Disease Registry, released his findings to area residents last night. The report appears to validate longtime health concerns of people living near the now closed plant.

44. But he says the findings are incomplete. "I'm concerned about the health of the students at Gulfside Elementary that went to school during that period of four years while the plant was operating and the school had opened its doors." Wilson is also concerned about possible contamination in the drinking water as well as other things that he says can't be accounted for. "I also have a concern about asbestos. They used a lot of asbestos and we can't find it, so the question is, where is it?" Wilson's findings and recommendations are outlined in a 200 page report.

45. Mary Mosley has lived in Tarpon Springs for 46-years. She says the worst thing that's happened to the community is Stauffer. "This awful place...was like gases and dust and fire you could see for miles away. It was like an inferno at night." Mosley says her neighbors are scared about their health based on what they've already seen. “We’ve heard of very rare diseases,very young children dying at an early age, a lot of lung diseases ...it may be a coincidence but we need to have a study to find out." That study is now continuing with no finality in sight.

46. The Role of the Nurse in the Community • If you were a nurse living in Tarpon Springs during the time this facility operated, what are some possible actions you could have taken?

47. The Stauffer Chemical facility has been named a federal Superfund site. To find out what this means, go to this URL: http://www.epa.gov/students/terms_of_environment.htm • It is also included under “Links.”

48. On-Line Quiz • After you have read these slides and the case study, go to the Environmental Quiz and complete it. It is only 5 questions. You must press “Submit” when you have finished the quiz. You cannot go in to the quiz more than once.