The Nursing Process
The core and essence for all nursing actions is the assessment, diagnosis, planning, intervention, and evaluation process. It is a systematic and deliberate process of problem solving that allows nursing to be practiced in a rational, rational and logical manner. The nursing process requires continuous input from patients and their families throughout the entire process, from assessment to evaluation. Based on new information from the patient, or from any other source, interventions and diagnoses can be modified at any stage. The patient should be allowed to participate in the nursing process as much as possible, except for any physical or emotional limitations. Nursing professionals may have to adapt different parts of the nursing process to address environmental health concerns. The intervention could be to change the source of drinking waters that has a major impact on a whole community. The process is compatible to the California Public Health Foundation (1992),'s framework of investigator educator advocate. This framework was established to address specific nursing roles and responsibilities in relation to environmental health issues. The CPHF framework complements, not duplicates, the nursing process. Data are collected during the assessment phase to determine a patient s current health and to identify factors which may affect their well-being. This activity includes gathering information about a patient's health history, including past injuries, illnesses, family health patterns, and psychosocial factors that could affect their health. In routine assessments of patients, environmental health components can be incorporated by asking questions about previous exposure to chemical physical and biological hazards. Also, it should be possible to ask about the time periods between onset of symptoms or activities performed before or while they occur. A nurse should be aware that co-morbidity patterns among patients, family members, and communities can indicate environmental etiologies. Assessments can also be done by nurses in the patient's home or workplace. They gather objective and subjective information to determine the cause of any health problems. Health problems are identified and discussed during this phase. Depending on their practice setting, nurses might use the North American Nursing Diagnosis Association’s (NANDA) diagnostic terms or medical diagnostic terminology. APNs who work as nurse practitioners often use these terms. Routine consideration of environmental factors that affect health is essential in the diagnostic phase of the nursing process without knowledge of such factors problems may be misdiagnosed and subsequent interventions will address environmental issues haphazardly if at all.Planning/outcomes is the phase of the nursing process in which optimal outcomes are identified. The health problem is identified and plans are made to implement them. It is important that nurses are able to make diagnoses that take into account environmental factors in order to be able to implement interventions to address environmentally-related illnesses. Without attention to environmental factors intervention plans are likely to focus on secondary- and tertiary-level activities (care and cure) rather than primary prevention strategies.Intervention is the component of the nursing process in which the nurse implements activities to promote health and prevent or alleviate illness and injury. This part of the nursing process may include the role of an educator, informing patients, families, and communities about potential hazards in the environment and how they can protect themselves. Effective interventions require a knowledge of resources including texts databases and professional experts and an ability to access these resources.Intervention also includes the role of advocate. Although nurses are familiar enough with advocacy for patients, many have never been trained in advocacy techniques for populations or settings other than hospitals. The concept of advocacy must be expanded to include advocacy for communities and other groups as well as in settings such the workplace or community meetings. Because they are often intertwined in relation to social and political factors, this extension of nursing advocacy is essential for addressing environmental-related health issues. In matters of environmental health, primary prevention methods that focus on the individual patient are seldom as effective as interventions that focus only on them.
Evaluation is the final step of the nursing process. It can be done on many levels and often results in additional interventions. One way to determine the effectiveness of nursing interventions is by evaluating their health outcomes. An evaluation of hazard mitigation methods is another way to measure effectiveness in environmental-related illness intervention. Is the hazard contained or eliminated from the environment? Is the area safe for others? The effectiveness of interventions directed at other populations at similar risk should also be evaluated. This could include family members, co-workers, and community members. Did the hazard and protective measures known to all? Did others who were at risk receive effective treatment? Are there measures being taken to prevent future exposures? Are the community and patients satisfied with the measures taken to eliminate hazardous conditions in the environment? Are the people affected by the hazard happy with the care provided, including educational interventions and medical treatment? These questions and their answers provide nurses and other health care professionals with valuable information to help determine the effectiveness of interventions in a particular incident. They also help to identify more effective ways to deal with similar problems in the future. Although the responsibilities for implementing clinical services related to environmental health may vary depending on the practice setting, the nursing process can be used to apply environmental health concepts in any setting and role.
