Environmental Florence Nightingales: Nursing's New Front Line
Wakefield, Julie, Environmental Health Perspectives
In the 1850s, Florence Nightingale advocated fresh air and clean water as a primary treatment for soldiers in British military hospitals. Nightingale's writings are often credited with introducing environmental health into the practice of nursing. The advent in the 1900s of public health nursing--a term coined by Lillian Wald to describe her efforts to improve environmental conditions through nursing, communication, and even cultural enrichment among immigrant populations in New York City--also contributed to today's understanding of this field of nursing. In 1893 Wald, a nurse and social worker, founded the Visiting Nurse Service of New York with 10 nurses. By 1916 the group had 250 nurses visiting 1,300 patients a day, funded through private donations of $600,000 a year. "[Wald] gave us a wonderful example of utilizing a wide network of colleagues and acquaintances and persuasive communication of data to affect change in public policy and the lives of an entire community," says Lillian Mood, community liaison for the South Carolina Department of Health and Environmental Control in Columbia.
As a result of the efforts of Nightingale, Wald, and others like them, environmental health became integral to nursing during the first half of the twentieth century. During this period, nurses were instrumental in the success of public health campaigns that curbed enteric diseases through sanitation reforms, eradicated childhood polio through immunization, reduced infant mortality through water quality advances, and improved occupational health through child labor and workplace safety legislation.
However, changes in the practice of nursing after the end of World War II and a confluence of other factors gradually led nursing away from an emphasis on environmental health. Medicine in general became more specialized, focusing on treatment of diseases rather than prevention. Moreover. the inception of task-based medical reimbursement health systems help further compartmentalize nursing. And technology has also changed how nursing is practiced. "Nursing has evolved in some ways into a high-tech enterprise, and the foundational environmental aspects are underemphasized," says Hollie Shaner, president of the Nightingale Institute for Health and the Environment in Burlington, Vermont, which works to educate health care professionals about the environmental effects of human activity in the world and particularly the environmental effects of health care delivery. "Sure, there is the need for direct care for patients," Shaner admits. However, she says, if nurses are to be truly effective in their interventions, a thorough understanding of environmental factors and conditions, many of which may need modification, is essential.
"We started out doing it, and then we lost it," says Barbara Sattler, director of the Environmental Health Education Center at Baltimore's University of Maryland School of Nursing, referring to the use of environmental health practices in nursing. However, there has been a resurgence of interest in environment-related medical practices such as toxic exposure assessment, community education on environmental hazards, and preventive care, and many nurses today are trying to regain the emphasis on environmental health through a variety of community nursing projects, nursing education training programs, and a wide network of nurses sharing their expertise and vision.
In September 2000, a bizarre series of maladies beset the Boehle-Satterfield family of Baltimore. Tami Boehle-Satterfield, an artist, and her 8-year-old daughter Carson developed headaches, nasal congestion, and coughs. Timothy Satterfield, a 40-year-old business executive, began to tire faster than usual and experienced sinus pain. Dizzy spells plagued the 11-year-old son, Dylan. The diagnoses from myriad doctors and specialists ranged from allergies to migraines to anxiety. But the family's health problems, though sporadic, persisted for months and seemed to intensify. …