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
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
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
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
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.
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
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
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
Student Answering the Phone at a
Poison Control Center
Students Attending Water Supply
and Quality Conference
Student Taking BP at an EPA
Brownfields-Funded Health Clinic:
Environmental Justice
Pinellas County Air Quality
Monitoring Station
Students Observing a Polluted
Creek Up Close and Personal
(double click movie to make it run)
Kennedy Space Center
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
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
FLORIDA POISON
INFORMATION CENTER
TAMPA
Jill Harrison
March 26, 2001
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
Public Health Problem Focus
• Poisonings that occur in the 21 county
service area
• Answers to help prevent poisonings
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
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
Findings of Field Visit
• Educate RNs to the capabilities of the
Poison Information Center
• Education of Poison Topics
• Education of Poisoning Prevention
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
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
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
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
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.
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
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
Are You Next?
For more information:
Candace Burns:
cburns@hsc.usf.edu
Nancy Menzel:
nmenzel@hsc.usf.edu
Environmental Health Basics
NUR 4636 L
Community Health Clinical
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
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)
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
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)
Risk Management
• Pollution Prevention Hierarchy (most to
least effective)
–
–
–
–
–
–
Reduction of pollution at the source
Waste minimization
Reuse
Recycle
Emissions controls
Cleanup
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
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
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
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.
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.
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.
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?
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_enviro
nment.htm
• It is also included under “Links.”
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.