Environmental Nursing Diagnoses: A Proposal for Further Development of Taxonomy II
Authors: Green Pauline M. , Polk Laura V. , Slade Diann S. 
Published: August 2004

BACKGROUND

The authors proposed a need for Taxonomy II to include more environmental nursing diagnoses at the 14th Biennial Conference on Nursing Diagnosis. Currently, Nursing Diagnoses: Definitions and Classification, 2001–2001 (NANDA, 2001) lists three diagnoses that focus on the environment: impaired environmental interpretation syndrome, risk for poisoning, and latex allergy response. As communities, nations, and geographic regions experience environmental health problems on individual, local, national, and global levels, nurses need to take an active role in assessing, diagnosing, and treating clients who experience environmental health effects of pollution, contamination, and poisoning. It is logical, therefore, to now examine the concept of environment and its linkages with health in order to provide a blueprint for further development of environmental nursing diagnoses and expansion of Taxonomy II.

MAIN CONTENT POINTS

Nursing theory has given formal recognition to the importance of the relationship between humans and the environment. The concept of environment has become a well‐known component of the nursing metaparadigm (Human, Health, Nursing, and Environment), and all the major theorists include an environmental component in their conceptual models. However, while nursing literature has formally acknowledged that human‐environment interaction has an effect on health, theorists have failed to delineate the human responses that derive from this interaction. Other disciplines such as biology and toxicology consider environment as a set of compartments—air, soil, water, biological systems – and examine the effects that pollutants exert on these compartments. Similarly, public health views environment as discrete compartments but, in addition, examines the effects pollutants have on individuals, groups, and society. Sociology has expanded its use of the term environment and now recognizes the complex interaction of the natural and social worlds. Anthropology also views environment as an emerging area of study that explores how human behavior changes in response to interaction within the ecosystem.

The authors again propose that NANDA expand the number of environmental nursing diagnoses contained in Taxonomy II and offer the following for consideration and comment. Four major headings will help classify the nursing diagnoses: (a) Individual (specify child or adult), (b) Family, (c) Community/Groups/Aggregates, and (d) Global. Under Individual diagnoses, we propose Actual/Risk for Poisoning (specify type); Actual/Risk for Pesticide Contamination (specify type: pesticide, household, industrial); Actual/Risk for Adverse Reproductive Capacity (specify male or female; causative agent [ethylene oxide, antineoplastic drugs, ionizing radiation]; Actual/Risk for Pollution (specify type: air, water, soil, or biological systems). Under Family diagnoses, we propose Actual/Risk for Solid Waste Contamination (specify type: trash, raw sewage); Actual/Risk for Indoor Pollution (specify type: tobacco, radon, pesticides, noise, lead, water); Actual/Risk for Outdoor Pollution (specify type: aerosol or applied pesticides, noise, exhaust fumes). Diagnoses listed under individual are also applicable to the family system. Under Community/Groups and Aggregates, we propose Actual/Risk for Community‐Wide Infection (specify type: community‐wide, specific group or aggregate; specify type of infection and infection source: food borne, vector borne, zoonosis borne); Actual/Risk for Workplace Environmental Exposure/Contamination (specify type of chemical or biological agent). Under Global, we propose Actual/Risk for Transboundary Environmental Exposure/Contamination (specify type: solid waste, trash, sewage, acid rain, nuclear waste; specify originating and receiving countries); Actual/Risk for Global Spread of Infection (specify type of infection: TB, hepatitis, Ebola virus).

CONCLUSIONS

As nursing develops a greater appreciation for the health burden of environmental exposures, the profession can look to NANDA to offer leadership in the area of environmental health nursing diagnosis research. The development of a schema containing specific environmental nursing diagnoses will provide a strong foundation for achieving improved health outcomes.