Environmental health and holistic nursing are interconnected fields that have a profound influence on patient care and public well-being. As healthcare faces growing challenges from environmental factors, the need to define holistic approaches in nursing has become increasingly important. Holistic nursing practice integrates environmental awareness with comprehensive patient care, recognizing the complex relationships between human health and ecological systems.

This article explores the intersection of environmental health and holistic nursing, examining their roles in modern healthcare. It delves into the foundations of holistic nursing and its connection to environmental determinants of health. The discussion covers global environmental challenges, the nurse’s role in protecting environmental health, and efforts to green the healthcare sector. Additionally, the article addresses the integration of environmental health into nursing education and emerging trends in holistic health nursing, providing insights into the evolving landscape of holistic care in nursing.  Please also review AIHCP’s Holistic and Integrative Health Care Certification Program

Understanding Environmental Health in the Context of Holistic Nursing

Definitions and Scope

Environmental health is a critical aspect of nursing practice that has a profound impact on individual and community well-being. The American Nurses Association (ANA) has established an Environmental Health standard, which states that “The registered nurse practices in a manner that advances environmental safety and health.” This standard underscores the importance of environmental considerations in nursing care.

The environment encompasses the air we breathe, the water we drink, the food we eat, and the places where we live, work, and play. Environmental health hazards are substances or pathogens that have the potential to cause adverse health effects in individuals or communities. These hazards can be categorized into five main areas: housing, occupational, atmospheric, foodborne diseases, and waterborne diseases.

Examples of environmental hazards include air contaminants, toxic waste, radiation, disease-causing microorganisms and plants, pesticides, heavy metals, chemicals in consumer products, and extreme temperatures and weather events. Recognizing these hazards enables community health nurses to provide valuable information to community members and implement prevention strategies that promote positive outcomes.

Interdisciplinary Nature

Environmental health issues rarely have simple solutions that can be addressed by a single discipline. The complex nature of these issues, the rapidly advancing science base, and the need for primary prevention strategies often require collaborative efforts from various fields. Effective interventions for environmentally related illnesses necessitate interdisciplinary teamwork.

Holistic Nurses offer a unique and invaluable perspective on environmentally related health issues. However, to incorporate environmental health concerns into their practice, nurses need to function as members of interdisciplinary teams. This collaborative approach, with some overlap of function, allows members of various disciplines to interact with a shared overall mission.

Relevance to Nursing Practice

Environmental determinants of health and disease are integral to all components of nursing practice, including assessment, diagnosis, intervention, planning, and evaluation. However, environmental factors affecting health are often overlooked in routine patient assessments. By taking a proactive approach, nurses can initiate preventive actions to address hazards before they manifest as diseases.

The nursing process, consisting of assessment, diagnosis, planning/outcomes, intervention, and evaluation, is central to all nursing actions. Applying this process to environmental health issues may require nurses to employ various phases in new ways. For instance, interventions might involve recommending changes that affect entire neighborhoods or communities.

Holistic Nurses have a crucial role in assessing and addressing environmental health issues. This aligns with the nursing profession’s values regarding disease prevention and social justice. The International Council of Nurses (ICN) has emphasized that nurses need to be concerned with the promotion, maintenance, and restoration of the natural environment’s health.

As the largest group of workers in the healthcare industry, nurses have an ethical obligation to address health disparities and equity issues associated with environmental exposures. They can determine the probability of risk, conduct risk assessments, and design risk management plans that address policy development, engineering strategies, education on risk, and legal remedies for securing a “place at the table” for nurses as decision-makers.

The Foundations of Holistic Nursing

Holistic nursing is a comprehensive approach to healthcare that considers the interconnectedness of the mind, body, spirit, emotions, and environment in patient care. This practice is grounded in a body of knowledge, evidence-based research, and sophisticated skill sets, all of which are underpinned by a philosophy of living and being that emphasizes caring, relationship, and interconnectedness.

Theoretical Frameworks

The foundation of holistic nursing is supported by several theoretical frameworks that guide practice. These theories provide a structure for understanding the complex interplay between various aspects of human health and well-being. Some of the key theories that inform holistic nursing include:

1. King’s Theory of Goal Attainment
2. Neuman’s Systems Model
3. Rogers’ Theory of Unitary Human Beings
4. Nightingale’s Environment Theory
5. Watson’s Philosophy and Science of Caring

These theoretical frameworks help holistic nurses to conceptualize care that addresses the whole person, recognizing that individuals are more than just their illnesses or symptoms.

Core Values

The practice of holistic nursing is built upon a set of core values that reflect an integrated approach to caring for the whole person. These values, as outlined by the Academy of Integrative Health and Medicine (AIHM), include:

1. Prevention as the best intervention
2. Integration of healing systems
3. Relationship-centered care
4. Individualized care
5. Teaching by example
6. Recognition of innate healing powers
7. Embracing all experiences as learning opportunities
8. Acknowledging the healing power of love
9. Optimal health as the primary goal

These core values guide holistic nurses in their practice, ensuring that they address not only the physical needs of patients but also their psychological, social, and spiritual needs. This comprehensive approach recognizes that all these aspects combine to create the person, and therefore, to heal the person, all aspects must be considered.

Holistic Assessment and Interventions

Holistic nursing assessment is a crucial component of this practice, involving a systematic and continual collection, validation, and analysis of data about a patient within their bio-psychosocial context. This assessment goes beyond traditional questions about symptoms to inquire about relationships, coping mechanisms, emotional responses, routines, and lifestyle factors that can impact overall well-being.

The components of a holistic nursing assessment include:

1. Physical assessment
2. Psychological assessment
3. Social assessment
4. Spiritual assessment

Based on these comprehensive assessments, holistic nurses employ a variety of interventions that address the multifaceted nature of human health. These may include:

1. Relaxation and breathing techniques
2. Mindfulness and meditation practices
3. Aromatherapy
4. Reiki and therapeutic touch
5. Herbal remedies

The implementation of these techniques involves tailoring the approach to each patient’s unique needs and preferences, always considering the individual’s beliefs and values concerning holistic care.

By integrating these foundations, core values, and holistic assessment and intervention techniques, holistic nursing strives to provide care that is not only comprehensive but also deeply respectful of the individual’s unique experiences and needs. This approach has shown to result in higher rates of patient satisfaction and improved health outcomes compared to conventional care, highlighting the significance of holistic nursing in modern healthcare practice.

Environmental Determinants of Health

Environmental determinants of health encompass a wide range of physical, social, and built factors that significantly influence human health and well-being. These determinants play a crucial role in shaping health outcomes and contribute to health disparities across different populations.

Physical Environment

The physical environment where individuals live, learn, work, and play has a profound impact on their health. It includes the air people breathe, the water they drink, and the spaces they inhabit. Environmental pollutants in the physical environment can lead to various health problems, including respiratory diseases, heart disease, and certain types of cancer.

Air pollution, in particular, has been associated with increased rates of asthma, lung diseases, and premature deaths from heart and lung conditions. Similarly, contaminated water sources can result in illnesses, infections, and elevated risks of cancer. The World Health Organization estimates that more than 12 million people worldwide die annually due to living or working in unhealthy environments.

It is important to note that exposure to environmental hazards is not equally distributed. People with low incomes are more likely to reside in polluted areas and have unsafe drinking water. Additionally, children and pregnant women face higher risks of health problems related to pollution.

Social Environment

The social environment plays a significant role in determining health outcomes. Social and cultural factors, such as socioeconomic status, education, and access to resources, can influence health throughout an individual’s life course. Disadvantaged neighborhoods often face multiple challenges, including exposure to more air pollution due to proximity to heavy traffic, lack of local amenities like grocery stores and health clinics, and exposure to signs of social disorder.

These social determinants of health can lead to stark differences in health outcomes between and within communities. People with low incomes and people of color are disproportionately affected by these disparities, which are rooted in a long history of discrimination, disinvestment, and exploitation in the United States.

Built Environment

The built environment refers to the human-made surroundings that provide the setting for human activity. It includes aspects such as urban planning, transportation systems, and the availability of health-promoting resources. The design of the built environment can significantly impact health behaviors and social interactions.

For instance, the proximity to healthy or unhealthy food stores has been linked to dietary behaviors and related chronic disease outcomes. Food availability and advertising influence energy intake and the nutritional value of foods consumed. Similarly, access to recreational facilities, land use mix, and urban design features affect walking and physical activity levels.

The built environment can also contribute to health risks. Spread-out suburban designs often facilitate reliance on automobiles, increasing pollution and decreasing time spent walking. This has multiple health effects, including increased respiratory and cardiopulmonary illnesses due to pollution, reduced leisure time for health-promoting activities, and increased risk of traffic accidents.

Addressing these environmental determinants of health requires interventions and policy changes at local, state, and federal levels. Strategies such as providing opportunities for walking and biking in communities, improving access to healthy foods, and reducing exposure to environmental pollutants can help promote health and reduce health disparities.

Global Environmental Health Challenges

Air pollution and respiratory health

Air pollution continues to be a significant concern to public health worldwide, posing challenges for both developed and developing countries. Individuals with chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD) and asthma are particularly vulnerable to the detrimental effects of air pollutants. Studies have linked particle pollution exposure to various respiratory health effects, including cough, phlegm, wheeze, and acute, reversible decrements in pulmonary function.

Particle pollution has been associated with inflammation of the airways and lungs, bronchial hyperreactivity, and an acute phase reaction. These effects can lead to respiratory infections, increased emergency department visits, and hospitalizations. Long-term exposure to fine particles has been linked to decreased lung function growth in children and chronic loss of pulmonary function in adults.

People with heart or lung disease, children, individuals with diabetes, and certain demographic groups are at greater risk of particle pollution-related health effects. The extent of pulmonary inflammation depends on particle dose and composition, with organic carbon particles and transition metals from combustion sources eliciting a strong inflammatory response.

Water scarcity and waterborne diseases

Despite water covering 70% of our planet, freshwater—essential for drinking, bathing, and irrigation—is incredibly scarce. Only 3% of the world’s water is fresh, and two-thirds of that is unavailable for use. As a result, approximately 1.1 billion people worldwide lack access to water, and 2.7 billion experience water scarcity for at least one month of the year.

Inadequate sanitation affects 2.4 billion people, exposing them to waterborne diseases such as cholera, typhoid fever, and other illnesses. Alarmingly, two million people, mostly children, die annually from diarrheal diseases alone. Climate change is exacerbating this situation by altering patterns of weather and water around the world, causing shortages and droughts in some areas and floods in others.

Water pollution from various sources, including pesticides, fertilizers, untreated human wastewater, and industrial waste, further compounds the problem. Even groundwater is not safe from contamination, as pollutants can leach into underground aquifers. The effects of water pollution can be immediate, as with harmful bacteria from human waste, or may take years to manifest, as with toxic substances from industrial processes.

Toxic exposures and chronic diseases

Exposure to toxicants in the environment has been linked to the rapid increase in chronic, noncommunicable diseases worldwide. Escalating rates of neurocognitive, metabolic, autoimmune, and cardiovascular diseases cannot be attributed solely to genetics, lifestyle, and nutrition. Early life and ongoing exposures to bioaccumulated toxicants may also contribute to chronic disease development.

Studies have shown that exposure to chemicals in everyday products used to build and maintain homes, as well as pesticides and combustion products, can lead to a condition known as Toxicant-induced Loss of Tolerance (TILT). TILT represents a new class of environmentally induced diseases that share the same underlying bio-mechanism, involving the activation of mast cells, which are the “first responders” to foreign substances like chemicals and viruses.

The consequences of these exposures are particularly concerning for children, who are more susceptible to the effects of environmental toxicants. The complex web of disease and environmental contributors requires a multifaceted approach to address these global environmental health challenges, with potential for significant benefits in improved health and productivity worldwide.

The Holistic Nurse’s Role in Environmental Health Protection

Nurses play a crucial role in protecting environmental health through various strategies and interventions. Their unique position in healthcare allows them to address environmental health concerns at individual, community, and policy levels.

Risk Assessment

Environmental health risk assessment is a fundamental aspect of nursing practice. Nurses integrate environmental health components into routine patient assessments by including questions about prior exposure to chemical, physical, or biological hazards. They also explore temporal relationships between the onset of symptoms and activities performed before or during the occurrence of symptoms.

The Environmental Protection Agency (EPA) employs a four-step risk assessment process to evaluate potential pollution and hazards:

1. Hazard Identification: Identifying potential negative outcomes from exposure to specific agents.
2. Dose Response: Determining the relationship between exposure amount and health effects.
3. Exposure Assessment: Quantifying the extent, frequency, and length of human contact with environmental agents.
4. Risk Characterization: Synthesizing information to provide an overall understanding of risks and uncertainties.

Nurses can utilize these steps to conduct individual environmental health assessments, which are essential tools for identifying, preventing, and educating individuals about environmental health concerns. These assessments consider a broad range of potential environmental exposures, including indoor agents, outdoor air pollution, water sources, and exposure to pesticides or industrial waste.

Health Promotion

Health promotion is a powerful tool that nurses use to create a positive, lasting impact on patients’ lives. The three basic health promotion strategies are:

1. Health communication: Helping people better understand health needs and equipping them for important individual health decisions.
2. Health education: Teaching people about different health conditions to bolster prevention or early treatment.
3. Policy, systems, and environmental change (PSEs): Implementing changes at various levels to address health challenges.

Nurses can work with these strategies to promote health within the communities they treat. They can act as educators by speaking at community gatherings and becoming involved in community-level activities related to the environment and human health. Additionally, nurses may participate in risk or hazard communication for public health agencies.

Environmental Justice

Nurses have a significant role in promoting environmental justice by addressing disparities in environmental health risks. Home health assessments are critical for promoting health equity by addressing disparities in housing quality. For example, programs to improve home indoor air quality have been proven to reduce the incidence of asthma among BIPOC children and children residing in substandard housing.

Community health assessments provide information about potential and real environmental risks faced by individuals living, working, or recreating in a particular community. Nurses can conduct windshield surveys to visually identify potential environmental risks, such as the location of industries, hazardous waste, dumps, major thoroughfares, pests, the use of pesticides, air quality, and housing conditions.

By engaging in these activities, nurses contribute to the broader goal of environmental health protection, ensuring that all individuals and communities have access to a safe and healthy environment. Their role extends beyond individual patient care to advocacy for policies and practices that promote environmental health and justice on a larger scale.

Greening the Healthcare Sector

The healthcare industry has a significant environmental impact, contributing to carbon emissions, plastic use, and waste generation. However, there is a growing recognition of the need for sustainability in healthcare facilities. This shift towards greening the healthcare sector encompasses various aspects, including sustainable hospital design, eco-friendly medical products, and effective waste management strategies.

Sustainable Hospital Design

Sustainable hospital design has gained momentum in recent years, with the US Green Building Council’s Leadership in Energy and Environmental Design (LEED) standards serving as a benchmark for green building construction. These eco-friendly hospitals aim to reduce energy costs and improve patient outcomes while minimizing their environmental footprint.

Key principles of sustainable hospital design include:

1. Maximizing natural light: Increasing the use of natural light through transparent openings, skylights, and low-power LED lighting can reduce energy consumption and positively impact patient well-being.
2. Improving indoor air quality: Incorporating indoor plants and using materials with low volatile organic compounds (VOCs) can enhance air quality within the facility.
3. Utilizing green building materials: Selecting materials that resist the growth of pathogenic bacteria, fungi, and viruses contributes to a healthier indoor environment.
4. Integrating gardens and landscaping: Green spaces not only enhance esthetics but also provide therapeutic benefits to patients and staff.
5. Optimizing building orientation: Carefully designing facades and envelopes to match climatic preferences and solar orientation can significantly reduce energy consumption and cooling demands.

Eco-friendly Medical Products

The medical device industry is increasingly recognizing the importance of sustainability in product design and manufacturing. Eco-friendly medical devices aim to reduce environmental impact throughout their lifecycle, from production to disposal.

Examples of sustainable medical product innovations include:

1. Reusable insulin pens: Novo Nordisk’s NovoPen Echo and NovoPen Echo Plus are designed for easy disassembly and recycling, reducing waste generation.
2. Propellant-free inhalers: The Breezhaler by Novartis eliminates the need for hydrofluoroalkane propellants, reducing the device’s carbon footprint.
3. Sustainable packaging: Manufacturers are exploring ways to minimize packaging materials and increase the use of recyclable or biodegradable options.

Waste Management Strategies

Effective waste management is crucial for reducing the environmental impact of healthcare facilities. Hospitals and clinics generate various types of waste, including hazardous, medical, pharmaceutical, and general waste.

Key strategies for improving waste management in healthcare include:

1. Waste segregation: Implementing color-coded bins and clear signage to facilitate proper waste separation at the point of generation.
2. Staff training: Providing comprehensive education on waste management protocols, infection control measures, and environmental sustainability.
3. Waste reduction: Analyzing waste streams to identify opportunities for reducing waste production and implementing better diversion strategies.
4. Exploring alternatives to incineration: Utilizing greener sterilization methods for regulated medical waste when possible.
5. Implementing reusable products: Transitioning from disposable to reusable medical supplies can significantly reduce waste generation, particularly in operating rooms.

By adopting these sustainable practices, healthcare facilities can reduce their environmental impact, lower costs, and contribute to a more sustainable future for the industry.

Integrating Environmental Health into Nursing Education

The integration of environmental health into nursing education has become increasingly important as the healthcare sector recognizes the significant impact of environmental factors on human health. This integration encompasses various levels of nursing education, from undergraduate curricula to graduate programs and professional development opportunities.

Professional Development

Continuing education and professional development opportunities are essential for practicing nurses to stay current with environmental health issues. Organizations like the AIHCP offers a Holistic and Integrative Healthcare Program for nurses to earn a four year certification as a Holistic Nurse.

These professional development initiatives often include monthly webinars on relevant environmental health topics, emphasizing environmental justice and health equity. Participants are encouraged to hold educational sessions for fellow health professionals, sharing their learning and experiences in environmental health nursing.

By integrating environmental health into nursing education at all levels, the profession is better equipped to address the complex interplay between environmental factors and human health, ultimately contributing to improved public health outcomes and environmental sustainability.

Emerging Trends in Environmental Health and Holistic Nursing

Technological Innovations

The healthcare industry has witnessed a significant transformation due to technological advancements. Since the COVID-19 pandemic, developing and applying nursing technology has become a top priority, with new technologies revolutionizing patient care. These innovations include predictive analytics, mobile robotic systems, artificial intelligence (AI), and telehealth services. Predictive analytics, powered by AI, considers data from past patients to suggest optimal treatment courses, improving patient outcomes. Clinical mobility devices, such as handheld computers and smartphones, allow nurses to create convenient points of care and share real-time patient data with their teams. Robots are now capable of completing common nursing duties, such as making point-to-point deliveries and conducting contactless triage interviews.

Alternative Therapies

The integration of complementary and alternative medicine (CAM) into nursing practice has gained significant traction. Patients are increasingly seeking alternative therapies, prompting nurses to familiarize themselves with various CAM modalities. Common CAM therapies include acupuncture, aromatherapy, hypnosis, massage therapy, meditation, Tai Chi, therapeutic touch, and herbal supplements. These therapies have shown efficacy in various healthcare settings, such as reducing anxiety and pain post-surgery, improving balance in older adults, and aiding in addiction treatment. Nurses are encouraged to obtain appropriate education and clinical experience to maintain competency in CAM, as it complements conventional medical regimes and provides additional tools to boost overall quality of life and patient compliance with wellness programs.

Community-Based Interventions

Community and public health specialist nurses (CPHSNs) have emerged as key influencers in climate action, empowering communities to actively engage in achieving socio-political change. These nurses play a fundamental role in health promotion, supporting healthier lifestyle choices and advocating for adequate decisions from policymakers in urban settings. CPHSNs identify and diagnose environmental hazards resulting from climate change impact in urban areas and determine interventions that might lead to behavioral changes. Nurses worldwide are following United Nations recommendations for climate action within cities, helping individuals and families either mitigate their negative environmental impact or adapt to climate change impact by increasing their resilience. Planning for social innovation may involve reclaiming green infrastructures and sustainable designs for climate-resilient cities, such as greenways, which offer communities healthier lives by improving non-motorized routes and mitigating pollution in cities.

Conclusion

The intersection of environmental health and holistic nursing has a profound influence on patient care and public well-being. This comprehensive approach recognizes the complex relationships between human health and ecological systems, addressing not only physical symptoms but also psychological, social, and environmental factors. The integration of environmental health into nursing education and practice equips healthcare professionals to tackle global challenges such as air pollution, water scarcity, and toxic exposures. This holistic perspective allows nurses to play a crucial role in promoting health equity and environmental justice.

Looking ahead, the field of environmental health and holistic nursing is poised for exciting developments. Technological innovations are causing a revolution in patient care, while alternative therapies are gaining recognition as valuable complements to conventional treatments. Community-based interventions led by nurses are empowering individuals and communities to adapt to climate change and create more sustainable urban environments. These emerging trends highlight the evolving nature of holistic nursing and its potential to shape a healthier, more sustainable future for all.

Please also review AICHP’s Holistic Nursing Program and see if it meets your academic and professional goals.  The program is online and independent study and open to qualified nurses looking to implement holistic and integrative strategies into their nursing practice.

FAQs

What does holistic nursing entail?
Holistic nursing is a field of nursing that aims to heal the individual as a whole. This approach is applicable across various settings, including acute care hospitals, hospices, academic institutions, and private practices.

What responsibilities do nurses have in environmental health?
Nurses involved in environmental health undertake a variety of roles such as providing direct patient care, advocating for health, educating the public, developing health policies, assessing health and environmental risks, conducting research, and communicating the risks linked to environmental health hazards.

How is holistic health defined?
Holistic health focuses on the comprehensive care of an individual, addressing physical, mental, spiritual, and social needs. It emphasizes that an imbalance in any of these aspects can affect overall health.

Can you explain Florence Nightingale’s approach to holistic nursing?
Florence Nightingale, recognized as the pioneer of Holistic Nursing, emphasized the holistic principles of unity, wellness, and the interconnectedness of humans and their environment. Holistic Nursing, according to Nightingale, is an integral part of nursing practice rather than an isolated aspect.

Additional Resources

Correll, R. (2024). “What is Environmental Health and What Critical Issues Impact Our Health?”. Very Well Health.  Access here

“Environmental Health” OASH  Access here

Ranniger, G. (2022). “What is environmental health?”. EHN. Access here

“Environmental Health” ANA. Access here