Environment Nursing - Community Health

Environment Nursing - Community Health Nurse as Environmental Advocate

What environmental hazards are present in the situation?

The high levels of heat and air pollution make the outdoors a hazard to the elderly patients. Elderly patients are especially at risk when exposed to such environmental conditions. Within the facility, there are improper ventilation and cooling systems, so there is no relief from the outdoor conditions. Additionally, the staff members seem unconcerned and ill-informed about the risks of the situation and feel that as long as there is heat in the winter, the residents will be stable. "As people get older, they lose some of the mechanisms of compensation to protect against the heat...They don't get thirsty as easily, so they tend not to drink enough. Their bodies have more difficulty regulating temperature, and sometimes they have a lower level of awareness of their own needs" (Heatstroke and the elderly, 2009, North Shore - Long Island Jewish Health System).

What health effects, if any, are these hazards causing?

The immediate risks are those of heat stroke and aggravated asthma. "Smog, smoke, pollen or other pollutants are just a few of the various agents that cause the irritation to worsen. When the passageway becomes irritated it constricts thus making it extremely difficult for the asthma sufferer to get air to his/her lungs. This difficulty in breathing must be dealt with immediately. Other symptoms of an asthma attack are wheezing, coughing, a 'heavy feeling' in the chest and a choking sensation. As reported by the NIH 'the normal effects of aging can make asthma harder to diagnose and treat'" (Asthma and the elderly, 2009, therubins.com).

Also, on a long-standing basis, being unable to exercise and move around can cause a lack of mobility in the residents and cause other chronic health conditions, such as obesity and heart problems

What factors are interacting with environmental hazards to contribute to the problem?

The patient's age makes them more susceptible to environmental hazards inside and outside. Improperly maintained facilities make the oppressive heat and lack of air circulation worse within the facility. The ignorance of the staff compounds these problems, as they are under the impression that an opened window is enough to cool a room. Elderly individuals are also "more likely to take prescription medicines that impair the body's ability to regulate its temperature or that inhibit perspiration" (Heat stress in the elderly, 2009, CDC).

What levels of prevention are warranted in the situation? What might a community health nurse do to intervene?

The immediate concern is removing the residents to a safer area during oppressively hot days with bad air quality. For residents who wish to exercise, arranging for transport to a local cooling center where they can exercise is one option. For round-the-clock care, however, the unit overall must be maintained with a proper air conditioning and ventilation unit. The community health nurse must stress that this is to be done ASAP, otherwise the nurse will report the facility for health code violations. Until the unit is repaired, the nurse can provide supportive instruction to help residents deal with the heat, such as drinking water more frequently, wearing light-colored clothing, and confining intense activity to the coolest hours of the day. If they are in immediate danger, however, they should be removed to another facility.