Pesticides Initiative Creates Standards for Front-Line Health Care Providers
In a pioneering step to prepare the nation’s primary health care providers to recognize and effectively treat pesticide toxicity, the National Environmental Education and Training Foundation has released national pesticide competency and practice skills guidelines for physicians and nurses.
In a pioneering step to prepare the nation’s primary health care providers to recognize and effectively treat pesticide toxicity, the National Environmental Education and Training Foundation has released national pesticide competency and practice skills guidelines for physicians and nurses -- part of NEETF’s 10-year “National Strategies for Health Care Providers: Pesticides Initiative.”
The companion documents, “National Pesticide Competency Guidelines for Medical and Nursing Education” and “National Pesticide Practice Skills Guidelines for Medical and Nursing Practice,” were developed specifically for everyday, front-line health care professionals. The initiative has been developed in response to a gap in health professional education and the public health risks posed by the widespread use of pesticides in the United States.
“Environmental health risks are a leading cause of illness due, in part, to the widespread use of pesticides, yet most physicians today receive minimal training in environmental health as part of their education and ongoing practice,” said Andrea Lindell, R.N., D.NSc, dean of the College of Nursing, University of Cincinnati and one of two project coordinators for the national guidelines. “These new tools will be the foundation from which front-line health care professionals will gain the core knowledge and practice skills they need to deal with pesticides-related illness.”
Pesticide toxicity involves issues beyond acute pesticide poisoning incidents in agricultural settings. Pesticides are also a concern because of potential chronic health effects from long-term exposures. In addition, pesticide exposure can occur in a number of settings outside agriculture, including urban environments, homes, and schools. The educational competency guidelines are designed for use in basic and advanced components of educational institutions; similarly, the practice skills guidelines are aimed at primary-care practitioners.
“The changing worlds of medical and nursing education present unique challenges in introducing any environmental health issues into already-saturated curricula and competitive professional development offerings,” said James R. Roberts, M.D., assistant professor of pediatrics, Medical University of South Carolina, and a co-author of the guidelines. ”But it is still important to find room for pesticides exposures -- both in terms of the very real health threats they pose, and as a first step in addressing the growing problem of environmental toxicants,” he said.
The competency guidelines indicate possible ‘points of insertion’ and recognize that curricula are highly variable in the form and substance of topics. The practice skills guidelines detail opportunities for incorporating pesticide issues into the ongoing practice of health care and within the context of individuals’ continued education.
Highlights of the competency guidelines include:
The “National Strategies for Health Care Professionals: Pesticides Initiative” calls for all primary health care providers to acquire a basic knowledge of the health effects of pesticides and the treatments and preventive public health strategies to address them. The goal is to change the way primary care providers assess and respond to potential pesticide exposure cases in their daily practice.
Practitioners must be prepared to respond to exposures from a range of sources -- everything from household and lawn care products to agricultural chemicals. Primary providers must be prepared to take an environmental history and be prepared to: “problem solve” with patients who may have been exposed to pesticides; readily diagnose if appropriate; provide timely treatment for pesticide-related health conditions; provide prevention education; and consult with local authorities, where appropriate.
The U.S. Environmental Protection Agency estimates there are approximately 250-500 physician-diagnosed cases per 100,000 agricultural workers. Data collected from Poison Control Centers found that in 1996, more than 40,000 adults were sufficiently exposed to various types of pesticides to warrant a call to their local Poison Control Center. These exposures were non-agricultural in nature and are believed to represent less than 30% of the incident cases of acute pesticide-related illness in the United States. Chronic health effects include cancer and asthma, as well as reproductive and central nervous effects.
Even when environmental factors are identified as a source of a health problem, there is often little knowledge about how to address or prevent the problem. A study has shown that among the 76% of U.S. medical schools requiring environmental medicine content, students spend an average of only seven hours of study in environmental medicine over four years’ training in medical school.
The guidelines’ authors include experts representing the American Association of Colleges of Nursing, American Association of Occupational Health Nurses, National Organization of Nurse Practitioner Faculties, and American Association of Pesticide Safety Educators. Dr. Lindell and George Bernier, Jr., M.D., professor and dean emeritus, University of Texas Medical Branch served as project coordinators.
The “National Strategies for Health Care Providers: Pesticides Initiative” is a partnership of NEETF and the U.S. Environmental Protection Agency, in collaboration with the U.S. Department of Health and Human Services, the U.S. Department of Agriculture, the U.S. Department of Labor, and a wide range of stakeholders.
The companion documents, “National Pesticide Competency Guidelines for Medical and Nursing Education” and “National Pesticide Practice Skills Guidelines for Medical and Nursing Practice,” were developed specifically for everyday, front-line health care professionals. The initiative has been developed in response to a gap in health professional education and the public health risks posed by the widespread use of pesticides in the United States.
“Environmental health risks are a leading cause of illness due, in part, to the widespread use of pesticides, yet most physicians today receive minimal training in environmental health as part of their education and ongoing practice,” said Andrea Lindell, R.N., D.NSc, dean of the College of Nursing, University of Cincinnati and one of two project coordinators for the national guidelines. “These new tools will be the foundation from which front-line health care professionals will gain the core knowledge and practice skills they need to deal with pesticides-related illness.”
Pesticide toxicity involves issues beyond acute pesticide poisoning incidents in agricultural settings. Pesticides are also a concern because of potential chronic health effects from long-term exposures. In addition, pesticide exposure can occur in a number of settings outside agriculture, including urban environments, homes, and schools. The educational competency guidelines are designed for use in basic and advanced components of educational institutions; similarly, the practice skills guidelines are aimed at primary-care practitioners.
“The changing worlds of medical and nursing education present unique challenges in introducing any environmental health issues into already-saturated curricula and competitive professional development offerings,” said James R. Roberts, M.D., assistant professor of pediatrics, Medical University of South Carolina, and a co-author of the guidelines. ”But it is still important to find room for pesticides exposures -- both in terms of the very real health threats they pose, and as a first step in addressing the growing problem of environmental toxicants,” he said.
The competency guidelines indicate possible ‘points of insertion’ and recognize that curricula are highly variable in the form and substance of topics. The practice skills guidelines detail opportunities for incorporating pesticide issues into the ongoing practice of health care and within the context of individuals’ continued education.
Highlights of the competency guidelines include:
- sample curricular components as “points of insertion,” such as environmental or preventive medicine electives, and public sector medicine courses
- defined levels for individual competencies
- role of faculty development in advancing pesticide-related curriculum
- “primer” on pesticide regulation, use, exposures, and absorption
- five specific educational competencies
- “primer” on pesticide regulation, use, exposures, and absorption
- literature review
- detailed ideas for incorporating pesticide issues into practice areas
- key principles of adult education
- six recommended practice skill areas, including information content and a sampling of relevant resources
The “National Strategies for Health Care Professionals: Pesticides Initiative” calls for all primary health care providers to acquire a basic knowledge of the health effects of pesticides and the treatments and preventive public health strategies to address them. The goal is to change the way primary care providers assess and respond to potential pesticide exposure cases in their daily practice.
Practitioners must be prepared to respond to exposures from a range of sources -- everything from household and lawn care products to agricultural chemicals. Primary providers must be prepared to take an environmental history and be prepared to: “problem solve” with patients who may have been exposed to pesticides; readily diagnose if appropriate; provide timely treatment for pesticide-related health conditions; provide prevention education; and consult with local authorities, where appropriate.
The U.S. Environmental Protection Agency estimates there are approximately 250-500 physician-diagnosed cases per 100,000 agricultural workers. Data collected from Poison Control Centers found that in 1996, more than 40,000 adults were sufficiently exposed to various types of pesticides to warrant a call to their local Poison Control Center. These exposures were non-agricultural in nature and are believed to represent less than 30% of the incident cases of acute pesticide-related illness in the United States. Chronic health effects include cancer and asthma, as well as reproductive and central nervous effects.
Even when environmental factors are identified as a source of a health problem, there is often little knowledge about how to address or prevent the problem. A study has shown that among the 76% of U.S. medical schools requiring environmental medicine content, students spend an average of only seven hours of study in environmental medicine over four years’ training in medical school.
The guidelines’ authors include experts representing the American Association of Colleges of Nursing, American Association of Occupational Health Nurses, National Organization of Nurse Practitioner Faculties, and American Association of Pesticide Safety Educators. Dr. Lindell and George Bernier, Jr., M.D., professor and dean emeritus, University of Texas Medical Branch served as project coordinators.
The “National Strategies for Health Care Providers: Pesticides Initiative” is a partnership of NEETF and the U.S. Environmental Protection Agency, in collaboration with the U.S. Department of Health and Human Services, the U.S. Department of Agriculture, the U.S. Department of Labor, and a wide range of stakeholders.
