2.50
Hdl Handle:
http://hdl.handle.net/10755/157926
Type:
Presentation
Title:
Terra: A Model to Guide Nursing Inquiry Addressing Environmental Health
Abstract:
Terra: A Model to Guide Nursing Inquiry Addressing Environmental Health
Conference Sponsor:Western Institute of Nursing
Conference Year:2009
Author:Butterfield, Patricia G., PhD, RN, FAAN
P.I. Institution Name:Washington State University College of Nursing
Title:Dean & Professor
Contact Address:2917 W Fort George Wright D, Spokane, WA, 99224, USA
Contact Telephone:509-324-7332
Co-Authors:Julie Postma, RN, PhD, Postdoctoral Fellow
Purpose: The goal of the ERNIE (Environmental Risk Reduction through Nursing Interventions and Education) study is to test the impact of a public health nursing intervention on environmental health (EH) risks to rural low-income families. Unique features of this four year RCT include: (1) the use of local public health nurses to deliver the intervention, (2) the collection of EH prevalence data in a previously unstudied population, and (3) the provision of a practical home-based intervention addressing multiple EH risks. Background: The conceptual foundation for EH focused inquiry has been inadequate for our profession. Because of the challenges in finding conceptual frameworks that reflect a nursing lens, most investigations to date have been conducted either atheoretically or by adapting models in other disciplines. To address this deficit, to capture nursing's perspective, and to provide grounding for our own investigative work in rural Western communities, we developed the TERRA (Translational Environmental Risk Reduction in Rural Areas) model. Our goal in developing the model was to identify concepts salient to family level decisions about EH risk reduction. By placing individual focused concepts (e.g., risk perception) in a broader political-economic context, we created a model that reflected the multidimensional forces shaping a family's capacity to take risk reduction actions. Concepts in the TERRA model include: (1) macro-determinants (physical-spatial, economic-resources, culturalideologic), (2) EH inequities, (3) EH risks, (4) EH mental models, (5) environmental risk reduction interventions, and (6) outcomes (proximal and distal). Method: Two small qualitative studies informed preliminary development of the TERRA model: an initial study with low-income rural mothers and a second study of local leaders' perceptions. Findings from this work provided evidence of the dialectic tension between mothers' feelings of being "trapped" in poverty and leaders' beliefs that Westerners wanted to live as regulatory-free as possible. This evidence compelled us to build a framework that explicated what EH actions were rationally at the disposal of families and what actions were not accessible to families because of poverty, public health service gaps, and prevailing political/economic ideologies. Our work was further informed by the World Health Organization's ME-ME (multiple exposures/multiple effects) model, which emphasized the need to look holistically at EH threats rather than adopting a piecemeal single-agent approach to EH. Subsequent efforts yielded a model that captured the dilemmas as well as the opportunities for families to act in response to multiple risks. Implications: Scientists are just beginning to understand the consequences of environmental exposures under conditions of poverty and marginalization. In the face of such uncertainty, practical nursing interventions hold the best promise to be family protective. Our goal is to strengthen the conceptual as well as the evidence base for EH focused nursing science. To this end, we hope the TERA model will be one more conceptual tool available for consideration by nursing scholars.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleTerra: A Model to Guide Nursing Inquiry Addressing Environmental Healthen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157926-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Terra: A Model to Guide Nursing Inquiry Addressing Environmental Health</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Butterfield, Patricia G., PhD, RN, FAAN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Washington State University College of Nursing</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Dean &amp; Professor</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">2917 W Fort George Wright D, Spokane, WA, 99224, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">509-324-7332</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">pbutter@ad.wsu.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Julie Postma, RN, PhD, Postdoctoral Fellow</td></tr><tr><td colspan="2" class="item-abstract">Purpose: The goal of the ERNIE (Environmental Risk Reduction through Nursing Interventions and Education) study is to test the impact of a public health nursing intervention on environmental health (EH) risks to rural low-income families. Unique features of this four year RCT include: (1) the use of local public health nurses to deliver the intervention, (2) the collection of EH prevalence data in a previously unstudied population, and (3) the provision of a practical home-based intervention addressing multiple EH risks. Background: The conceptual foundation for EH focused inquiry has been inadequate for our profession. Because of the challenges in finding conceptual frameworks that reflect a nursing lens, most investigations to date have been conducted either atheoretically or by adapting models in other disciplines. To address this deficit, to capture nursing's perspective, and to provide grounding for our own investigative work in rural Western communities, we developed the TERRA (Translational Environmental Risk Reduction in Rural Areas) model. Our goal in developing the model was to identify concepts salient to family level decisions about EH risk reduction. By placing individual focused concepts (e.g., risk perception) in a broader political-economic context, we created a model that reflected the multidimensional forces shaping a family's capacity to take risk reduction actions. Concepts in the TERRA model include: (1) macro-determinants (physical-spatial, economic-resources, culturalideologic), (2) EH inequities, (3) EH risks, (4) EH mental models, (5) environmental risk reduction interventions, and (6) outcomes (proximal and distal). Method: Two small qualitative studies informed preliminary development of the TERRA model: an initial study with low-income rural mothers and a second study of local leaders' perceptions. Findings from this work provided evidence of the dialectic tension between mothers' feelings of being &quot;trapped&quot; in poverty and leaders' beliefs that Westerners wanted to live as regulatory-free as possible. This evidence compelled us to build a framework that explicated what EH actions were rationally at the disposal of families and what actions were not accessible to families because of poverty, public health service gaps, and prevailing political/economic ideologies. Our work was further informed by the World Health Organization's ME-ME (multiple exposures/multiple effects) model, which emphasized the need to look holistically at EH threats rather than adopting a piecemeal single-agent approach to EH. Subsequent efforts yielded a model that captured the dilemmas as well as the opportunities for families to act in response to multiple risks. Implications: Scientists are just beginning to understand the consequences of environmental exposures under conditions of poverty and marginalization. In the face of such uncertainty, practical nursing interventions hold the best promise to be family protective. Our goal is to strengthen the conceptual as well as the evidence base for EH focused nursing science. To this end, we hope the TERA model will be one more conceptual tool available for consideration by nursing scholars.</td></tr></table>en_GB
dc.date.available2011-10-26T20:20:18Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:20:18Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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