American Journal of Nursing (Vol. 4, #4)  [Printer-friendly version]
March 1, 2004


[Rachel's introduction: What does it mean for a nurse to take a
precautionary approach to occupational hazards and to the health of
patients? Charlotte Brody and Ann Melamed offer five specific steps a
nurse can take to implement precaution.]

By Charlotte Brody, RN, and Ann Melamed, MA, RN

Q. I heard that the ANA [American Nurses Association] adopted the
"precautionary approach" to address environmental health hazards. What
does this mean?

A. In October 2003 the ANA board of directors adopted the
"precautionary approach" based on the "precautionary principle"
developed by German policymakers in the 1970s to address strongly
suggestive but unproven links between air pollution and the death of
trees. The result of this effort to save trees includes principles
that nurses promote daily: early detection and monitoring; reduction
of stressors; preventive action where the likely benefit justifies the
costs; and reducing risks before full proof of harm is available if
the effects could be serious or irreversible.

In "Late Lessons from Early Warnings: The Precautionary Principle
1896-2000," a review of radiation illustrates what can happen when we
wait for irrefu--table proof before taking preventive action. Thomas
Edison warned about the harm that could result from overexposure to X-
rays in 1896, only a few years after the discovery was made. The
possibility of fetal damage from pelvimetry (an X-ray method of
diagnosing pregnancy) was documented as early as 1908. These warnings
continued to be discounted, though, and it was only after other
studies affirmed these findings that the practice of pelvimetry
stopped and requirements were added to other medical exposures to
radiation. By then, the damage had been done. A 1989 study estimated
that 5% of all childhood cancers were caused by pelvimetry. If health
care practitioners and the government had heeded the warnings 30, 40,
or 50 years earlier, how many cases of cancer could have been
prevented? The history of radiation shows how the precautionary
principle could have been used to prevent, not merely treat, disease.

Through the ANA's long involvement with coalitions, including Health
Care Without Harm, occupational health and pollution prevention are
being promoted simultaneously. As part of the ANA's prevention
philosophy, when research demonstrates a possible toxic relationship
between chemical exposure and health effects, nursing should be an
advocate for a precautionary approach. Actions should include
reduction or elimination of exposures as well as continued scientific

Nurses can implement the precautionary approach in their work and
apply it to all areas of nursing practice, policy, research,
education, and workplace strategies. Here are five activities to help
apply the precautionary approach in nursing practice.

** Get involved on product committees and be an advocate for reviewing
the potential effects of new and old products and therapies on workers
and the environment before they are implemented.

** Negotiate contract language that includes staff nurse input on
product selection with criteria that includes patients, workers, and
long-term environmental impact.

** Organize a product fair with PVC- and DEHP-free products and
include educational materials about their hazards. Develop a plan to
phase out the use of PVC, beginning with the NICU [neonatal intensive
care unit] and maternal-child units.

** Research alternatives (see to toxic
cleaning products, disinfectants, and sterilants and develop a plan to
use them instead.

** Encourage nursing research to "clarify the complex relationship
between human disease and the physical and biological effects of
environmental hazards with the goal of facilitating social and
behavioral changes," as stated in the 1995 Institute of Medicine

Using a precautionary approach will help all of us see through the fog
of controversy to discern what the science is trying to show. Then we
can determine what we can reasonably do to protect ourselves and our
planet. What better way to celebrate Earth Day on April 30?


Institute of Medicine (IOM) Report, 1995. Nursing, Health and the
Environment. Washington, DC: National Academy Press.

Late Lessons from Early Warnings: The Precautionary Principle
1896-2000. Environmental issue report no. 22, European environmental

Wingspread Statement on the Precautionary Principle.

Charlotte Brody is coexecutive director of Health Care Without Harm
( and executive director of Commonweal
( Ann Melamed is an environmental health
specialist with the ANA.

Copyright 2006 The American Nurses Association, Inc.