title: Barriers and facilitators in the delivery of environmental risk reduction by public health nurses in the home setting.
abstract: OBJECTIVE
  The goal of this study was to identify the factors that contributed to or detracted from the ability of public health nurses (PHNs) to deliver environmental risk reduction (ERR) in the home setting.
  
  
  METHODS
  Structured one-to-one interviews were conducted with 10 PHNs from 2 county health departments in the western United States that were delivering an ERR intervention in a randomized clinical trial.
  
  
  RESULTS
  Barriers to incorporating ERR into PHN practice were: a change in the perceived mission of public health, nurses' lack of environmental health (EH) training, the absence of a strong relationship with EH, the multidimensional role of PHNs, presentation of nurse participation by management, incorporation of ERR visits into nursing schedules, and challenges engaging parents in EH. Facilitating factors included: training and support, opportunities for capacity building, belief that ERR is important, building a more visible face for PHN, and personal interest in EH and ERR.
  
  
  CONCLUSIONS
  Adapting PHN practice to include ERR strategies is feasible, but not without challenges. With adequate training, time, and institutional support, multiple challenges can be overcome. PHNs are well positioned to improve the health of families and communities by integrating ERR into their scope of practice.
authors.affiliation: Columbia Public Health Center, Seattle, Washington, USA. elizabeth.tinker@kingcounty.gov
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tinker
authors.forename: Julie
authors.initials: J
authors.lastname: Postma
authors.forename: Patricia
authors.initials: P
authors.lastname: Butterfield
mesh_terms: D000328:Adult; D003152:Community Health Nursing / Q000379:methods* / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000379:methods*; D004781:Environmental Exposure / Q000517:prevention & control*; D004782:Environmental Health; D005260:Female; D006297:Health Services Accessibility; D006701:Home Nursing / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011637:Public Health Nursing / Q000379:methods* / Q000706:statistics & numerical data; D036301:Qualitative Research; D040242:Risk Reduction Behavior; D013637:Tape Recording; D014481:United States; D014861:Washington