Education for sustainable health care: From learning to professional practice

Assessing the presence of sustainability education in the curriculum of medical students and surgical trainees in Africa: A cross-sectional study

Background and Aims

Integrating sustainability principles into medical and surgical curricula raises awareness and empowers future healthcare professionals to adopt sustainable practices, reducing the environmental impact of surgical care. This study aims to assess the presence of sustainability education in African medical schools and surgical residency curricula to inform policymakers and educators in African healthcare systems.

Methods

This cross-sectional study was undertaken through an online survey among medical students and surgical trainees in African countries to describe the presence of sustainability education in surgical training programs and medical curricula across Africa. The results of this survey were reported in accordance with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES).

Results

A total of 141 participants from 17 countries responded to our e-survey, primarily consisting of undergraduate medical students (92.2%, n = 130). Only 9.2% of participants reported familiarity with the concept of sustainability in surgical care, and 60.3% stated that they had yet to receive any education on sustainability. Waste management was the most commonly taught sustainability topic among those who confirmed the presence of sustainability education in their curricula. Additionally, 76% of participants reported not participating in sustainability-related projects during their training.

Conclusion

This study highlights the urgent need for comprehensive integration of sustainability principles in surgical care and identifies barriers, such as a lack of awareness and resources to this integration. Addressing these gaps and implementing the suggested approaches can lead to more environmentally conscious and socially responsible surgical systems in Africa.

Environmental awareness and sustainable consumption behaviours of Turkish nursing students

Objectives

This study aims to determine the environmental awareness and sustainable consumption behaviours of nursing students.

Methods

This cross-sectional study was conducted with 380 undergraduate nursing students studying at Faculty of Nursing, Ege University, Türkiye. The Personal Information Form, Environmental Awareness Scale (EAS), and Sustainable Consumption Behaviours Scale (SCBS) were used to collect the research data. Number, percentage, mean, Kolmogorov-Smirnov Z test, t-test, one-way analysis of variance, Pearson's correlation test, and linear regression analysis were used in statistical evaluation.

Results

The mean total score on the EAS was 46.12 (SD = 6.60), and the mean total score of the SCBS was 61.83 (SD = 9.10). A significant, moderate, and positive correlation was found between students' environmental awareness and sustainable consumption behaviours. Moreover, students' gender and the people they lived with caused statistically significant differences in the EAS score. The people students lived with, the place where they lived for the longest time, and their perceived income level caused statistically significant differences in the SCBS score.

Conclusions

Nursing students had high environmental awareness and moderate to good sustainable consumption behaviours. It is necessary to include the contribution of sustainable practices to the environment and the effects of these practices on human health in curricula for nurses and thus provide environmental awareness to students.

Rapid review: Guides and frameworks to inform planetary health education for health professions

ISSUE ADDRESSED

Human actions have led to a range of global environmental changes. Health professionals must be prepared to deliver systemic changes to mitigate and adapt to the ecological crisis. This rapid review aimed to describe exemplar frameworks that inform planetary health education across health professions.

METHODS

The rapid review methodology was informed by a scoping review process. A targeted search strategy was conducted using one representative database and additional strategies such as expert consultation and citation searching were used. Results are described narratively.

RESULTS

Of the 11 637 articles, 17 were eligible for inclusion. The frameworks differed, with many recently developed for health professions broadly using a range of methodologies, including qualitative research, opinion/consensus data, literature reviews, and adaptation of previous models. Models such as metric-based scoring indicators and Sustainable Quality Improvement were featured in the frameworks, as were the application of First Nations Natural Laws.

CONCLUSION

This rapid review identifies and showcases accessible, interdisciplinary frameworks to inform the integration of planetary health in curricula, highlighting a rapidly evolving field through which interdisciplinary collaborations in healthcare are important to inform its pedagogy and application. Health education is an important component of health promotion; and thus this rapid review offers a range of approaches that health professionals, health promotion practitioners, and educators can use to inform the integration of planetary health, including sustainable healthcare, into curricula. SO WHAT?: Educational frameworks are informed by research and practice and provide key guidance to practitioners and educators; summarising key available planetary health education frameworks consolidates and guides effective education and builds on the existing body of knowledge to support urgent pro-environmental change.

Climate change and health in international medical education - a narrative review

Objective

Climate change is a key threat to human health worldwide. Accordingly, medical education should prepare future physicians for climate-associated hazards and corresponding professional challenges. Currently, this is not yet implemented across the board. The aim of this review is to present (I) the knowledge and (II) the attitudes of medical students and physicians towards climate change and (III) the expectations of medical education as formulated by medical students. In addition, the available literature will be used to look at (IV) global teaching activities, (V) international learning goals and learning goal catalogues, and (VI) applied teaching methods and formats. This review should simplify and, considering the urgency of the topic, accelerate the design of future teaching activities.

Methodology

The paper is based on a selective literature search supplemented by a topic-guided internet search.

Results

Knowledge about the causes and concrete health consequences of climate change seems to be incomplete. The majority of medical students consider human health to be at risk from climate change and the health sector to be inadequately prepared. A majority of surveyed medical students would like to see teaching about climate change. It is evident that internationally, teaching projects on climate change and climate health, as well as topic-specific learning objectives and learning goal catalogues, have been developed and integrated into medical education.

Conclusion

There is a need for and acceptance of teaching climate change in the medical curriculum. This literature review can assist in the development and implementation of new teaching formats.

Factors influencing the integration of planetary health topics into undergraduate medical education in Ireland: a qualitative study of medical educator perspectives

AIMS

Planetary health is a transdisciplinary field that explores the relationship between the escalating climate and environmental crises and human health. In light of the human health cost arising from planetary health issues, there is a need to educate future medical practitioners accordingly. This study investigates the factors influencing the integration of planetary health into undergraduate medical education at an Irish university and makes recommendations for future practice.

METHODS

A qualitative descriptive study design was employed. Twelve semi-structured interviews were conducted with academic staff actively involved in teaching on the undergraduate medical curriculum at Royal College of Surgeons in Ireland University of Medicine and Health Sciences. Both barriers and facilitators to integrating planetary heath into the curriculum were explored. Braun and Clarke's thematic analysis was used to analyse the findings.

RESULTS

Barriers to integration include: a lack of curricular space, a perceived lack of awareness among students and educators and a potential lack of knowledge among educators and senior management in relation to these issues. These barriers were tempered by significant facilitators suggesting a shifting paradigm within institutions, innovative approaches to content delivery and an increasing demand from undergraduate medical students.

CONCLUSION

This study found a demand from medical educators for the integration of planetary health topics into the medical curriculum. It is suggested that significant adaptation of existing medical curricula is required both in Ireland and further afield, to meet this need. Recommendations based on the barriers and facilitators that emerged during the analysis include: emphasising the clinical relevance of these topics, as suggested by the current evidence base; promoting senior and departmental leadership; and emphasising the potential for improvements in institutional prestige.

Planetary Health Education and Capacity Building for Healthcare Professionals in a Global Context: Current Opportunities, Gaps and Future Directions

The emerging concept of planetary health needs to be discussed in a more organized and sustainable way within the global public health and healthcare disciplines. Therefore, planetary health should be considered a cardinal component of the global academic framework for healthcare professionals. The availability of related curricula and courses is crucial to equip health professionals in this relatively new discipline of planetary health. In this review article, we aimed to explore published articles and online databases of courses to summarize the available planetary health education opportunities and discussions for health professionals, to identify the gaps in resource allocation and to suggest future recommendations. We observed a visible resource inequity in the global south with the lack of a universal planetary health module for healthcare professionals. Additionally, there is minimal inclusion of allied health disciplines in this learning process. We therefore recommend a dedicated network of motivated healthcare professionals and regional hubs with an agenda to ensure a comprehensive, uniform, and inclusive planetary health education curriculum and practice.

Effectiveness of scenario-based learning and augmented reality for nursing students' attitudes and awareness toward climate change and sustainability

Background

Mainstreaming sustainable healthcare into the curricula of health professions is a key action to raise awareness and change attitudes. Therefore, the present study aimed to assess the contribution of scenario-based learning and augmented reality to the environmental awareness and attitudes toward climate change and sustainability among undergraduate nursing students.

Methods

This study was designed as a time-series analysis. Undergraduate nursing students in their 3 years were introduced to sustainability and climate change in the context of healthcare through scenario-based learning sessions. Questionnaires were used to collect data on participants’ attitudes towards sustainability and climate change, the usefulness of the educational sessions and the extent to which students changed their clinical practice. A data summary, related sample Friedman and Wilcoxon signed-rank tests were used to test for differences in survey scores.

Results

Attitudes and environmental awareness toward climate change and sustainability increased significantly as students received the learning sessions over the 3 years. After their first clinical training period, students already showed a high awareness of unsustainable practices in their working environment; however, they still struggled to apply sustainability and address unsustainable practices in healthcare settings. Most students felt that the scenarios helped them to make links between climate change, resources, and health.

Conclusions

The scenario-based learning and augmented reality increase environmental awareness and attitudes toward climate change and sustainability among nursing students. Students are very aware of unsustainable practices in their work environment, but more work needs to be done on the application of sustainability principles to nursing practice.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-01023-9.

Exploring, Diversifying and Debating Sustainable Health (Care) Approaches

Today’s sustainability challenges have major implications for human health and health care. At the same time, the way health care is organized and conducted has major sustainability implications. Sustainable health and sustainable health care approaches in research, which engage with health and sustainability as intertwined phenomena, feature increasingly prominently in various literatures, i.e. (i) literature based on the premise of ‘(un)healthy environments result in (un)healthy people’ (e.g., planetary health); (ii) literature on the implications of ecological change for the sustainability of healthcare systems; and (iii) literature on healthcare systems’ sustainability in view of a range of socio-economic factors. However, an integrative elaboration of the manifold relationships between health and sustainability challenges in these literatures is currently lacking. This review paper therefore maps how these three literatures represent intertwinements between health and sustainability challenges, as well as their suggestions to address these challenges. In addition, we explore which themes and questions are pertinent, meaning they have remained largely unaddressed. By performing a qualitative mapping review, we find that calls for structural attention to inequality, to in-and exclusion, and to stakeholder needs and perspectives cut across these three literatures. Furthermore, we identify three cross-cutting key questions that require future research attention. First, how do divergent ideas on what is and divergent ideas on how can that be known give rise to different health- and sustainability visions and pathways? Second, what do abstract problem statements and solutions presented in agenda-setting work look like in practice in specific and diverse empirical contexts across the globe? And third, how are diverse health and sustainability dynamics historically and spatially interconnected? Moreover, we observe that some voices have so far remained largely silent in scientific debates on health and sustainability intertwinements, namely non-expert voices such as patients and citizens, voices from a variety of social scientific and humanities disciplines, voices from relevant domains beyond (environmental) health, and voices from the global South (from non-experts, social scientific and humanities researchers and domains beyond health). We conclude that a focus on inclusive and equitable engagement with intertwined health- and sustainability challenges is imperative. This requires moving away from developing universal knowledge to address generic problems, to foregrounding plurality in terms of problem statements, knowledge, solutions, and the values embedded therein.

Nursing students' attitudes towards climate change and sustainability: A cross-sectional multisite study

BACKGROUND

Education is a social tipping intervention necessary for stabilising the earth's climate by 2050. Integrating sustainable healthcare into healthcare professions curricula is a key action to raise awareness.

OBJECTIVES

This study aimed to: i) investigate nursing students' attitudes towards and awareness of climate change and sustainability issues and its inclusion in nurse education, ii) explore differences across a range of countries, and iii) compare attitudes in 2019 with those of a similar sample in 2014.

DESIGN

A cross-sectional multicentre study. Data were collected through the Sustainability Attitudes in Nursing Survey (SANS_2) questionnaire.

SETTINGS

Seven different universities and schools of nursing in five countries (UK, Spain, Germany, Sweden, and Australia).

PARTICIPANTS

A convenience sample of first-year undergraduate nursing students.

METHODS

The SANS_2 questionnaire was self-administered by nursing students at the seven participating universities at the start of their undergraduate degree, between September 2019 and February 2020.

RESULTS

Participants from all seven universities (N = 846) consistently showed awareness and held positive attitudes towards the inclusion of climate change and sustainability issues in the nursing curriculum (M = 5.472; SD: 1.05; min-max 1-6). The relevance of climate change and sustainability to nursing were the highest scored items. Esslingen-Tübingen students scored the highest in the 'inclusion of climate change and sustainability in the nursing curricula'. Students at all universities applied the principles of sustainability to a significant extent at home. Nursing students' attitudes towards climate change and sustainability showed significantly higher values in 2019 (Universities of Plymouth, Brighton, Esslingen-Tübingen, Jaen, Murcia, Dalarna, and Queensland) than in 2014 (universities of Plymouth, Jaen, Esslingen, and Switzerland).

CONCLUSIONS

Nursing students have increasingly positive attitudes towards the inclusion of sustainability and climate change in their nursing curriculum. They also recognise the importance of education regarding sustainability and the impact of climate change on health, supporting formal preparation for environmental literacy. It is time to act on this positive trend in nursing students' attitudes by integrating these competencies into nursing curricula.

Nursing students' perception of climate change and sustainability actions - A mismatched discourse: A qualitative, descriptive exploratory study

BACKGROUND

Climate change is described as the biggest global challenge for human health in the upcoming decade. Nurses play a central role in mitigating the effect of climate change on the healthcare sector and adapting to the phenomenon. Therefore, nursing students must be prepared for a new professional role keeping climate change in mind; consequently, it is important to study students' perceptions of climate change and sustainability.

OBJECTIVES

To explore nursing students' perceptions of climate change and sustainability and examine how they perceive their role as nursing students in working towards a more sustainable development within the healthcare sector.

DESIGN

It is a qualitative, descriptive exploratory study.

SETTINGS

A nursing program at a university in central Sweden.

PARTICIPANTS

Nursing students.

METHODS

Individual in-depth interviews and one group interview were conducted for the study.

RESULTS

The main findings revealed that students saw themselves living in a mismatched discourse. They perceived the future of humanity as gloomy but thought that sustainability is the society's joint obligation to achieve the right to a good life for all people equally.

CONCLUSIONS

Nursing students perceived themselves as important actors in the work of climate change and sustainability. Thus, nursing education needs to integrate the impact of climate change on healthcare and promote sustainability into the curriculum for preparing students to take responsibility for sustainability in society.

Burnout among Direct-Care Workers in Nursing Homes during the COVID-19 Pandemic in Spain: A Preventive and Educational Focus for Sustainable Workplaces

Due to their continuous contact with pain and death, healthcare workers have one of the most stressful professions. Pain and death are more common in nursing homes. During the health crisis associated with COVID-19, these work centers have been characterized as spaces of high vulnerability to infection for the elderly, with a high mortality rate. This research aims to determine how the health crisis associated with COVID-19 has influenced healthcare professionals working in nursing homes for the elderly. Using a quantitative and cross-sectional method, the research was developed in residential centers in the Region of Murcia (Spain) during the second wave of the pandemic. A survey design based mainly on the Maslach Burnout Inventory (MBI) was employed. MBI measures three subscales: emotional burnout, depersonalization, and self-fulfillment. The results show that 6.4% of the respondents were burned out, 53.8% of the participants were emotionally exhausted, 35.1% were found to suffer from depersonalization, and in the case of personal development, the respondents showed a low level of 15.6%. This study shows the need to consider the establishment, in the academic environment, of training programs for health professionals related to coping with, managing, and identifying stress, especially in adverse circumstances. Similarly, in the professional field, it is necessary to develop strategies to prevent stress and anxiety in the workplace. The development of training programs for this purpose is essential for achieving a sustainable work context.

AMEE Consensus Statement: Planetary health and education for sustainable healthcare

The purpose of this Consensus Statement is to provide a global, collaborative, representative and inclusive vision for educating an interprofessional healthcare workforce that can deliver sustainable healthcare and promote planetary health. It is intended to inform national and global accreditation standards, planning and action at the institutional level as well as highlight the role of individuals in transforming health professions education. Many countries have agreed to 'rapid, far-reaching and unprecedented changes' to reduce greenhouse gas emissions by 45% within 10 years and achieve carbon neutrality by 2050, including in healthcare. Currently, however, health professions graduates are not prepared for their roles in achieving these changes. Thus, to reduce emissions and meet the 2030 Sustainable Development Goals (SDGs), health professions education must equip undergraduates, and those already qualified, with the knowledge, skills, values, competence and confidence they need to sustainably promote the health, human rights and well-being of current and future generations, while protecting the health of the planet.The current imperative for action on environmental issues such as climate change requires health professionals to mobilize politically as they have before, becoming strong advocates for major environmental, social and economic change. A truly ethical relationship with people and the planet that we inhabit so precariously, and to guarantee a future for the generations which follow, demands nothing less of all health professionals.This Consensus Statement outlines the changes required in health professions education, approaches to achieve these changes and a timeline for action linked to the internationally agreed SDGs. It represents the collective vision of health professionals, educators and students from various health professions, geographic locations and cultures. 'Consensus' implies broad agreement amongst all individuals engaged in discussion on a specific issue, which in this instance, is agreement by all signatories of this Statement developed under the auspices of the Association for Medical Education in Europe (AMEE).To ensure a shared understanding and to accurately convey information, we outline key terms in a glossary which accompanies this Consensus Statement (Supplementary Appendix 1). We acknowledge, however, that terms evolve and that different terms resonate variably depending on factors such as setting and audience. We define education for sustainable healthcare as the process of equipping current and future health professionals with the knowledge, values, confidence and capacity to provide environmentally sustainable services through health professions education. We define a health professional as a person who has gained a professional qualification for work in the health system, whether in healthcare delivery, public health or a management or supporting role and education as 'the system comprising structures, curricula, faculty and activities contributing to a learning process'. This Statement is relevant to the full continuum of training - from undergraduate to postgraduate and continuing professional development.

What are the implications of climate change for speech and language therapists?

BACKGROUND

The emerging global issue of climate change has large-scale effects on health and well-being, including communication disorders. The broad range of the speech and language therapy profession's scope of practice incorporates prevention, advocacy and equality in service delivery. These act as a springboard for involvement in climate change and health.

AIMS

This is an appeal to speech and language therapists (SLTs) to focus and take action on this issue and its considerable effects on communication and swallowing disorders.

METHODS & PROCEDURES

This article discusses the importance of taking a public health position on prevention and equality of services to manage environmental determinants of communication and swallowing disorders. It also describes the extent to which climate change affects these disorders and exacerbates the inequality of healthcare services in low- and middle-income countries.

MAIN CONTRIBUTION

Five strategies are provided for action on fulfilling therapists' roles in reducing the incidence, development and exacerbation of climate-related communication and swallowing disorders, as well as the role of SLTs in acting as advocates. The case is made for expanding the scope of services to focus on prevention and service equality so as to best meet the needs of the wider community.

CONCLUSIONS & IMPLICATIONS

Despite other challenges currently facing SLTs, climate change and its increasing effects on communication disorders and dysphagia is difficult to ignore. SLTs owe it to their clients, the wider community, low- and middle-income countries, the economy, and the future to take action. What this paper adds What is already known on the subject Multiple studies published in peer-reviewed scientific journals show that climate change is extremely likely to be due to human activities. The global effects will be higher temperatures, changes in precipitation, more droughts and heatwaves, stronger and more intense hurricanes, and a rising sea level which directly threaten the health of entire populations. Other health professions are beginning to take climate change into account in training and practice. What this paper adds to existing knowledge Many disorders of communication and swallowing are caused or exacerbated by the effects of climate change. Increasing temperatures, extremes of precipitation, population displacement and air pollution contribute to cardiovascular and cerebrovascular events, respiratory disease, malnutrition, premature birth, air- and water-borne diseases, and mental illness. These may affect the communication and swallowing abilities across the lifespan, but particularly those of children and older adults. What are the potential or actual clinical implications of this work? SLTs' roles in prevention, advocacy and education act as a starting point for involvement in climate change and health. Three practical strategies for action include educating SLTs and other health professionals on climate change and its effects on communication and swallowing, promoting awareness with clients and their families, and gathering and disseminating reliable data.

Education for sustainable healthcare: Leadership to get from here to there

The current global crises, including climate, COVID-19, and environmental change, requires global collective action at all scales. These broad socio-ecological challenges require the engagement of diverse perspectives and ways of knowing and the meaningful engagement of all generations and stages of personal and professional development. The combination of systems thinking, change management, quality improvement approaches and models, appreciative/strength-based approaches, narratives, storytelling and the strengths of Indigenous knowledges, offer synergies and potential that can set the stage for transformative, strengths-based education for sustainable healthcare (ESH). The need for strong leadership to enact a vision for ESH is outlined here with the intent to enable and nurture the conditions for change, ultimately improving health and well-being across generations.