Psychological Explanations and Interventions for Indifference to Greening Hospitals

Nurses' Environmental Practices in Northern Peruvian Hospitals

BACKGROUND

Decreasing emissions of the global healthcare sector will be an important tool for decreasing the magnitude of climate change. The environmental practices of nurses can have a positive environmental impact. The purpose of this study is to identify environmental practices performed by nurses while at work and home along with their associated factors.

METHODS

This study is a cross-sectional descriptive study conducted by surveying nurses from two public hospitals in Lambayeque, Peru. We utilized the Nurses' Environmental Awareness Tool to collect information about nurses' knowledge on environmental impacts, their risk to health, and environmental behaviors at both work and home.

RESULTS

Of the 106 participants who responded, the average age was 41 years, and 29 (28%) worked in surgical services. A little more than half of nurses reported appropriate energy use (51%) and recycling (53%) at work, while 94 (89%) implemented environmental biosafety. There was an observed association between age and years of employment with appropriate energy use, recycling, implementation of environmental biosafety, appropriate chemical substance use, and preventing medication waste.

CONCLUSION

Nurses reported a favorable tendency toward adequate environmental practices at work and at home. However, more studies are needed to identify the factors that increase nurses' use of these practices.

APPLICATIONS TO PRACTICE

As one of the most trusted professions, professional nurses have an opportunity to play a pivotal role in promoting environmental health and practices in both the workplace and their personal lives. This study highlights areas of potential intervention in the workplace to develop and promote appropriate environmental practices by nurses to decrease pollution by the healthcare sector.

Regulating Environmental Impact of Medical Devices in the United Kingdom—A Scoping Review

Medical devices are highly regulated to ensure safety and efficacy of the products and minimize the risk of harm to users and patients. However, the broader impacts of these devices on the environment have scarcely been questioned until recently. The United Kingdom National Health Service intends to achieve a “net zero” emissions service by 2040 and has identified specific targets to achieve through this process. However, medical device manufacturers do not see sufficient incentives to invest in reducing greenhouse gas emissions unless enforced by legislation. Furthermore, there is little evidence on the legislation required to reduce emissions from medical devices. This study addresses the relationship of medical device regulations and the environmental impact of the devices throughout their lifecycle. A scoping review was conducted on academic literature on the topic, followed by a critical review of the current medical device regulations and associated guidelines in the United Kingdom. The challenges to regulating environmental impact of medical devices were identified under seven themes. These challenges were contextualized with the National Health Service target of achieving zero emissions by 2040. The review indicates that current guidelines support single-use disposal of devices and equipment as the best approach to prevent pathogen transmission and landfilling and incineration are the most used waste management strategies. Manufacturers need to be guided and educated on reducing their emissions while ensuring the development of safe and effective devices.

Design Opportunities to Reduce Waste in Operating Rooms

While taking care of the population’s health, hospitals generate mountains of waste, which in turn causes a hazard to the environment of the population. The operating room is responsible for a disproportionately big amount of hospital waste. This research aims to investigate waste creation in the operating room in order to identify design opportunities to support waste reduction according to the circular economy. Eight observations and five expert interviews were conducted in a large sized hospital. The hospital’s waste infrastructure, management, and sterilization department were mapped out. Findings are that washable towels and operation instruments are reused; paper, cardboard, and specific fabric are being recycled; and (non-)hazardous medical waste is being incinerated. Observation results and literature findings are largely comparable, stating that covering sheets of the operation bed, sterile clothing, sterile packaging, and department-specific products are as well the most used and discarded. The research also identified two waste hotspots: the logistical packaging (tertiary, secondary, and primary) of products and incorrect sorting between hazardous and non-hazardous medical waste. Design opportunities include optimization of recycling and increased use of reusables. Reuse is the preferred method, more specifically by exploring the possibilities of reuse of textiles, consumables, and packaging.

Can United States Healthcare Become Environmentally Sustainable? Towards Green Healthcare Reform

In 2014, the United States health care industry produced an estimated 480 million metric tons of carbon dioxide (CO2); nearly 8% of the country's total emissions. The importance of sustainability in health care - as a business reliant on fossil fuels for transportation, energy, and operational functioning - is slowly being recognized. These efforts to green health care are incomplete, since they only focus on health care structures. The therapeutic relationship is the essence of health care - not the buildings that contain the practice. As such, this article will first postulate reasons for a lack of environmental sustainability in US health care. Second, the article will focus on current green health care initiatives in the United States in which patients and physicians participate. Third, the rationale for participation in green initiatives will be explained. Fourth, the article will propose that, based on the environmental values of patients and physicians, health care insurance plans and health care insurance companies can be targeted for green health care reform, thereby closing the loop of sustainable health care delivery.

Going green: decreasing medical waste in a paediatric intensive care unit in the United States

The healthcare industry generates significant waste and carbon emissions that negatively impact the environment. Intensive care units (ICU) are a major contributor to the production of waste, due to patient complexity and needs requiring extensive equipment, cleaning practices and pre-emptive supplies. To quantify the extent of the problem, health care professionals collected all unused medical supplies destined to be discarded over three one-week periods in a paediatric intensive care unit, weighed the items, and created an inventory. This article argues for greener hospital standards and provides a specific example of a project framework to reduce disposable waste with the hope that others can embark on similar initiatives for a more ethical and sustainable future for hospitals. Healthcare facilities must not just meet short-sighted safety standards of the now. In order to be a virtuous organization, one must consider all implications of daily decisions, including disposable supplies and cleaning.

Why be sustainable? The Australian and New Zealand College of Anaesthetists Professional Document PS64: Statement on Environmental Sustainability in Anaesthesia and Pain Medicine Practice and its accompanying background paper

Healthcare’s environmental sustainability is increasingly an area of research and advocacy focus. The Australian and New Zealand College of Anaesthetists (ANZCA) has produced a professional document, PS64, Statement on Environmental Sustainability in Anaesthesia and Pain Medicine Practice, and a background paper, PS64 BP. The purpose of the statement is to affirm ANZCA’s commitment to environmental sustainability and support anaesthetists in promoting environmentally sustainable work practices. This article presents the main features of PS64 and its background paper, and the associated supporting evidence. The healthcare sector is highly interconnected with activities that emit pollution to air, water and soils, considerably adding to humanity’s collective ecological footprint. As anaesthetists, we are uniquely high-carbon doctors due to our work anaesthetising with greenhouse gases (particularly desflurane and nitrous oxide) and our exposure and contribution to large amounts of resource and energy use and waste generation in operating theatres. Discussion is made of the improving research base of anaesthetic life-cycle assessments—that is, cradle-to-grave studies of how much energy, water and so on a product or process requires throughout its entire life. Thereafter, reducing, reusing and recycling as well as water use are examined. Ongoing research efforts within environmentally sustainable anaesthesia are highlighted. Environmentally sustainable anaesthesia requires scholarship, health advocacy, leadership, communication and collaboration. The focus is placed on practical initiatives within PS64 and the background paper that can be achieved by all anaesthetists striving towards more sustainable healthcare practices that reduce waste, reap financial benefits and improve health.

Health service planning and sustainable development: considering what, where and how care is delivered through a pro-environmental lens

The aim of the present paper was to review the opportunities currently available to health service planners to advance sustainable development in their future-facing roles within health service organisation. Critical challenges and enablers to facilitate health services planners in adopting a pro-environmental lens are discussed.

Athletic Trainers' Attitudes and Perceptions of Environmental Sustainability

CONTEXT

  Environmental sustainability efforts are becoming a critical concern in health care. However, little is known regarding how athletic trainers feel about the environment or what can be done to reduce the environmental impact of the practice of athletic training.

OBJECTIVE

  To examine athletic trainers' attitudes toward and perceptions of factors related to environmental sustainability.

DESIGN

  Sequential, mixed methods using a survey, focus groups, and personal interviews.

SETTING

  Field study.

PATIENTS OR OTHER PARTICIPANTS

  Four hundred forty-two individuals completed the survey. Sixteen participated in the qualitative portion.

MAIN OUTCOME MEASURE(S)

  Quantitative results from the Athletic Training Environmental Impact Survey included data from a 5-point Likert scale (1 = lowest rating and 5 = highest rating). Descriptive statistics and 1-way analyses of variance were used to describe perceptions and determine differences in mean opinion, National Athletic Trainers' Association district, and use of green techniques. Qualitative data were transcribed verbatim and analyzed inductively.

RESULTS

  The mean score for opinion of the environment was 3.30 ± 0.52. A difference was found between opinion and National Athletic Trainers' Association district ( F_{9, 429} = 2.43, P = .01). A Bonferroni post hoc analysis identified this difference ( P = .03) between members of District 2 (Delaware, New Jersey, New York, Pennsylvania) and District 9 (Alabama, Florida, Georgia, Kentucky, Louisiana, Mississippi, Tennessee). An inductive analysis resulted in 3 emergent themes: (1) barriers to using green techniques, (2) motivators for using green techniques, and (3) solutions to overcoming the barriers. The information gleaned from participants in the qualitative portion of the study can be useful for clinicians wishing to implement basic conservation efforts in their practice settings and may guide future sustainability projects.

CONCLUSIONS

  Overall, participants reported a positive opinion of environmental sustainability topics related to athletic training. However, many barriers to practicing green techniques were identified.

Implementing climate change mitigation in health services: the importance of context

Academic interest in strategies to reduce the impact of health services on climate change is quickening. Research has largely focused on local innovations with little consideration of the contextual and systemic elements that influence sustainable development across health systems. A realistic framework specifically to guide decision-making by health care providers is still needed. To address this deficit, the literature is explored in relation to health services and climate change mitigation strategies, and the contextual factors that influence efforts to mitigate climate effects in health service delivery environments are highlighted. A conceptual framework is proposed that offers a model for the pursuit of sustainable development practice in health services. A set of propositions is advanced to provide a systems approach to assist decision-making by decoding the challenges faced in implementing sustainable health services. This has important implications for health care providers, funders and legislators since the financial, policy and regulatory environment of health care, along with its leadership and models of care generally conflict with carbon literacy and climate change mitigation strategies.

Environmental sustainability in hospitals – a systematic review and research agenda

Objectives

Hospitals are significant contributors to natural resource depletion and environmental change. Our objective was to establish the extent to which hospital environmental sustainability has been studied and the key issues that emerge for policy, practice and research.

Methods

The PubMed, Engineering Village, Cochrane and King's Fund databases were searched for articles relating to hospital environmental sustainability published in English between 1 January 1990 and 1 October 2013. Further studies were found by review of reference lists. One hundred ninety-three relevant articles were found and 76 were selected for inclusion in the review.

Results

Common research themes were identified: hospital design, direct energy consumption, water, procurement, waste, travel and psychology and behaviour. Some countries (particularly the United Kingdom) have begun to invest systematically in understanding the environmental effects of hospitals. We found large variability in the extent of the evidence base according to topic. Research regarding the architectural fabric of hospital buildings is at a relatively mature stage. Similarly, there is a developed research base regarding devices and technologies used within hospitals to reduce the environmental effects of direct hospital energy and water use. Less is known about the clinical, psychological and social factors that influence how health care professionals use resources, travel to/from hospital, and interact with the buildings and technologies available. A significant part of the environmental footprint of hospitals relates to clinical practice, e.g. decisions regarding the use of pharmaceuticals and medical devices. Medical ‘cradle to grave’ life cycle assessment studies have been published to understand the full financial and environmental costs of hospital activities. The effects of preventive or demand management measures which avoid unnecessary hospital procedures are likely to be much greater than incremental changes to how hospital procedures are performed.

Conclusions

There remain significant gaps in the evidence base on hospital sustainability. Assessments of environmental impacts and natural resource use are beginning to be produced, both at the level of individual hospitals and at the health system level. These are an important start, but in many areas do not yet provide sufficiently detailed information to guide decision-making. There are many areas where the interests of patients and the environment coincide, but others where tensions exist. Rising resource costs and climate change mitigation measures are likely to create an increasing stimulus for research on hospital sustainability. Such research will benefit from inter-disciplinary coordination across research funders and countries.

Towards environmentally responsible nursing: a critical interpretive synthesis

AIM

To provide a synthesis of studies on the environmental issues in nursing.

BACKGROUND

Interest in the environmental issues affecting health sciences has been increasing in recent decades. Health care is one of the largest publicly provided services and it share of the environmental burden is high. Nurses play an important role in environmental health issues as they are the largest group of healthcare staff and are most directly connected to the use of energy and materials. Despite this, previous studies on nurses' roles in environmental issues have been presented in a relatively fragmented way.

DESIGN AND DATA SOURCES

Systematic literature searches of peer-reviewed papers published between 2002-2012 were carried out using the CINAHL, Science Direct and PubMed electronic databases.

REVIEW METHOD

Critical interpretive synthesis was then undertaken to provide a comprehensive overview of the topic.

RESULTS

Eleven studies were included. Based on our synthesis, environmentally responsible nursing can be identified in relation to the: (1) theoretical framework; (2) background arguments; (3) role of responsible stakeholders; and (4) targets of environmental management. A fifth element: (5) tools for practical environmental responsibility, was also presented.

CONCLUSION

Awareness of environmental issues is starting to encourage nursing services to seek sustainable practices. Nurses themselves are naturally in a key position to promote and develop environmentally responsible nursing. Environmentally responsible nursing helps to promote healthy environmental practices. It also reduces undesirable practices that can burden the environment and have a negative impact on health.

Healthcare professionals' perspectives on environmental sustainability

Background:

Human health is dependent upon environmental sustainability. Many have argued that environmental sustainability advocacy and environmentally responsible healthcare practice are imperative healthcare actions.

Research questions:

What are the key obstacles to healthcare professionals supporting environmental sustainability? How may these obstacles be overcome?

Research design:

Data-driven thematic qualitative analysis of semi-structured interviews identified common and pertinent themes, and differences between specific healthcare disciplines.

Participants:

A total of 64 healthcare professionals and academics from all states and territories of Australia, and multiple healthcare disciplines were recruited.

Ethical considerations:

Institutional ethics approval was obtained for data collection. Participants gave informed consent. All data were de-identified to protect participant anonymity.

Findings:

Qualitative analysis indicated that Australian healthcare professionals often take more action in their personal than professional lives to protect the environment, particularly those with strong professional identities. The healthcare sector’s focus on economic rationalism was a substantial barrier to environmentally responsible behaviour. Professionals also feared conflict and professional ostracism, and often did not feel qualified to take action. This led to healthcare professionals making inconsistent moral judgements, and feeling silenced and powerless. Constraints on non-clinical employees within and beyond the sector exacerbated these difficulties.

Discussion:

The findings are consistent with the literature reporting that organisational constraints, and strong social identification, can inhibit actions that align with personal values. This disparity can cause moral distress and residue, leading to feelings of powerlessness, resulting in less ethical behaviour.

Conclusion:

The data highlight a disparity between personal and professional actions to address environmental sustainability. Given the constraints Australian healthcare professionals encounter, they are unlikely to shift to environmentally responsible practice without support from institutions and professional associations. Professional development is required to support this endeavour. The poor transference of pro-ecological behaviour from one setting to another is likely to have international implications for healthcare practice.

Environmentally sustainable health and social care: Scoping review and implications for the English NHS

Objectives

To review the evidence on environmental sustainability in health and social care, describe what the implications of sustainability might be for service models and policy, and explore the connection between environmental and financial sustainability.

Methods

Literature review of 78 published articles and qualitative analysis of 28 semi-structured interviews.

Results

Provision of health and social care has a substantial impact on the environment, and opportunities exist at a number of levels to deliver services in a more sustainable way. While there is some scope to improve efficiency at the operational level, significant improvements in sustainability may require a more fundamental transformation in service models, for example, with a stronger emphasis on prevention. The current policy framework in England is perceived to create a number of barriers that discourage professionals from redesigning services in ways which could promote both environmental and financial sustainability.

Conclusions

Increasingly, health and social care will need to be delivered in ways that are not only financially sustainable, but environmentally sustainable too. Close conceptual connections exist with improving productivity – focusing on cost-effectiveness, value and prevention of avoidable activity could enhance sustainability from both an environmental and a financial perspective. Priorities for health care organisations could include prevention, exploring the opportunities presented by new technologies, and improving medicines management and prescribing practices. Policy-makers need to explore what changes are needed to create a more enabling environment, as well as how existing policies can be delivered in the most sustainable way.

Reducing health care's carbon footprint--the power of nursing

Global warming and environmentalism continue to be national and international issues as their complexities and implications become better understood. One ironic contributor to the degradation of the environment is the health care system. Serving as clinical laboratories, hotels, restaurants, and offices that never close, U.S. hospitals produce more than 2 million tons of waste annually. Although the consequences and significance of health care's carbon footprint are undeniable, strategies to reduce this impact are challenging. This article discusses how the role, traits, and knowledge of nurses combined with their positions in the health care system make them key players in creating an environmentally sustainable health care industry. With an analysis of environmental action versus inaction, this article explores how nurses at the forefront of health care are equipped to change practice that will reach far beyond the bedside.

Hospitals going green: a holistic view of the issue and the critical role of the nurse leader

The healthcare industry produces millions of tons of waste each year and is one of the largest consumers of energy in the United States. This article focuses on how nurses can facilitate "green" hospitals and work toward environmental sustainability. The authors critically approach the topic from the perspectives of nursing, environmental health, psychology, politics, international health, economics, and ethics. Specifically, the article addresses the critical role of the professional nurse as a leader in the creation of environmentally friendly and holistic clinical practice.

Beyond climate focus and disciplinary myopia. The roles and responsibilities of hospitals and healthcare professionals

This paper calls for the need to address climate change within the concept of sustainable development, in recognition of the interrelationships between environmental, economic and social systems. So far, health- providing organizations such as hospitals have paid surprisingly little attention to the relationships between environmental change (e.g. climate change) and human health, or between hospitals (as professional organizations) and their impact on sustainable development. Although it is usually such industries as the chemical, extractive and metal industries, etc., that are associated with environmentally harmful activities, there is also an urgent need to emphasize the roles and responsibilities of hospitals and their embeddedness in a wider ecological, economic and social context. The key objective here is to discuss the relevance of sustainability and environmental management issues in a sector that until now has conveniently ignored its roles and responsibilities in relation to sustainability issues. The paper concludes that arguments based on systems theory, environment, medicine, economics and innovation strongly urge hospitals to reconsider their present roles and environmental responsibilities.

Reduce–Recycle–Reuse: Guidelines for Promoting Perioperative Waste Management

The perioperative environment generates large amounts of waste, which negatively affects local and global ecosystems. To manage this waste health care facility leaders must focus on identifying correctable issues, work with relevant stakeholders to promote solutions, and adopt systematic procedural changes. Nurses and managers can moderate negative environmental effects by promoting reduction, recycling, and reuse of materials in the perioperative setting.