Sustainability: an evolutionary concept analysis. Exploring nursing's role within the sustainability movement

Pro-environmental health behaviour and educational needs among pregnant women: A cross-sectional survey

AIM

To investigate pro-environmental health perceptions, behaviour and educational needs among pregnant women in Korea.

BACKGROUND

Based on concerns about the effects of environmental hazards and pollution on their babies and themselves, pregnant women behave in ways that protect their health. The framework of this study was based on Rogers' protection motivation theory.

DESIGN

Cross-sectional survey using questionnaires.

METHOD

The sample comprised 358 pregnant women recruited from July - August 2018 in South Korea. Participants were recruited from prenatal classes at two healthcare centres and patients receiving prenatal check-ups at two women's hospitals.

RESULTS

Perceived educational needs were ranked in the following order: particulate matter (23.7%), electromagnetic waves (11.7%), instant food (food additives) (9.0%) and environmental hormones (8.3%). Age (β = 0.17, p = .001), perceived severity (β = 0.19, p = .001) and response efficacy (β = 0.28, p < .001) affected pro-environmental behaviour, which explained 23.0% of the variance.

CONCLUSION

Educational programs are necessary for mitigating environmental risks during pregnancy. Pregnant women engage in pro-environmental behaviour influenced by pro-environmental perceptions, especially perceptions of severity regarding environmental diseases and the efficacy of health behavioural responses. Nursing professionals can use these results to promote pro-environmental health in pregnant women.

IMPACT

This study demonstrated that pregnant women need environmental health programs in prenatal education. Pro-environmental perceptions regarding the severity of the environmental diseases and behavioural efficacy preceded the formation of environmental health behaviours. Nurses should support pregnant women's environmental health through educational interventions including air, electromagnetic, food pollution and endocrine disruptors.

Comparing undergraduate student nurses' understanding of sustainability in two countries: A mixed method study

AIM

To explore sustainability education in nursing students in two countries.

DESIGN

Mixed methods including a sustainability survey and focus groups.

METHODS

First-year undergraduate nursing students from two countries were invited to participate. 69 students from China and 32 students from England agreed to take part. Data were collected between December 2015 and February 2016. Students completed the Sustainability Attitudes in Nursing Survey (SANS_2) and a purposive sample were invited to participate in focus groups in each country.

RESULTS

All students had a positive attitude towards sustainability. However, for these four items, the results indicated that Chinese nursing students rate them significantly higher in importance than English students: Climate change is an important issue for nursing Issues about climate change should be included in the nursing curriculum Sustainability is an important issue for nursing Sustainability should be included in the nursing curriculum. The qualitative data identified four themes: Student nurses' conceptual understanding of sustainability focused mostly on environmental aspects and clinical waste management; Promoting sustainability within nursing education: teaching and learning methods. Promoting sustainability within nursing education: evaluating and certifying learning. Factors to consider when introducing sustainability to nursing education. The paper outlines the similarities and differences between Chinese and English nursing students' perceptions.

CONCLUSION

Sustainability in nurse education has similar concerns across countries.

IMPACT

Sustainability is an important issue for student nurses but strategies promoting incorporation of sustainability issues within nursing curricula are needed.

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.

An undergraduate educational model for developing sustainable nursing practice: A New Zealand perspective

In this article we reflect on the concept of sustainability and in particular, sustainability within our undergraduate nursing programme. Given the complexity of global environmental change and the prediction that this will impact on health, nurses need to be responsive, knowledgeable and prepared to act on these changes (Anåker and Elf, 2014). Therefore as nurse educators we are responsible for ensuring that undergraduate nursing students are prepared for this reality. Sustainability is a relatively new concept emerging in the discipline of nursing. It is a multifaceted concept embedded within a systems framework, influenced by international, national and local factors. The concept of sustainability can be difficult to articulate and to evidence in daily nursing practice. Student nurses at the School of Nursing, Otago Polytechnic, Dunedin, are expected to meet the graduate profile indicating that they are a sustainability-practicing graduate on completion of their degree programme. As faculty staff, we have been encouraged to explore the concept of sustainability and how it relates to nursing practice. An in-depth review of the international literature, engagement of faculty colleagues, development of frameworks, and mapping of the educational content within the Bachelor of Nursing programme, has led us to develop a model for conveying and teaching sustainable practice.

Developing sustainable social programmes for rural ethnic seniors: perspectives of community stakeholders

This qualitative study explores barriers to delivering sustainable rural community programmes to increase social participation among Australian ethnic seniors. In 2013, in-depth interviews were conducted with 14 stakeholders across eight rural/regional organisations that had received state government funding to provide social participation initiatives for ethnic seniors. Within interviews, participants were asked to outline factors that had enhanced or hindered their capacity to deliver the funded projects, and their plans for sustainability. Data were analysed thematically in accordance with Shediac-Rizkallah and Bone's (1998) tripartite programme sustainability framework (project design and implementation, organisational setting and broader community environment). Findings indicate that in the context of resource and staffing constraints and a lack of ethnic critical mass, programme sustainability reflected the increased capacity of rural ethnic seniors to integrate into existing community groups and maintain their own groups and activities. However, this is dependent on the ability of mainstream government, health and social care services to cater for diverse cultural needs and preferences, the ability of rural organisations to support ethnic seniors to manage their own cultural groups and activities, and the capacity of funding bodies, rural community and policy structures to maintain cultural sensitivity while compensating for the rural premium. In addition to identifying some key learnings for rural governments, health and community organisations, this research highlights the precarious nature of rural programme sustainability for ethnic seniors in the context of wider community, organisational and policy constraints.

Searching for sustainability within public health policy: insights from an injury prevention perspective

Background

Sustaining public health programmes in the long-term is key to ensuring full manifestation of their intended benefits. Although an increasing interest in sustainability is apparent within the global literature, empirical studies from within the European setting are few. The factors that influence sustainability are generally conceptualized at three levels: programme level, the immediate context and the wider environment. To-date attention has focused primarily on the former two. Using a community-based child injury prevention programme in England as an exemplar, this paper explores the concept of sustainability within the wider policy environment, and considers the impact of this on local programmes.

Methods

A content review of global and UK national public health policies (1981-2014) relevant to child safety was undertaken. Interviews were held with senior representatives of global and UK agencies involved in developing child safety policy.

Results

Forty-nine policies were reviewed. The term 'sustain', or its derivatives, featured in 36 (73%) of these. Its' use however, related primarily to conservation of resources rather than continued programme operation. Potential mechanisms for supporting programme sustainability featured within some documents; however, the approach to sustainability was inconsistent between policies and over time. Policy stakeholders identified programme sustainability as relevant to their core business, but its' conceptualization varied according to individual interpretation.

Conclusions

Programme sustainability is poorly addressed within global and UK-based public health policy. Strengthening a national and international policy focus on sustainability and incorporating sustainability into public health planning frameworks may create a more supportive environment for local programmes.

Development and validation of the pro-environmental behaviour scale for women's health

AIM

This study was aimed to develop and test the Pro-environmental Behavior Scale for Women's Health.

BACKGROUND

Women adopt sustainable behaviours and alter their life styles to protect the environment and their health from environmental pollution. The conceptual framework of pro-environmental behaviours was based on Rogers' protection motivation theory and Weinstein's precaution adoption process model.

DESIGN

The cross-sectional design was used for instrument development.

METHOD

The instrument development process consisted of a literature review, personal depth interviews and focus group interviews. The sample comprised 356 adult women recruited in April-May 2012 in South Korea using quota sampling. For construct validity, exploratory factor analysis was conducted to examine the factor structure, after which convergent and discriminant validity and known-group comparisons were tested.

RESULTS

Principal component analysis yielded 17 items with four factors, including 'women's health protection,' 'chemical exposure prevention,' 'alternative consumption,' and 'community-oriented behaviour'. The Cronbach's α was 0·81. Convergent and discriminant validity were supported by performing correlations with other environmental-health and health-behaviour measures.

CONCLUSION

Nursing professionals can reliably use the instrument to assess women's behaviours, which protect their health and the environment.

An organizational perspective on the long-term sustainability of a nursing best practice guidelines program: a case study

BACKGROUND

Many healthcare innovations are not sustained over the long term, wasting costly implementation efforts and often desperately-needed initial improvements. Although there have been advances in knowledge about innovation implementation, there has been considerably less attention focused on understanding what happens following the early stages of change. Research is needed to determine how to improve the 'staying power' of healthcare innovations. As almost no empirical knowledge exists about innovation sustainability in nursing, the purpose of our study was to understand how a nursing best practice guidelines (BPG) program was sustained over a long-term period in an acute healthcare centre.

METHODS

We conducted a qualitative descriptive case study to examine the program's sustainability at the nursing department level of the organization. The organization was a large, urban, multi-site acute care centre in Canada. The patient safety-oriented BPG program, initiated in 2004, consisted of an organization-wide implementation of three BPGs: falls prevention, pressure ulcer prevention, and pain management. Data were collected eight years following program initiation through 14 key informant interviews, document reviews, and observations. We developed a framework for the sustainability of healthcare innovations to guide data collection and content analysis.

RESULTS

Program sustainability entailed a combination of three essential characteristics: benefits, institutionalization, and development. A constellation of 11 factors most influenced the long-term sustainability of the program. These factors were innovation-, context-, leadership-, and process-related. Three key interactions between factors influencing program sustainability and characteristics of program sustainability accounted for how the program had been sustained. These interactions were between: leadership commitment and benefits; complementarity of leadership actions and both institutionalization and development; and a reflection-and-course-correction strategy and development.

CONCLUSIONS

Study findings indicate that the successful initial implementation of an organizational program does not automatically lead to longer-term program sustainability. The persistent, complementary, and aligned actions of committed leaders, in a variety of roles across a health centre department, seem necessary. Organizational leaders should consider a broad conceptualization of sustainability that extends beyond program institutionalization and/or program benefits. The development of an organizational program may be necessary for its long-term survival.

Nurses' perceptions of climate and environmental issues: a qualitative study

AIM

The aim of this study was to explore nurses' perceptions of climate and environmental issues and examine how nurses perceive their role in contributing to the process of sustainable development.

BACKGROUND

Climate change and its implications for human health represent an increasingly important issue for the healthcare sector. According to the International Council of Nurses Code of Ethics, nurses have a responsibility to be involved and support climate change mitigation and adaptation to protect human health.

DESIGN

This is a descriptive, explorative qualitative study.

METHODS

Nurses (n = 18) were recruited from hospitals, primary care and emergency medical services; eight participated in semi-structured, in-depth individual interviews and 10 participated in two focus groups. Data were collected from April-October 2013 in Sweden; interviews were transcribed verbatim and analysed using content analysis.

RESULTS

Two main themes were identified from the interviews: (i) an incongruence between climate and environmental issues and nurses' daily work; and (ii) public health work is regarded as a health co-benefit of climate change mitigation. While being green is not the primary task in a lifesaving, hectic and economically challenging context, nurses' perceived their profession as entailing responsibility, opportunities and a sense of individual commitment to influence the environment in a positive direction.

CONCLUSIONS

This study argues there is a need for increased awareness of issues and methods that are crucial for the healthcare sector to respond to climate change. Efforts to develop interventions should explore how nurses should be able to contribute to the healthcare sector's preparedness for and contributions to sustainable development.

The sustainability of healthcare innovations: a concept analysis

AIM

To report on an analysis of the concept of the sustainability of healthcare innovations.

BACKGROUND

While there have been significant empirical, theoretical and practical contributions made towards the development and implementation of healthcare innovations, there has been less attention paid to their sustainability. Yet many desired healthcare innovations are not sustained over the long term. There is a need to increase clarity around the concept of innovation sustainability to guide the advancement of knowledge on this topic.

DESIGN

Concept analysis.

DATA SOURCES

We included literature reviews, theoretical and empirical articles, books and grey literature obtained through database searching (ABI/INFORM, Academic Search Complete, Business Source Complete, CINAHL, Embase, MEDLINE and Web of Science) from 1996-May 2014, reference harvesting and citation searching.

METHODS

We examined sources according to terms and definitions, characteristics, preconditions, outcomes and boundaries to evaluate the maturity of the concept.

RESULTS

This concept is partially mature. Healthcare innovation sustainability remains a multi-dimensional, multi-factorial notion that is used inconsistently or ambiguously and takes on different meanings at different times in different contexts. We propose a broad conceptualization that consists of three characteristics: benefits, routinization or institutionalization, and development. We also suggest that sustained innovations are influenced by a variety of preconditions or factors, which are innovation-, context-, leadership- and process-related.

CONCLUSION

Further conceptual development is essential to continue advancing our understanding of the sustainability of healthcare innovations, especially in nursing where this topic remains largely unexplored.