The case for a paradigm shift: from global to planetary nursing

Eco-nursing competencies for nurses: A scoping review

Background

Nurses are tasked with addressing the health impacts of climate change. Eco-nursing competencies, covering knowledge, attitudes, and skills related to climate change, equip nurses to actively mitigate and adapt to its effects on health and the environment.

Objective

To synthesize existing literature on eco-nursing roles and competencies for nurses.

Methods

A scoping review of published papers examined nurses' roles and eco-nursing competencies. Databases searched included Academic Search Complete, CINAHL Plus, MEDLINE (PubMed), and Google Scholar. Search terms encompassed climate change and nursing synonyms, limited to English articles up to April 15, 2023. Thematic analysis was used to synthesize findings, delineating roles, and eco-nursing competencies. Results were tabulated.

Results

Out of 445 papers identified, 31 underwent data analysis. These papers highlighted nurses' roles in climate change (42%), along with climate change knowledge and skills (64.5%), and attitudes (13%). Roles encompassed research, education, advocacy, leadership, and clinical practice, with corresponding competencies embedded within existing core competencies for general nurses, nurse specialists, and nurse managers.

Conclusion

The review demonstrates that nurses' roles in climate change necessitate relevant knowledge, attitudes, and skills. Future research should contextualize these roles and eco-nursing competencies based on geographical locations, considering the distinct disease burden in each area.

Registration

The study protocol was registered in the Open Science Framework on 5 March 2023 before conducting the full study https://doi.org/10.17605/OSF.IO/9GC4N.

Tweetable abstract

Amidst growing concerns about climate change, nurses are increasingly tasked with preparing to mitigate its health impacts through the delineation of eco-nursing competencies. These competencies will equip nurses to effectively tackle the health and environmental ramifications of climate change, building upon existing core competencies tailored to various geographic contexts.

Nurses and Climate Change: A Narrative Review of Nursing Associations' Recommendations for Integrating Climate Change Mitigation Strategies

BACKGROUND

According to the World Health Organization, climate change is the greatest challenge of the twenty-first century. It is already affecting the health of many Canadians through extreme heat, wildfires and the expansion of zoonotic diseases. As trusted professionals, nurses are in favourable position to take action on climate change.

PURPOSE

To document the recommendations issued by Quebec, Canadian, American and international nursing associations regarding nursing practices that address climate change or environmental issues.

METHODS

This narrative review was conducted by establishing a list of environmental and general nursing associations in the geographical areas of interest through Google searches as well as by retrieving documents about climate change or environmental issues published by these organizations on their websites. Data related to the documents' characteristics and recommended nursing roles were then extracted.

RESULTS

The review identified 13 nurses' organizations and 20 documents describing 37 recommendations for nurses in seven socioecological areas: individual, patient-focused, workplace, nursing associations, public health organizations, political and education.

CONCLUSIONS

There is a gap between the breadth of roles that nurses may be called upon to play in addressing climate change and the degree to which relevant organizations are prepared to create the required conditions for them to do so. Several lessons emerged, including that the urgency of the climate crisis requires clear guidelines on how nurses can integrate climate change and its resultant health concerns into practice through nurses' associations, education and bottom-up nursing innovations. Funding is required for such initiatives, which must also prioritize health inequalities.

The perspectives of nurses, as prominent advocates in sustainability, on the global climate crises and its impact on mental health

OBJECTIVE

To evaluate the perspective of nurses in Turkey towards the global climate crisis and its impact on mental health using a qualitative approach.

MATERIALS AND METHOD

This study was conducted from August to September 2023 with 35 nurses living in seven regions of Turkey using an inductive qualitative approach. The researchers employed the snowball sampling method to select participants. Interviews with the participants were conducted until data saturation was reached. Thematic analysis was used to emerge themes.

RESULTS

The findings revealed five main themes (perception of the global climate crisis, effects of the global climate crisis, effects of the global climate crisis on mental health, reflections of the global climate crisis on nursing and nurses' views on prevention and intervention studies for the global climate crisis). Also, the findings revealed 12 sub-themes (physical outcomes, mental outcomes, direct and indirect impacts, psychosocial effects and personal, national and international-based reflections).

CONCLUSION

Our study indicates that nurses exhibit genuine concern for the global climate crisis and experience psychological effects related to this pressing environmental issue. Nurses are keenly aware of their responsibility to safeguard the planet and demonstrate a strong sense of concern for the state of the world.

IMPACT

It is evident that nurses, being prominent advocates for sustainability, are cognizant of their responsibility to protect the planet and demonstrate genuine apprehension for the state of the world.

IMPLICATIONS

Nurses play a crucial role, as they make up 60% of the global healthcare workforce and are often the frontline healthcare professionals during natural disasters. It is vital to elucidate and clarify the terminology concerning the relationship between the climate crisis and the mental health of nurses, to determine the scope of this relationship and to make recommendations for future research areas.

PATIENT OR PUBLIC CONTRIBUTION

No patient or Public Contribution.

Planetary Health: Preparing Nursing Students for the Future

BACKGROUND

Climate change around the globe is impacting human and planetary health at unprecedented rates. Nurses are well positioned to act as climate leaders, given their critical role globally.

PROBLEM

Current and future nurses must work to mitigate climate-related health effects. It is necessary that a planetary health approach is integrated into nursing education.

APPROACH

Curricular modifications, using the Planetary Health Education Framework, are presented, which will promote awareness and understanding of climate health among future nurses. The framework is grounded in equity, which is well suited to nursing education, and can be readily adapted into current nursing curricula.

OUTCOMES

Recommendations for nursing education are presented within the 5 domains of the framework.

CONCLUSIONS

Future nurses are called on to be exemplary planetary health communicators, educators, advocates, and leaders. The Planetary Health Education Framework promotes nursing leadership in practice and in advocating for a climate-resistant future.

The interfaces between One Health and Global Health: A scoping review

One Health (OH) and Global Health (GH) are interconnected perspectives that may contribute to subsidizing GH policies. This scoping review aims to map the volume, nature, and characteristics of studies focused on the interface of OH and GH concepts. We used PubMed (MEDLINE), Embase, Scopus, and The Virtual Health Library (BVS) as the literature data sources for the review. The search strategy used the descriptors "one health", "one health concept", "one medicine", "global health", "international health", and "planetary health" in title and abstracts. We included original research presented as articles in scientific journals, book chapters or conference papers written in English, Spanish, or Portuguese, exploring the intersections between OH and GH concepts, not necessarily as their primary objectives, and published up to December 31, 2021. A total of 1.060 references were identified in the databases after removing duplicates, 139 publications selected for full-text evaluation and 45 publications were included for analysis. All included publications were published between 2011 and 2021, with the highest concentration in 2014 (22.2%). First authors were most frequently from the United States (35.6%), followed by the United Kingdom (15.6%). Overall, seven key themes were identified zoonosis, emerging infectious diseases, antimicrobial resistance, food safety, policy, human resources, and Sustainable Development Goals (SDG). The majority of the included publications employed OH concepts based on the United States Centre for Disease Control and Prevention, and the American Veterinary Medical Association definitions. We observed a common understanding of OH as an area of knowledge involving multiple disciplines and professionals and recognizing that both humans' and animals' health and the environment are interdependent. Although most authors demonstrated that health issues transcend national boundaries, a formal definition for GH was frequently not clearly identified. OH and GH interfaces are essential for accomplishing the 2030 Agenda and its SDG.

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.

An authentic learner-centered planetary health assignment: A five-year evaluation of student choices to address Sustainable Development Goal 13 (Climate Action)

A Code Red has been declared for the planet and human health. Climate change (e.g., increasing temperatures, adverse weather events, rising sea levels) threatens the planet's already declining ecosystems. Without urgent action, all of Earth's inhabitants face an existential threat. Health professions education should therefore prepare learners to not only practice in a changing world, but authentic educational activities should also develop competencies for global and planetary citizenship. Planetary health has been integrated across the five-year Bond University (Australia) medical curriculum. It begins in the second week of Year 1 and ends with a session on Environmentally Sustainable Healthcare in the General Practice rotation in the final year. The purpose of this article is to describe the outcomes of the first 5 years (2018-2022) of a learner-centered planetary health assignment, underpinned by the 2030 United Nations (UN) Sustainable Development Goals (SDGs), in the second year of a five-year medical program. Using systems and/or design thinking with a focus on SDG13 (Climate Action) plus a second SDG of choice, self-selected teams of 4-6 students submit a protocol (with feedback) to develop a deliverable "product" for an intended audience. Data analysis of the first 5 years of implementation found that the most frequently selected SDGs in addition to SDG13 were: SDG12 Sustainable Production and Consumption (41% of teams), mostly relating to healthcare emissions and waste; SDG3 Health and Well-being (22%), generally involving the impact of air pollution; and SDG6 Clean Water and Sanitation (15%). A survey at the concluding conference garnered student feedback across various criteria. The planetary health assignment is authentic in that teams provide solutions to address climate change. Where appropriate, final "products" are sent to local or federal ministers for consideration (e.g., policy proposals) or integrated into the curriculum (e.g., learning modules). We believe that the competencies, attitudes, and values fostered through engagement with planetary health. Throughout the medical program, as evidenced by their evaluations, stands students in good stead to be change agents, not only in clinical practice but in society. An awareness has been created about the need for planetary citizenship in addition to global citizenship.

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.

Planetary Health Nursing

ABSTRACT

Planetary health is focused on the interconnectedness of the health of humans, other species, and the physical environment. Disruption of the Earth's natural ecosystems due to human overconsumption; disregard for sustainable practices; and the domination of other humans, species, and natural systems has led to an urgent moment in which humans must act to preserve these ecosystems, which support life on this planet. Restoring planetary health requires new directions for nursing. The pragmatic implications for nursing research, education, advocacy, and practice are explored in this article.

Sustaining planetary health through systems thinking: Public health's critical role

Understanding and responding to adverse human health impacts of global environmental change will be a major priority of 21st century public health professionals. The emerging field of planetary health aims to face this challenge by studying and promoting policies that protect the health of humans and of the Earth's natural systems that support them. Public health, drawing on its experience of guiding policies to improve population health, has contributed to planetary health's development. Yet, few public health practitioners are familiar with planetary health's systems-oriented approaches for understanding relationships between economic development, environmental degradation, and human health. In this narrative review, we present key planetary health concepts and show how systems thinking has guided its development. We discuss historical approaches to studying impacts of economic development on human health and the environment. We then review novel conceptual frameworks adopted by planetary health scientists to study and forecast impacts of policies that influence human health and Earth's natural systems at varying spatiotemporal scales. We conclude by presenting examples of how applying the "Doughnut" model (an economic framework where the needs of people are met without overshooting the world's ecological limits) could guide policies for promoting health co-benefits to humans and natural systems.

Nursing strategies for environmental justice: A scoping review

OBJECTIVE

To describe types of strategic actions nurses take to promote environmental justice (EJ) through research, education, advocacy, and practice (REAP) reported in peer-reviewed literature.

DESIGN AND SAMPLE

A scoping review of literature was conducted that described EJ nursing strategies and included nurses listed as authors, subjects, partners, or organizational members. The sample consisted of 35 articles, representing 24 primary research studies and 11 nonresearch articles. Data were separately analyzed by research and nonresearch articles for a clearer understanding of evidence-based strategies within domains of REAP.

RESULTS

Articles in the sample highlighted the importance of authentic community partnership and represented diversity of nursing strategies that addressed a range of environmental exposures and subsequent health and racial inequities. Climate justice, a concept that emerged from the EJ movement and intersects with planetary health, is a recent focus in professional nursing.

CONCLUSIONS

This scoping review establishes an understanding of the extent of nursing knowledge and research in EJ and lays the groundwork for further research on effective EJ nursing strategies. Community-Based Participatory Research/Participatory Action Research methods are fundamental for EJ research, and further theoretical development is needed to guide evaluation of EJ nursing strategies for education, advocacy, and practice.

European Nursing Council Code for European nursing and the UN Sustainable Development Goals

A code of ethics for the practice of nursing seeks to capture, in a written document, the normative values, ethical principles and standards of good care to guide nurses - qua moral agents. A codification of the accepted collective values of nursing can play a constitutional and directional role for the profession. It can further stimulate discussions about nursing that reflect the dynamic essence of the profession. Consequently, there is merit to continually reflecting on a code's function and role especially when a new or revised code is introduced to the nursing profession and the wider public such as the European Nursing Council's Code of Ethics and Conduct for European Nursing. This paper examines codes of ethics in general and the European Nursing Council Code in particular using the framework of Gaumnitz and Lere. Although the European Nursing Council Code has all the ingredients of a contemporary professional ethics code, our position is that future iterations or addenda to this Code should be aligned to the UN Sustainable Development Goals and take a more radical step in becoming an exemplar of a nursing code that can be a catalyst for the advancement of the Sustainable Development Goals.

Is there a place for servant leadership in nursing?

With nursing in the spotlight in 2020, Catherine Best explores the role servant leadership can play in strengthening the profession

As 2020 is the International Year of the Nurse and Midwife, nursing is in the spotlight. Nurses are well-placed to help achieve the United Nations Sustainable Development Goals which aim to improve health globally. However, in order to do so, high-quality healthcare leadership is needed. Disengaged leaders, high turnover, poor organisational culture and dysfunctional external relations can affect nurses' capacity to deliver optimum care. This article considers the role of the servant leader in bringing together nurses from all nations to speak with one voice in order to positively influence global health.

The United Nations Sustainable Development Goals: The Ethic and Ethos of Holistic Nursing

Holistic nursing is founded on the values of integrality and the awareness of whole-people and whole-system interconnectedness. These concepts are foundational to the broader global health agendas and initiatives of our time, which seek to improve human, animal, and planetary health. The United Nations 2030 Agenda for Sustainable Development represents the most remarkable transnational initiative in history: a 15-year plan (2015-2030) rallying the efforts of all countries, governments, and concerned citizens worldwide to foster human-planet thriving and survival. The purpose herein is to substantiate the United Nations 2030 Agenda as a holistic nursing priority and theory-practice opportunity for current and future professional maturation. This article provides a background of the 17 Sustainable Development Goals (SDGs), a discussion regarding their relevance to holistic nursing, and an explanation of the essential nature of partnerships in attaining each of these "Global Goals." We link the discussion of the SDGs directly to the American Holistic Nurses Association's Core Values and identify implications for practice, education, research, and policy. Holistic nursing is ideally situated throughout the health care system and in the broader global context to advocate and advance the SDGs.