Sustainable healthcare education: A systematic review of the evidence and barriers to inclusion

PURPOSE OF THE ARTICLE

Health professions education is failing to prepare students to practice sustainable healthcare despite the climate crisis an urgent provision of educational opportunities is required. This systematic review aimed to synthesise educational approaches applied to sustainable healthcare education within health professions curricula and critically evaluate their impact.

MATERIALS AND METHODS

Databases searched: APA PsycInfo, BEI, CINAHL, Embase, ERIC, Medline, Scopus, Cochrane Library, Web of Science, BASE, DART-Europe, EThOS and ProQuest. Secondary searching techniques were also utilised, with searching conducted October 2021. Eligible studies included healthcare professional students/trainees, exposed to sustainable healthcare education, and evaluated through impact on knowledge, attitudes or skills. Empirical studies of any publication status were included. Non-English language studies were excluded. Eligible studies were quality assessed using JBI (2022) critical appraisal checklists and synthesised narratively.

RESULTS

Twenty-three studies were included, comprising 3343 participants and seven health professions. Studies primarily adopted a quasi-experimental design and demonstrated variable quality. Most common educational approaches were workshops and clinical skills sessions, though eight different approaches were observed. Positive impacts were achieved for knowledge, attitudes and skills.

CONCLUSIONS

Diverse approaches have been applied to sustainable healthcare education, though no superior approach is evident. Instead, many effective approaches are outlined, to be adopted in alignment with the learning outcomes.

Education for sustainable health care: From learning to professional practice

A number of planetary boundaries, including climate change as a result of greenhouse gas emissions, has already been exceeded. This situation has deleterious consequences for public health. Paradoxically, 4.4% of these emissions are attributable to the healthcare sector. These problems have not been sufficiently acknowledged in health professions curricula. This paper addresses two main issues, humanistic learning and the application of knowledge acquisition to clinical practice. Humanistic learning principles can be used to emphasize learner-centered approaches, including knowledge acquisition and reflection to increase self-awareness. Applying humanistic principles in everyday life and clinical practice can encourage stewardship, assisting students to become agents for change. In terms of knowledge and skills application to clinical practice, an overview of varied and novel approaches of how sustainable education can be integrated at different stages of training across several health care professions is provided. The Health and Environment Adaptive Response Taskforce (HEART) platform as an example of creating empowered learners, the NurSusTOOLKIT, a multi-disciplinary collaboration offering free adaptable educational resources for educators and the Greener Anaesthesia and Sustainability Project (GASP), an example of bridging the transition to clinical practice, are described.

Factors Influencing Arab Nursing Students' Attitudes toward Climate Change and Environmental Sustainability and their Inclusion in Nursing Curricula

OBJECTIVE

To assess the factors influencing the attitudes of Bachelor of Science in Nursing students toward climate change and environmental sustainability and the inclusion of these concepts in the nursing curricula of four Arab countries.

METHOD

A convenience sample of 1,059 students from four Arab countries was surveyed using the Environmental Sustainability Attitudes in Nursing Survey-2 (SANS-2) questionnaire in this descriptive-comparative study.

RESULTS

The majority of the respondents exhibited positive attitudes toward the five items of SANS-2, with "Environmental sustainability is an important issue for nursing" receiving the lowest mean score and "Issues about climate change should be included in the nursing curriculum" receiving the highest mean score. Saudi students had more positive attitudes toward environmental sustainability in health care compared with students from Iraq, Egypt, and the Palestinian Territories. Country of residence, type of community, and knowledge about environmental issues and their impact on health in any nursing course were significant factors that influenced attitudes toward environmental sustainability.

CONCLUSION

The inclusion of climate change and environmental sustainability in nursing curricula in the Arab region was emphasized by the findings. Including environmental sustainability practices in nursing education will help student nurses develop critical thinking and skills in the adaptive delivery of health care, especially when resources are scarce.

Developing awareness of sustainability in nursing and midwifery using a scenario-based approach: Evidence from a pre and post educational intervention study

BACKGROUND

The delivery of healthcare has an impact on the environment and contributes to climate change. As a consequence, the way in which nurses and midwives use and dispose of natural resources in clinical practice, and the subsequent impact on the environment, should be integral component of nursing and midwifery education. Opportunities need to be found to embed such issues into nursing curricula; thus bringing sustainability issues 'closer to home' and making them more relevant for clinical practice.

OBJECTIVES

The study was designed to measure the impact of a sustainability-focussed, scenario-based learning educational intervention on the attitudes and knowledge of student nurses and midwives.

DESIGN

Pre test/Post test intervention study using scenario-based learning as the educational intervention. The Sustainability Attitudes in Nursing Survey (SANS_2) was used as the outcome measure.

SETTINGS

Clinical skills session in a UK University School of Nursing and Midwifery.

PARTICIPANTS

676 second year undergraduate nursing and midwifery students.

METHODS

The 7-point scale SANS survey was completed before and after the teaching session; standard non-parametric analysis compared pre and post intervention scores.

RESULTS

Changes were observed in attitude towards climate change and sustainability and to the inclusion of these topics within the nursing curricula (p=0.000). Participants demonstrated greater knowledge of natural resource use and the cost of waste disposal following the session (p=0.000). Participants also reported that sessions were realistic, and levels of agreement with statements supporting the value of the session and the interactive nature of delivery were higher following the session.

CONCLUSIONS

Using a scenario-based learning approach with nursing and midwifery students can change attitudes and knowledge towards sustainability and climate change. Embedding this approach in the context of clinical skills provides a novel and engaging approach that is both educationally sound and clinically relevant.