Climate change integration in nursing education: A scoping review

BACKGROUND

The environmental impacts of climate change such as extreme weather, affects human physical and mental health; therefore, including climate change and health is important in nursing education. Despite the recognition of the link between climate change and health, this important knowledge has not yet been systematically integrated into nursing curricula, highlighting the need for immediate action to prepare nurses for these emerging human health challenges.

OBJECTIVES

The objective of this review was to gain an overview of the existing literature exploring climate change in nursing curricula and answer following questions: DESIGN: Scoping review.

METHODS

A protocol was created and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Checklist (PRISMA-SrC). Five data bases were searched: CINAHL, Academic Search Premier, PubMed, Scopus and Cochraine, in addition to databases, grey literature was searched from different sources (reference lists, Google). A total of 1055 articles were derived from the search and 47 articles were included in this review. After selection results from selected studies on educational interventions and climate change education, and opinion pieces were charted, followed by a team review and consensus on the findings.

CONCLUSION

This review shows the importance of integrating the topic of climate change into nursing curricula. This integration of climate change-related content into nursing curricula is essential for preparing students, not just for their future roles in healthcare, but also their role in policy and climate justice. These results also reflect strong support from students for that integration. But while progress has been made, further research is essential to evaluate the impacts of these teaching strategies on nursing education.

Effect of an Education Intervention on Nursing Students' Knowledge of and Attitudes Toward Caring for Transgender and Nonbinary People

BACKGROUND

Transgender and nonbinary (TGNB) people experience inequities in health care access, quality, and outcomes. Health care professionals' lack of knowledge and biased attitudes toward gender minorities contribute to inequitable care.

PURPOSE

This study examined the effect of TGNB health education on nursing students' knowledge and attitudes about caring for TGNB clients.

METHODS

A quasi-experimental study using a one-group pretest/posttest design was conducted with 46 nursing students at 2 private baccalaureate nursing programs.

RESULTS

A paired-samples t test found a significant increase in knowledge about caring for TGNB clients at posttest (P = .02). Attitudes toward caring for TGNB clients showed a significant improvement in the Sex and Gender Beliefs subscale at posttest (P = .014).

CONCLUSIONS

The findings suggest that TGNB health education is effective for inclusion in nursing curricula to better prepare nurses to care for gender-diverse clients.

Protecting Children's Health: Asthma and Climate Change

ABSTRACT

Children are particularly vulnerable to the impacts of climate change. Their lungs are developing, making children with asthma especially susceptible to temperature extremes, variations in precipitation, poor air quality, and changes in pollen and flora. Structural and social determinants of health, such as racism and poverty, that disproportionately affect children of color are linked to higher rates of asthma and negative effects of climate change. These factors lead to increased absences from school and social activities, loss of work for caregivers, and increased health care costs, thus negatively affecting children, their families, and the greater community. Nurses must support caregivers and children to link climate change to asthma care, be involved in health education; climate change mitigation and adaptation strategies and policies; and develop the evidence to address climate change and asthma strategies. We address the impacts of climate change on children with asthma and nursing adaptation responses.

Nursing Students' Self-Efficacy in Immigrant Health

BACKGROUND

The United States has the largest, most diverse immigrant population. Nurses will care for immigrant clients in all areas of nursing practice.

PURPOSE

The purpose of this study was to determine nursing students' self-efficacy in working with immigrant clients following a service-learning experience.

METHODS

A pre-/posttest descriptive study was used to measure students' self-efficacy in cultural aspects of screening, providing health education, and assisting with health care access prior to and after a voluntary service-learning experience at a resettlement agency.

RESULTS

Statistical significance was found in overall scale score and in all 19 individual items except 2 related to working with (P = .21) and communicating with (P = .49) the health care team. Overall, pretest and posttest results revealed that students' self-efficacy working with immigrant clients was improved.

CONCLUSION

Collaborating with an immigrant resettlement program to provide a structured immigrant health learning experience for prelicensure nursing students can improve self-efficacy in working with immigrant clients.

Factors That Influence Climate Change-Related Mortality in the United States: An Integrative Review

Global atmospheric warming leads to climate change that results in a cascade of events affecting human mortality directly and indirectly. The factors that influence climate change-related mortality within the peer-reviewed literature were examined using Whittemore and Knafl’s framework for an integrative review. Ninety-eight articles were included in the review from three databases—PubMed, Web of Science, and Scopus—with literature filtered by date, country, and keywords. Articles included in the review address human mortality related to climate change. The review yielded two broad themes in the literature that addressed the factors that influence climate change-related mortality. The broad themes are environmental changes, and social and demographic factors. The meteorological impacts of climate change yield a complex cascade of environmental and weather events that affect ambient temperatures, air quality, drought, wildfires, precipitation, and vector-, food-, and water-borne pathogens. The identified social and demographic factors were related to the social determinants of health. The environmental changes from climate change amplify the existing health determinants that influence mortality within the United States. Mortality data, national weather and natural disaster data, electronic medical records, and health care provider use of International Classification of Disease (ICD) 10 codes must be linked to identify climate change events to capture the full extent of climate change upon population health.

The role of nurses in surveillance to enhance global health security: A delphi study

BACKGROUND

Internationally, nurses are gaining recognition for their contributions to public health and global health initiatives, however, their contributions to surveillance and the detection of new and emerging infectious disease, which is an important element of global health security, remain largely unknown.

PURPOSE

The purpose of this study was to investigate the perceptions of nurse experts related to the current and optimal roles of nurses in surveillance of new and emerging infectious diseases. Additionally, this study aimed to identify the skills needed by nurses in all practice settings for optimal performance of surveillance and to identify barriers to achieving optimal performance of surveillance.

METHODS

A three-round Delphi study was conducted. Nurse experts participated in Round 1 interviews followed by ranking current and optimal role, skill, and barrier statements in Rounds 2 and 3.

FINDINGS

Findings revealed four current roles and 13 optimal roles for nurses in surveillance, 13 skills needed to perform surveillance activities, and seven barriers to optimal performance of surveillance activities by nurses.

DISUCSSION

Results of this study are intended to inform nursing practice and education in the U.S., and to provide guidance on the role of nurses in surveillance of new and emerging infectious disease as part of the Global Health Security Agenda.

Nurses´ and nurse managers´ perceptions of sustainable development in perioperative work: A qualitative study

AIMS AND OBJECTIVES

To describe how nurses and nurse managers consider sustainable development principles in their daily work, how well they recognise these principles and how these principles are considered in decision-making in perioperative work.

BACKGROUND

Sustainable development involves interpersonal social and cultural relations and long-term economic and ecological thinking in societal decision-making. These dimensions are well-suited for a foundation of decision-making in acute health care. No previous research has been performed on perioperative work from the sustainable development perspective.

DESIGN

Qualitative descriptive design was used. Data were collected from perioperative nurses (n = 20) and nurse managers (n = 6) working in five surgical departments in a Finnish university hospital. Data were analysed by content analysis. The reporting follows qualitative research checklist (COREQ).

RESULTS

The principles of sustainable development were poorly known among the participants. Nurse managers considered their opportunities to influence decision-making were reduced by their limited economic knowledge. Resource use, individuality, and ecological viewpoints were emphasised in the decision-making process in perioperative work.

CONCLUSIONS

Findings reveal that perioperative nurses and nurse managers are aware of economic and ecological sustainability, but they do not actively consider it as part of their work. Social and cultural sustainability must be developed further in decision-making in perioperative work.

RELEVANCE TO CLINICAL PRACTICE

Perioperative nurses and nurse managers consider that it is important to develop the principles of sustainable development in perioperative work. This research indicates that economic understanding is not guiding decision-making, and there is a lack of knowledge about the benefits of ecological procedures. Social and cultural sustainability are not connected in perioperative work, although there is collaboration between the surgical team and the patient is essential. This study helps to organise operating room management effectively and diversely.

Advancing Gerontological Nursing Science in Climate Change

Older adults have unique health risks related to climate change. This commentary addresses the health impacts of climate change for older adults, identifies gaps in gerontological nursing research, and highlights areas for research to address the significant gap in nursing science. Climate risks of extreme weather events, such as heat, rain, flooding, and wildfires, as well as poor air quality, vector-borne diseases, interruptions of services, and treatment plans all place older adults at risk of experiencing greater morbidity and early mortality. Despite these risks, there is a gap in nursing research related to climate change and aging. Nurse scientists can address this gap with an interdisciplinary approach. There are climate resources and theoretical frameworks to support scientific inquiry. Funding sources must be made available to assure rigorous scholarship of climate-related health impacts for older adults. Gerontological nurse researchers must build capacity to address climate change and health. [Research in Gerontological Nursing, 13(1), 6-12.].

Promoting education on the health effects of climate change for nurses in Finland

Background

Climate change has a direct and indirect impact on human health that include health impacts from rising temperatures and poor air quality. Without changes in our greenhouse gas emissions, it is estimated that by the end of this century average temperatures will rise from two to four degrees Celsius worldwide. In Finland, this rise in temperature is estimated to be 1.5-2 times higher than other regions of the world. During the heatwaves in Finland in the 2000s, the mortality rate among the elderly increased by 21%. Nurses should be aware of these health effects and the patients who are particularly vulnerable to the health impacts caused by climate change.

Purpose

The purpose of the study was to identify the health issues that Finnish nurses associate with climate change. The purpose was also to find out how prepared nurses are to deal with the health effects of climate change.

Methods

A qualitative descriptive study was conducted in November 2018 using focus group interviews to collect data.

Results

Interviews revealed that nurses have seen much of the health damage caused by climate change in their patients. However, they had not linked their observed changes in patients' health to climate change. Nurses interviewed felt unaware of the health effects of climate change. In addition, nurses felt that climate change was not adequately addressed in basic and in-service training.

Conclusions

Education could strengthen the competence of nurses in helping their patients prevent and reduce the health impacts caused by climate change. It is therefore important to include climate change and its impact on human health in the nursing curriculum.

Key messages

Nursing organizations can influence nurses’ understanding of climate change in their practice. Nurses' understanding can be used leverage their role in reaching nurses for new and emerging health conditions that influence public health.

Identifying best practices in electronic health record documentation to support interprofessional communication for the prevention of central line-associated bloodstream infections

BACKGROUND

There is a paucity of research on best practices for communication through the electronic health record (EHR) to support shared decision-making and to prevent adverse events. To explore this issue, this study focused on interprofessional communication around a specific clinical issue, the prevention of central line-associated bloodstream infections.

METHODS

The Delphi technique was used to describe what information is needed to support decisions regarding central venous catheter (CVC) management, and best practices for communicating this information among the interprofessional team.

RESULTS

The expert panel, 4 physicians and 6 nurses, identified 12 information types necessary for decisions regarding CVC management and the removal of unnecessary lines. For each of the 12 information types, the panel reached agreement regarding the best channel to communicate this information, including asynchronous EHR formats and synchronous oral channels.

CONCLUSIONS

Findings address 2 important aspects of postinsertion CVC practices and a gap in the literature by moving beyond a description of current practices to a description of how the EHR ought to be used to support collaboration and interprofessional communication. Future research should examine how the communication practices identified in this study contribute to a reduction in central line-associated bloodstream infections.

Health Concerns of Northeastern Pennsylvania Residents Living in an Unconventional Oil and Gas Development County

OBJECTIVES

This study was conducted to describe the health concerns of residents of an unconventional oil and natural gas development (UOGD) community and identify methods to best disseminate health information to the residents.

DESIGN AND SAMPLE

A qualitative descriptive study of 27 residents of Wyoming County, Pennsylvania, was conducted.

RESULTS

Residents described their health concerns in terms of their changing community as a result of UOGD, their feelings of stress and powerlessness related to these changes, and the limited response of their local policymakers and protective agencies. There were indications of misinformation related to routine environmental health and UOGD environmental risks. Web-based educational programs with downloadable printed materials to bridge the knowledge gaps of residents and health professionals are recommended.

CONCLUSIONS

Recommendations include public health nurses providing education to communities and other health professionals regarding environmental health risks, working with communities to advocate for health-protective regulations, and adopting a community-based participatory approach to meet the needs of community members.

Promoting cultural understanding through pediatric clinical dyads: an education research project

This project explored the experiences of six undergraduate nursing students, three American nursing students and three nursing students from the Sultan of Oman, who participated in a faculty initiated education research project as part of their pediatric clinical practicum. Students were placed in dyads, with one American-born student and one Omani student in each dyad. Omani students also were paired with American nurse preceptors. A transcript-based content analysis was used to analyze data generated from qualitative focus group student interviews and student journals. The analysis generated three themes that described how myths were dispelled, cultural barriers were broken down and knowledge gained from another cultural perspective. The nurse preceptors were surveyed at the conclusion of the program. The survey findings suggest that preceptors gained a different cultural perspective of nursing care and they were better informed of the Omani students' learning needs. There was, however, an additional investment of preceptor time in meeting the learning needs of international students. Additional faculty time was also required for preparation and time during clinical conferencing to address differences in nursing practice between U.S. and Oman while meeting course learning objectives. Overall, the educational program provided evidence of enhancing American and Omani student cultural competence and Omani student adaptation to the United States. Coupling a domestic student with an international student to form dyads from the beginning of international students' experience could be a significant enhancement to both groups of students' learning experience.

Nursing education's response to the 1995 Institute of Medicine Report: Nursing, Health, and the Environment

PROBLEM

Although environmental health has been central to nursing practice since the work of Florence Nightingale, the inclusion of environmental health concepts into nursing education has, for the most part, been confined to public health and occupational health nursing. The 1995 Institute of Medicine report, Nursing, Health, and the Environment, clearly stated that environmental health was an important aspect of nursing practice, but nurses were not adequately educated to address such in their practice.

METHODS

This article highlights the initiatives by nurse educators, faculty development programs, federal agencies, nonprofit organizations, and private foundations to educate and engage nurses in environmental health since 1995, with a focus on the Alliance of Nurses for Healthy Environments. The historical summary was developed using professional literature, documents, personal interviews, and survey data.

FINDINGS

Nurses responded to the mandates of the 1995 Institute of Medicine report, Nursing, Health, and the Environment, in formal educational programs, through continuing education for nurses, workshops, symposia, and regional faculty development trainings. Since the formation of the Alliance of Nurses for Healthy Environments, collaborative efforts led to the development of competencies, nursing outreach to organizations such as the American Nursing Association, the National Council of State Boards of Nursing, and the American Association of Colleges of Nursing to advance practice standards, academic curriculum, and the development of an electronic textbook.

CONCLUSION

The environmental health nursing agenda moved forward since the publication of the 1995 IOM report; however, the development of the Alliance of Nurses for Healthy Environments accelerated the educational accomplishments through organizational collaboration.

Female Arab-Muslim Nursing Students’ Reentry Transitions

As nursing students are increasingly studying abroad and returning to their home countries to practice, it is important to identify international nursing students’ reentry transition to understand their reentry needs. Phenomenological inquiry was used to describe the reentry experience of seven Omani nurses after studying in the United States. The nurses’ reentry experience was influenced by the personal and professional transformation from studying abroad and included themes of adaptation to cultural differences and service to themselves, their profession, and their nation. These nurses returned home to resume previous roles; they were changed and this required them to redefine and adapt to their roles within their families and workplace. Nurses returning from international study could benefit from a formal reentry program to assist their transition to family, community, and professional life and to enhance the nurses’ contribution from their international education.

Health promotores' perceptions of their communities' health needs, knowledge, and resource needs in rural Nicaragua

OBJECTIVES

This study was conducted to determine rural Nicaraguan health promotores' perceptions of their community's health problems, their self-identified learning needs, and resource needs. Despite the valuable contributions of promotores, there is limited research regarding unpaid volunteer promotores' perceptions of their needs in providing care to remote communities.

DESIGN AND SAMPLE

A qualitative descriptive study of 13 unpaid, volunteer promotores in Waslala, Nicaragua, was conducted.

MEASURES

Data were collected during individual interviews with seven promotores and two focus groups with 13 promotores. Data were analyzed by reading verbatim transcripts repeatedly and establishing general themes. Promotores confirmed the findings.

RESULTS

Waslalan promotores described a synergy of traditional folk health beliefs and natural practices along with use of modern medications while working to meet the health needs of their communities. Without much formal training, the promotores used public health strategies to influence health behaviors and address health disparities in the communities they serve. Serving their communities and God were their motivation in their work.

CONCLUSIONS

Recommendations include supporting efforts to meet promotores' needs regarding community health education with messages from community leaders and nurses, finding methods to financially compensate promotores, and including promotores in health program planning and evaluation.

Preserving health in the Marcellus region

Community health nurses (CHNs) have an opportunity and responsibility to address potential environmental health issues related to shale drilling, even in the face of scientific uncertainty. Potential health impacts to air and water quality related to shale drilling are addressed within the context of the CHNs role of educator, case finder, advocate and researcher. Since 2005, an estimated 5,500 unconventional natural gas wells have been drilled in Pennsylvania's Marcellus Shale (Pennsylvania Department of Environmental Protection [PA DEP], n.d.), resulting in tremendous controversy throughout the state regarding impacts to human health and the environment. Although there are numerous anecdotal reports of illnesses in humans and animals living in drilling areas, there is a notable lack of peer-reviewed research on the impacts. Research efforts are underway to study these issues, including a proposed retrospective study of hospital and clinic data by Geisinger Health System's Weis Center for Research (Begos, 2012). However, CHNs have the opportunity and the responsibility to help address potential environmental health issues related to shale drilling, even in the face of scientific uncertainty. This responsibility is highlighted by the American Nurses Association's (ANA) (2003, p. 2) adoption of the Precautionary Principle, which states that "when an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically." CHN practice includes the promotion and preservation of health, and the prevention of disease, as well as assisting people in their response to illness (Maurer & Smith, 2009). In Pennsylvania's Marcellus Shale regions, CHNs must assume the critical nursing roles of educator, case finder, advocate and researcher when addressing the health needs in shale drilling communities. Unfortunately, CHNs practicing within these regions may feel unprepared to take on these roles related to unconventional gas extraction. The following discusses these CHN roles in the context of environmental health impacts of shale drilling on air and water quality.

Identifying the key personnel in a nurse-initiated hospital waste reduction program

Hospitals in the United States generate more than 6600 tons of trash a day and approximately 85% of the waste is nonhazardous solid waste such as food, cardboard, and plastic. Treatment and management of hospital waste can lead to environmental problems for the communities that receive the waste. One health system's shared governance model provided the foundation to develop a nurse-led hospital waste reduction program that focused on point-of-care waste management. Waste reduction program development required working with a variety of departments within and external to the health system. The interdisciplinary approach informed the development of the waste reduction program. This article identifies the key departments that were necessary to include when developing a hospital waste reduction program.