Toward a Climate-Ready Health Care System: Institutional Motivators and Workforce Engagement.

Policy Points The US health care system faces mounting pressure to reduce greenhouse gas emissions and adapt to the impacts of climate change; motivated institutions and an engaged health care workforce are essential to the development, implementation, and maintenance of a climate-ready US health care system. Health care workers have numerous profession-specific and role-specific opportunities to address the causes and impacts of climate change. Policies must address institutional barriers to change and create incentives aligned with climate readiness goals. Institutions and individuals can support climate readiness by integrating content on the health care implications of climate change into educational curricula.

The Future of Nursing 2020-2030: The Critical Role of Nurses and Nurse Leaders in Addressing the Health Impacts of Climate Change.

Climate change represents a looming health challenge and a critical area for nursing leadership at all levels of organizations and settings. With a lens on The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity, addressing climate change-related health consequences should be a major focus and spotlight for nurses and nurse leaders with a lens on individuals, communities, populations, and from a national and global perspective.

A cross-sectional study to assess faculty and student knowledge of climate change and health: Readiness for curricular integration.

AIMS: To examine the perceived knowledge, attitudes and beliefs regarding climate change and health of academic faculty and students in programmes for health professionals and to identify barriers/facilitators to and resources required for curriculum integration. DESIGN: Cross-sectional survey eliciting quantitative and open-ended responses. METHODS: A 22-question survey to assess climate-health knowledge/attitudes/beliefs was distributed to all students and faculty (n = 224) at one academic institution in the United States. Open-ended questions addressed barriers, facilitators and required resources. Descriptive statistics are reported, and thematic analysis was used to identify themes from open-ended responses. RESULTS: Response rate was 15%. Most respondents (76%) were between 20 and 34 years old. The majority were from nursing (39%), occupational therapy (13%) and communication speech disorders (12.5%). Most respondents perceived climate change as relevant to direct patient care (78%) and believed that it is impacting the health of individuals (86%) and should be integrated into curricula (89%). Yet, most (60%) reported modest to no knowledge about the health impacts. Faculty reported little to no comfort teaching climate change and health concepts (76%). Open-ended responses identified student/faculty receptivity and professional/clinical relevance as important facilitators of successful integration. Barriers included intensity of programmes; time and competing curricular priorities; and a lack of faculty expertise, resources, institutional and professional commitment. CONCLUSIONS: Most health professions students and faculty indicated that educating future health professionals about climate change and health is important, but existing barriers must be addressed. IMPACT: This study addressed student and faculty perceptions of integrating climate change and health into health professions curricula. Discipline-specific and interprofessional educational approaches are necessary to optimize future health professionals' efforts to prevent and mitigate climate change impacts for at-risk patients, communities and populations.

Health impacts of climate change on gender diverse populations: A scoping review.

PURPOSE: To determine what is known about climate change health effects for gender diverse (GD) populations, and identify gaps in research, practice, education, and policy. DESIGN/METHODS: A scoping review was conducted. FINDINGS: Twenty-seven information sources met inclusion criteria. Natural disasters and inadequate disaster relief responses were identified as an overarching health threat for GD populations. Within this theme, four sub-themes emerged. No other climate-related health impacts for GD populations were mentioned in the sources reviewed. CONCLUSIONS: There are major gaps in knowledge about health implications of climate change for GD populations. Gender-sensitive data must be collected in order to better understand these threats and detect disparities. Currently most practice and policy recommendations focus on disaster relief. More research on the broad effects of climate change on GD populations is urgently needed to inform practice and policy. CLINICAL RELEVANCE: Climate change amplifies existing risks of adverse health outcomes. Because of discrimination, stigma, and violence, gender diverse individuals are particularly vulnerable.

Knowledge, attitudes, and practices of primary healthcare providers with assessing and supporting older informal caregivers.

A time burden, financial strain, and prioritizing care recipient needs over their own are key barriers preventing informal caregivers from engaging in health-promoting self-care. Primary healthcare providers are well positioned to assess and support informal caregivers. A cross sectional descriptive, correlational study was used to examine the knowledge, attitudes, and practices of healthcare providers regarding assessment and support of older informal caregivers. The Healthcare Professional Facilitated Health Promotion (HPFHP) Model guides this study by depicting the collaborative patient-healthcare professional relationship. The Caregiver Self-Care Survey for Healthcare Providers measured the knowledge, attitudes, and practices of 80 healthcare providers on assessing and supporting older informal caregivers. Descriptive and inferential statistics were calculated using IBM Statistical Package for the Social Sciences (SPSS) 28.0 software. Results indicated that despite positive attitudes, knowledge deficit and system level barriers prevented integration of caregiver assessment in practice. A caregiver identification process, user-friendly assessment tool, and system level changes are overdue.

The intersection of climate change with the era of COVID-19.

The purpose of this integrative review is to examine recent literature on the intersection of SARS-CoV-2 (COVID-19 novel coronavirus) and climate change that will lead to a greater understanding of the complexities of the urgent pandemic linked with the emerging climate crisis. A literature search for peer-reviewed, English language, literature published since the pandemic emerged was conducted using Cumulated Index to Nursing and Allied Health Literature (CINAHL), PubMed, and the Cochrane Library. The final sample yielded a total of 22 commentaries, editorials, discussion papers, and a research study that explicitly addressed the intersection of COVID-19 and climate change. Sixty articles emerged in the initial review of the intersection of the COVID-19 pandemic and climate change with the final yield of 22 articles deemed valid for inclusion after full text review. With the emergence of COVID-19 and scholarly discourse that addresses the intersection of the pandemic with climate change, key issues emerged that intersect with policy /advocacy, social justice, and nursing's public health role in clinical practice, education, policy/advocacy, and research/scholarship. Five themes that emerged included the role of public health in COVID-19 and climate change efforts; global approach addressing human-environment issues; intersection of COVID-19 and climate change from a community and global perspective; impacts of COVID-19, climate change and the environment and professional associations and specialty organizations' views and responsibilities with a lens on COVID-19 and climate change. Despite the importance of addressing racial inequities as well as systemic and structural racism that impacts those most affected by climate change and pandemics such as COVID-19, no literature addressed this topic. Public health nursing has a critical role in addressing climate change and the pandemic response to COVID 19 in the 21st century.

Climate Change and Population Health: Incorporating Stages of Nursing's Political Development.

Climate change is the greatest public health threat of the 21st century and is associated with environmental degradation and deleterious health consequences. In 2019, the Lancet Commission Report on Health and Climate Change: Ensuring that the Health of a Child Born Today Is Not Defined By a Changing Climate (Watts et al., 2019) examined the critical health issues that children will face in the era of climate change. Greenhouse gas emissions (GGEs) are responsible for an alarming increase in the warming of the planet, shifts in weather patterns, loss of arable land, and exacerbations of acute health issues, chronic health problems, and disaster-related health consequences. The purpose of this paper is to provide an overview of climate change and the associated deleterious health consequences in our climate-changing world. The paper will also examine the stages of political development to advance the 21st century role of the nursing profession in climate and health advocacy and policy.

A CLIMATE: A Tool for Assessment of Climate-Change-Related Health Consequences in the Emergency Department.

Climate change is an urgent public health problem that has looming implications and associated deleterious health consequences. The intersection of climate change and health has broad implications for health professionals in a variety of settings but especially for ED settings. Climate change is already affecting human health and health systems-which includes impacts on ED care. Disaster response and emergency preparedness are critically important public health interventions in our climate-changing world, and the contributions of emergency nurses are essential. Disaster preparedness, environmental emergency response, and health emergency management are important elements of emergency nursing and are explicated in Sheehy's Emergency Nursing Principles and Practices, 7th Edition. The purpose of this article is to present an overview of a clinical tool and mnemonic, A CLIMATE, developed by the authors with application to a case review. It is imperative that the nursing profession-particularly emergency clinicians-address the intersection of climate and health to engage in the assessment, intervention, management, evaluation, education, and referral of those who present to emergency departments with potential climate-related health impacts.

Health Literacy and Health Outcomes in Persons Living with HIV Disease: A Systematic Review.

Low health literacy is associated with challenges for those living with HIV including medication non-adherence and poorer health outcomes. The aim of this study was to systematically review the literature on health literacy and health outcomes in persons living with HIV. The extended guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, as well as A Measurement Tool to Assess Systematic Reviews (AMSTAR) checklist were utilized to guide the approach to the review. A variety of electronic databases including PubMed, CINAHL, PsychInfo, and Cochrane Library were searched. Additional literature available on U.S. government websites was also included in the search. Search terms were used in a variety of combinations and included HIV, health literacy, adherence, and health outcomes. Forty-eight studies were identified that addressed health literacy and health outcomes in HIV. Although several studies in this review did not provide robust results of statistical significance linking health literacy with health outcomes, all of the studies addressed the key significance of health literacy within the scope of living with HIV disease. The relationship between health literacy and the identified health outcomes requires further research and explication.

Advancing a School of Nursing Center for Climate Change, Climate Justice, and Health.

This chapter addresses the development and advancement of the Center for Climate Change, Climate Justice, and Health (CCCCJH) in the School of Nursing at the MGH Institute of Health Professions, the first nurse-led center emerged from the overwhelming evidence of climate change and its associated deleterious health consequences. The Center steering committee developed a mission, vision, and core values as well as a logo to guide the first year of initiatives and galvanize the efforts for the future. Workshop and symposium development, implementation, and evaluation are discussed. Future directions and the importance of educational initiatives aimed at expanding nursing and interprofessional knowledge of the intersection of climate and health are discussed.

A qualitative description of service providers' experiences of ethical issues in HIV care.

BACKGROUND: Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge. PURPOSE: This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care. RESEARCH DESIGN: A descriptive qualitative design was used to collect data from health service providers and patients using focused group discussions. This article is based on responses from health service providers only. PARTICIPANTS AND CONTEXT: This article is based on 11 focused group discussions with a total sample of 71 service providers in seven US sites and one Botswana site. ETHICAL CONSIDERATIONS: Ethical review boards at all the study sites reviewed the study protocol and approved it. Ethical review boards of the study's coordinating centers, Rutgers University and the University of California at San Francisco, also approved it. The study participants provided a written informed consent to participate. FINDINGS: HIV service providers encountered ethical challenges in all the four Beauchamp and Childress' biomedical ethics of respect for patients' autonomy, beneficence, justice, and nonmaleficence. DISCUSSION: The finding that HIV service providers encounter ethical challenges in their interaction with patients is supported by prior studies. The ethical challenges are particularly prominent in multicultural care and resource-constrained care environments. CONCLUSION: Provision of HIV care is fraught with ethical challenges that tend to pose different issues depending on a given care environment. It is important that strong partnerships are developed among key stakeholders in HIV care. In addition, health service providers need to be provided with resources so they can provide quality and ethically sound care.

Addressing climate change through a nursing lens within the framework of the United Nations Sustainable Development Goals.

BACKGROUND: In 2000, the United Nations (UN) introduced the Millennium Development Goals (MDG), described as a global movement with the primary aim of ending world-wide poverty ("Millennium Summit," 2000). The second phase of the project, known as the post-2015 Sustainable Development Goals (SDG) agenda offers an increased emphasis on lessening the mitigating factors associated with climate change and adapting to the negative effects of climate change. Nurses are in the unique position to address the health-related impacts related to climate change through community health approaches aimed at education and promotion of environmental stewardship. PURPOSE: The purpose of this scoping review was to examine the relationships among the health consequences of climate change, nursing literature on climate change, and nursing implications. The following will be addressed: "What is nursing's role in policy, practice, and advocacy when addressing the effects of climate change? What is the importance of the SDGs as a framework for addressing climate change in the role of nursing?" METHOD: This scoping review of the literature was conducted which included the evaluation of a broad range of articles using scoping methods as frameworks. FINDINGS: An overarching theme regarding the nursing community's responsibility in addressing the effects of climate change and their role as advocates, educators, and global citizens was extracted from the scoping review. DISCUSSION: There are many opportunities for nurses to become actively involved in efforts aimed at mitigation, adaptation, and resilience efforts in climate change, including becoming involved in policy, advocacy, research, and practice opportunities.

Climate Change, Climate Justice, and Environmental Health: Implications for the Nursing Profession.

PURPOSE: Climate change is an emerging challenge linked to negative outcomes for the environment and human health. Since the 1960s, there has been a growing recognition of the need to address climate change and the impact of greenhouse gas emissions implicated in the warming of our planet. There are also deleterious health outcomes linked to complex climate changes that are emerging in the 21st century. This article addresses the social justice issues associated with climate change and human health and discussion of climate justice. ORGANIZING CONSTRUCT: Discussion paper. METHODS: A literature search of electronic databases was conducted for articles, texts, and documents related to climate change, climate justice, and human health. FINDINGS: The literature suggests that those who contribute least to global warming are those who will disproportionately be affected by the negative health outcomes of climate change. The concept of climate justice and the role of the Mary Robinson Foundation-Climate Justice are discussed within a framework of nursing's professional responsibility and the importance of social justice for the world's people. The nursing profession must take a leadership role in engaging in policy and advocacy discussions in addressing the looming problems associated with climate change. CONCLUSIONS: Nursing organizations have adopted resolutions and engaged in leadership roles to address climate change at the local, regional, national, and global level. It is essential that nurses embrace concepts related to social justice and engage in the policy debate regarding the deleterious effects on human health related to global warming and climate change. Nursing's commitment to social justice offers an opportunity to offer significant global leadership in addressing the health implications related to climate change. CLINICAL RELEVANCE: Recognizing the negative impacts of climate change on well-being and the underlying socioeconomic reasons for their disproportionate and inequitable distribution can expand and optimize the profession's role in education, practice, research, and policy-making efforts to address climate change.

Mandate for the Nursing Profession to Address Climate Change Through Nursing Education.

PURPOSE: The adverse health effects from climate change demand action from the nursing profession. This article examines the calls to action, the status of climate change in nursing education, and challenges and recommendations for nursing education related to climate change and human health. ORGANIZING CONSTRUCT: Discussion paper. FINDINGS: The integration of climate change into nursing education is essential so that knowledge, skills, and insights critical for clinical practice in our climate-changing world are incorporated in curricula, practice, research, and policy. Our Ecological Planetary Health Model offers a framework for nursing to integrate relevant climate change education into nursing curricula and professional nursing education. Nursing education can offer a leadership role to address the mitigation, adaptation, and resilience strategies for climate change. CONCLUSIONS: An ecological framework is valuable for nursing education regarding climate change through its consideration of political, cultural, economic, and environmental interrelationships on human health and the health of the planet. Knowledge of climate change is important for integration into basic and advanced nursing education, as well as professional education for nurses to address adverse health impacts, climate change responses policy, and advocacy roles. CLINICAL RELEVANCE: For current and future nurses to provide care within a climate-changing environment, nursing education has a mandate to integrate knowledge about climate change issues across all levels of nursing education. Competence in nursing practice follows from knowledge and skill acquisition gained from integration of climate change content into nursing education.

Sexual transmission-risk behaviour among HIV-positive persons: a multisite study using social action theory.

AIM: Sexual risk behaviour was explored and described using Social Action Theory. BACKGROUND: The sexual transmission of HIV is complex and multi-factorial. Social Action Theory provides a framework for viewing self-regulation of modifiable behaviour such as condom use. Condom use is viewed within the context of social interaction and interdependence. DESIGN: Cross-sectional survey. METHODS: Self-report questionnaire administered to adults living with HIV/AIDS, recruited from clinics, service organizations and by active outreach, between 2010 - 2011. FINDINGS: Having multiple sex partners with inconsistent condom use during a 3-month recall period was associated with being male, younger age, having more years of education,substance use frequency and men having sex with men being a mode of acquiring HIV. In addition, lower self-efficacy for condom use scores were associated with having multiple sex partners and inconsistent condom use. CONCLUSION: Social Action Theory provided a framework for organizing data from an international sample of seropositive persons. Interventions for sexually active, younger, HIV positive men who have sex with men, that strengthen perceived efficacy for condom use, and reduce the frequency of substance use, may contribute to reducing HIV-transmission risk.

A multinational qualitative investigation of the perspectives and drivers of exercise and dietary behaviors in people living with HIV.

Globally, people living with HIV (PLWH) are at remarkably high risk for developing chronic comorbidities. While exercise and healthy eating reduce and mitigate chronic comorbidites, PLWH like many others, often fail to engage in recommended levels. We qualitatively examined the perspectives and contextual drivers of diet and exercise reported by PLWH and their health care providers. Two hundred and six participants across eight sites in the United States, Puerto Rico and Botswana described one overarching theme, Arranging Priorities, and four subthemes Defining Health, Perceived Importance of Diet and Exercise, Competing Needs, and Provider Influence. People living with HIV and their health care providers recognize the importance of eating a healthy diet and engaging in regular exercise. Yet there are HIV-specific factors limiting these behaviors that should be addressed. Health care providers have an important, and often underutilized opportunity to support PLWH to make improvements to their exercise and diet behavior.

Volunteer Service and Service Learning: Opportunities, Partnerships, and United Nations Millennium Development Goals.

PURPOSE: This article explores approaches to service involvement and provides direction to nurse leaders and others who wish to begin or further develop global (local and international) service or service learning projects. APPROACH: We review types of service involvement, analyze service-related data from a recent survey of nearly 500 chapters of the Honor Society of Nursing, Sigma Theta Tau International (STTI), make recommendations to guide collaborative partnerships and to model engagement in global and local service and service learning. FINDINGS: This article offers a literature review and describes results of a survey conducted by the STTI International Service Learning Task Force. Results describe the types of service currently conducted by STTI nursing members and chapters, including disaster response, service learning, and service-related responses relative to the Millennium Development Goals (MDGs). The needs of chapter members for information about international service are explored and recommendations for promoting global service and sustainability goals for STTI chapters are examined. CONCLUSIONS: Before engaging in service, volunteers should consider the types of service engagement, as well as the design of projects to include collaboration, bidirectionality, sustainability, equitable partnerships, and inclusion of the United Nations Sustainable Development Goals. CLINICAL RELEVANCE: STTI supports the learning, knowledge, and professional development of nurses worldwide. International service and collaboration are key to the advancement of the nursing profession. Culturally relevant approaches to international service and service learning are essential to our global organization, as it aims to impact the health status of people globally.

Standardizing nurse training strategies to improve knowledge and self-efficacy with tracheostomy and laryngectomy care.

OBJECTIVE: Appropriate tracheostomy and laryngectomy care requires that nurses maintain specific knowledge and a particular skillset, to ensure safe, competent care. Deficiencies in this nursing care remain a persistent problem. The objective of this study was to evaluate the effect of a nurse training program on knowledge and self-efficacy with tracheostomy and laryngectomy care. STUDY DESIGN: Prospective, interventional survey design. SETTING: Academic, tertiary care hospital between September 2014 and April 2015. SUBJECTS AND METHODS: 1450 nurses at an academic tertiary care hospital were surveyed on tracheostomy and laryngectomy care at two time points: before and after the implementation and completion of the nurse training program. The nurse training program included a hands-on training session and online tutorial on appropriate tracheostomy and laryngectomy care. 732 nurses completed the hands-on training and were asked to complete the online tutorial. A total of 338 surveys were collected. Survey data were collected through an online survey development platform. Analyses were performed using SAS software. Chi-square tests and t-tests were utilized with a significance level of 0.05. RESULTS: 165 pre-training surveys and 173 post-training surveys were completed. Statistical analysis of the post-training data demonstrated statistically significantly higher knowledge and self-efficacy scores of nurses who completed the training than nurses who did not. CONCLUSIONS: Findings from this study reveal poor overall nursing knowledge and self-efficacy with this care and suggest that optimizing and standardizing nurse training is an effective strategy to improve nursing knowledge and self-efficacy with head and neck surgical airways.

Addressing the Confusion Related to DNS, DNSc, and DSN Degrees, With Lessons for the Nursing Profession.

PURPOSE: This article examines the evolution of Doctor of Nursing Science (DNS or DNSc) and Doctor of Science in Nursing (DSN) degrees, including their emergence as research-intensive doctoral degrees in the 1960s, efforts to distinguish the degrees from the Doctor of Philosophy (PhD) and Doctor of Nursing Practice (DNP) degrees, the recent decline in program numbers, and implications for degree holders. APPROACH: The article reviews the U.S. history of doctoral education in nursing, research examining similarities and differences between the PhD and DNS, DNSc, or DSN degrees, and how the DNS, DNSc, or DSN degree differs from DNP programs. The article also examines the confusion regarding the focus of the DNS, DNSc, or DSN degree among nurses, patients, and potential funders; and describes actions taken by universities to address the confusion, with examples provided by academic deans, nurse leaders, and nurse researchers. FINDINGS: Longstanding confusion about the research merits of the DNS, DNSc, or DSN degree, and the growing prominence of the similarly-titled DNP degree, has created confusion about the focus of DNS, DNSc, or DSN programs and the capabilities of degree holders. Many universities have addressed this confusion by converting their DNS, DNSc, and DSN programs to a PhD or retroactively converting degrees to a PhD. Other universities have chosen not to pursue this route. CONCLUSIONS: The DNS, DNSc, or DSN experience highlights the importance of clarifying and standardizing the purpose and goals of nursing education programs and the repercussions for degree holders when such clarity is lacking. The international academic nursing communities have consistently pursued one doctoral-level nursing degree and therefore have not shared this challenging landscape in nursing education. CLINICAL RELEVANCE: Findings and recommendations presented in this article have implications for schools of nursing and professional groups that oversee the development of educational programs and pathways for nurses.