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.

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.

Nurse practitioners' and certified nurse midwives' experiences providing comprehensive early abortion care in New England, USA.

Access to abortion is linked to better maternal health and is essential to advancing women's economic and social equality. Globally, nurses and midwives have been identified as key for increasing access to this service. In this qualitative study we describe the experiences of nurse practitioners and nurse midwives who provide comprehensive early abortion care in the New England region of the United States. In contrast to much of the existing literature from around the world on nurses who deliver abortion care, we found participants' experiences providing comprehensive early abortion was generally positive. The study has implications for theory development, research, and policy.

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.

Educating Pregnant Women About the Dangers of Extreme Heat and Air Pollution.

Climate change poses a serious threat to the health and well-being of pregnant women and their developing fetuses. Certain populations are at greater risk of adverse outcomes from air pollution, a contributing factor to climate change. In addition, heightened exposure to extreme heat, a consequence of climate change, exacerbates the existing health care inequities in the United States. Nurses, midwives, and other health care clinicians are uniquely positioned to reduce the harmful effects of climate change by educating pregnant women and their families and advocating for systems and policies that can decelerate climate change. The purpose of this article is to provide resources for clinicians to use in educating pregnant women about the risks of extreme heat and air pollution, their potential effects on pregnancy and neonatal outcomes, and strategies to help mitigate risk. We conclude with implications for practice, opportunities for advocacy, and areas for future research.

Screening for Heat Related Illness in Pregnant People: Sample Case Study for Clinician Education.

Climate change has significant implications for pregnant people. The Heat-Related Illness Screening Tool was developed by faculty in the nurse-led Center for Climate Change, Climate Justice, and Health at the MGH Institute of Health Professions. In an effort to integrate content on the health effects of climate change on pregnant people, faculty in the Women's Health/Gender-Related Nurse Practitioner program in the School of Nursing developed a case study that incorporated heat and environmental exposures in pregnancy into an existing module on preterm birth. The case study aims to increase awareness about the intersections between climate change, social determinants of health, structural racism, and potential adverse pregnancy outcomes. Together this case study and screening tool for heat-related illness represent innovations for health professions educators and clinicians to detect intensifying risks to already vulnerable people who are pregnant.

Critiquing the Unintended Pregnancy Framework.

The unintended pregnancy framework, a central tenet of sexual and reproductive health care delivery and research, has been depicted as an adverse outcome that should be prevented. There is growing criticism of the inadequacies of this framework, although little modification in public health guidelines, measurement, or clinical practice has been seen. This article critically reviews the literature on unintended pregnancy to encourage reflection on how this framework has negatively influenced practice and to inspire the advancement of more patient-centered care approaches. We begin by outlining the historical origins of the unintended pregnancy framework and review how this framework mischaracterizes patients' lived experiences, fails to account for structural inequities, contributes to stigma, and is built upon weakly supported claims of a negative impact on health outcomes. We close with a discussion of the relationship between health care provision and unintended pregnancy care and the implications and recommendations for realigning clinical practice, research, and policy goals.

Development of a screening tool for assessment of climate change-related heat illness in the clinical setting.

ABSTRACT: Extreme heat contributes to heat-related illnesses resulting from heat intolerance, which is the inability to maintain a thermal balance to tolerate heat stress. In the United States, heat-related mortality for older persons has almost doubled in the past 20 years. Other populations at risk for heat-related illness (HRI) include children, pregnant people, those who work outside, young people participating in outdoor sports, and at-risk populations such as Black, indigenous, and populations of color. The classic heat tolerance test used for decades monitoring physiological responses to repetitive motions is impractical across large and potentially health challenged populations and does not identify environmental or social factors or specific vulnerable populations. To address this issue, we developed a heat-related illness screening tool (HIST) to identify individuals at risk for HRI morbidity and mortality based on their physical, environmental, and social vulnerabilities with an emphasis on populations of concern. The HIST has the potential to be used as routine clinical screening in the same way as other commonly used screening tools. Heat intolerance affects patient outcomes and quality of life; therefore, early screening with a simple, easy-to-administer screening tool such as the HIST can identify people at risk and refer them to services that address heat exposure and/or create safety nets to prevent heat-related illnesses.

Abortion With Pills: Review of Current Options in The United States.

Interest in self-management approaches to abortion with pills in the United States preceded the coronavirus disease 2019 (COVID-19) pandemic and has accelerated during this global health crisis. Coupled with the unclear future of legal abortion in the United States, clinical care providers need to be aware of the range of self-managed abortion approaches and of the varying levels of engagement with the formal health care system they entail. This article is intended to serve as a resource to inform providers of the current landscape of abortion with pills in the United States, while also describing possible shifts in the future that may result due to the ongoing pandemic and the continuing erosion of access to abortion care and services.

From the outside in: a unique model for stimulating curricula reform in nursing education.

Given the current demands on nursing education, the introduction of new content into curricula can present significant challenges for nursing faculty. This is particularly true when the content being introduced is the subject of deep ethical, religious, or political controversy. This article offers a unique model for approaching curricula reform that draws on a decade-long effort to increase abortion-related content in nursing programs in New England and other regions of the United States mounted by a nonprofit organization. Strategies used and successes of the project are discussed. Faculty interested in introducing controversial topics into curricula, as well as advocacy groups that seek to stimulate curricula reform, may find this discussion to be particularly relevant and instructive to their efforts.

Sexual and reproductive health content in nurse practitioner transition to practice training programs.

OBJECTIVE: To describe the sexual and reproductive health (SRH) offerings of transition to practice training programs for certified primary care nurse practitioners in the United States. STUDY DESIGN: Program Directors from all identified primary care training programs (n = 51) were invited to participate in an online survey to assess the SRH didactic and clinical offerings based on competencies developed by the World Health Organization and adapted for the US across 15 domains and 15 related procedures. RESULTS: Twenty-two (43%) surveys were completed. There was considerable variation in offerings, with no single domain required by all programs, nor any program requiring trainees to complete didactic and clinical offerings in all domains. On average, programs required didactic and clinical training for approximately a third of the competencies in the Reproductive Tract Cancers domain (the most required domain) and for approximately a quarter of the competencies in the Contraceptive domain. Infertility/Fertility and Environmental Risks to Reproductive Health were the least commonly required domains. Clinical training tended to be more frequently required or offered than didactic instruction in almost all domains.Regarding procedures, both didactic and clinical training on insertion and removal of intrauterine devices were required by one third of programs. No-scalpel vasectomy was the procedure in which programs were least likely to offer trainees either didactic or clinical training, followed by uterine aspiration for missed or elective abortion or heavy menstrual bleeding. CONCLUSION: Although SRH is recognized as an essential component of primary care, its inclusion in transition to practice primary care training programs for NPs is low and inconsistent. IMPLICATIONS STATEMENT: Preparing primary care NPs to deliver competent SRH care is important for workforce development and patient care. Our study highlights a need for additional research to determine the baseline competency in SRH care among primary care NPs in order to further enhance education, training and policies with this aim.

Pathways to Competence in Sexual and Reproductive Health Care for Advanced Practice Nurses.

Sexual and reproductive health (SRH) care is often overlooked in advanced practice nursing educational programs, but advanced practice registered nurses are expected to provide care in this sensitive area. Competencies for SRH care were developed by the World Health Organization, and individual countries including the United States have adapted them to their unique health systems and populations. In this article, we discuss extant and future pathways for advanced practice registered nurses to develop competence in SRH care.

Updates to the US Food and Drug Administration Regulations for Mifepristone: Implications for Clinical Practice and Access to Abortion.

This article provides information on recent changes in the US Food and Drug Administration (FDA) labeling and safety regulations for mifepristone (Mifeprex). The revised label now permits midwives, advanced practice nurses, and physician assistants to order and prescribe mifepristone, eliminating the requirement for physician supervision. The updated label also extends eligibility for use from 49 to 70 days' gestation and decreases the number of required visits from 3 to 2. The recommended dose of mifepristone has been reduced, and the dosage, timing, and route of administration for misoprostol have also been changed to reflect current research. These changes have implications for clinical practice and may lead to expanded access for women in the United States.

Unintended pregnancy: a framework for prevention and options for midlife women in the US.

Recently unintended pregnancies have been described as "a new kind of mid-life crisis." Given the high prevalence of unwanted or mistimed pregnancy in the US, we examined the sexual and reproductive health patterns of sexually active midlife women. An examination of the prevalence of unintended pregnancy among midlife women revealed a gap in data indicating unmet sexual and reproductive health needs of midlife women. The application of a framework for primary, secondary and tertiary prevention for unintended pregnancy may assist with guiding care for women and identifying implications for reproductive health policy and potential political interference as they relate to sexual and reproductive health in midlife women.

Abortion education in nurse practitioner, physician assistant and certified nurse-midwifery programs: a national survey.

OBJECTIVE: This study was undertaken to examine the inclusion and extent of abortion education in accredited nurse practitioner (NP), physician assistant (PA) and certified nurse-midwifery (CNM) programs in the United States. METHODS: In January 2000, a confidential survey requesting information about the curricular inclusion of eight reproductive health topics was mailed to program directors at all 486 accredited NP, PA and CNM programs in the United States. RESULTS: Two hundred two surveys were returned, with a response rate of 42%. Overall, 53% of programs reported didactic instruction on surgical abortion, manual vacuum aspiration or medication abortion and 21% reported including at least one of these three procedures in their routine clinical curriculum. CONCLUSION: Abortion education is deficient in NP, PA and CNM programs in the United States. As integral components of women's health care, abortion, pregnancy options counseling and family planning merit incorporation into routine didactic and clinical education.

Providing options counseling for women with unintended pregnancies.

Nearly half of the pregnancies in the United States are unintended, and nurses frequently encounter women with unintended pregnancies in the clinical setting. Nurses may be responsible for counseling these women on how to explore and decide between the options of parenting, adoption, and abortion. To date, little has been written about options counseling, despite the fact that unintended pregnancy is one of the most common health conditions that women face. This article presents epidemiological data on prevalence, outcomes, consequences, causes, and prevention of unintended pregnancy. It examines the conflicts that nurses may experience when providing care to women with unintended pregnancies and discusses the intersection of professional responsibilities and personal values. Finally, the article presents general strategies and specific suggested steps for providing options counseling.

Caring for women with unintended pregnancies.

Unintended pregnancy is a common reproductive health event. Professional responsibilities for nurses providing care to women with unintended pregnancies include appropriate assessment, options counseling, provision of or referral for desired services, care coordination, and prevention efforts aimed at decreasing future unintended pregnancies. Nurses' awareness of available services and their involvement in referring or providing services is an essential component to reproductive health care.

Clinical issues in post-abortion care.

This article provides an overview of the clinical issues in post-abortion care, including types of abortion procedures, expected post-abortion course, possible complications, and the components of the post-abortion visit. By providing follow-up care to their patients, NPs can increase continuity of care and promote successful contraceptive use.