The Way of Nursing: Leading Disruptive Change for All.

Conceptual frameworks in nursing help shape the thinking and behavior of nursing practice. They also facilitate understanding about nursing's unique contributions that complement the way of medicine. Current health crises illuminate the need for disruptive change, and consequently the need for new conceptual frameworks to guide disruptive practice. The Way of Nursing conceptual framework moves nursing beyond the nursing metaparadigm and the nursing process toward the necessary thinking to address the complex health challenges of individual patients, families, communities, and the planet. The Way of Nursing affirms nurses' capacity to lead change and disrupt systems for the benefit of all.

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.

Planetary Health: An Essential Framework for Nursing Education and Practice.

Traditionally, we would have considered biodiversity loss, increasing severity and frequency of natural disasters, more frequent infectious disease outbreaks, and increased human migration around the world as disparate issues requiring unique solutions. We are now realizing that the health of humans and the health of the planet are interconnected, and that the Earth's natural systems that support life are in critical jeopardy. Planetary health needs to be a core component of nursing education and practice. Several conditions make this the perfect time for transformative change. The COVID-19 pandemic revealed the deep connection between the human health and the health of the planet and illuminated the need for global solutions that are both sustainable and equitable. The Future of Nursing 2020 - 2030: Charting a Path to Achieve Health Equity report acknowledged the urgent need to address climate change. The new American Association of Colleges of Nursing essentials for nursing education supports transformation of nursing curricula. Finally, the recent publication of a global transdisciplinary framework for planetary health education offers nursing a blueprint for education and practice.

Nurses at the United Nations.

There is an urgent call to redesign health care to be more equitable, to address the climate change crisis, and to implement the United Nations' Sustainable Development Goals (SDGs) for the health of the global community. Now is the time for nurses to get involved in leading these necessary changes. In 2019, the authors were chosen to present a concurrent session at the 68th United Nations Civil Society Conference. The conference focused on SDG 11, Building Inclusive and Sustainable Cities and Communities. The experience convinced the authors that nurses have unique knowledge and skills to contribute to the mission of the United Nations.

Nurses Promoting Inclusive, Safe, Resilient, and Sustainable Cities and Communities: Taking Action on COVID-19, Systemic Racism, and Climate Change.

This article is one in a series in which contributing authors discuss how the United Nations (UN) Sustainable Development Goals (SDGs) are linked to everyday clinical issues; national public health emergencies; and other nursing issues, such as leadership, shared governance, and advocacy. The 2030 Agenda for Sustainable Development, a 15-year plan of action to achieve the goals, was unanimously adopted by all UN member states in September 2015 and took effect on January 1, 2016. The Agenda consists of 17 SDGs addressing social, economic, and environmental determinants of health and 169 associated targets focused on five themes: people, planet, peace, prosperity, and partnership. The SDGs build on the work of the UN Millennium Development Goals, which were in effect from 2000 to 2015. The current article highlights SDG 11-making "cities and human settlements inclusive, safe, resilient and sustainable."

Sharing Our Stories and Holding Our Past to Task.

The structures that maintain systemic racism frequently keep us from seeing and valuing the full humanity of all those around us, especially when they are of a different race. This article describes a process to create safe dialogues between people of different races to inform our understanding of systemic racism so that we can work together to end its reign.

Policy brief on climate change and mental health/well-being.

Climate change has a significant global impact on individuals' mental health and well-being. However, global health systems are inadequately prepared to address this issue. Studies indicate that climate events such as floods, droughts, tornados, earthquakes, and fires not only exacerbate chronic mental illness, but also impact well-being causing anxiety, stress, and in the worst case, suicide. The World Health Organization estimates that 12.6 million preventable deaths per year can be attributed to environmental factors, all of which are exacerbated by climate change, and an additional 250,000 deaths per year are projected between 2030 and 2050. Nurses must advocate for research, education, and policies that support disaster-resilient infrastructure and human services that allow communities across the globe to effectively mitigate the impact of climate change on human health.

Making Advance Directives Visual: Introducing Young Adults to Advance Care Planning With Video-Recorded Advance Directives.

The complexities surrounding the dying process may distort rational decision-making and impact care at the end of life. Advance care planning, which focuses on identifying the individual's definition of quality of life, holds great potential to provide clarity at the end of life. Currently, young adults are not the intended audience for advance care planning. A quality improvement project engaged 36 college-age adults in structured group advance care planning discussions and evaluated the perceived value of a self-recorded advance directive. Findings from a pre- and postintervention survey suggested that young adults welcomed a conversation about end-of-life care; they wished for more information and expressed that a video-recorded advance directive stimulated thoughts about their own definition of quality of life. Participants' improved self-perception of comfort, confidence, certainty, and knowledge regarding the advance care planning process and end-of-life care indicated young adults may be a willing and eager population for the expansion of advance care planning. In addition to directing advance care planning to a younger audience, a personal video-recorded advance directive may complement the current advance care planning process and aid individuals in defining their quality of life.

Planetary Health: The Next Frontier in Nursing Education.

Much has been said about the severe health impacts of climate change for individuals and societies. The nursing profession has done significant work educating practicing nurses about climate change (Health Care Without Harm, 2018; Leffers, Smith, Huffling, McDermott-Levy, & Sattler, 2016), promoting policy changes (Leffers & Butterfield, 2018), and leading effective actions and practice changes (Alliance of Nurses for Healthy Environments, 2019). However, climate change is only one symptom of an emerging and potentially catastrophic multisystem failure. Failing to take a systems approach and addressing only one symptom at a time can lead to unintended consequences, ineffective use of resources, and activist burnout. The severity and urgency of global environmental issues requires a paradigm shift from understanding health solely in human terms, to a deep awareness that human health and environmental health are inseparable. This article discusses the emerging interdisciplinary field of planetary health and the potential impact of nursing leadership. Modifications to nursing education are required so that future nurses are ready to lead transformative planetary health initiatives.

Sparking a Movement for a Healthy Climate Through Leadership Development.

Climate change is increasingly impacting health, and health care is contributing to climate change through carbon emissions. Nurses can help mitigate climate change and its effects through leadership development initiatives to expand the impact of the efforts of a single person by activating others. This article describes one such nurse-led leadership development project. The intervention adapted a workshop series curriculum for faith community audiences to a health professional audience. The program gave participants the ability to assess their assets, understand the psychology of communication of climate change, and design appropriately-scaled actions to help mitigate climate change. The program consisted of three in-person workshop sessions plus bi-weekly individual consultations with participants. The seven participants included physicians, nurses, physician and nurse educators, a public health professional, and a veterinary medicine student. The workshops included content on communicating about climate change, crafting a public narrative/storytelling, and tools and methods for organizing in the climate movement. Participants completed action plans including a broad range of leadership efforts as part of the intervention; all participants completed at least the first step of their action plan during the program period. Qualitative interviews highlighted facets of participants' experiences. Nurses and other health professionals are leading the way in mitigating climate change; leadership development programs such as this are one way of taking effective climate action.

A Toolkit to Improve Diversity in Patient and Family Advisory Councils: A New Method to Advance Health Equity.

The Institute of Medicine (2001) identifies equity as one of six essential components of health-care quality. However, many health-care organizations lack a formal method to deeply understand and evaluate diverse patient and family experiences. Understanding care experiences of patients and families from minority racial and ethnic groups is essential to improving pervasive health disparities and to making health care more equitable. This article describes the creation of a toolkit aimed at strengthening health-care organizations' abilities to advance health equity through patient and family advisory councils (PFACs). This resource, cocreated with representatives from diverse PFACs, identifies and promotes strategies to recruit and retain diverse representation in advisory councils.

PLANETARY GRAND CHALLENGES: A CALL FOR INTERDISCIPLINARY PARTNERSHIPS.

Universities have traditionally been places where individual scholars work on individual topics, in individual disciplines, with individual funding. Even though large research institutions include all the major disciplines, faculty and students remain in their schools or colleges, rarely crossing the campus to interact. Matters do not improve once knowledge is generated. Each discipline has its own journals, its own conferences, and its own professional organizations. The academy was designed to support unparalleled expertise in specialized knowledge. However, universities are beginning to realize that the greatest challenges we face are systems problems and can only be solved by systems thinking and systems solutions. Climate change, antibiotic resistance, water scarcity, and unsustainable population growth are just a few of the planetary health crises that require interdisciplinary partnerships to solve. Fortunately, we are beginning to see early signs of a shift toward, and even normalization of, interdisciplinary collaboration. In fact, some national grants require team members from different fields as a stipulation for funding. Interdisciplinary research permits cross-field benefits in which the synergy of two or more knowledge sets is greater than the sum of its parts. Innovation increases and previously elusive solutions become possible. The field of partnership studies closely aligns with the vision and mission of interdisciplinarity and offers a philosophical framework to guide teaching and research.

Developing a Medical School Curriculum on Racism: Multidisciplinary, Multiracial Conversations Informed by Public Health Critical Race Praxis (PHCRP).

Background: To fight racism and its potential influence on health, health care professionals must recognize, name, understand and talk about racism. These conversations are difficult, particularly when stakes feel high-in the workplace and in interracial groups. We convened a multidisciplinary, multi-racial group of professionals in two phases of this exploratory project to develop and pilot an intervention to promote effective dialogues on racism for first year medical students at the University of Minnesota Medical School. Methods: Informed by a Public Health Critical Race Praxis (PHCRP) methodology in Phase I, initial content was developed by a group of seven women primarily from racial and ethnic minority groups. In a later phase, they joined with five White (primarily male) colleagues to discuss racism and race. Participants met monthly for 12 months from Jan 2016-Dec 2016. All participants were recruited by study PI. An inductive approach was used to analyze meeting notes and post intervention reflections to describe lessons learned from the process of employing a PHCRP methodology to develop the aforementioned curriculum with a multidisciplinary and multi-racial group of professionals dedicated to advancing conversations on racial equity. Results: Participants from Phase I described the early meetings as "powerful," allowing them to "bring their full selves" to a project that convened individuals who are often marginalized in their professional environments. In Phase II, which included White colleagues, the dynamics shifted: "…the voices from Phase I became quieter…"; "I had to put on my armor and fight in those later meetings…". Conclusions: The process of employing PHCRP in the development of an intervention about racism led to new insights on what it means to discuss racism among those marginalized and those with privilege. Conversations in each phase yielded new insights and strategies to advance a conversation about racism in health care.

Partnership Nursing: Recovering Lost Threads of the Nursing Story.

Nursing has been challenged to claim full partnership with other health care providers. To reach this goal nurse educators must ensure that curriculum and textbooks provide appropriate content on the nature and use of power, how to collaborate, and how to develop partnerships.