Towards environmentally responsible nursing: a critical interpretive synthesis

Strategies and tactics to reduce the impact of healthcare on climate change: systematic review

OBJECTIVE

To review the international literature and assess the ways healthcare systems are mitigating and can mitigate their carbon footprint, which is currently estimated to be more than 4.4% of global emissions.

DESIGN

Systematic review of empirical studies and grey literature to examine how healthcare services and institutions are limiting their greenhouse gas (GHG) emissions.

DATA SOURCES

Eight databases and authoritative reports were searched from inception dates to November 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Teams of investigators screened relevant publications against the inclusion criteria (eg, in English; discussed impact of healthcare systems on climate change), applying four quality appraisal tools, and results are reported in accordance with PRISMA (preferred reporting items for systematic reviews and meta-analyses).

RESULTS

Of 33 737 publications identified, 32 998 (97.8%) were excluded after title and abstract screening; 536 (72.5%) of the remaining publications were excluded after full text review. Two additional papers were identified, screened, and included through backward citation tracking. The 205 included studies applied empirical (n=88, 42.9%), review (n=60, 29.3%), narrative descriptive (n=53, 25.9%), and multiple (n=4, 2.0%) methods. More than half of the publications (51.5%) addressed the macro level of the healthcare system. Nine themes were identified using inductive analysis: changing clinical and surgical practices (n=107); enacting policies and governance (n=97); managing physical waste (n=83); changing organisational behaviour (n=76); actions of individuals and groups (eg, advocacy, community involvement; n=74); minimising travel and transportation (n=70); using tools for measuring GHG emissions (n=70); reducing emissions related to infrastructure (n=63); and decarbonising the supply chain (n=48).

CONCLUSIONS

Publications presented various strategies and tactics to reduce GHG emissions. These included changing clinical and surgical practices; using policies such as benchmarking and reporting at a facility level, and financial levers to reduce emissions from procurement; reducing physical waste; changing organisational culture through workforce training; supporting education on the benefits of decarbonisation; and involving patients in care planning. Numerous tools and frameworks were presented for measuring GHG emissions, but implementation and evaluation of the sustainability of initiatives were largely missing. At the macro level, decarbonisation approaches focused on energy grid emissions, infrastructure efficiency, and reducing supply chain emissions, including those from agriculture and supply of food products. Decarbonisation mechanisms at the micro and meso system levels ranged from reducing low value care, to choosing lower GHG options (eg, anaesthetic gases, rescue inhalers), to reducing travel. Based on these strategies and tactics, this study provides a framework to support the decarbonisation of healthcare systems.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO: CRD42022383719.

Advancing sustainable healthcare: a concept analysis of eco-conscious nursing practices

BACKGROUND

As the healthcare sector grapples with its environmental footprint, the concept of Eco-conscious Nursing emerges as a pivotal framework for integrating sustainability into nursing practice. This study aims to clarify and operationalize Eco-conscious Nursing, examining its attributes, antecedents, consequences, and providing operational definitions to guide future research and practice.

METHODS

Utilizing a systematic literature review across PubMed, Google Scholar, and CINAHL Ultimate, this study identifies and analyzes existing theories, frameworks, and practices related to eco-conscious nursing. Through conceptual analysis, key attributes, antecedents, and consequences of Eco-conscious Nursing are delineated, leading to the formulation of comprehensive operational definitions.

RESULTS

The study reveals Eco-conscious Nursing as a multifaceted concept characterized by environmental stewardship, sustainable healthcare practices, and a commitment to reducing the ecological impact of nursing care. Operational definitions highlight the role of education, awareness, and institutional support as antecedents, with improved environmental health and sustainable healthcare outcomes as key consequences.

CONCLUSION

Eco-conscious Nursing represents a crucial ethos for the nursing profession, emphasizing the necessity of sustainable practices within healthcare. The operational definitions provided serve as a foundation for embedding eco-conscious principles into nursing, addressing the urgent need for sustainability in healthcare settings. Future research should focus on the empirical application of these definitions and explore the economic and cross-cultural dimensions of eco-conscious nursing.

Nurses and Climate Change: A Narrative Review of Nursing Associations' Recommendations for Integrating Climate Change Mitigation Strategies

BACKGROUND

According to the World Health Organization, climate change is the greatest challenge of the twenty-first century. It is already affecting the health of many Canadians through extreme heat, wildfires and the expansion of zoonotic diseases. As trusted professionals, nurses are in favourable position to take action on climate change.

PURPOSE

To document the recommendations issued by Quebec, Canadian, American and international nursing associations regarding nursing practices that address climate change or environmental issues.

METHODS

This narrative review was conducted by establishing a list of environmental and general nursing associations in the geographical areas of interest through Google searches as well as by retrieving documents about climate change or environmental issues published by these organizations on their websites. Data related to the documents' characteristics and recommended nursing roles were then extracted.

RESULTS

The review identified 13 nurses' organizations and 20 documents describing 37 recommendations for nurses in seven socioecological areas: individual, patient-focused, workplace, nursing associations, public health organizations, political and education.

CONCLUSIONS

There is a gap between the breadth of roles that nurses may be called upon to play in addressing climate change and the degree to which relevant organizations are prepared to create the required conditions for them to do so. Several lessons emerged, including that the urgency of the climate crisis requires clear guidelines on how nurses can integrate climate change and its resultant health concerns into practice through nurses' associations, education and bottom-up nursing innovations. Funding is required for such initiatives, which must also prioritize health inequalities.

The perspectives of nurses, as prominent advocates in sustainability, on the global climate crises and its impact on mental health

OBJECTIVE

To evaluate the perspective of nurses in Turkey towards the global climate crisis and its impact on mental health using a qualitative approach.

MATERIALS AND METHOD

This study was conducted from August to September 2023 with 35 nurses living in seven regions of Turkey using an inductive qualitative approach. The researchers employed the snowball sampling method to select participants. Interviews with the participants were conducted until data saturation was reached. Thematic analysis was used to emerge themes.

RESULTS

The findings revealed five main themes (perception of the global climate crisis, effects of the global climate crisis, effects of the global climate crisis on mental health, reflections of the global climate crisis on nursing and nurses' views on prevention and intervention studies for the global climate crisis). Also, the findings revealed 12 sub-themes (physical outcomes, mental outcomes, direct and indirect impacts, psychosocial effects and personal, national and international-based reflections).

CONCLUSION

Our study indicates that nurses exhibit genuine concern for the global climate crisis and experience psychological effects related to this pressing environmental issue. Nurses are keenly aware of their responsibility to safeguard the planet and demonstrate a strong sense of concern for the state of the world.

IMPACT

It is evident that nurses, being prominent advocates for sustainability, are cognizant of their responsibility to protect the planet and demonstrate genuine apprehension for the state of the world.

IMPLICATIONS

Nurses play a crucial role, as they make up 60% of the global healthcare workforce and are often the frontline healthcare professionals during natural disasters. It is vital to elucidate and clarify the terminology concerning the relationship between the climate crisis and the mental health of nurses, to determine the scope of this relationship and to make recommendations for future research areas.

PATIENT OR PUBLIC CONTRIBUTION

No patient or Public Contribution.

Nurses' Environmental Practices in Northern Peruvian Hospitals

BACKGROUND

Decreasing emissions of the global healthcare sector will be an important tool for decreasing the magnitude of climate change. The environmental practices of nurses can have a positive environmental impact. The purpose of this study is to identify environmental practices performed by nurses while at work and home along with their associated factors.

METHODS

This study is a cross-sectional descriptive study conducted by surveying nurses from two public hospitals in Lambayeque, Peru. We utilized the Nurses' Environmental Awareness Tool to collect information about nurses' knowledge on environmental impacts, their risk to health, and environmental behaviors at both work and home.

RESULTS

Of the 106 participants who responded, the average age was 41 years, and 29 (28%) worked in surgical services. A little more than half of nurses reported appropriate energy use (51%) and recycling (53%) at work, while 94 (89%) implemented environmental biosafety. There was an observed association between age and years of employment with appropriate energy use, recycling, implementation of environmental biosafety, appropriate chemical substance use, and preventing medication waste.

CONCLUSION

Nurses reported a favorable tendency toward adequate environmental practices at work and at home. However, more studies are needed to identify the factors that increase nurses' use of these practices.

APPLICATIONS TO PRACTICE

As one of the most trusted professions, professional nurses have an opportunity to play a pivotal role in promoting environmental health and practices in both the workplace and their personal lives. This study highlights areas of potential intervention in the workplace to develop and promote appropriate environmental practices by nurses to decrease pollution by the healthcare sector.

Green HRM practices for encouraging pro-environmental behavior among employees: the mediating influence of job satisfaction

This study aims to investigate the relationship between green human resource management (HRM) practices and pro-environmental behavior among employees with mediating role of job satisfaction in this relationship. A questionnaire was used to collect data from the employees working in the pharmaceutical industry of Pakistan. Structural equation modeling (SEM) was employed to examine study hypotheses. The study's findings indicate that green HRM practices favorably effect employees' job satisfaction, with the exception of green recruiting and selection, which leads to a greater degree of pro-environmental activity among employees. Additionally, it was discovered that job satisfaction, with the exception of green recruitment and selection, partially mediates the association between green HRM practices and pro-environmental behavior. The study also advances the field of analyzing firms' green activities from a psychological and sociological perspective, testing employee job satisfaction as a psychological condition that supports the link between green HRM and pro-environmental behavior. The study highlights the importance of green HRM practices in promoting pro-environmental behavior among employees. By aligning HRM procedures with environmental objectives, implementing environmental training, and involving employees in sustainability initiatives, organizations can build a culture of environmental responsibility and encourage sustainable behavior.

Effects of climate change on patients with respiratory and cardiovascular conditions

Climate change is one of the most significant global challenges and is already having detrimental effects on people's health. Pollution levels and ambient temperatures continue to increase, resulting in higher levels of humidity and pollen production. These environmental threats can affect many vulnerable patients, particularly those with respiratory and cardiovascular conditions, and nurses have a crucial role in raising awareness of the health implications of climate change. This article explores the pathophysiological effects of climate change on patients with asthma, chronic obstructive pulmonary disease and cardiovascular disease, and aims to enhance nurses' understanding of the health challenges of climate change.

How Do Green Human Resource Management Practices Encourage Employees to Engage in Green Behavior? Perceptions of University Students as Prospective Employees

This study measured the perceptions of prospective employees (university students) towards organizations practicing green human resource management and how these perceptions could influence their future green behavior in the workplace. The sample of the study consisted of students from the largest university in North Cyprus and 400 questionnaires were administered with 342 valid responses being returned. The data was tested by confirmatory factor analysis by using analysis of moment structures (AMOS) software version 24.0 and factor, regression, and correlation analyses were conducted. The data analysis revealed that green human resource management had a direct influence on prospective employees’ perceived green task-related and voluntary behaviors and an indirect influence via the mediation of psychological green climate perception. The importance of incorporating sustainable dimensions within HRM departments, as well as the function of GHRM practices in achieving sustainability, was highlighted in this study. This study further contributes to the literature of behavioral HRM and focuses on the green side of HRM to contribute to the environmental management literature as well as providing insight into prospective employees’ (students) perceptions of GHRM practices, which will create an impact on their future green workplace behaviors.

The roles, activities and impacts of middle managers who function as knowledge brokers to improve care delivery and outcomes in healthcare organizations: a critical interpretive synthesis

Background

Middle Managers (MMs) are thought to play a pivotal role as knowledge brokers (KBs) in healthcare organizations. However, the role of MMs who function as KBs (MM KBs) in health care is under-studied. Research is needed that contributes to our understanding of how MMs broker knowledge in health care and what factors influence their KB efforts.

Methods

We used a critical interpretive synthesis (CIS) approach to review both qualitative and quantitative studies to develop an organizing framework of how MMs enact the KB role in health care. We used compass questions to create a search strategy and electronic searches were conducted in MEDLINE, CINAHL, Social Sciences Abstracts, ABI/INFORM, EMBASE, PubMed, PsycINFO, ERIC and the Cochrane Library. Searching, sampling, and data analysis was an iterative process, using constant comparison, to synthesize the results.

Results

We included 41 articles (38 empirical studies and 3 conceptual papers) that met the eligibility criteria. No existing review was found on this topic. A synthesis of the studies revealed 12 MM KB roles and 63 associated activities beyond existing roles hypothesized by extant theory, and we elaborate on two MM KB roles: 1) convincing others of the need for, and benefit of an innovation or evidence-based practice; and 2) functioning as a strategic influencer. We identified organizational and individual factors that may influence the efforts of MM KBs in healthcare organizations. Additionally, we found that the MM KB role was associated with enhanced provider knowledge, and skills, as well as improved organizational outcomes.

Conclusion

Our findings suggest that MMs do enact KB roles in healthcare settings to implement innovations and practice change. Our organizing framework offers a novel conceptualization of MM KBs that advances understanding of the emerging KB role that MMs play in healthcare organizations. In addition to roles, this study contributes to the extant literature by revealing factors that may influence the efforts and impacts of MM KBs in healthcare organizations. Future studies are required to refine and strengthen this framework.

Trial registration

A protocol for this review was not registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07387-z.

Nursing students' perception of climate change and sustainability actions - A mismatched discourse: A qualitative, descriptive exploratory study

BACKGROUND

Climate change is described as the biggest global challenge for human health in the upcoming decade. Nurses play a central role in mitigating the effect of climate change on the healthcare sector and adapting to the phenomenon. Therefore, nursing students must be prepared for a new professional role keeping climate change in mind; consequently, it is important to study students' perceptions of climate change and sustainability.

OBJECTIVES

To explore nursing students' perceptions of climate change and sustainability and examine how they perceive their role as nursing students in working towards a more sustainable development within the healthcare sector.

DESIGN

It is a qualitative, descriptive exploratory study.

SETTINGS

A nursing program at a university in central Sweden.

PARTICIPANTS

Nursing students.

METHODS

Individual in-depth interviews and one group interview were conducted for the study.

RESULTS

The main findings revealed that students saw themselves living in a mismatched discourse. They perceived the future of humanity as gloomy but thought that sustainability is the society's joint obligation to achieve the right to a good life for all people equally.

CONCLUSIONS

Nursing students perceived themselves as important actors in the work of climate change and sustainability. Thus, nursing education needs to integrate the impact of climate change on healthcare and promote sustainability into the curriculum for preparing students to take responsibility for sustainability in society.

How the hospital context influences nurses' environmentally responsible practice: A focused ethnography

AIM

To describe ways in which a hospital context, physically and culturally, influences nurses' abilities to promote and engage with environmentally responsible practice.

DESIGN

A focused ethnographic study.

METHODS

Data were collected during May and August, 2019. Nurses (n = 22) working in the emergency room and three medicine units within a large Western Canadian hospital were invited to participate. Semi-structured interviews were conducted, and observations were collected. Reporting is in accordance with the consolidated criteria for reporting qualitative research.

RESULTS

Three themes were identified: patient care not environmental care, organizational role and operational efficiency. Overall, participants indicated patient care was their primary priority, and due to their workload, they were unable to simultaneously consider the environmental impact of their work. Participants stated they had difficulties practicing in environmentally responsible ways because they felt unsupported by their hospital organization. Regardless, there was a desire for the organization to support environmentally responsible practices.

CONCLUSION

Climate change is a major health concern, and partnership between hospitals and nurses is necessary to ensure environmentally responsible healthcare is delivered. We suggest both a top-down and bottom-up approach to help develop hospital contexts that are relevant and environmentally responsible.

IMPACT

Nurses have a professional responsibility to address climate change, yet this study identified that nurses found it challenging to practice in environmentally responsible ways within the hospital context. Challenges they faced are related to their workload, their misaligned nursing priorities and, more importantly, because they felt unsupported by their hospital. Findings are important to both the nursing profession as well as other hospital leaders so that a culture of environmentally responsible healthcare can be developed within hospitals.

Environmental Awareness and sensitivity of nursing students

OBJECTIVE

Currently, environmental problems have reached alarming levels, constituting a serious problem for public health. This study was conducted in order to evaluate the environmental awareness and sensitivity of nursing students.

METHODS

This descriptive study was conducted on 286 nursing students of a foundation university in Northern Cyprus in the fall term of the 2016-2017 academic year. Data were collected by using the personal information form and Environmental Awareness and Sensitivity Scale. Participants had moderate levels of environmental awareness and sensitivity. Nonsmoking nursing students had higher environmental awareness. Besides, participants who attended lectures on the environment, stayed in dormitories, participated in the activities of environmental organizations, and warned people who polluted the environment had higher environmental awareness and sensitivity.

CONCLUSION

These findings suggest that the number of lectures and social activities on the environment could be increased in order to promote the environmental awareness of nursing students.

Outrage and the emotional labour associated with environmental activism among nurses

AIM

To investigate the emotions associated with environmental activism among nurses.

BACKGROUND

Nursing has a long history of political activism in relation to social justice issues. Some nurses are environmental activists.

DESIGN

Ethnography.

METHODS

Focus groups and individual interviews were triangulated with additional observational data. The 40 participants (USA = 23, UK = 17) were nurses actively engaged with environmental/sustainability issues. Data collection was from March-October 2017. Data were analysed using discourse analysis.

RESULTS

The trigger for nurses' environmental activism was a strong emotional response to recognizing risks to human health. Their activism results in an additional emotion burden above which they routinely experience in caring for patients. Many feel over-whelmed by the magnitude of the issues. Nurses in America feel more supported and empowered to be activists than UK nurses.

CONCLUSION

This study reveals for the first time that advocating for the environment is emotional labour, additional to the previously recognized emotional labour associated with caring for patients. Encouragement and support from others, particularly fellow nurses, helps nurse environmental activists continue to fight for the health of communities and the planet.

IMPACT

Outrage at threats to human health triggers nurses' environmental activism. Environmental activism creates an additional emotional burden above that routinely experienced in caring for patients. Nurses in America feel more supported and empowered to be activists than UK. Nurses whose practice embraces environmental activism need practical and emotional support from other nurses.

Becoming and being an environmentally 'woke' nurse: A phenomenological study

BACKGROUND

Increasing numbers of nurses view environmental activism as part of their role. No studies have explored the reasons.

AIM

This study aimed to identify what awakened and shaped US and UK nurses' environmental activism.

DESIGN

A Gadamerian hermaneutic phenomenological study.

METHODS

Forty nurses were recruited in 2017 using purposive sampling (USA n = 23, UK n = 17). Four focus groups were followed by individual interviews. Iterative, fully immersive phenomenological analysis was conducted with corroboration of themes and a final "shared horizon."

FINDINGS

Participants described "lightbulb" events whereby they recognized environmental threats to people and the planet. Their nursing-centered values of social justice, generational fairness, and alleviating suffering underpinned a shared belief in their ability to help mitigate those threats. They believed it was their duty as nurses to take action on behalf of individuals, communities, and the planet.

DISCUSSION

The nursing skill set of these nurses makes for effective leadership and environmental activism. Environmentally "woke" nurses have the skills to create solutions and systems approaches that increase sustainability, improve health and make a difference to people's lives, now and for future generations.

Promoting employee's proenvironmental behavior through green human resource management practices

Success of organizational initiatives for environmental sustainability hinges upon employees' proenvironmental behaviors. One of the contemporary important challenges faced by HR professionals is to ensure proper integration of environmental sustainability into human resource policies. The green human resource management (green HRM) has emerged from organizations engaging in practices related to protection of environment and maintaining ecological balance. The aim of this study is to examine the effects of green HRM practices (green recruitment and selection, green training and development, green performance management and appraisal, green reward and compensation, and green empowerment) on employee's proenvironmental behavior. Moreover, this study is going to test the mediating effect of proenvironmental psychological capital and the moderating effect of environmental knowledge on green HRM practices–proenvironmental behavior. Data from 347 employees working in coal generating, power industry, food, chemical, and pharmaceutical industries were collected. Results revealed that green HRM practices positively affected employee's proenvironmental behavior, and proenvironmental psychological capital mediated this link. Employee's environmental knowledge moderated the effect of green HRM practices on proenvironmental behavior.

Effective Dementia Education and Training for the Health and Social Care Workforce: A Systematic Review of the Literature

Ensuring an informed and effective dementia workforce is of international concern; however, there remains limited understanding of how this can be achieved. This review aimed to identify features of effective dementia educational programs. Critical interpretive synthesis underpinned by Kirkpatrick's return on investment model was applied. One hundred and fifty-two papers of variable quality were included. Common features of more efficacious educational programs included the need for educational programs to be relevant to participants' role and experience, involve active face-to-face participation, underpin practice-based learning with theory, be delivered by an experienced facilitator, have a total duration of at least 8 hours with individual sessions of 90 minutes or more, support application of learning in practice, and provide a structured tool or guideline to guide care practice. Further robust research is required to develop the evidence base; however, the findings of this review have relevance for all working in workforce education.

What works in delivering dementia education or training to hospital staff? A critical synthesis of the evidence

BACKGROUND

The quality of care delivered to people with dementia in hospital settings is of international concern. People with dementia occupy up to one quarter of acute hospital beds, however, staff working in hospitals report lack of knowledge and skills in caring for this group. There is limited evidence about the most effective approaches to training hospital staff on dementia.

OBJECTIVE

The purpose of this literature review was to examine published evidence on the most effective approaches to dementia training and education for hospital staff.

DESIGN AND REVIEW METHODS

The review was conducted using critical synthesis and included qualitative, quantitative and mixed/multi- methods studies. Kirkpatrick's four level model for the evaluation of training interventions was adopted to structure the review.

DATA SOURCES

The following databases were searched: MEDLINE, PsycINFO, CINAHL, AMED, British Education Index, Education Abstracts, ERIC (EbscoHost), The Cochrane Library-Cochrane reviews, Economic evaluations, CENTRAL (Wiley), HMIC (Ovid), ASSIA, IBSS (Proquest), Conference Proceedings Citation Indexes (Web of Science), using a combination of keyword for the following themes: Dementia/Alzheimer's, training/education, staff knowledge and patient outcomes.

RESULTS

A total of 20 papers were included in the review, the majority of which were low or medium quality, impacting on generalisability. The 16 different training programmes evaluated in the studies varied in terms of duration and mode of delivery, although most employed face-to-face didactic techniques. Studies predominantly reported on reactions to training and knowledge, only one study evaluated outcomes across all of the levels of the Kirkpatrick model. Key features of training that appeared to be more acceptable and effective were identified related to training content, delivery methods, practicalities, duration and support for implementation.

CONCLUSIONS

The review methodology enabled inclusion of a broad range of studies and permitted common features of successful programmes to be identified. Such features may be used in the design of future dementia training programmes, to increase their potential for effectiveness. Further research on the features of effective dementia training for hospital staff is required.

Characteristics of nursing professionals and the practice of ecologically sustainable actions in the medication processes

Objectives:

to verify the correlation between the characteristics of professionals and the practice of sustainable actions in the medication processes in an ICU, and to determine if interventions such as training and awareness can promote sustainable practices performed by nursing staff in the hospital.

Methods:

before-and-after design study using Lean Six Sigma methodology, applied in an intensive care unit. Nursing staff were observed regarding the practice of ecologically sustainable actions during medication processes (n = 324 cases for each group (pre and post-intervention)) through a data collection instrument. The processes analyzed involved 99 professionals in the pre-intervention phase and 97 in the post-intervention phase. Data were analyzed quantitatively and the association of variables was accomplished by means of statistical inference, according to the nature of the related variables.

Results:

the education level was the only characteristic that showed to be relevant to an increase in sustainable practices, with a statistically significant difference (p = 0.002). When comparing before and after the intervention, there was an increase in environmentally friendly actions with statistically significant differences (p = 0.001).

Conclusions:

the results suggest that institutions should encourage and invest in formal education, as well as training of health professionals to promote sustainable practices in the hospital.

Ecological caring-Revisiting the original ideas of caring science

The aim of this empirically grounded philosophical paper is to explore the notion of holistic care with the intention to expand it into a notion of ecological care and in such a way revisit the original ideas of caring science. The philosophical analysis, driven by lifeworld theory and especially Merleau-Ponty's philosophy, is firmly rooted in contemporary clinical care. We used interview data from patients in a study at an anthroposophic clinic in Sweden, which forms part of an ecological community with, for example, ecological agriculture. The empirical study is analysed according to reflective lifeworld research. Starting from the fact that illness can be defined as a loss of homelikeness in the body and in the familiar world, our findings illustrate how ecological care helps the patient to once again find one's place in a world that is characterized by interconnectedness. The task of ecological care is thus not only to see the patient within a world of relationships but to help the patient find his/her place again, to understand himself/herself and the world anew. Ecological care is not only about fighting an illness, but also recognizes a patient from inside a world that s/he is affected by and affects, that s/he is understood and understands from. Such care tries to restore this connection by making possible the rhythmical movement as well as the space in-between activity and rest, between being cared for and actively involving oneself in one's recovery and between closing oneself off from the world and once again going out into it.

Solid waste management in primary healthcare centers: application of a facilitation tool

Objectives:

to propose a tool to facilitate diagnosis, formulation and evaluation of the Waste Management Plan in Primary Healthcare Centers and to present the results of the application in four selected units.

Method:

descriptive research, covering the stages of formulation /application of the proposed instrument and the evaluation of waste management performance at the units.

Results:

the tool consists in five forms; specific indicators of waste generation for outpatients healthcare units were proposed, and performance indicators that give scores for compliance with current legislation. In the studied units it is generated common waste (52-60%), infectious-sharps (31-42%) and recyclable (5-17%). The average rates of generation are: 0,09kg of total waste/outpatient assistance and 0,09kg of infectious-sharps waste/outpatient procedure. The compliance with regulations, initially 26-30%, then reached 30-38% a year later.

Conclusion:

the tool showed to be easy to use, bypassing the existence of a complex range of existing regulatory requirements, allowed to identify non-conformities, pointed out corrective measures and evaluated the performance of waste management. In this sense, it contributes to decision making and management practices relating to waste, tasks usually assigned to nurses. It is recommended that the tool be applied in similar healthcare units for comparative studies, and implementation of necessary adaptations for other medical services.

Sustentabilidade ambiental nos processos de medicação realizados na assistência de enfermagem hospitalar

Resumo Objetivo Foram analisadas ações sustentáveis realizadas pela equipe de enfermagem de uma unidade de terapia intensiva durante os processos de medicação e proposto intervenções para a melhoria da sustentabilidade ambiental na área hospitalar. Métodos Estudo antes e depois usando a metodologia Lean Seis Sigma aplicada em uma unidade de terapia intensiva. A amostra foi composta por 648 processos de medicação realizados pela equipe de enfermagem. Os dados foram coletados por meio de roteiros de observação e analisados quantitativamente. Resultados Os resultados pós-intervenções incluíram a redução dos materiais como sacos plásticos (37,1%), redução de sobras de anti-inflamatórios hormonais (67,1%), aumento na remoção de etiquetas de sacos plásticos para serem reciclados (146,9%) e descarte correto de resíduos (32,2%) com diferença estatística significante (p ≤0.05). Conclusão As estratégias de intervenções implementadas a partir da análise do problema, validação e priorização das ações teve influência positiva na redução, reciclagem e disposição correta dos resíduos com benefícios para a instituição, meio ambiente e a saúde humana.

What do tomorrow's doctors need to learn about ecosystems? - A BEME Systematic Review: BEME Guide No. 36

BACKGROUND

Human health is fundamentally determined by the health of ecosystems. Guidance is lacking about how to address the topic of ecosystems within medical education.

AIMS

To determine the nature of discussions around ecosystems in the educational, medical and medical education literature. To identify learning needs of tomorrow's doctors.

METHODS

A narrative synthesis approach was used. Systematic searches were completed in 14 databases. Two independent reviewers screened results. Preliminary synthesis included textual descriptions and quality appraisal. Data were analysed using the Education for Sustainable Healthcare framework and thematic analysis. Relationships between studies were explored. Best evidence synthesis, contacting authors of primary studies and critical reflection reinforced robustness.

RESULTS

Six thousand seven hundred and fifty-three abstracts and 123 full texts were screened. Twenty-seven studies were included. Many studies lacked clear reporting. Medical students and doctors displayed knowledge about ecosystems, but lacked confidence to enact sustainable practices. Education about causes and consequences of environmental change is required. Few studies proposed specific learning objectives.

CONCLUSIONS

To prepare for roles as health care workers and leaders, medical students must learn about relationships between ecosystems, health and health care. The Education for Sustainable Healthcare framework outlines essential knowledge and attitudes but requires addition of practical competencies. Further research should explore the framework's relevance in different contexts, in order to structure training accordingly.