Can a sustainability and health scenario provide a realistic challenge to student nurses and provoke changes in practice? An evaluation of a training intervention

Validation of the Sustainability Attitudes in Nursing Survey-2 for nurses: A cross-sectional study

AIM

To validate the Sustainability Attitudes in Nursing Survey-2 for nurses.

BACKGROUND

Climate change and environmental sustainability is an increasing global issue. Nurses' behaviors could produce harmful emission through their activities, while nurses also care for people with climate change-related health problems. Therefore, nurses have a responsibility of achieving environmental sustainability. To enhance environmental sustainability in nursing, examining attitudes toward climate change and environmental sustainability among nurses from diverse culture is needed.

DESIGN

Cross-sectional design using secondary data.

METHODS

Data from 349 nurses working at tertiary hospitals in Korea were collected in August 2022. The content validity index and the construct, convergent, discriminant and criterion validities were evaluated. Cronbach's alpha and intraclass correlation coefficient were also evaluated to determine reliability.

RESULTS

The survey comprised five items with single factor, similar to its original version. Its validity and reliability were acceptable. Cronbach's α was .86. The intraclass correlation coefficient was .81 for the entire scale.

CONCLUSION

This study found the Sustainability Attitudes in Nursing Survey-2 to be a valid and reliable tool for measuring nurses' attitudes toward environmental sustainability. Understanding nurses' attitudes and the educational needs related to environmental sustainability could help develop a more environmentally sustainable workplace in nursing.

Nursing students' and educators' perspectives on sustainability and climate change: An integrative review

AIM

To identify and synthesize research on the awareness, attitudes and action related to sustainability and climate change from the perspective of nursing students and educators globally.

DESIGN

Integrative review.

METHODS

The review was guided by Whittemore and Knafl. Included studies were appraised using the Mixed Methods Appraisal Tool. A deductive content analysis based on Elo and Kyngäs' methodology was employed.

DATA SOURCES

CINAHL, MEDLINE, EMBASE, Web of Science, British Education Index, GreenFILE and Scopus were searched up to the 8th November 2022.

RESULTS

Thirty-two studies were included in the review. Two studies included nursing educators in their samples, the rest focused solely on students. Findings suggest that whilst some students were aware of sustainability issues and felt that nurses have a responsibility to mitigate climate change, others showed limited awareness and believed that nurses have more important priorities. A global interest was seen among students for increased curricular content related to sustainability and climate change. Waste management and education of others were suggested actions students can take; however, barriers included lack of confidence and limited power.

CONCLUSION

There is a need for sustainability education within nursing curricula, accompanied by student support.

IMPLICATIONS FOR THE PROFESSION

The review acts as a starting point to make sustainable healthcare and climate change mitigation integral aspects of nursing.

IMPACT

Sustainability education within nursing curricula can positively impact on sustainable healthcare and climate change mitigation. More research is needed on the perspectives of nursing educators.

REPORTING METHOD

The review is reported according to the PRISMA guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Rapid review: Guides and frameworks to inform planetary health education for health professions

ISSUE ADDRESSED

Human actions have led to a range of global environmental changes. Health professionals must be prepared to deliver systemic changes to mitigate and adapt to the ecological crisis. This rapid review aimed to describe exemplar frameworks that inform planetary health education across health professions.

METHODS

The rapid review methodology was informed by a scoping review process. A targeted search strategy was conducted using one representative database and additional strategies such as expert consultation and citation searching were used. Results are described narratively.

RESULTS

Of the 11 637 articles, 17 were eligible for inclusion. The frameworks differed, with many recently developed for health professions broadly using a range of methodologies, including qualitative research, opinion/consensus data, literature reviews, and adaptation of previous models. Models such as metric-based scoring indicators and Sustainable Quality Improvement were featured in the frameworks, as were the application of First Nations Natural Laws.

CONCLUSION

This rapid review identifies and showcases accessible, interdisciplinary frameworks to inform the integration of planetary health in curricula, highlighting a rapidly evolving field through which interdisciplinary collaborations in healthcare are important to inform its pedagogy and application. Health education is an important component of health promotion; and thus this rapid review offers a range of approaches that health professionals, health promotion practitioners, and educators can use to inform the integration of planetary health, including sustainable healthcare, into curricula. SO WHAT?: Educational frameworks are informed by research and practice and provide key guidance to practitioners and educators; summarising key available planetary health education frameworks consolidates and guides effective education and builds on the existing body of knowledge to support urgent pro-environmental change.

Sustainable healthcare education: A systematic review of the evidence and barriers to inclusion

PURPOSE OF THE ARTICLE

Health professions education is failing to prepare students to practice sustainable healthcare despite the climate crisis an urgent provision of educational opportunities is required. This systematic review aimed to synthesise educational approaches applied to sustainable healthcare education within health professions curricula and critically evaluate their impact.

MATERIALS AND METHODS

Databases searched: APA PsycInfo, BEI, CINAHL, Embase, ERIC, Medline, Scopus, Cochrane Library, Web of Science, BASE, DART-Europe, EThOS and ProQuest. Secondary searching techniques were also utilised, with searching conducted October 2021. Eligible studies included healthcare professional students/trainees, exposed to sustainable healthcare education, and evaluated through impact on knowledge, attitudes or skills. Empirical studies of any publication status were included. Non-English language studies were excluded. Eligible studies were quality assessed using JBI (2022) critical appraisal checklists and synthesised narratively.

RESULTS

Twenty-three studies were included, comprising 3343 participants and seven health professions. Studies primarily adopted a quasi-experimental design and demonstrated variable quality. Most common educational approaches were workshops and clinical skills sessions, though eight different approaches were observed. Positive impacts were achieved for knowledge, attitudes and skills.

CONCLUSIONS

Diverse approaches have been applied to sustainable healthcare education, though no superior approach is evident. Instead, many effective approaches are outlined, to be adopted in alignment with the learning outcomes.

Nursing Faculty's Perceptions of Climate Change and Sustainability

AIM

The aim of this research study was to investigate the perceptions of climate change and sustainability of faculty teaching in associate and baccalaureate degree nursing programs in South Carolina and their attitudes toward inclusion of relevant content into the nursing curriculum.

BACKGROUND

Climate change is a topic that receives limited discussion in most nursing education curricula.

METHOD

This cross-sectional, descriptive study gathered data from 21 schools of nursing via an online survey consisting of demographic questions, the New Ecological Paradigm Scale, and the Sustainability Attitudes in Nursing Survey 2 and two questions regarding the current inclusion of content.

RESULTS

Eighty-one percent of respondents did not include health implications of climate change in their teaching content; 67% did not include health implications of sustainability.

CONCLUSION

Results provide preliminary evidence of gaps and areas of need for curricular content related to climate change and sustainability.

Global Health in Swedish Nursing Curricula: Navigating the Desirable and the Necessary

Global health challenges are likely to be aggravated in the coming years by rapid climate change and environmental degradation. To address the resulting health inequities, nurses need an integrated understanding of environmental and social determinants of health. This study adopts an explorative inductive approach to examine how global health and sustainability are expressed the course syllabi of undergraduate nursing programmes (n = 24) in Sweden. After excluding biomedical and other unrelated content, 67 syllabi were selected for a thematic analysis. Results indicate that global health, the social determinants of health and sustainability tend to appear in a fragmented manner in the syllabi. Global health content is often limited, relegated to elective courses, or altogether missing. A theoretical framework is lacking, and focus lies on an individual rather than structural perspective. Based on international policy, earlier studies on undergraduate nursing education and theoretical work, suggestions are made for how global health and sustainability content could be integrated into nursing education, notably by using a structural competency approach.

Integrating Environmental Sustainability Content Into an RN-to-BSN Program: A Pilot Study

BACKGROUND

The link between environmental sustainability, climate change, and health outcomes makes environmental sustainability an important topic for educators to include in nursing curricula.

METHOD

Students completed a sustainability in nursing learning module, over a 4-week period, during which students created blog posts based on the learning materials and clinical practice observations. The Sustainability Attitudes in Nursing Survey questionnaire was incorporated to measure changes in student attitudes regarding sustainability.

RESULTS

Descriptive statistics indicated that students had higher average scores on the posttest for all variables except one measurement. Paired t-test results revealed statistically significant differences in nine sustainability attitude items in the pretest and posttest scores. These findings suggest that the intervention likely contributed to improved attitudes about sustainability in the workplace.

CONCLUSION

Results of this study are promising because the brief intervention had a significant effect on practicing nurses' attitudes about sustainability in their work environments. [J Nurs Educ. 2020;59(11):637-641.].

Fulfilling a new obligation: Teaching and learning of sustainable healthcare in the medical education curriculum

Aims: Leading the growing international recognition of the need for sustainability in healthcare delivery, the UK medical regulator has mandated that newly qualified doctors must be able to apply the principles of sustainable healthcare to medical practice. This original research investigates how best to incorporate this new learning into the medical curriculum. Methods: Data from multiple sources were triangulated to generate themes through grounded theory. Meetings were held with representatives of key stakeholder organizations, relevant documents were reviewed and semi-structured interviews were conducted with diverse medical educators who teach sustainable healthcare. Results: There is continual pressure on space in the curriculum, and faculty lack the knowledge to teach this emerging subject, which is also difficult to examine. Students increasingly demand that sustainability be addressed in their education and future careers. Many sources of support and learning resources are available. Conclusions: Practical recommendations for implementation in any medical school include: teaching sustainability as a cross-cutting theme rather than a topic, clinicians and students learning from each other in this developing field, and embedding into assessment the wider determinants of disease. Sustainable healthcare emphasizes prevention rather than late intervention, with benefits to the environment on which health depends, healthcare systems and patients.

Factors Influencing Arab Nursing Students' Attitudes toward Climate Change and Environmental Sustainability and their Inclusion in Nursing Curricula

OBJECTIVE

To assess the factors influencing the attitudes of Bachelor of Science in Nursing students toward climate change and environmental sustainability and the inclusion of these concepts in the nursing curricula of four Arab countries.

METHOD

A convenience sample of 1,059 students from four Arab countries was surveyed using the Environmental Sustainability Attitudes in Nursing Survey-2 (SANS-2) questionnaire in this descriptive-comparative study.

RESULTS

The majority of the respondents exhibited positive attitudes toward the five items of SANS-2, with "Environmental sustainability is an important issue for nursing" receiving the lowest mean score and "Issues about climate change should be included in the nursing curriculum" receiving the highest mean score. Saudi students had more positive attitudes toward environmental sustainability in health care compared with students from Iraq, Egypt, and the Palestinian Territories. Country of residence, type of community, and knowledge about environmental issues and their impact on health in any nursing course were significant factors that influenced attitudes toward environmental sustainability.

CONCLUSION

The inclusion of climate change and environmental sustainability in nursing curricula in the Arab region was emphasized by the findings. Including environmental sustainability practices in nursing education will help student nurses develop critical thinking and skills in the adaptive delivery of health care, especially when resources are scarce.

Athletic Trainers' Attitudes and Perceptions of Environmental Sustainability

CONTEXT

  Environmental sustainability efforts are becoming a critical concern in health care. However, little is known regarding how athletic trainers feel about the environment or what can be done to reduce the environmental impact of the practice of athletic training.

OBJECTIVE

  To examine athletic trainers' attitudes toward and perceptions of factors related to environmental sustainability.

DESIGN

  Sequential, mixed methods using a survey, focus groups, and personal interviews.

SETTING

  Field study.

PATIENTS OR OTHER PARTICIPANTS

  Four hundred forty-two individuals completed the survey. Sixteen participated in the qualitative portion.

MAIN OUTCOME MEASURE(S)

  Quantitative results from the Athletic Training Environmental Impact Survey included data from a 5-point Likert scale (1 = lowest rating and 5 = highest rating). Descriptive statistics and 1-way analyses of variance were used to describe perceptions and determine differences in mean opinion, National Athletic Trainers' Association district, and use of green techniques. Qualitative data were transcribed verbatim and analyzed inductively.

RESULTS

  The mean score for opinion of the environment was 3.30 ± 0.52. A difference was found between opinion and National Athletic Trainers' Association district ( F_{9, 429} = 2.43, P = .01). A Bonferroni post hoc analysis identified this difference ( P = .03) between members of District 2 (Delaware, New Jersey, New York, Pennsylvania) and District 9 (Alabama, Florida, Georgia, Kentucky, Louisiana, Mississippi, Tennessee). An inductive analysis resulted in 3 emergent themes: (1) barriers to using green techniques, (2) motivators for using green techniques, and (3) solutions to overcoming the barriers. The information gleaned from participants in the qualitative portion of the study can be useful for clinicians wishing to implement basic conservation efforts in their practice settings and may guide future sustainability projects.

CONCLUSIONS

  Overall, participants reported a positive opinion of environmental sustainability topics related to athletic training. However, many barriers to practicing green techniques were identified.

Teaching About Climate Change in Medical Education: An Opportunity

Climate change threatens many of the gains in development and health over the last century. However, it could also be a catalyst for a necessary societal transformation to a sustainable and healthy future. Doctors have a crucial role in climate change mitigation and health system adaptation to prepare for emergent health threats and a carbon-constrained future. This paper argues that climate change should be integrated into medical education for three reasons: first, to prepare students for clinical practice in a climate-changing world; secondly, to promote public health and eco-health literacy; and finally, to deepen existing learning and strengthen graduate attributes. This paper builds on existing literature and the authors' experience to outline potential learning objectives, teaching methods and assessment tasks. In the wake of recent progress at the United Nations climate change conference, COP-21, it is hoped that this paper will assist universities to integrate teaching about climate change into medical education. Significance for public healthThere is a strong case for teaching about climate change in medical education. Anthropogenic climate change is accepted by scientists, governments and health authorities internationally. Given the dire implications for human health, climate change is of fundamental relevance to future doctors. Integrating climate change into medical education offers an opportunity for future doctors to develop skills and insights essential for clinical practice and a public health role in a climate-changing world. This echoes a broader call for improved public health literacy among medical graduates. This paper provides medical schools with a rationale and an outline for teaching on climate change.