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.

Mental Health Impacts of Climate Change Among Vulnerable Populations Globally: An Integrative Review.

Background: Climate change has been shown to be directly linked to multiple physiological sequelae and to impact health consequences. However, the impact of climate change on mental health globally, particularly among vulnerable populations, is less well understood. Objective: To explore the mental health impacts of climate change in vulnerable populations globally. Methods: We performed an integrative literature review to identify published articles that addressed the research question: What are the mental health impacts of climate change among vulnerable populations globally? The Vulnerable Populations Conceptual Model served as a theoretical model during the review process and data synthesis. Findings/Results: One hundred and four articles were selected for inclusion in this review after a comprehensive review of 1828 manuscripts. Articles were diverse in scope and populations addressed. Land-vulnerable persons (either due to occupation or geographic location), Indigenous persons, children, older adults, and climate migrants were among the vulnerable populations whose mental health was most impacted by climate change. The most prevalent mental health responses to climate change included solastalgia, suicidality, depression, anxiety/eco-anxiety, PTSD, substance use, insomnia, and behavioral disturbance. Conclusions: Mental health professionals including physicians, nurses, physician assistants and other healthcare providers have the opportunity to mitigate the mental health impacts of climate change among vulnerable populations through assessment, preventative education and care. An inclusive and trauma-informed response to climate-related disasters, use of validated measures of mental health, and a long-term therapeutic relationship that extends beyond the immediate consequences of climate change-related events are approaches to successful mental health care in a climate-changing world.

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.

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.

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.

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.

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.

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.

Integrating Climate Change Topics Into Nursing Curricula.

BACKGROUND: Health professionals have a key role in addressing the health impacts of climate change at several levels: direct patient care, client and community education, health professions education, and through advocacy and health policy development. METHOD: Recognizing that nurses are the first line in health education, nursing faculty at the MGH Institute of Health Professions developed the first nurse-led Center for Climate Change, Climate Justice and Health (CCCCJH). RESULTS: A steering committee of nurse climate change scholars and interested faculty developed a mission, vision, core values, and a strategic plan for the CCCCJH and are working on integrating climate change topics into nursing curricula at all levels. CONCLUSION: Nurses are in the ideal position to lead the way to increase awareness among health professionals and students about the health impacts of climate change. Curricular integration of climate change topics at all levels will prepare our students to meet the needs and challenges of the future. [J Nurs Educ. 2019;58(6):364-368.].

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.

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.

Ten-year clinical experience of humanitarian cardiothoracic surgery in Rwanda: Building a platform for ultimate sustainability in a resource-limited setting.

OBJECTIVE: Despite its near complete eradication in resource-rich countries, rheumatic heart disease remains the most common acquired cardiovascular disease in sub-Saharan Africa. With a ratio of physicians/population of 1 per 10,500, including only 4 cardiologists for a population of 11.4 million, Rwanda represents a resource-limited setting lacking the local capacity to detect and treat early cases of strep throat and perform lifesaving operations for advanced rheumatic heart disease. Humanitarian surgical outreach in this region can improve the delivery of cardiovascular care by providing sustainability through mentorship, medical expertise, training, and knowledge transfer, and ultimately the creation of a cardiac center. METHODS: We describe the experience of consecutive annual visits to Rwanda since 2008 and report the outcomes of a collaborative approach to enable sustainable cardiac surgery in the region. The Ferrans and Powers Quality of Life Index tool's Cardiac Version (http://www.uic.edu/orgs/qli/) was administered to assess the postoperative quality of life. RESULTS: Ten visits have been completed, performing 149 open procedures, including 200 valve implantations, New York Heart Association class III or IV, with 4.7% 30-day mortality. All procedures were performed with the participation of local Rwandan personnel, expatriate physicians, nurses, residents, and support staff. Early complications included cerebrovascular accident (n = 4), hemorrhage requiring reoperation (n = 6), and death (n = 7). Quality of life was assessed to further understand challenges encountered after cardiac surgery in this resource-limited setting. Four major domains were considered: health and functioning, social and economic, psychologic/spiritual, and family. The mean total quality of life index was 20.79 ± 4.07 on a scale from 0 to 30, for which higher scores indicated higher quality of life. Women had significantly lower "social and economic" subscores (16.81 ± 4.17) than men (18.64 ± 4.10) (P < .05). Patients who reported receiving their follow-up care in rural health centers also had significantly lower "social and economic" subscores (15.67 ± 3.81) when compared with those receiving follow-up care in urban health facilities (18.28 ± 4.16) (P < .005). Value afforded to family and psychologic factors remained high among all groups. Major postsurgical challenges faced included barriers to follow-up and systemic anticoagulation. CONCLUSIONS: This report represents the first account of a long-term humanitarian effort to develop sustainability in cardiac surgery in a resource-limited setting, Rwanda. With the use of volunteer teams to deliver care, transfer knowledge, and mentor local personnel, the results demonstrate superior outcomes and favorable indices of quality of life. The credibility gained over a decade of effort has created the opportunity for a partnership with Rwanda to establish a dedicated center of cardiac care to assist in mitigating the burden of cardiovascular disease throughout sub-Saharan Africa.

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.

Auricular acupuncture to relieve health care workers' stress and anxiety: impact on caring.

BACKGROUND: The caring relationship between individual health care providers and patients is a critical component of healing. However, caring can result in physical, emotional, psychological, and spiritual symptoms in providers that can interfere with their capacity to enter into these relationships. PURPOSE: The aim of this study was to evaluate whether auricular acupuncture is an effective tool for reducing health care provider stress and anxiety and, second, to determine if auricular acupuncture impacts provider capacity for developing caring relationships with patients. METHODS: Preintervention and postintervention surveys were evaluated to see if auricular acupuncture was associated with changes in State-Trait Anxiety Inventory (STAI), Professional Quality of Life, and Caring Ability Inventory scores. RESULTS: Compared with baseline, participants had a significant reduction in state anxiety (STAI), trait anxiety (STAI), burnout, and secondary traumatic stress scores (Professional Quality of Life). Significant increases were noted in courage and patience, 2 dimensions of the Caring Ability Inventory. CONCLUSIONS: Auricular acupuncture is an effective intervention for the relief of stress/anxiety in providers and supports heightened capacity for caring.

Partnership for sustainability in cardiac surgery to address critical rheumatic heart disease in sub-Saharan Africa: the experience from Rwanda.

IMPORTANCE: Rheumatic heart disease (RHD) in the developing world results in critical disability among children, adolescents, and young adults-marginalizing a key population at its peak age of productivity. Few regions in sub-Saharan Africa have independently created an effective strategy to detect and treat streptococcal infection and mitigate its progression to RHD. OBJECTIVE: We describe a unique collaboration, where the Rwanda Ministry of Health, the Rwanda Heart Foundation, and an expatriate humanitarian cardiac surgery program have together leveraged an innovative partnership as a means to expand Rwanda's current capacity to address screening and primary prevention, as well as provide life-saving cardiac surgery for patients with critical RHD. EVIDENCE REVIEW: Interviews with key personnel and review of administrative records were conducted to obtain qualitative and quantitative data on the recruitment of clinical personnel, procurement of equipment, and program finances. The number of surgical cases completed and the resultant clinical outcomes are reviewed. FINDINGS: From 2008 to 2013, six annual visits were completed. A total of 128 prosthetic valves have been implanted in 86 complex patients in New York Heart Association (NYHA) class III or IV heart failure, with excellent clinical outcomes (5 % 30-day mortality). Postoperative complications included a cerebrovascular accident (n = 1) and hemorrhage, requiring reoperation (n = 2). All procedures were performed with participation of local personnel. CONCLUSIONS AND RELEVANCE: This strategy provides a reliable and consistent model of sophisticated specialty care delivery; inclusive of patient-centered cardiac surgery, mentorship, didactics, skill transfer, and investment in a sustainable cardiac program to address critical RHD in sub-Saharan Africa.