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.

Health Consequences of Climate Change: Continuing Education Opportunities for Health Professionals in the United States.

Climate change is a looming public health challenge. The health consequences of climate change are increasingly recognized as contributing to negative health outcomes for individuals, families, communities, and populations. The education of health professionals in academic programs and continuing education in clinical practice settings is critical in today's world. The Association of American Medical Colleges and the National League for Nursing, among other organizations, have urged academic programs to include the impact of climate change on health in health professions education and have started to integrate it into curricula. However, health professionals educated over the past several decades have received little content related to the deleterious impact of climate change on health. Therefore, continuing education programs addressing the health consequences of climate change are being developed to fill the gap in health professions education globally. This review study explicated the available continuing education opportunities for public health professionals and health care providers related to the health consequences of climate change. [J Contin Educ Nurs. 2023;54(12):561-566.].

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.

Leadership in Nursing Education for Advancing a School of Nursing-Led Center for Climate Change, Climate Justice, and Health.

BACKGROUND: This article examines innovations in the development and advancement of a school of nursing-led climate change center and innovative leadership related to climate change and health in nursing education. METHOD: The integration of health consequences of climate change in curricula and continuing education is essential to prepare nursing students and nurses for clinical practice. RESULTS: Transformational leadership is a key concept for effective leadership in nursing education to address climate change as the looming public health challenge of the 21st century. Transformational leadership strengthened one nursing program's curricula, dissemination of relevant scholarship, and achievements with public health outreach related to climate change, climate justice, and health. CONCLUSION: Nursing education leaders can influence nursing practice and improve societal health outcomes related to the health consequences of climate change across all levels of education and continuing education for professional nurses. [J Nurs Educ. 2023;62(9):528-531.].

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.

Knowledge, attitudes, and practices of primary healthcare providers with assessing and supporting older informal caregivers.

A time burden, financial strain, and prioritizing care recipient needs over their own are key barriers preventing informal caregivers from engaging in health-promoting self-care. Primary healthcare providers are well positioned to assess and support informal caregivers. A cross sectional descriptive, correlational study was used to examine the knowledge, attitudes, and practices of healthcare providers regarding assessment and support of older informal caregivers. The Healthcare Professional Facilitated Health Promotion (HPFHP) Model guides this study by depicting the collaborative patient-healthcare professional relationship. The Caregiver Self-Care Survey for Healthcare Providers measured the knowledge, attitudes, and practices of 80 healthcare providers on assessing and supporting older informal caregivers. Descriptive and inferential statistics were calculated using IBM Statistical Package for the Social Sciences (SPSS) 28.0 software. Results indicated that despite positive attitudes, knowledge deficit and system level barriers prevented integration of caregiver assessment in practice. A caregiver identification process, user-friendly assessment tool, and system level changes are overdue.

Occupational Heat Stress: An Overview for Nurse Practitioners.

ABSTRACT: The health impacts of climate change are pervasive and complex. The role of nurse practitioners is a key in addressing these emerging health challenges. However, few health care providers are aware of the extensive signs and symptoms that accompany climate-related health sequelae. This article explores the increasing prevalence of occupational heat stress and best practices for nurse practitioners in addressing this problem. The A CLIMATE mnemonic is a clinical tool applied to occupational heat stress and aims to address a comprehensive health assessment and proactive management. Two clinical case studies will be offered as exemplars of occupational heat stress. The cases are framed within the A CLIMATE mnemonic for health assessment and physical examination for nurse practitioner practice.

Health impacts of climate change on gender diverse populations: A scoping review.

PURPOSE: To determine what is known about climate change health effects for gender diverse (GD) populations, and identify gaps in research, practice, education, and policy. DESIGN/METHODS: A scoping review was conducted. FINDINGS: Twenty-seven information sources met inclusion criteria. Natural disasters and inadequate disaster relief responses were identified as an overarching health threat for GD populations. Within this theme, four sub-themes emerged. No other climate-related health impacts for GD populations were mentioned in the sources reviewed. CONCLUSIONS: There are major gaps in knowledge about health implications of climate change for GD populations. Gender-sensitive data must be collected in order to better understand these threats and detect disparities. Currently most practice and policy recommendations focus on disaster relief. More research on the broad effects of climate change on GD populations is urgently needed to inform practice and policy. CLINICAL RELEVANCE: Climate change amplifies existing risks of adverse health outcomes. Because of discrimination, stigma, and violence, gender diverse individuals are particularly vulnerable.

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.

Use of Dolutegravir for Antiretroviral Therapy for Women of Childbearing Age.

The purpose of this article is to offer an update on the use of antiretroviral therapy (ART) for HIV among women of childbearing age. We focus specifically on the use of dolutegravir (DTG) because of a recently identified potential safety issue related to neural tube defects in the fetuses of women who used DTG at the time of conception. Nurses and advanced practice registered nurses should engage in shared decision-making processes for reproductive life planning with women of childbearing age who are living with or are at risk for HIV. During these processes, exploration of the full range of ART regimens is essential. Consistent and reliable contraception is necessary with the use of DTG because it is not recommended in the first trimester of pregnancy.

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.].

Understanding the mental health impact of human trafficking.

The purpose of this report was to review the mental health consequences related to human trafficking and the important role of health care providers, particularly advanced practice nurses, nurse practitioners (NPs), and psychiatric mental health NPs in identifying and responding to trafficking victims. The framework was based on a biopsychosocial model for assessment and a trauma-informed approach to care. An integrative review of the literature was conducted to offer a comprehensive overview of the mental health consequences. Deleterious mental health consequences are common in individuals who have experienced trafficking, and symptoms suffered by individuals were assessed using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria for posttraumatic stress disorder, as well as additional guidelines specific to a trauma-informed approach. Mental health sequelae experienced by trafficking survivors must be understood using a comprehensive trauma-informed framework for assessment and treatment.

Health Literacy and Health Outcomes in Persons Living with HIV Disease: A Systematic Review.

Low health literacy is associated with challenges for those living with HIV including medication non-adherence and poorer health outcomes. The aim of this study was to systematically review the literature on health literacy and health outcomes in persons living with HIV. The extended guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, as well as A Measurement Tool to Assess Systematic Reviews (AMSTAR) checklist were utilized to guide the approach to the review. A variety of electronic databases including PubMed, CINAHL, PsychInfo, and Cochrane Library were searched. Additional literature available on U.S. government websites was also included in the search. Search terms were used in a variety of combinations and included HIV, health literacy, adherence, and health outcomes. Forty-eight studies were identified that addressed health literacy and health outcomes in HIV. Although several studies in this review did not provide robust results of statistical significance linking health literacy with health outcomes, all of the studies addressed the key significance of health literacy within the scope of living with HIV disease. The relationship between health literacy and the identified health outcomes requires further research and explication.