The impact of climate change on the health of global populations has prompted the nursing industry to reassess how it will adapt and evolve to meet the challenges associated with a rise in global temperatures.

The consequences will be felt heavily with the potential for increasing mental health conditions, illness related to air quality, extreme heat and cold, water availability, disruption of healthcare services during weather events, and the displacement of individuals resulting in climate change refugees highlighting just a handful of issues borne out of environmental change.

The publication of a special issue in the Journal of Nursing Scholarship explored climate change’s relationship with the nursing profession further, in 2019. In the publication, New York University’s Meyers Sullivan Marx said:

“Recent natural disasters have had considerable health consequences, including deaths in nursing homes and an extreme lack of access to medical services. Now more than ever, it is critical that the nursing community work with other health professionals plan for changing conditions and ensure sound decision-making when faced with difficult situations.”

And the plan for changing conditions has included several inter-disciplinary measures that plan to help develop a nursing workforce that is responsive to climate health and public health.

Environmental Education

Educating a nursing workforce has been raised as a way of progressively developing the healthcare industry to make it more climate aware. This interdisciplinary approach would see the integration of climate content into curricula to help prepare nurses for public health crises.

Academics have proposed the adoption of an “Ecological Planetary Health Model” which would allow nurse education to be inclusive of broader influences such as environmental, economical, political, cultural and social factors. It places typical nursing practices within a larger context which is inclusive of factors that also affect a changing climate.

Speaking about environmental education, Ruth Mcdermott Levy, associate professor at the M.Louise Fitzpatrick College of Nursing, Villanova University, said:

“Nursing education prepares nurses to address the general health needs of all, but it is localised as well. For example, I have a PhD nursing student from Kenya, her nursing education included much more learning about the care of the patient with malaria or prevention of diseases of malnutrition than the curriculum in an high-income country, Northern Hemisphere such as the U.S.”

Such a proposed inter-disciplinary approach opens up avenues to learn about air pollution and climate change alongside content about respiratory and cardiac pathology which already exists in nursing education, for example.

Yet implementation must overcome a broader lack of engagement with climate change in nursing practice, limited knowledge about climate change in nursing faculty, and some resistance to the inclusion of the topic in curricula.

Prioritisation of Locations

The issue extends further than just education as climate change impacts differently around the globe. There will be areas that thought to be at risk of flooding, those that face exacerbated droughts, and regions more prone to hurricanes and storms. For example, the health issues facing Europe will be far different from those facing Asia-Pacific.

Africa is one region deemed to be highly susceptible to the effects of climate change, and understanding these geographical contexts will play a role in determining the nature of healthcare responses.

Whilst nursing efforts will naturally focus on issues posed within their own countries, there is still a need to recognise that environmental change will be most aggressively felt in African and Asian countries. Greater elaboration on the complexity of the situation on this continent shows how one health problem roles into another.

In the future, exacerbated droughts will reduce agricultural productivity and cause famine. Much of Africa’s agricultural systems are rain-fed and the majority of farmers are small-scale farmers with few financial resources or access to infrastructure. This combination of climatic and non-climatic stressors means Africa has a vulnerability to famine due to lack of food.

In Ethiopia, significant rainfall reductions have already been observed within critical crop‐growing areas and this has been attributed to anthropogenically influenced warming of the Indian Ocean.

In addition, this lack of food will exacerbate pre-existing health problems. For example, HIV/AIDS research tells us that successful antiretroviral treatment depends on the consumption of nutritious food. People in these areas will, therefore, suffer further repercussions.

Health agencies could end up spending ever great proportions of their resources on food, decreasing their ability to address other health issues. With a lack of availability of food in Africa comes an increase in affordability, meaning the onus is then placed on health agencies who would typically address non-communicable and communicable diseases.

More generally, beyond Africa, place needs to be recognised as a fundamental and important consideration. Issues arise for example as to how climate change impacts health differently in distinct localities and regions. A far greater geographical awareness must drive place-specific professional responses.

An understanding of place is of large benefit when attempting to understand how a rise in communicable diseases has affected one region, or how the localised drought has reduced crop production in a cluster of neighbourhoods.

Climate Mitigation, Adaptation and Resilience

Climate mitigation, adaptation and resilience within the nursing practice has been likened to the levels of diseases presentation familiar with nursing educator – primary, secondary and tertiary.

Climate mitigation in nursing refers to the efforts made to reduce greenhouse gas emissions in the industry. This can include anything from diligence in the use of supplies to prevent needless waste, to a greater reliance on more energy efficient methods.

Climate adaptation then prepares nurses roles in facilitating adaptation to promote the health of patients and communities. For example, in areas prone to exacerbated storms where electrical services can be disrupted, students should be taught to include alternative plans for a patient who is discharged with nebuliser treatments.

Finally, climate resilience in nursing creates an interdisciplinary approach to creating communities and systems that are able to withstand the effects of climate change. Even with efforts in mitigation and adaptation, effects of climate change will still be felt, making this approach important in facilitating organisation and engaging with policies that strengthen healthcare communities.

Speaking about environmental education, Ruth Mcdermott Levy said:

“We are teaching patients and their families how to modify their care on days with poor air quality or extreme heat, educating future nurses in disaster responses, and training professional nurses in community-level disaster response.  Nurses are also leading hospital-based sustainability teams and addressing resilient health systems and disaster preparedness so that communities are resilient to climate change. Finally, U.S. nurses are advocating and speaking to policymakers to stay in the Paris Agreement and support policies for climate mitigation, adaptation, and resilience.”