with contributions by Peggy Chinn
Also see Adeline Falk-Rafael’s “addendum” to this post below

The nursology.net management team agreed to participate in the September 20, 2019 #Climate Strike – Nursology.net went to a  green screen acknowledging the importance of this public action for the entire day on September 20th. By doing so, we joined people “[i]n over 150 countries . . , to support young climate strikers and demand an end to the age of fossil fuels. The climate crisis won’t wait, so neither will we.” (from Global Climate Strike)

Climate can be defined as “characteristic weather conditions of a country or region; the prevalent pattern of weather in a region throughout the year, in respect of variation of temperature, humidity, precipitation, wind, etc., esp. as these affect human, animal, or plant life” (Oxford English Dictionary, 1889/2008)

The lack of sufficient attention to widely documented climate change by so many people, is, of course, the impetus for #Climate Strike. Climate change is defined as “an alteration in the regional or global climate; esp. the change in global climate patterns increasingly apparent from the mid to late 20th cent. onwards and attributed largely to the increased levels of atmospheric carbon dioxide produced by the use of fossil fuels .”(Oxford English Dictionary, 1889/2008).

The nursology.net management team’s concern with climate reflects our heritage of Florence Nightingale’s emphasis on environment and the effects of environment on human beings’ health status. Climate is, of course, a major aspect of environment, although climate is rarely mentioned in nurse theorists’ discussions of environment. An exception is found in the content of Orem’s self-care framework. Orem (2001) referred to two dimensions of what she labeled environmental features–physical, chemical, and biological features; and socioeconomic cultural features. Physical and chemical features include what typically is thought of as at least part of the climate—the atmosphere of the earth, gaseous composition of air, solid and gaseous pollutants, smoke, [and] weather conditions (Orem, 2001). Another exception is found in the content of a new conceptual model—the Conceptual Model of Nursology for Enhancing Equity and Quality—Population Health and Health Policy (Fawcett, in press). Following a suggestion from a PhD nursology student at the University of Massachusetts 2018 Five Campus PhD Forum, climate was explicitly included in this conceptual model in the definition of the physical environment.

Two recent nursing scholars have given primary focus on the environment in their work; their work provides important foundations for nursing action. Patricia Butterfield’s Upstream Model for Population Health (BUMP Health) provides a framework for addressing general issues related to health and the environment at a population level (Butterfield, 2017).  Dorothy Kleffel has been a thought-leader in nursing for more than 2 decades pointing the way toward a nursing focus on the environment and its effect on health (Kleffel, 1996).

A recent search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL Complete), using the search terms, climate AND nursing, yielded 1,875 publications. However, a search using the terms, climate change AND nursing, yielded only 186 publications Two particularly informative publications are scoping reviews of the literature (Hosking & Campbell-Lendrum, 2012; Lilienfeld, Nicholas, Breakey, & Corless, 2018). Another informative publication is a call for action (Travers, Schenk, Rosa, & Nicholas, 2019).

Contemporary interest in environment and climate change has been prompted by two global initiatives–the 2008 World Health Organization (WHO) Member States World Health Assembly resolution (Hosking & Campbell-Lendrum, 2012) and the United Nations (UN) Sustainable Development Goals (Lilienfeld et al., 2018). The WHO resolution supports progress on studies of the effects of climate change on human health, including health vulnerability, health protection and its costs, the impact of migration and adaptation policies, and decision-support and other tools. Other health effects of climate change include an increase in communicable and noncommunicable diseases, weather-related injuries, mental health disorders, and effects of nutritional deficiencies on growth and development (Lilienfeld et al., 2018).

Hosking and Campbell-Lendrum’s (2012) scoping review of literature published between 2008 and June 2010 yielded 40 relevant papers. Of concern is that none of the papers were reports of studies of effective interventions, which clearly was a major gap in our literature of that time. Lilienfeld et al.’s (2018) scoping review placed climate change with the context of nursology. They identified and categorized 48 papers in their search of literature from 1996 to 2018, only a few of which were research reports. The categories are;

• Background of climate change
• Health consequences
• Nursing knowledge and attitudes
• Reference to UN Millennium Development Goals and/or the UN Sustainable Development Goals
• Migration and/or adaptation strategies
• Urgency
• Plan
• Climate justice

Once again, a major gap is research, especially the design and testing of interventions.

Travers, Schenk, Rosa, and Nicholas’ (2019) call for action by nurses may be the catalyst needed to advance nursology’s contribution to filling the gap in the literature. They underscored the findings of previous literature reviews revealing the effects of climate change on the environment and, consequently, on human health. Their call for action, which encompasses research, education, advocacy, and practice, exhorts nurse “to step up and see themselves as part of the solution to climate change” (Travers et al., 2019, p. 11).

There is, however, little evidence that nurses have begun to step up, to move beyond “talk about what needs to be done” (Travers et al., 2019, p. 11). As reported in The Washington Post (Tan, 2019), nurses are continuing to talk about climate change. An encouraging development is nurses’ willingness to join climate-oriented organizations as they increase their awareness of and even experiences of recent natural disasters, including hurricanes, wild fires, floods, and tornados (Tan, 2019).

The global action of the #Climate Strike, including worldwide demonstrations led by teenagers on Friday, September 20, 2019, and planned future Friday demonstrations certainly is encouraging. Perhaps these demonstrations will be a catalyst to actions by nursology students, faculty, and practitioners to conduct the research needed to identify effective interventions to mitigate the deleterious effects of climate change on human health. Perhaps, too, these demonstrations will move the UN and federal governments worldwide to fund that research.

Nursology is founded on a holistic conceptual orientation that points the way to recognizing the role of environment on human health, and toward nursing action to respond to this global crisis. It is time for nursologists and nursing as a discipline to step up to the challenge and provide a leading voice for healing the planet, for healing those who are harmed by the climate crisis, and join the many others who are demanding social and political action now to turn this crisis around.

Addendum by Adeline Falk-Rafael: Watson’s early publications of her philosophy and science of caring also explicitly identified the provision for “supportive protective and(or) corrective” environments, including specifically the physical environment as a carative factor. Although her language has changed, I believe the intent has not. That aspect of her theory was one key which led me to develop the mid-range theory of Critical Caring, based on her and Nightingale’s work (although my thinking has also been influenced by Butterfield’s and Kleffel’s work). Note: Adeline  (who is on our management team) was hiking in the Alps when we prepared this post!  Thank you Adeline for adding this important information to this post!)

References

Butterfield, P. G. (2017). Thinking Upstream: A 25-Year Retrospective and Conceptual Model Aimed at Reducing Health Inequities. Advances in Nursing Science, 40, 2–11. http://dx.doi.org/10.1097/ANS.0000000000000161

Fawcett, J. (in press). The conceptual model of nursology for enhancing equity and quality: Population health and health policy. In M. Moss & J. Phillips (Eds.), Health equity and nursing: Achieving equity through population health & public policy. New York, NY: Springer.

Hosking, J. & Campbell-Lendrum, D. (2012). How well does climate change and human health research match the demands of policymakers? A scoping review. Environmental Health Perspectives, 8, 1076-1082.

Kleffel, D. (1996). Environmental Paradigms: Moving Toward an Ecocentric Perspective. Advances in Nursing Science, 18, 1–10. https://doi.org/10.1097/00012272-199606000-00004

Lilienfeld, E., Nicholas, P. K., Breakey, S., & Corless, I. B. (2018). Addressing climate change through a nursing lens within the framework of the United Nations sustainable development goals. Nursing Outlook, 66, 482-494.

Orem, D. E. (2001). Nursing: Concepts of practice (6th ed.). St. Louis, MO: Mosby.

Oxford English Dictionary (1889/2008). Definitions of climate and climate change.

Tan, R. (2019, September 20). Why nurses, America’s most trusted professionals, are demanding “climate justice.” The Washington Post. Retrieved from
https://www.washingtonpost.com/local/why-nurses-americas-most-trusted-profession-are-speaking-out-against-climate-change/2019/09/19/1c5314d8-dae2-11e9-a688-303693fb4b0b_story.html

Travers, J. L., Schenk, E. C., Rosa, W. E., & Nicholas, P. K. (2019). Climate change, climate justice, and a call for action. Nursing Economic$, 37, 9–12.