Climate Health Curricula among Health Professional Schools in the Appalachian College Association
Tauna Gulley, Professor of Nursing; Connie R. Workman, Associate Professor of Nursing; and Meg Wright Sidle, Director of Institutional Research and Effectiveness, University of Pikeville
Intended Audience: Faculty Teaching in Health Professional Schools
Abstract: This paper describes results of research exploring climate health curricula among health professional schools in the Appalachia Colleges Association.
Introduction
Climate change is negatively impacting planetary health and according to the World Health Organization (WHO, 2021), climate change is the “single biggest threat facing humanity.” Integrating concepts of climate change in nursing and other health professional curricula is necessary so knowledge and skills can be attained for practice, research and policy development (Leffers et al., 2017). Extreme weather events are a result of climate change. Nurses and other allied health professionals are in optimal positions to prepare and respond to extreme weather events (Lopez-Medina et al., 2019). Educators in health professional programs must include climate change and health in their curricula to ensure students become competent in these areas of practice; therefore, health professional education must address potential health effects of climate change. Unfortunately, gaps remain in the curriculum of nursing and allied health programs (Dalapati et al., 2023).
The impact of climate change on population health is serious (McDermott-Levy, Jackman-Murphy, Leffers, & Jordan, 2019). Currently, extreme temperatures, flooding, and wildfires result in families being relocated from their homes, decreased access to clean water, and limited access to healthcare. Nurses and other health professionals must recognize the effects of climate change on population health; however, having the resources and time to address the issue in the curriculum of health professional schools is challenging (Kotcher, Maibach, Miller, Campbell, Alqodmani, Maiero, & Wyns, 2021). Preparing a nursing workforce that understands the impact of climate change on human health is critical; therefore, it is essential for schools of nursing to include concepts of climate change throughout nursing curriculum so graduate nurses will have a better understanding of the relationship between climate change and population health. For these reasons, the American Association of Colleges of Nursing (AACN) has included climate change, environmental health, and population health in The Essentials: Core Competencies for Professional Nursing Education (AACN, 2021) and the concepts are stated as AACN Essentials 3.6b: The Impact of Climate Change on Environmental and Population Health.
The Essentials document provides a framework for nursing education that includes ten domains and the expected competency for each domain. As stated in the Essentials (AACN, 2021), nursing education for the 21st century includes associate degree nursing programs, referred to as entry level professional nursing education. Entry level programs prepare graduates for competent care for individuals, families and communities across various domains. In addition to the domains, there are featured concepts that are woven across the domains. Environmental health is listed among the featured concept social determinants of health as a factor that impacts population health (AACN, 2021, p. 14). Population health is domain three and the expected competency states the nursing student will "understand the impact of climate change on environmental and population health” (AACN, 2021, p.36). Therefore, preparing nursing students to respond to the health effects of catastrophic events like flooding or public health emergencies such as the COVID-19 pandemic is essential. In addition, teaching nursing students the importance of engaging in health promotion strategies that support environmental health in ways that promote positive health outcomes for individuals, families and communities is vital.
Environmental health is the relationship between humans and their environment in ways that can promote health and wellbeing through breathing clean air, drinking clean water, and having clean soil to grow healthy food. Florence Nightingale recognized the role of the environment on individual health. She wrote about clean air, clean water, and how "nature alone cures and nursing has to put the patient in the best condition for nature to act upon him (or her)." Healthier environments will prevent millions of deaths per year. For example, communities could be built to become more walkable or bike friendly. Asthma triggers could be removed from homes, and communities could mitigate risk of flooding (Vardoulakis, Salmond, Krafft, & Morawska, 2020). However, knowledge gaps continue to prevent the implementation of evidence-based health protective strategies to improve the health of the environment. Nurses are in an optimal position to protect the health of the environment in order to promote the health of the individuals, families and communities they care for. Therefore, we must ensure nursing schools include environmental health issues in their curriculums.
Climate change has negatively impacted environmental health in many ways. For example, heavy precipitation affects the water supply and crop production. Heavy precipitation is a climate change indicator as noted by NOAA (2021). When the ocean is warmer, there is an increase in the amount of water that evaporates into the air so the air becomes moisture-laden. When moisture-laden air enters a storm system, heavier rain or snow can fall. Heavy precipitation can cause flooding, soil erosion, runoff into streams and lakes. Runoff can result in decreased water quality which can kill fish and crop loss due to erosion and depletion of soil nutrients (EPA, 2024). Human health is negatively impacted by decreased water quality and decreased food supply. For this study, climate health is defined as the impact of climate change on environmental health and population health.
At this time, there is no formal curriculum at the author’s institution that addresses climate change and health, or climate and health. The University of Pikeville is a member of the Appalachian College Association (ACA) a non-profit consortium of private four-year liberal arts institutions whose mission is to promote collaboration and scholarly activities among the faculty and students of the member institutions. The purpose of this exploratory study was to gain an understanding of ways health professional schools in the ACA address climate change and health in their curricula. Results of this study will inform the development of a climate change and health curriculum that can be used by health professional schools in the ACA.
At the time of this study, the Appalachian College Association (ACA) consisted of 33 private four-year colleges located in the Appalachian Mountains of various states including Georgia, Kentucky, North Carolina, Tennessee, Virginia, and West Virginia. This consortium was chosen because the author’s institution is a member of the ACA; therefore, there is potential for collaborative program assessment and curriculum planning. According to the 2022 National Nursing Workforce Study of 271,402 registered nurses, 35.6% reported being prepared at the associate degree level.
Material and methods
The Institutional Review Board (IRB) at the author’s institution reviewed and approved the study prior to data collection. A survey exploring the concept of climate and health was sent to the ACA schools in two ways: 1.) the Sender.net subscriber list for Health Sciences and Professions (which includes Nursing faculty) within the ACA schools and 2.) the ACA Connect for the two groups: The Nursing Faculty Learning Community (FLC) and the Health Sciences & Professions FLC. After weekly reminders were sent for four weeks, seven responses were elicited. Then, an email with an invitation to complete the survey were sent directly to faculty. After four more weeks, eleven responses were obtained. Finally, phone calls were made to faculty from the health professions schools listed in the institution’s directory; then the number of responses increased to goal. Survey questions are in Table 1.
Results
Responses were received from seventeen (17) of the thirty-three ACA schools representing seven different disciplines. The majority of the responses were from nursing (70.4%) and the least number of responses came from optometry (7.4%) and occupational therapy (7.4%).
The majority of the respondents reported they were unsure whether or not their institution offered climate health education (51.9%), 25.9% reported their institution did offer climate health education and 22.2% stated their institution did not offer climate health education. Of those 25.9% reporting their institution offered climate health education, 87.5% reported climate health was taught as part of a class. Institutions that responded to the survey are in Table 2 with number of responses in parenthesis.
Concepts taught related to climate health
Survey responses include:
- Proper waste disposal for allied health professionals
- Climate health, global impact, community health impact and assessments
- Specific climate elements which affect health such hyperthermia (heat stroke),
- environmental allergies (ragweed), lupus flairs with climate change, asthma and the environment, and infectious diseases
- Illness related to climate
- It's intermingled when discussing patho, respiratory and derm.
- Importance of sustainability (non-nursing)
- At the college, nutrition courses are taught about food deserts. In our teacher ed courses, we briefly discuss water & air pollution and the health effects from those, content about asthma, allergens, mental & emotional health, technology health. (non-nursing)
Institution offers a stand-alone course on climate health
Sixty three percent (63%) of respondents reported their institution did not offer a stand-alone course on climate health and 33.3% reported they were unsure. One institution reported offering two stand-alone courses on climate health, BIO 102: Environmental Biology (elective) and BIO 288: Environmental Ethics (elective).
The majority of respondents (76.9%) reported the classroom was the instruction method used to teach about climate health and clinical (7.7%); lab and simulation were also used. Instructional resources used to teach about climate health included online modules (25%) and fieldwork (25.0%), videos (8.3%), and other (41.7%) including clinical experience, lecture, textbook, and class discussion. Climate health knowledge was assessed through case studies (36.4%) and examinations (18.2%). Examples of learning objectives and learning activities regarding the impacts of climate change on human health and environmental health are found below:
Examples of course learning objectives and activities aimed at teaching about the impacts of climate change on human health
Survey responses include:
- Safety and Health Maintenance of proper disposal of waste products
- Collecting a health history from a patient during an interview
- Recognize how climate change worsens air quality and identify the links between poor air quality and health impacts such as heart attacks, strokes, and pulmonary diseases.
- Learning Objective: Assess client lifestyle practice risks that may impact health (e.g., excessive sun exposure)
- NCLEX-RN Test Plan 2023 Learning Activity: case study, education plan, etc.
- Biology courses go into the field to study and take samples, etc.
- Select a disease process and identify 3, three, potential environmental causes. One disease process often influences the development of other illnesses. Based on your knowledge of pathophysiology, with your chosen disease process identify and explain which likely developed FIRST that then initiated a “domino effect”?
- It's mostly lecture. I don't have a learning objective to include.
- Objective: Identify the local significances and human impact of global environmental issues, such as food security, public health, environmental justice, and climate change. Activity: Class discussion
- Support resource development and sustainability by identifying and applying scientific principles of food selection and preparation in order to retain nutritive value and produce quality food products. (non-nursing)
- Students will present a 10-minute presentation on the effects of a health issue (asthma, cyber-bullying, etc.) and how the knowledge of this health issue can be impactful for teaching future students. (non-nursing)
- We currently have no standards for teaching on climate health in OT. (non-nursing)
Examples of course learning objectives and activities aimed at teaching about the impact of climate change on environmental health
- Students will identify and utilize proper waste receptacles for categories of waste/sharps
- Clinical experience
- Objective: Identify the local significances and human impact of global environmental issues, such as food security, public health, environmental justice, and climate change. Activity: Class discussion
Participation in interdisciplinary activities incorporating climate health
Eight respondents reported their students did not participate in interdisciplinary activities incorporating climate health. One respondent reported discussing climate health briefly in community nursing. Clinical experiences, classroom lecture and interprofessional education were activities reported.
Barriers and support for teaching and learning about climate health
The majority of respondents (61.9%) reported no barriers with lack of knowledge (62.5%) being the biggest barrier. In addition, 75.0% of respondents reported no support for adding teaching and learning about climate health in their curriculum. Collaboration with others was the greatest level of support experienced.
Discussion
The majority of the ACA schools do not offer associate degree level nursing programs. Only three of the 17 schools responding to this survey offer associate degree level nursing programs. However, results of this study are applicable across all nursing programs. Understanding the impact of climate change on environmental and population health is fundamental knowledge.
When asked to share an example of a learning objective and a learning activity aimed at teaching about the impact of climate change on human health, responses included more activities and fewer learning objectives. Responses were scarce when asked to share an example of a learning objective and a learning activity aimed at teaching about the impact of climate change on environmental health. The following examples of learning objectives and activities could be incorporated in a fundamentals nursing course.
Learning Objectives:
By the end of this course, students will be able to
- Describe the impact of climate change on a specific human health illness or condition.
Activity: Students will provide a visual image of climate change either through a drawing, painting or other creative venue. The human health issue or condition will be incorporated in the visual image and the subsequent effects on the human body will be illustrated.
- Describe the impact of climate change on an environmental health issue.
Activity: Students will locate two recent news topics from the area in which they live that describes an environmental health issue that resulted from the impact of climate change.
Based on the information gleaned from the survey, nursing and other allied health professional students could benefit from curricula that included elements of the impact of climate change on environmental health and population health. In addition, nursing students could benefit from curricula that transfers knowledge of climate change to actual practice. The fundamentals of nursing course is an excellent starting point for nurse educators to introduce climate change and the impact on environmental and population health. However, teaching students about climate change does not necessarily affect future practice behaviors. There is a difference between intellectualizing concepts versus demonstrating stewardship. Behaviors must be demonstrated by nursing faculty and then, the expectation will be imparted to the nursing student. One example could be to include recycling in the classroom and clinical settings, planning care that is safe, and intentional, while minimizing waste in the healthcare setting. As always, when in clinical settings, agency policies must be followed. We would be remiss if we did not mention the likelihood of reducing the impact of climate change through teaching our patients about disease prevention strategies, which would improve population health and result in reduced inpatient hospital admissions (Redvers, 2021).
Conclusions
Nursing faculty are in optimal positions to guide nursing students in ways to care for our planet. Behaviors that demonstrate care and concern for the health of our environment should be visible to our students, clients, and health care teams. By looking through the lens of caring not only for our patients, but for ourselves, our future, and future generations, we can make a positive impact on population health, and environmental health.
Table 1: Survey Questions
- What is your name, title, and discipline you represent?
- What is your email?
- What is the name of your institution?
- Does your discipline offer climate health education? Yes or No
- If yes, is climate health part of a class?
- If yes, list specific concepts taught related to climate health.
- Does your institution offer a stand-alone course on climate health? Yes or No
- If yes, please provide the name of the course
- If yes, is the course a required course, non-required course or an elective?
- What instruction methods are used to teach about climate health?
- Classroom?
- Laboratory?
- Clinical?
- Simulation?
- Other?
- What instructional resources are used to teach about climate health?
- Online modules?
- Videos?
- Fieldwork opportunity?
- How is Climate Health knowledge assessed?
- Quizzes?
- Examinations?
- Papers?
- Other?
- Please share an example of a learning objective and a learning activity aimed at teaching about the impacts of climate change on human health
- Please share an example of a learning objective and a learning activity aimed at teaching about the impact of climate change on environmental health.
- Do your students participate in interdisciplinary activities that incorporate teaching and learning about climate health? IF yes, please describe the activities.
- Have you experienced barriers to teaching and learning about climate health? Yes or No. If yes, please go to question 13.
- What have you experienced as barriers to adding teaching and learning about climate health in your curricula?
- Lack of Resources
- Lack of Funding
- Lack of Time
- Lack of Interest
- Lack of Knowledge
- Other?
- Have you experienced support for adding teaching and learning about climate health in your curricula? If yes, please go to question 15.
- What have you experienced as support for adding teaching and learning about climate health in your curricula?
- Collaboration with others
- Support from faculty
- Support from administration
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