Responsibility of the nurse in recognizing and raising awareness of the threats of climate change on health

Taylor Foster


Climate change is seen as one of the 21 first century’s biggest health threats. It has been evident for years that human health and wellbeing is reliant on the integrity of the world’s environmental systems. The increasing severity of climate change and its detrimental effects on health are becoming significantly more numerous and are expected to rise dramatically throughout the world. After reflecting back on my time at Otago Polytechnic School of Nursing and my many placements, it left me questioning my knowledge on sustainability and its relationship with climate change. I decided to then further my development and knowledge regarding climate change and the effects it will have on health professionals in years to come. Through the use of the PICOT model I was able to refine my search question to ‘responsibility of the nurse in recognizing and raising awareness of the threats that climate change has on health.’ For this review I discuss a clinical issue and review the research and evidence which I reviewed. To conclude this literature review I will make relevant recommendations.

During my time at the educational institution studying a Bachelor of Nursing I have not only learnt about the various aspects and roles that nursing has to offer; but also how to reflect, critically think and further educate myself. When reflecting back on my time at this Nursing School I searched for areas that not only interested me, but also areas in which I didn’t have a broad understanding or knowledge of. The idea of climate change and its effect on health and nursing fluttered through my mind. This idea was then reiterated during one of my clinical placements. I attended an in-service on ‘Climate Change and Health,’ 

It then became apparent to me that Climate Change was a topic that as a future registered nurse will influence the way I practice and the health care that I provide.

Search question

With the realization that climate change is an area which clearly relates to the health and wellbeing of people I continued to search for a question that would combine; climate change, health and wellbeing, and nursing practice. I considered would the harmful implications of climate change affect the role of a nurse? And whether nurses are accountable in the prevention and promotion of the effects of climate change? As a lover of the outdoors and someone who takes pride in trying to minimize my ecological footprint this topic is something that I feel strongly about. The PICOT model (Whitehead, 2013) is an abbreviation that describes the fundamentals of a well-formed critical question which I used to refine my search question, refer to table one.

Table 1:


Information relating to question



My population for this search question   targets all health professionals but specifically on the role of the nurse   and nurse educators.

Nurses should be educated   and prepared for the increasing impact and changes that climate change will   have on health throughout the world.

Nurses need to be educated   by academics who have knowledge and understanding of the implications of   climate change.

Exposure (intervention)

Nurses who will be exposed to the future   changes of health caused by climate change.

I will look at articles   that explain the relation of nursing and climate change and what we as nurses   can do to help prevent and prepare for the changes to come in health care   system.


I will compare what healthcare services   will look like if nurses and other health professionals don’t prepare or take action on the effects of health   globally due to climate change.

Since my paper focuses on   why we need to make changes in the health profession to adapt to climate   change, I will use comparison articles that will display the ricocheting   effects that climate change will have on health globally.


The outcome of my search will be to conduct   a strong argument as to why health professionals, specifically nurses need to   be educated and prepared for the changes in health that climate change will   globally.

By reviewing a wide range   of research articles on how climate change will effect health care globally   as well as health care professionals, will allow me to understand the   implications and look into what can be done to prepare nurses for the   ricocheting effects climate change will have.


Its effect on the 21 century and years to come

Its effect on the 21 century and years to come

The clinical issue

To understand this review is it important to understand what climate change is and the relation it has with healthcare, therefore nursing. Climate change is outlined as the increasing industrialization of the planet due to human activity such as; agriculture, industry and transportation. These activities have caused an alteration in the natural balance of the earth’s climate, causing an increase in greenhouse gases, therefore contributing to the rising temperatures of the earth. (Ministry for the Environment, 2016). The connection between health and its environment have been known for years. It is only until recent years that people have starting understanding that the severity of climate change and the severity of it various negative components. With climate change effecting, ecological, biological and physical systems it is obvious that the health of humans will be affected (Barna, Goodman & Mortimer, 2012).

The effects on health globally will have a variation of direct and indirect repercussions, with different populations and countries being affected individually. Direct effects of climate change will be likely related to the ever-changing geographical distribution such as; mortality due to heat/cold waves, floods, droughts and cyclones. Whereas the indirect implications may be proven more difficult to manage; increased health problems due to water and vector borne diseases, water and food contamination, malnutrition, mental health issues, skin cancers due to UV radiation, social and economic distribution, cardio-respiratory diseases and allergic diseases. (Bennett et al., 2016).

Understanding sustainability as a future health care provider is something I take great pride and interest in. As nurses one of our responsibilities is to promote, communicate and advocate for not only patients, but also communities and populations. It is important to recognize and respond to the health impact that climate change will have on health and nursing practice. As prominent health professionals and representatives of over half the health care workforce, nurses will need to practice to alleviate the risks and actions that increasing climate change will have on health, therefore the way in which nurses practice (Brednorfer, Hay & Head, 2015).

Evidence and findings

This review contains a variety of literature; allowing me to gather a broad range of evidence and information to relate to each part of the review question. As stated in the critical issue section, climate change is one of the 21 centuries’ largest health threats (Costello et al., 2009). The adverse health effects of climate change will effect populations in many ways. The most prominent and severe effects climate change will have on the worlds health are; patterns of disease and mortality, food/water availability and sanitation, shelter and human settlements, extreme weather events, and population and migration (Allen, 2015). In 2030 and 2050 it is estimated that climate change is expected to cause up to 250,000 additional deaths per year due to these health implications. (World Health Organization, 2016) with rising temperatures, the rate of disease and mortality will increase.

Cardiovascular and respiratory illnesses and deaths are likely to increase due to the uncontrollable cold and heat waves. (Bennett et al., 2016). New Zealand has already seen implications of the ever changing weather with the country having one of the highest rates of asthma in the world, often due to poor housing/insulation, exposure to weather changes and deprivation of appropriate medication (Asthma Information, 2014). Temperatures will aid the upsurge of maturation and replication of vector-borne and rodent-borne diseases such as; mosquitos, parasites, malaria, tick-borne, encephalitis and dengue fever. Thus, increasing the likelihood of populations, especially those who have low immunity to be infected (Bennett et al., 2016). A recent example of this is seen during the huge outbreak of Zika virus (Boseley & Watts, 2016). The World Health Organization declared the outbreak of Aedes egypti mosquitos in Brazil an emergency of international concern. The Zika virus is transmitted by the same mosquito as dengue fever and now linked to microcephaly spread through Brazil at a rapid pace (Boseley & Watts, 2016).

Food and water availability and sanitation will be impaired due to the ever-growing effects of climate change. Crops, forestry, fisheries, livestock, water systems and aquaculture will be diminished by the worsening of weather events (Costello et al., 2009). Equally, droughts, heavy rainfall, animal infestations, and the rise in sea levels and rivers will contaminate and disturb the production of food and sanitation of water. Thus will cause a serve shortage in food production leading to malnutrition, infections, rise in food costs and causing further inequities (Costello et al., 2009).

Weather related disasters such as, flooding, rainfall, cold/heat waves, sea level increase, droughts, tropical storms will become more prominent worldwide (Bennett et al., 2016). Therefore, the associate health problems; contamination of food and water, food shortages, emergency health care plans, long term mental health and anxiety and many others have the potential to occur (Costello et al., 2009). With the ever changing weather patterns, increase in diseases, shortage of food and water populations around the world will begin to migrate and to other destinations in search for a better physical lifestyle. This will cause a huge shift in populations and put stress on the already weak health systems throughout the world. Competition for valuable things in life will increase, prices of good food will increase and the ever- growing inequities of growing populations will continue to spread wider and wider (Costello et al., 2009).

Consequently, health care professionals are going to become in even higher demand in the future due to the increasing events of climate change. So what is the connection between nurses and all of the severe repercussions that climate change will have on health? The role of the nurse can be defined as the provider of health needs, care, advice, support and education to help people manage their health. Nurses’ practice in a variation of setting with partnerships created with individual, families, and communities, locally, regionally, nationally and internationally (Nursing Council of New Zealand, 2016). Climate change and nursing correlate together as it is not just a global issue, but also a public health issue (Adlong & Dietsch, 2015). The World Health Organization estimates that by 2030, the annual cost of climate change health compensations will be $2-4 billion US (World Health Organization, 2016). Nurses are one of the most prevalent health care professionals in the industry, they have a huge role in educating, preventing, advocating, and preparing for climate change (Brednorfer, Hay & Head, 2015).

The effects of climate change will not only be seen in the increase of hospitalizations, but also throughout communities. Because of their trusted rolls in the community, nurses are able to influence those around them on the effects of climate change. Nurses can research and educate communities on what the effects that climate change will have on their communities, and work together to prevent and minimize these repercussions (Adlong & Dietsch, 2015). An example of this is advocating for energy efficiency which can vary from proper housing insulation, to planning group transportation such as a walking school bus. By doing so not only minimizes the communities’ ecological footprint, but also increases the health and well being of those in the community. Increased housing insulation will prevent high rates of asthma, whilst also lowering the financial strain of power use. Group transportation encourages exercise and lowers the communities’ carbon footprint (Macmillan & Hosking, 2010).

Increased hospitalizations due to starvation, water and vector borne diseases and extreme weather events are just a few of the consequences that nurses will have to deal with in a hospitalized setting. Yet again, if nurses are able to educate, advocate and communicate to the public about the repercussions of climate change, communities will also become aware and advocate for change.(Costello et al., 2009). With nurses already beginning to promote and recognize the importance for action against climate change, its interesting to understand nurses’ perceptive and knowledge on climate change and how it will affect them. The definition of sustainability in relation to nursing is the concept of not only sustainability of all environmental considerations but also the implementation of sustainable practice towards maintaining an environment that does not harm future generations (Anåker, Nilsson, Holmer & Elf, 2015). The International Council of Nursing (ICN) states that nurses need to support actions seeking to reduce the effects of global warming and climate change. Therefore, meaning nurses need to be aware of how climate change will affect the health of humans and how to address these health risks. Nurses have the opportunities to contribute to sustainable practice and development, provide opposites for groups, communities and individuals in creating a health society (International Council of Nurses, 2007, 2008). Using articles that conducted qualitative surveys allowed me to review the thoughts and opinions nurses have on climate change. Anåker, Nilsson, Holmer and Elf’s (2015) survey demonstrated that although the results revealed nurses have a responsibility in addressing climate change and its impacts, a majority of the nurses felt as though that reasonability was over shadowed by other job requirements. Therefore, climate change and environmental issues became a second-order concern for a majority of the nurses (Anåker, Nilsson, Holmer & Elf, 2015).

Polivka et al. (2012) demonstrated that although 83% of nursing participants in their study agreed that nurses have a responsibility in addressing health related impacts of climate change, yet only 16% felt as though they were prepared for the implications that will occur. Therefore, nurse’s insight of climate change and the environmental role they contribute to has an impact on the wellbeing of others and sustainability development. Due to the already large work load that nurses have sustainability and responsibilities of climate change and global warming are often over looked and characterized as second-order concerns within nursing.


From the evidence that in this literature review it is clear that something needs to be done to enhance the relationship between climate change and the role of the nurse.

Firstly, student nurses, nurses and nurse educators need to all be educated on the consequences that climate change will have on health. (Goodman & Easy, 2014). Although student nurses are already educated on the role of sustainability as a health professional, they also need to be educated on the implications of climate change and how it will affect their practice in the future (Barna, Goodman & Mortimer, 2012).

Secondly, by nurses being educated on the effects of climate change this will increase their confidence and ability to cope with the ever-changing effects on health that climate change will have. Not only will nurses be prepared in a hospital setting but also throughout individualized communities (Goodman, 2013). With nurses having such a trusted relationship throughout communities’ nurses can help implement ideas to help those around them. Health “Win wins” are something that nurses can educate communities with such as; using less motorized vehicles and encouraging exercise, improving housing insulation will lesson asthma rates as well as power bills, eating less processed and meat and dairy products, will help lower greenhouse gases and increase communities education and consumption of eating more fruit and vegetables. These are all seen as “win wins” situations, by the nurse advocating for these actions will not only lower carbon footprints and climate change but also increase the health and wellbeing of communities (Macmillan & Hosking, 2010).

Thirdly, policy development can be a role in which nurses can participate in. As nurses have a renowned attribute for advocating on behalf communities and patients, by continuing educating themselves and communities, nurses are able to voice back opinions and concerns to other health professionals and begin reasons for course of actions.


Throughout this literature review I have researched, discussed and analyzed my search question using evidence based research allowed me to determine what the health consequences are of climate change and the role shared between climate change and nurses. Evidence showed that although nurses’ are aware of their responsibility and relationship with sustainability and climate priority nurses feel as though they don’t have the time, or education to see it as a first importance of nursing. It is clear to me that actions need to be taken to educate practicing and student nurses on climate change as it is the 21 century’s biggest health threat. Without preparation and education, the responsibility of a nurse and the drastic health effects of climate change will become very over whelming. The responsibility of the nurse in recognizing and raising awareness of the threats that climate change has on health is an area that needs to be further educated as it is, and is continually going to be a big part of the future of health care individuals, families, communities and globally.


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Allen, P. (2015). Climate change: It’s our problem. Pediatric Nursing, 41(1), 42-46. 

Anåker, A., Nilsson, M., Holmner, Å., & Elf, M. (2015). Nurses’ perceptions of climate and environmental issues: A qualitative study. J Advanced Nursing, 71(8), 1883-1891.

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