The Greta Thunberg effect : student nurses ’ attitudes to the climate crisis

The risks of the climate crisis and environmental damage have recently been highlighted in the media – for example, through the actions of climate activist Greta Thunberg. The negative impacts of the climate crisis on health and healthcare are well documented, with reports of unacceptable levels of risk for the health of populations worldwide. We compared the attitudes towards sustainability and the climate crisis of student nurses starting a nursing degree in 2019 with those from 2014. Study results showed that the 2019 students were more likely to agree that the climate crisis and sustainability are important topics in nursing and should be included in the curriculum. We suggest how this can be achieved and highlight future research needs. Citation Richardson J et al (2021) The Greta Thunberg effect: student nurses’ attitudes to the climate crisis. Nursing Times [online]; 117: 5, 44-47. In this article. ● The relationship between health, healthcare practice and the climate crisis ● A study comparing student nurses’ attitudes to sustainability in 2014 and 2019 ● How sustainability can be embedded in the curriculum and the further research that is needed Clinical Practice Research Sustainability Copyright EMAP Publishing 2021 This article is not for distribution except for journal club use 45 Nursing Times [online] May 2021 / Vol 117 Issue 5 www.nursingtimes. net environmental concerns when considering definitions of sustainability in critical care practice. Our study methodology took the form of a comparative independent-subjects survey design, using an adapted version of Richardson et al’s (2016) Sustainability Attitudes in Nursing Survey questionnaire. Data was collected in 2014 and 2019 from first-year student nurses studying undergraduate adult, children’s or mental health nursing at a university in the south west of England. In September 2019, students were asked to complete the survey at an induction session; the majority were studying one particular field of nursing, although a small number were studying a combination of two fields over four years rather than three. Data for students commencing their studies in September 2014 had been previously collected for an earlier study – by Richardson et al (2019) – anonymised and entered into a statistics data file. The questionnaire was specifically developed to assess student nurses’ attitudes towards sustainability and the climate crisis, and the possible inclusion of these topics in the nursing curriculum. It comprised five statements, each requiring a response on a seven-point Likert scale (1 = strongly disagree; 7 = strongly agree). The questionnaire has been used to evaluate sustainability educational sessions (Richardson et al, 2017), has demonstrated good psychometric properties (Richardson et al, 2016) and has been translated for use in Arabic, Dutch, German, French, Swedish and Spanish. We included an additional three statements in the 2019 version to determine the extent to which the inclusion of sustainability topics influenced students’ choice of university (Box 1). We designed the timing of the survey’s completion to capture students’ attitudes before any sustainability and climate crisis education had taken place on their course: surveys were completed at the start of a sustainability induction session delivered in the first two weeks of the course and administered by the tutor running the session. They did not require any details that allowed students to be individually identified and ethical approval was gained from the university’s research ethics committee. We analysed the data collected using a combination of descriptive and inferential statistics. The 2019 and 2014 data was compared using independent t-tests and Levene’s test for variances. We also analysed the 2019 data for any differences between student attitudes on the adult, children’s and mental health nursing programmes. awareness following relevant educational interventions (Richardson et al, 2019). Study design and methods Given the increasing public awareness of the climate crisis and environmental damage, our study aimed to investigate student nurses’ attitudes about the crisis and sustainability at the start of their undergraduate studies in 2019 and compare them with those of student nurses starting their degree programme in 2014. Our objectives were to: ● Assess and compare the two groups’ baseline attitudes towards sustainability and the climate crisis; ● Determine the extent to which student nurses believe topics on sustainability and the climate crisis should be included in nursing education, and whether this influenced their choice of university. Griggs et al (2017) identified some confusion around the term ‘sustainability’ when applied in the context of nursing. In this article, and the research study it discusses, it is defined as “more than merely lasting or surviving; it means designing and delivering healthcare that uses resources in ways that don’t prejudice future health and wellbeing” (Naylor and Appleby, 2012). We adopted the “triple-bottom-line” framework of economic development, social development and environmental protection that is consistent with Baid et al’s (2019) research, emphasising the relationship between financial, social and needs to be treated as clinical waste and, therefore, incinerated. Climate crisis and student nurse education Unsurprisingly, there are calls for the nursing profession to address the climate crisis through education (Leffers et al, 2017) and leadership (International Council of Nurses, 2018). The ICN’s (2018) position statement emphasises the need for “nurses to take immediate action to build climateresilient health systems”. Nurses need to work more sustainably to deal with the mitigation and adaptation challenges presented by the climate crisis, and the possible depletion of scarce natural materials (Grose and Richardson, 2013a; Grose and Richardson, 2013b). It has been highlighted that student nurses are poorly prepared to understand the connections between resources, the climate crisis, sustainability and health (Lopez-Medina et al, 2019; Barna et al, 2012; Goodman, 2011). As the climate crisis and fossil-fuel dependency pose serious threats to future healthcare, nurse educators arguably have an obligation to prepare students for the consequences and ensure they are equipped to deal with the associated healthcare planning and resource issues. A nurse who cannot make the links between clinical waste, resource use, carbon reduction and health inequalities will not be able to devise solutions for future healthcare challenges. Topics can be embedded using practical, vocational examples, while learning opportunities can be created by framing topics that are relevant to nursing in the context of: ● Public health and health inequalities; ● Poverty; ● Food security; ● Links between health and the natural environment; ● Infectious diseases (Barna et al, 2012). Increasingly, students expect sustainability to form a component of their university experience, and higher-education institutions will need to respond to this (National Union of Students, 2018). Cruz et al (2018) conducted research in four Arabic-speaking countries and found student nurses had positive attitudes towards including sustainability in the nursing curriculum. Similarly, student nurses in the UK – who, initially, had limited awareness of sustainability and the climate crisis in healthcare and, therefore, did not see the relevance of this topic for their education – demonstrated greater Clinical Practice Research Box 1. Survey statements Statements in the 2014 and 2019 surveys: ● Climate change is an important issue