Development of a Course on Complex Humanitarian Emergencies: Preparation for the Impact of Climate Change.

Graduates of accredited baccalaureate nursing programs in the United States are expected to show competency in emergency preparedness to "minimize the health consequences of emergencies including mass casualty disasters" (American Association of Colleges of Nursing, 2008, p. 23). Emergencies and disasters can lead to large population movements and, whether from the aftermath of natural disasters or resulting from conflict, can precipitate the need for humanitarian responses. A humanitarian emergency is defined as an event or series of events, usually over a wide area, that threaten the well-being, security, health or safety of communities, which can result from natural disasters or man-made emergencies, such as armed conflict (Humanitarian Coalition, n.d.). Internal or external conflicts can cause a breakdown of authority and overwhelm the abilities of a government, an ongoing United Nations (UN) country program, or any single agency, which then results in a complex humanitarian emergency (CHE; Center for Disaster Philanthropy, n.d.).While the generalist nurse is expected to be prepared to participate "in emergency preparedness and disaster response with an awareness of environmental factors" (American Association of Colleges of Nursing, 2008, p. 32), in order to appropriately plan for and address the subsequent impacts on current and future population health, nurses need to understand the increasingly complex interplay among climate change, migration, and conflict. Additionally, it is incumbent upon nursing to understand the context in which the effects of environmental factors, such as climate change, and potential conflict could occur and the resultant public health and clinical implications. Nurses need to be prepared to respond to affected communities in need, whether the emergency is domestic or global. This article reviews literature on climate change as it relates to conflict and health and describes a novel course for nursing students that can serve as an exemplar for preparing our future workforce to understand nursing practice within the confines of CHEs and natural disasters.The effects of climate change are far reaching and multifactorial. Substantial social and economic burdens result from climate change, and these burdens are expected to rise in the future. Some societies adapt well to these burdens, while others adapt less well (Carleton & Hsiang, 2016), and the differential impact from climate change will most burden the countries that are least able to respond (Watts et al., 2017). In a recent publication, The Lancet Countdown (a multidisciplinary, global research collaboration between academic institutions and practitioners), using a comprehensive figure (Figure 1 in Watts et al., 2017, p. 1153), demonstrates the complex interplay of climate change and health, with potential effects on determinants of health such as displacement, socioeconomic status, and conflict (Watts et al., 2017).Climate change can also affect population health through a variety of mechanisms (Cook, 2011; Luber et al., 2014), including impacts to environmental and social determinants of health, such as potable water and adequate food, shelter, and safe air (World Health Organization, 2016). Health effects from climate change can include such things as increased risk from infectious diseases and injuries, mental health disorders, respiratory and cardiovascular diseases, and allergic reactions (Levy, Sidel, & Patz, 2017). For example, heatstroke can result from increased temperatures, while malnutrition can be a concomitant result from economic disruption or resource depletion secondary to severe famine caused by drought (Applebaum et al., 2016; Butler & Harley, 2010). Indirect health consequences and potential social unrest can arise from resource competition, forced population migrations, loss of livelihoods, and enhanced grievances secondary to perceived scarcity and deprivation-these dynamics can directly impact political and societal stability, enhanced in nations with fragile or poor governance (Levy et al. …