• Energy Research

Abstract Background Mainstreaming sustainable healthcare into the curricula of health professions is a key action to raise awareness and change attitudes. Therefore, the present study aimed to assess the contribution of scenario-based learning and augmented reality to the environmental awareness and attitudes toward climate change and sustainability among undergraduate nursing students. Methods This study was designed as a time-series analysis. Undergraduate nursing students in their 3 years were introduced to sustainability and climate change in the context of healthcare through scenario-based learning sessions. Questionnaires were used to collect data on participants’ attitudes towards sustainability and climate change, the usefulness of the educational sessions and the extent to which students changed their clinical practice. A data summary, related sample Friedman and Wilcoxon signed-rank tests were used to test for differences in survey scores. Results Attitudes and environmental awareness toward climate change and sustainability increased significantly as students received the learning sessions over the 3 years. After their first clinical training period, students already showed a high awareness of unsustainable practices in their working environment; however, they still struggled to apply sustainability and address unsustainable practices in healthcare settings. Most students felt that the scenarios helped them to make links between climate change, resources, and health. Conclusions The scenario-based learning and augmented reality increase environmental awareness and attitudes toward climate change and sustainability among nursing students. Students are very aware of unsustainable practices in their work environment, but more work needs to be done on the application of sustainability principles to nursing practice.

There is limited European literature on nursing and sustainability; nursing students are poorly prepared on the connections between resources, climate change, sustainability, and health, so they must acquire knowledge and develop skills and competencies in this field. The use of digital technologies and teaching via E-learning has grown, and has been widely adopted as a learning method for nursing.The aim of the current study was to test and evaluate digital educational materials on environmental sustainability and health, in the context of university nursing education in different European countries.An observational cross-sectional design.University of Plymouth, University of Jaén, and University of Esslingen for Nursing Degree Studies.299 nursing students: 161 students from University of Jaén; 106 from Plymouth; and 32 from Esslingen. 22 professional evaluators with different profiles were recruited: Teachers, Clinical professionals, Delphi Experts, and Technical Experts.We conducted a piloting and validation process. The materials were designed and adapted to the NurSusTOOLKIT Sustainability Literacy and Competency framework. Evaluation was developed by professionals and students. We used the Spanish Standard for the assessment of Digital Educational Material Quality at University level questionnaire. All students provided informed consent prior to taking part in the learning and evaluation.The overall evaluations of materials by students and professionals were 7.98±1.28 and 8.50±1.17, respectively. The Ability to generate learning was scored higher among students (mean difference: 0.84; 0.22-1.47; p=0.008). In the overall assessment by students, statistically significant differences were found between the three universities (Welch: 11.69, p<0.001).Students, professionals, and technical experts considered the materials to be very good quality, especially regarding the quality of contents, format, and design. For students, these materials can generate reflection and learning regarding environmental and health issues during nursing training.

The purpose of this Consensus Statement is to provide a global, collaborative, representative and inclusive vision for educating an interprofessional healthcare workforce that can deliver sustainable healthcare and promote planetary health. It is intended to inform national and global accreditation standards, planning and action at the institutional level as well as highlight the role of individuals in transforming health professions education. Many countries have agreed to ‘rapid, far-reaching and unprecedented changes’ to reduce greenhouse gas emissions by 45% within 10 years and achieve carbon neutrality by 2050, including in healthcare. Currently, however, health professions graduates are not prepared for their roles in achieving these changes. Thus, to reduce emissions and meet the 2030 Sustainable Development Goals (SDGs), health professions education must equip undergraduates, and those already qualified, with the knowledge, skills, values, competence and confidence they need to sustainably promote the health, human rights and well-being of current and future generations, while protecting the health of the planet. The current imperative for action on environmental issues such as climate change requires health professionals to mobilize politically as they have before, becoming strong advocates for major environmental, social and economic change. A truly ethical relationship with people and the planet that we inhabit so precariously, and to guarantee a future for the generations which follow, demands nothing less of all health professionals. This Consensus Statement outlines the changes required in health professions education, approaches to achieve these changes and a timeline for action linked to the internationally agreed SDGs. It represents the collective vision of health professionals, educators and students from various health professions, geographic locations and cultures. ‘Consensus’ implies broad agreement amongst all individuals engaged in discussion on a specific issue, which in this instance, is agreement by all signatories of this Statement developed under the auspices of the Association for Medical Education in Europe (AMEE). To ensure a shared understanding and to accurately convey information, we outline key terms in a glossary which accompanies this Consensus Statement (Supplementary Appendix 1). We acknowledge, however, that terms evolve and that different terms resonate variably depending on factors such as setting and audience. We define education for sustainable healthcare as the process of equipping current and future health professionals with the knowledge, values, confidence and capacity to provide environmentally sustainable services through health professions education. We define a health professional as a person who has gained a professional qualification for work in the health system, whether in healthcare delivery, public health or a management or supporting role and education as ‘the system comprising structures, curricula, faculty and activities contributing to a learning process’. This Statement is relevant to the full continuum of training – from undergraduate to postgraduate and continuing professional development.

Education in sustainable development is a goal recognised by a large number of countries and a vital concept in healthcare. It is therefore important that nurse education incorporates elements of sustainable development into nursing education curricula. However, there is limited research on student nurses' attitudes towards sustainability and no comparison of attitudes towards sustainability and its inclusion in the nursing curriculum across Europe.This project aims to assess student nurses' attitudes towards sustainability, its relevance to nursing and its inclusion in the nursing curricula. 1. To assess base-line attitudes at the start of nursing and midwifery training; 2. To compare sustainability awareness between students participating in training in a number of European universities.A comparative survey design using the Sustainability Attitudes in Nursing Survey (SANS_2) questionnaire.Nursing classes of Universities and Nursing Schools in four European countries were investigated using a questionnaire consisting of five sustainability-related items.916 nursing students (UK: 450, Germany: 196, Spain: 124, Switzerland: 146).Standard descriptive and inferential statistical methods were used to establish psychometric quality (Principal Components Analysis, Cronbach's alpha, Pearson correlations) and compare student nurses from the four countries.The reliability of SANS_2 was good (Cronbach's alpha=.82) and the five items loaded on a single factor which explained 58% of variance. ANOVA of the SANS_2 total score showed significant differences between countries with German nursing students showing more sustainability awareness than students from the UK and Spain.SANS_2 is a reliable instrument to assess nursing students' sustainability awareness; there are significant differences in sustainability awareness of students of different European countries. Limitations of the study include non-random sampling, possible method effects and social desirability effects.Sustainability will become increasingly important in clinical practice; greater knowledge about the attitudes of nurses towards sustainability can support the development and testing of sustainability-focused teaching and learning materials.

Resumen: Los «Objetivos para el desarrollo sostenible 2030» marcan la necesidad de una educación para el desarrollo sostenible que logre mantener la salud planetaria. Así, las instituciones de educación superior que forman a profesionales sanitarios deberían considerar la integración de competencias para promover la salud planetaria. Las competencias para lograr la salud planetaria incluyen los desplazamientos debidos al cambio climático, las poblaciones vulnerables como niños, ancianos o los más pobres, la seguridad del agua y alimentaria, la carga de enfermedades infecciosas, las catástrofes como inundaciones o temperaturas extremas, los contaminantes aéreos, o los efectos en la salud mental. De esta forma, la educación para el desarrollo sostenible pretende dotar y capacitar al alumnado con los conocimientos, las habilidades y las actitudes para que pueda ser eficaz en la resolución de los retos de la salud planetaria, como son la interdependencia de los ecosistemas y la salud humana, incluyendo los efectos del cambio ambiental en la salud, así como el impacto del sector sanitario y su dependencia del medio ambiente. Algunas universidades europeas ya han empezado a sostenibilizar la formación de profesionales sanitarios, siendo ejemplos de los pasos necesarios a seguir. Abstract: The “2030 Sustainable Development Goals” outline the need for education for sustainable development to sustain planetary health. Thus, higher education institutions that train health professionals should consider embedding competencies to promote planetary health. Competencies for achieving planetary health include displacement due to climate change, vulnerable populations such as children, the elderly or the poorest, water and food security, the burden of infectious diseases, catastrophes such as floods or extreme temperatures, air pollutants, or mental health effects. Therefore, education for sustainable development aims to provide students with the knowledge, skills and attitudes to be effective in addressing global health challenges, such as the interdependence of ecosystems and human health, including the effects of environmental change on health, as well as the impact of the health sector and its dependence on the environment. Some European universities have already started to make the training of health professionals more sustainable and are examples of the steps that need to be taken.

Education is a social tipping intervention necessary for stabilising the earth's climate by 2050. Integrating sustainable healthcare into healthcare professions curricula is a key action to raise awareness.This study aimed to: i) investigate nursing students' attitudes towards and awareness of climate change and sustainability issues and its inclusion in nurse education, ii) explore differences across a range of countries, and iii) compare attitudes in 2019 with those of a similar sample in 2014.A cross-sectional multicentre study. Data were collected through the Sustainability Attitudes in Nursing Survey (SANS_2) questionnaire.Seven different universities and schools of nursing in five countries (UK, Spain, Germany, Sweden, and Australia).A convenience sample of first-year undergraduate nursing students.The SANS_2 questionnaire was self-administered by nursing students at the seven participating universities at the start of their undergraduate degree, between September 2019 and February 2020.Participants from all seven universities (N = 846) consistently showed awareness and held positive attitudes towards the inclusion of climate change and sustainability issues in the nursing curriculum (M = 5.472; SD: 1.05; min-max 1-6). The relevance of climate change and sustainability to nursing were the highest scored items. Esslingen-Tübingen students scored the highest in the 'inclusion of climate change and sustainability in the nursing curricula'. Students at all universities applied the principles of sustainability to a significant extent at home. Nursing students' attitudes towards climate change and sustainability showed significantly higher values in 2019 (Universities of Plymouth, Brighton, Esslingen-Tübingen, Jaen, Murcia, Dalarna, and Queensland) than in 2014 (universities of Plymouth, Jaen, Esslingen, and Switzerland).Nursing students have increasingly positive attitudes towards the inclusion of sustainability and climate change in their nursing curriculum. They also recognise the importance of education regarding sustainability and the impact of climate change on health, supporting formal preparation for environmental literacy. It is time to act on this positive trend in nursing students' attitudes by integrating these competencies into nursing curricula.

It has been suggested that climate change is the biggest threat to public health for the 21st Century; increased demand on health services will impact on already overstretched resources and systems will need to be able to respond. However limited attention is given to climate change and sustainability in nursing education; there is no clear guidance on curricula content for nurses or recommendations regarding the skills and competencies that will be required. Literature published in Dutch, English, German, and Spanish was searched and 32 papers met the inclusion criteria for the review. Results suggests that holistic/systems thinking is relevant to healthcare so bringing a 'sustainability lens' to nursing curricula could be seen as being consistent with wider determinants of health. The literature review has identified the educational approaches necessary to provide a broad based curriculum and a cross-disciplinary approach. The findings suggest that topics such as the use of resources, food, health promotion, globalism, disease management, and the environmental impact of delivering healthcare, if embedded in nursing education could support the nursing profession's response for this new and important aspect of healthcare.